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MDPP Core Maintenance, Months 7-9, Under 5% Weight Loss

Pennsylvania rates for HCPCS G9876

Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 7-9 under the MDPP Expanded Model (EM). A core maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 7 through 12 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for maintenance sessions. The beneficiary did not achieve at least 5% weight loss (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9

Rates data updated July 2026.

How much does MDPP Core Maintenance, Months 7-9, Under 5% Weight Loss cost?

$18.20

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $18.20 for this service. The price depends on where it is billed: about $18.20 from a physician practice, and about $63.10 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$18.20$13.18 to $69.18
FacilityA hospital or hospital-owned outpatient department$63.10$63.10 to $63.10

How much rates vary

Facilitymedian $63 · 10th to 90th $63 to $63Professionalmedian $18 · 10th to 90th $12 to $74
$10$20$50$100facility $63professional $18

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$72.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$38.90
Typical High
$75.86
Cigna
Setting
Facility
Modifier
Global
Typical Low
$19.05
Median
$19.05
Typical High
$19.05
Cigna
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$12.02
Typical High
$12.02
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$18.62
Typical High
$18.62
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$44.67
Typical High
$75.86
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$158.49
Typical High
$158.49
United
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$15.49
Typical High
$26.92

Where Pennsylvania sits

The same service costs 5.8 times more in South Dakota than in Hawaii. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Pennsylvania· 21st of 51

$18.20

SD $75.86HI $13.18

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.