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
$66
Average
$175
Median
$149
High
$371
Each hospital's average Medica rate, under the methodology and billing class chosen below.
56 hospitals; the 90th percentile is 2.8× 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.
Filter by billing methodology
Filter by billing class
113 hospital rates
iThe hospitals that file a Medica 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 Eau Claire 54703-5270 facility · percent of total billed charges · bothfrom % of charges | 8 | $170 | $167 | $13 | 8% | 48 | $136 – $180 |
| 2 | Mayo Clinic Rochester, MN professional · percent of total billed charges · outpatientfrom % of charges | 7 | $302 | $303 | $6 | 2% | 40–49 | $297 – $314 |
| 3 | Mayo Clinic Rochester, MN professional · fee schedule · outpatient | 2 | $71 | $71 | $1 | 2% | 26 | $69 – $72 |
| 4 | Mayo Clinic Health System Owatonna 55060-5503 professional · percent of total billed charges · outpatientfrom % of charges | 5 | $297 | $301 | $9 | 3% | 11 | $290 – $314 |
| 5 | Mayo Clinic Arizona Phoenix, AZ professional · percent of total billed charges · outpatientfrom % of charges | 5 | $413 | $418 | $48 | 11% | 1–10 | $372 – $495 |
| 6 | Mayo Clinic Health System Owatonna 55060-5503 professional · fee schedule · outpatient | 4 | $60 | $59 | $10 | 18% | 1–10 | $45 – $71 |
| 7 | Sanford Aberdeen Medical Center Aberdeen, SD percent of total billed charges · outpatientfrom % of charges | 2 | $297 | $297 | $10 | 3% | 1–10 | $287 – $307 |
| 8 | Allen Memorial Hospital Corporation Waterloo, IA percent of total billed charges · outpatientfrom % of charges | 1 | $178 | $178 | $10 | 6% | — | $168 – $188 |
| 9 | Altru Hospital Grand Forks, ND facility · fee schedule · outpatient | 4 | $55 | $66 | $31 | 47% | — | $39 – $115 |
| 10 | Altru Hospital Devils Lake Devils Lake, ND facility · fee schedule · outpatient | 4 | $55 | $66 | $31 | 47% | — | $39 – $115 |
| 11 | Aspirus St. Luke’s Hospital Duluth, MN fee schedule · both | 3 | $61 | $110 | $79 | 71% | — | $49 – $221 |
| 12 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $198 | $198 | — | — | — | $198 – $198 |
| 13 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · both | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 14 | Covenant Medical Center Inc Waterloo, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $100 | $100 | — | — | — | $100 – $100 |
| 15 | Curators of the University of Missouri Jefferson City, MO facility · fee schedule · outpatient | 1 | $106 | $106 | — | — | — | $106 – $106 |
| 16 | Essentia Health Duluth Duluth, MN facility · fee schedule · outpatient | 1 | $126 | $126 | — | — | — | $126 – $126 |
| 17 | Essentia Health Fargo 3000 32nd Ave S Fargo, ND facility · fee schedule · outpatient | 1 | $129 | $129 | — | — | — | $129 – $129 |
| 18 | Essentia Health St. Joseph's Medical Center Brainerd, MN facility · fee schedule · outpatient | 1 | $138 | $138 | — | — | — | $138 – $138 |
| 19 | Essentia Health St. Mary's - Detroit Lakes 1027 Washington Ave. Detroit Lakes, MN facility · fee schedule · outpatient | 1 | $135 | $135 | — | — | — | $135 – $135 |
| 20 | Essentia Health St. Mary's Children's Hospital Duluth, MN facility · fee schedule · outpatient | 1 | $129 | $129 | — | — | — | $129 – $129 |
| 21 | Essentia Health St. Mary's Medical Center Duluth, MN facility · fee schedule · outpatient | 1 | $129 | $129 | — | — | — | $129 – $129 |
| 22 | Essentia Health Virginia 901 9th St N Virginia, MN facility · fee schedule · outpatient | 1 | $126 | $126 | — | — | — | $126 – $126 |
| 23 | Fairview Bethesda Hospital St. Paul, MN fee schedule · both | 8 | $212 | $162 | $78 | 48% | — | $51 – $234 |
| 24 | Fairview Bethesda Hospital St. Paul, MN fee schedule · outpatient | 1 | $136 | $136 | — | — | — | $136 – $136 |
| 25 | Fairview Health Services Edina, MN fee schedule · both | 8 | $212 | $162 | $78 | 48% | — | $51 – $234 |
← Payers reporting HCPCS G0249 · Snapshot 20261111T120946Z-9134e7f7