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
$45
Average
$79
Median
$87
High
$103
Each hospital's average Medicaid rate, under the methodology and billing class chosen below.
6 hospitals; the 90th percentile is 2.2× 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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7 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 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 2 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · both | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 3 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 1 | $45 | $45 | — | — | — | $45 – $45 |
| 4 | Mercy Health Services-Iowa Corp. Mason City, IA professional · fee schedule · both | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 5 | Mercy Hospitals East Communities dba Mercy Hospital Washington Washington, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $71 | $71 | — | — | — | $71 – $71 |
| 6 | Mercy Medical Center-Clinton Inc Clinton, IA professional · fee schedule · inpatient | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 7 | Mercy Medical Center-Clinton Inc Clinton, IA professional · fee schedule · outpatient | 1 | $103 | $103 | — | — | — | $103 – $103 |
← Payers reporting HCPCS G0249 · Snapshot 20261111T120946Z-9134e7f7