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
PR PERC TESTS ALLERGENIC EXTRACTS
Low
$1
Average
$131
Median
$3
High
$578
Each hospital's average Medicaid rate, under the methodology and billing class chosen below.
39 hospitals; the 90th percentile is 266.0× 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 Medicaid 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 | Childrens Hospital of Los Angeles Angeles, CA facility · other · outpatient | 2 | $2 | $2 | — | — | 19 | $2 – $2 |
| 2 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA fee schedule · outpatient | 1 | $2 | $2 | $0 | 18% | — | $2 – $3 |
| 3 | ADVENTIST HEALTH MENDOCINO COAST Bragg, CA fee schedule · outpatient | 1 | $2 | $2 | $0 | 18% | — | $2 – $3 |
| 4 | ADVENTIST HEALTH TULARE Tulare, CA fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 5 | Brookings Health System Brookings, SD fee schedule · outpatient | 1 | $20 | $20 | — | — | — | $20 – $20 |
| 6 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · case rate · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 7 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 8 | Childrens Hospital of Los Angeles Angeles, CA professional · fee schedule · outpatient | 2 | $1 | $1 | — | — | — | $1 – $1 |
| 9 | Clarion Hospital Clarion, PA facility · case rate · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 10 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · case rate · outpatient | 1 | $26 | $26 | — | — | — | $26 – $26 |
| 11 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL professional · fee schedule · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 12 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · both | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 13 | Eisenhower Medical Center Rancho Mirage, CA fee schedule · both | 3 | $3 | $3 | — | — | — | $3 – $3 |
| 14 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 15 | Geisinger Lewistown Hospital Lewistown, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 16 | Geisinger Medical Center Muncy, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 17 | Geisinger Wyoming Valley Wilkes-Barre, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 18 | HANFORD COMMUNITY HOSPITAL Selma, CA fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 19 | Henry Ford Health Novi, MI other · outpatient | 1 | $578 | $578 | — | — | — | $578 – $578 |
| 20 | Henry Ford Health Southfield, MI other · outpatient | 1 | $578 | $578 | — | — | — | $578 – $578 |
| 21 | Henry Ford Health Rochester, MI other · outpatient | 1 | $538 | $538 | — | — | — | $538 – $538 |
| 22 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $22 | $22 | — | — | — | $22 – $22 |
| 23 | INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL facility · case rate · outpatient | 1 | $26 | $26 | — | — | — | $26 – $26 |
| 24 | INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL professional · fee schedule · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 25 | LODI MEMORIAL HOSPITAL ASSOCIATION INC Lodi, CA fee schedule · outpatient | 1 | $3 | $3 | $0 | 14% | — | $2 – $3 |
← Payers reporting CPT 95004 · Snapshot 20261111T120946Z-9134e7f7