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
$55
Average
$113
Median
$122
High
$172
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
35 hospitals; the 90th percentile is 2.6× 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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40 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 | AnMed Health Anderson, SC professional · fee schedule · inpatient | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 2 | AnMed Health Anderson, SC professional · fee schedule · outpatient | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 3 | AnMed Health Cannon Pickens, SC professional · fee schedule · inpatient | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 4 | AnMed Health Cannon Pickens, SC professional · fee schedule · outpatient | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 5 | AnMed Piedmont Piedmont, SC professional · fee schedule · inpatient | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 6 | AnMed Piedmont Piedmont, SC professional · fee schedule · outpatient | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 7 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 8 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $124 | $124 | — | — | — | $124 – $124 |
| 9 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $129 | $129 | — | — | — | $129 – $129 |
| 10 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $129 | $129 | — | — | — | $129 – $129 |
| 11 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $56 | $56 | — | — | — | $56 – $56 |
| 12 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · both | 1 | $55 | $55 | — | — | — | $55 – $55 |
| 13 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $124 | $124 | — | — | — | $124 – $124 |
| 14 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 15 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 16 | Gerald Champion Regional Medical Center Alamogordo, NM fee schedule · outpatient | 5 | $126 | $126 | — | — | — | $126 – $126 |
| 17 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · fee schedule · outpatient | 1 | $124 | $124 | — | — | — | $124 – $124 |
| 18 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · fee schedule · outpatient | 1 | $124 | $124 | — | — | — | $124 – $124 |
| 19 | Kaleida Health Buffalo, NY fee schedule · outpatient | 1 | $158 | $158 | — | — | — | $158 – $158 |
| 20 | Kaweah Health Medical Center Visalia, CA facility · fee schedule · outpatient | 1 | $171 | $171 | — | — | — | $171 – $171 |
| 21 | Kaweah Health Mental Health Hospital Visalia, CA facility · fee schedule · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 22 | LECONTE MEDICAL CENTER Sevierville, TN fee schedule · outpatient | 1 | $129 | $129 | — | — | — | $129 – $129 |
| 23 | Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient | 1 | $115 | $115 | — | — | — | $115 – $115 |
| 24 | METHODIST MEDICAL CENTER OF OAK RIDGE Oak Ridge, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 25 | MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION Morristown, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
← Payers reporting HCPCS G0249 · Snapshot 20261111T120946Z-9134e7f7