Tynbil: Know the *real* price for healthcare services

New Jersey rates for HCPCS G9878

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 achieved 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

Insurance Carrier	Facility/Professional	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $52.44 / $52.44 / $52.44	Facility	$52.44	$52.44	$52.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.79 / $52.80 / $96.72	Professional	$40.79	$52.80	$96.72
Cigna Facility/Professional Facility Modifier Low / Median / High Price $62.26 / $62.26 / $62.26	Facility	$62.26	$62.26	$62.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.92 / $45.92 / $45.92	Professional	$45.92	$45.92	$45.92
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.00 / $68.23 / $71.72	Professional	$58.00	$68.23	$71.72
United Facility/Professional Professional Modifier Low / Median / High Price $42.61 / $63.00 / $112.02	Professional	$42.61	$63.00	$112.02