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 E&M Preventive Medicine Periodic Comprehensive Established Pt 12-17 Yrs
Low
$30
Average
$104
Median
$94
High
$346
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
120 hospitals; the 90th percentile is 1.9× 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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144 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 | Mayo Clinic Health System Sparta, WI professional · fee schedule · outpatient | 1 | $106 | $106 | — | — | 40–49 | $106 – $106 |
| 2 | MVHS, Inc. Utica, NY fee schedule · both | 1 | $102 | $102 | — | — | 3–30 | $102 – $102 |
| 3 | Massachusetts General Hospital Boston, MA percent of total billed charges · bothfrom % of charges | 1 | $300 | $300 | $41 | 14% | 2–20 | $258 – $341 |
| 4 | OUR LADY OF LOURDES MEMORIAL HOSPITAL INC. Doing Business As: LOURDES Binghamton, NY facility · other · outpatient | 1 | $80 | $80 | — | — | 2–20 | $80 – $80 |
| 5 | Mayo Clinic Health System Cannon Falls 55009-5003 facility · percent of total billed charges · bothfrom % of charges | 1 | $159 | $159 | — | — | 1–10 | $159 – $159 |
| 6 | Mishawaka Medical Center Mishawaka, IN professional · fee schedule · both | 1 | $131 | $131 | $26 | 20% | 1–10 | $105 – $157 |
| 7 | St Peters Hospital Albany, NY professional · fee schedule · both | 1 | $103 | $103 | — | — | 1–10 | $103 – $103 |
| 8 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY professional · fee schedule · outpatient | 4 | $84 | $86 | $15 | 18% | — | $66 – $107 |
| 9 | AnMed Health Anderson, SC professional · fee schedule · inpatient | 1 | $79 | $79 | — | — | — | $79 – $79 |
| 10 | AnMed Health Anderson, SC professional · fee schedule · outpatient | 1 | $94 | $94 | $14 | 15% | — | $79 – $108 |
| 11 | AnMed Health Cannon Pickens, SC professional · fee schedule · inpatient | 1 | $79 | $79 | — | — | — | $79 – $79 |
| 12 | AnMed Health Cannon Pickens, SC professional · fee schedule · outpatient | 1 | $108 | $108 | — | — | — | $108 – $108 |
| 13 | AnMed Piedmont Piedmont, SC professional · fee schedule · inpatient | 1 | $79 | $79 | — | — | — | $79 – $79 |
| 14 | AnMed Piedmont Piedmont, SC professional · fee schedule · outpatient | 1 | $108 | $108 | — | — | — | $108 – $108 |
| 15 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $78 | $78 | — | — | — | $78 – $78 |
| 16 | Anderson Hospital Maryville, IL professional · other · outpatient | 1 | $108 | $108 | — | — | — | $108 – $108 |
| 17 | Ascension Via Christi Hospital Manhattan, Inc. Manhattan, KS fee schedule · both | 1 | $74 | $74 | — | — | — | $74 – $74 |
| 18 | Aspirus Divine Savior Hospital Portage, WI fee schedule · both | 1 | $106 | $106 | — | — | — | $106 – $106 |
| 19 | Aspirus Iron River Hospital Iron River, MI fee schedule · both | 1 | $76 | $76 | $31 | 40% | — | $45 – $107 |
| 20 | Aspirus Ironwood Hospital Ironwood, MI fee schedule · both | 1 | $91 | $91 | — | — | — | $91 – $91 |
| 21 | Aspirus Keweenaw Hospital Laurium, MI fee schedule · both | 1 | $107 | $107 | — | — | — | $107 – $107 |
| 22 | Aspirus Langlade Hospital Antigo, WI fee schedule · both | 1 | $90 | $90 | — | — | — | $90 – $90 |
| 23 | Aspirus Medford Hospital Medford, WI fee schedule · both | 1 | $106 | $106 | — | — | — | $106 – $106 |
| 24 | Aspirus Rhinelander Hospital Rhinelander, WI fee schedule · both | 1 | $93 | $93 | — | — | — | $93 – $93 |
| 25 | Aspirus St. Luke’s Hospital Duluth, MN fee schedule · both | 1 | $78 | $78 | — | — | — | $78 – $78 |
← Payers reporting CPT 99394 · Snapshot 20261111T120946Z-9134e7f7