Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Instrument Based Ocular Scr Bi W/Onsite Analysis
Low
$4
Average
$7
Median
$4
High
$41
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
37 hospitals; the 90th percentile is 2.0× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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44 hospital rates
iThe hospitals that file a Tricare rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY professional · fee schedule · outpatient | 4 | $4 | $4 | $0 | 8% | — | $4 – $5 |
| 2 | AnMed Health Anderson, SC professional · fee schedule · inpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 3 | AnMed Health Anderson, SC professional · fee schedule · outpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 4 | AnMed Health Cannon Pickens, SC professional · fee schedule · inpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 5 | AnMed Health Cannon Pickens, SC professional · fee schedule · outpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 6 | AnMed Piedmont Piedmont, SC professional · fee schedule · inpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 7 | AnMed Piedmont Piedmont, SC professional · fee schedule · outpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 8 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 9 | Anderson Hospital Maryville, IL professional · other · outpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 10 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 11 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 12 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 13 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · both | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 14 | EAST BATON ROUGE MEDICAL CENTER, LLC Baton Rouge, LA fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 15 | Ellis Hospital NY 12308; 2210 Troy Schenectady Road Niskayuna, NY facility · fee schedule · outpatient | 1 | $5 | $13 | $11 | 87% | — | $5 – $29 |
| 16 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL professional · fee schedule · both | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 17 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · fee schedule · outpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 18 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · fee schedule · outpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 19 | Kaweah Health Rehabilitation Hospital Visalia, CA facility · fee schedule · outpatient | 1 | $41 | $41 | — | — | — | $41 – $41 |
| 20 | Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 21 | Mayo Clinic Health System Sparta, WI professional · fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 22 | Mayo Clinic Health System Cannon Falls 55009-5003 facility · percent of total billed charges · bothfrom % of charges | 1 | $40 | $40 | — | — | — | $40 – $40 |
| 23 | NATIONWIDE CHILDREN'S HOSPITAL TOLEDO, LLC Toledo, OH professional · fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 24 | OCHSNER CLINIC FOUNDATION LA 70121; 4430 Veterans Memorial Blvd.Metairie, LA fee schedule · outpatient | 1 | $4 | $4 | $0 | 9% | — | $4 – $5 |
| 25 | PRISMA HEALTH BAPTIST COLUMBIA HOSPITAL COLUMBIA, SC fee schedule · both | 1 | $4 | $4 | — | — | — | $4 – $4 |
← Payers reporting CPT 99177 · Snapshot 20261111T120946Z-9134e7f7