G0109

Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes

Medicare pricing data for 743 providers across 36 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

Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes (HCPCS code G0109) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $15.30, but hospitals typically charge $44.05 — a 2.9x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$3.06

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $15.30, your out-of-pocket cost would be approximately $3.06. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$15.30
Average Hospital Charge
$44.05
Markup Ratio
2.9x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$44.05
Medicare Allowed$15.30
Medicare Payment$11.45

Hospitals charge 2.9x more than what Medicare allows for this procedure. Medicare actually pays $11.45 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
California$17$47462,724+12.0%
New York$17$6016259+9.3%
Hawaii$16$263315+6.1%
Maryland$16$35233,481+4.9%
Colorado$16$456315+3.7%
New Jersey$16$19112,622+2.0%
Virginia$16$39192,435+2.0%
New Hampshire$16$49247+1.8%
Massachusetts$16$7410262+1.6%
Illinois$16$58472,009+1.5%
Delaware$15$944290+1.2%
Washington$15$46271,015+1.2%
Florida$15$56786,386+0.8%
Pennsylvania$15$48261,4270.0%
Minnesota$15$4938637-0.3%
Arizona$15$3543601-1.3%
Oregon$15$4511388-1.8%
Georgia$15$41422,084-2.2%
Missouri$15$367765-2.4%
Wisconsin$15$8534916-2.5%
South Carolina$15$5381,237-2.9%
New Mexico$15$44288-3.6%
North Carolina$15$43402,934-3.7%
Ohio$15$42222,803-3.8%
Indiana$15$29241,187-4.0%
Kentucky$15$3411436-4.0%
Texas$15$47291,472-4.2%
Iowa$15$333114-4.6%
Louisiana$15$23631-4.6%
Tennessee$15$43101,890-5.2%
Kansas$15$31251,256-5.2%
Mississippi$14$393247-5.4%
Alabama$14$363232-5.6%
Oklahoma$14$255302-6.2%
Arkansas$14$376313-6.5%
Idaho$14$387212-7.4%

⚠️ 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