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 Provision Test Material(S) and Equipment Home Inr
Low
$82
Average
$111
Median
$114
High
$130
Each hospital's average Amerihealth Caritas rate, under the methodology and billing class chosen below.
12 hospitals; the 90th percentile is 1.6× 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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13 hospital rates
iThe hospitals that file a Amerihealth Caritas 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 | Bayhealth Hospital, Sussex Campus Milton, DE fee schedule · outpatient | 2 | $124 | $124 | $22 | 18% | — | $102 – $147 |
| 2 | Bayhealth Medical Center, Kent Campus Dover, DE fee schedule · outpatient | 2 | $127 | $127 | $25 | 20% | — | $102 – $151 |
| 3 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · both | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 4 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 1 | $82 | $82 | — | — | — | $82 – $82 |
| 5 | Henry Ford Health System West Bloomfield, MI facility · fee schedule · outpatient | 1 | $130 | $130 | — | — | — | $130 – $130 |
| 6 | Henry Ford Health System Plymouth, MI facility · fee schedule · outpatient | 1 | $130 | $130 | — | — | — | $130 – $130 |
| 7 | Henry Ford Macomb Hospital Corporation Clinton Twp, MI facility · fee schedule · outpatient | 1 | $130 | $130 | — | — | — | $130 – $130 |
| 8 | Henry Ford Wyandotte Hospital Brownstown Charter Twp., MI facility · fee schedule · outpatient | 1 | $130 | $130 | — | — | — | $130 – $130 |
| 9 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 2 | $83 | $83 | $1 | 1% | — | $82 – $85 |
| 10 | Mercy Health Services-Iowa Corp. Mason City, IA professional · fee schedule · both | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 11 | Mercy Medical Center-Clinton Inc Clinton, IA professional · fee schedule · inpatient | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 12 | Mercy Medical Center-Clinton Inc Clinton, IA professional · fee schedule · outpatient | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 13 | The New London Hospital Association, Inc. London, NH professional · fee schedule · outpatient | 1 | $86 | $86 | — | — | — | $86 – $86 |
← Payers reporting HCPCS G0249 · Snapshot 20261111T120946Z-9134e7f7