Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by th
Medicare pricing data for 21,172 providers across 52 states
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
Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by th (HCPCS code G0316) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $29.15, but hospitals typically charge $106.65 — a 3.7x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $29.15, your out-of-pocket cost would be approximately $5.83. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 3.7x more than what Medicare allows for this procedure. Medicare actually pays $23.22 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $37 | $84 | 30 | 269 | +26.5% |
| District of Columbia | $33 | $97 | 103 | 834 | +13.2% |
| California | $32 | $129 | 1,838 | 45,236 | +9.2% |
| Puerto Rico | $32 | $82 | 4 | 26 | +8.5% |
| New Jersey | $31 | $95 | 352 | 3,554 | +7.6% |
| Nevada | $31 | $131 | 123 | 3,038 | +7.0% |
| Hawaii | $31 | $83 | 88 | 1,554 | +5.7% |
| Maryland | $31 | $93 | 722 | 15,220 | +5.4% |
| Illinois | $30 | $103 | 960 | 14,849 | +4.5% |
| Washington | $30 | $90 | 870 | 12,878 | +3.8% |
| Oregon | $30 | $97 | 810 | 11,392 | +3.0% |
| New York | $30 | $164 | 1,087 | 16,311 | +2.3% |
| Connecticut | $30 | $115 | 252 | 2,940 | +2.3% |
| Virginia | $30 | $84 | 508 | 7,803 | +1.9% |
| Texas | $29 | $161 | 844 | 21,719 | +0.2% |
| Georgia | $29 | $90 | 431 | 17,069 | -0.0% |
| Massachusetts | $29 | $108 | 797 | 12,923 | -0.2% |
| Montana | $29 | $85 | 166 | 1,572 | -0.4% |
| Vermont | $29 | $107 | 81 | 1,138 | -0.7% |
| Colorado | $29 | $83 | 748 | 7,984 | -0.8% |
| Delaware | $29 | $146 | 93 | 1,019 | -1.1% |
| Florida | $29 | $86 | 919 | 15,134 | -1.6% |
| New Hampshire | $29 | $146 | 187 | 2,858 | -1.8% |
| Wyoming | $29 | $87 | 28 | 218 | -2.0% |
| Pennsylvania | $29 | $79 | 1,177 | 15,846 | -2.2% |
| New Mexico | $28 | $89 | 98 | 788 | -2.3% |
| Alabama | $28 | $75 | 113 | 2,029 | -2.8% |
| Maine | $28 | $108 | 210 | 2,970 | -2.9% |
| Tennessee | $28 | $107 | 356 | 21,122 | -2.9% |
| Missouri | $28 | $104 | 445 | 6,237 | -3.0% |
| Arizona | $28 | $83 | 413 | 5,364 | -3.0% |
| Kansas | $28 | $77 | 200 | 2,624 | -3.2% |
| Oklahoma | $28 | $87 | 90 | 1,095 | -3.5% |
| Ohio | $28 | $96 | 487 | 4,065 | -3.9% |
| Michigan | $28 | $82 | 926 | 10,223 | -4.2% |
| North Dakota | $28 | $93 | 81 | 1,010 | -4.3% |
| Minnesota | $28 | $96 | 1,189 | 12,465 | -4.4% |
| Iowa | $28 | $88 | 185 | 1,526 | -5.1% |
| Arkansas | $28 | $96 | 71 | 841 | -5.4% |
| Kentucky | $28 | $80 | 128 | 1,520 | -5.6% |
| South Dakota | $28 | $72 | 108 | 2,120 | -5.6% |
| South Carolina | $27 | $82 | 174 | 3,048 | -7.0% |
| Mississippi | $27 | $141 | 38 | 570 | -7.1% |
| West Virginia | $27 | $192 | 68 | 421 | -7.1% |
| Louisiana | $27 | $92 | 102 | 2,603 | -7.7% |
| Idaho | $27 | $50 | 101 | 1,692 | -7.7% |
| Utah | $27 | $84 | 414 | 13,854 | -7.8% |
| Rhode Island | $27 | $44 | 54 | 1,741 | -8.3% |
| Indiana | $27 | $85 | 358 | 4,426 | -8.3% |
| Nebraska | $27 | $80 | 145 | 1,389 | -8.9% |
| North Carolina | $26 | $113 | 744 | 10,318 | -9.5% |
| Wisconsin | $26 | $131 | 570 | 10,521 | -10.3% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber