95251

Continuous monitoring of blood sugar level in tissue fluid using sensor under skin with interpretation and report

Medicare pricing data for 12,837 providers across 52 states

🤖AI Overview

Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Continuous monitoring of blood sugar level in tissue fluid using sensor under skin with interpretation and report (HCPCS code 95251) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $32.75, but hospitals typically charge $104.98 — a 3.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$6.55

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $32.75, your out-of-pocket cost would be approximately $6.55. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$32.75
Average Hospital Charge
$104.98
Markup Ratio
3.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$104.98
Medicare Allowed$32.75
Medicare Payment$25.01

Hospitals charge 3.2x more than what Medicare allows for this procedure. Medicare actually pays $25.01 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$41$151441,044+25.3%
New York$36$13889341,214+10.5%
District of Columbia$36$10035910+9.9%
New Jersey$36$10139827,086+9.7%
California$36$12176051,829+9.0%
Puerto Rico$35$9335378+6.6%
Maryland$34$9426120,017+5.2%
Connecticut$34$1222148,744+4.9%
Massachusetts$34$13138418,752+2.8%
Florida$34$8965952,156+2.4%
Illinois$33$13551832,001+1.8%
Hawaii$33$7431841+1.4%
Delaware$33$85514,010+1.1%
Colorado$33$1091607,970+0.9%
Virginia$33$8829417,692+0.6%
Rhode Island$33$94491,454+0.4%
Texas$33$10181349,024+0.2%
Pennsylvania$33$9359830,868-0.1%
Washington$33$10033914,266-0.6%
Nevada$33$109794,551-0.7%
Michigan$32$8855618,483-0.9%
Arizona$32$8323313,264-1.2%
Georgia$32$10137220,741-2.6%
Missouri$32$9826116,894-2.8%
New Hampshire$32$120865,550-3.4%
Oregon$32$1012155,310-3.5%
North Carolina$32$9954023,601-3.7%
Wyoming$31$1081176-3.8%
Alabama$31$661859,465-4.2%
South Carolina$31$10224912,754-4.7%
Ohio$31$10347822,964-5.1%
Minnesota$31$1353909,205-5.2%
Montana$31$87603,417-5.7%
New Mexico$31$91671,983-5.7%
Oklahoma$31$902079,890-5.8%
Vermont$31$148381,302-6.3%
South Dakota$31$1031033,631-6.3%
Wisconsin$31$2042419,343-6.5%
Arkansas$31$851168,277-6.7%
Louisiana$30$832099,508-7.0%
Indiana$30$9725217,146-7.3%
Utah$30$83914,881-7.3%
Mississippi$30$76948,384-8.0%
Kentucky$30$901658,780-8.1%
West Virginia$30$99803,534-8.4%
Nebraska$30$1001386,834-8.4%
North Dakota$30$108511,628-8.4%
Iowa$30$1031947,676-9.0%
Kansas$30$911369,656-9.2%
Maine$30$97482,022-9.2%
Tennessee$30$9926316,377-9.3%
Idaho$30$81843,373-9.8%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber