G2074

Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)

Medicare pricing data for 555 providers across 44 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

Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) (HCPCS code G2074) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $192.60, but hospitals typically charge $227.45 — a 1.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$38.52

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $192.60, your out-of-pocket cost would be approximately $38.52. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$192.60
Average Hospital Charge
$227.45
Markup Ratio
1.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$227.45
Medicare Allowed$192.60
Medicare Payment$189.03

Hospitals charge 1.2x more than what Medicare allows for this procedure. Medicare actually pays $189.03 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$233$238253+21.1%
District of Columbia$220$225142+14.4%
California$206$216423,179+6.9%
New York$203$241361,556+5.6%
Massachusetts$202$210125,106+4.9%
New Hampshire$197$3558450+2.2%
Maryland$197$228363,032+2.1%
Illinois$196$23111379+1.8%
Colorado$196$2229401+1.8%
Washington$196$209141,043+1.8%
New Jersey$196$20010220+1.6%
Nevada$195$1995401+1.3%
Florida$192$44028831-0.2%
Virginia$192$26215484-0.4%
Oregon$191$201111,392-0.6%
Minnesota$190$5024350-1.1%
Vermont$190$1946437-1.3%
Texas$190$33216224-1.4%
Arizona$190$1965131-1.5%
Louisiana$189$19310457-2.0%
Rhode Island$188$19210463-2.1%
Pennsylvania$188$19623545-2.2%
New Mexico$187$418358-2.9%
Georgia$186$22122916-3.7%
Wisconsin$184$1907231-4.4%
Maine$184$2489648-4.4%
North Carolina$184$25228604-4.4%
West Virginia$184$1889654-4.5%
South Carolina$184$24217257-4.6%
Missouri$184$33011101-4.6%
Ohio$184$22818991-4.7%
Indiana$182$188111,047-5.4%
Kentucky$182$2009548-5.5%
Kansas$182$1895119-5.5%
Oklahoma$182$1874166-5.6%
Tennessee$181$185211,526-6.0%
Nebraska$181$184382-6.2%
Iowa$180$1855156-6.8%
Utah$179$2119478-6.8%
Alabama$179$31916611-6.9%
Mississippi$179$2884208-7.3%
Arkansas$177$181162-8.0%
Delaware$172$1753229-10.8%
Michigan$170$18521932-11.6%

⚠️ 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

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