THE MDPP BENEFICIARY ACHIEVED AT LEAST 5% WEIGHT LOSS (WL) FROM HIS/HER BASELINE WEIGHT IN MONTHS 1-12 OF THE MDPP SERVICES PERIOD UNDER THE MDPP EXPANDED MODEL (EM). THIS IS A ONE-TIME PAYMENT AVAILABLE WHEN A BENEFICIARY FIRST ACHIEVES AT LEAST 5% WEIG

Excellus pricing summary

Low

$143

Average

$201

Median

$149

High

$361

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6 hospital rates

#		Plans
1	MVHS, Inc. Utica, NY percent of total billed charges · bothfrom % of charges	2	$361	$361	—	—	—	$361 – $361
2	Samaritan Medical Center Watertown, NY professional · fee schedule · both	1	$143	$143	—	—	—	$143 – $143
3	St Joseph Mercy Chelsea Chelsea, MI professional · fee schedule · inpatient	1	$149	$149	—	—	—	$149 – $149
4	St Joseph Mercy Chelsea Chelsea, MI professional · fee schedule · outpatient	1	$149	$149	—	—	—	$149 – $149
5	St Mary Mercy Livonia Livonia, MI professional · fee schedule · inpatient	1	$149	$149	—	—	—	$149 – $149
6	St Mary Mercy Livonia Livonia, MI professional · fee schedule · outpatient	1	$149	$149	—	—	—	$149 – $149

← Payers reporting HCPCS G9880 · Snapshot 20261111T120946Z-9134e7f7

Low

$143

Average

$201

Median

$149

High

$361

Filter by billing methodology

Filter by billing class

6 hospital rates

#		Plans
1	MVHS, Inc. Utica, NY percent of total billed charges · bothfrom % of charges	2	$361	$361	—	—	—	$361 – $361
2	Samaritan Medical Center Watertown, NY professional · fee schedule · both	1	$143	$143	—	—	—	$143 – $143
3	St Joseph Mercy Chelsea Chelsea, MI professional · fee schedule · inpatient	1	$149	$149	—	—	—	$149 – $149
4	St Joseph Mercy Chelsea Chelsea, MI professional · fee schedule · outpatient	1	$149	$149	—	—	—	$149 – $149
5	St Mary Mercy Livonia Livonia, MI professional · fee schedule · inpatient	1	$149	$149	—	—	—	$149 – $149
6	St Mary Mercy Livonia Livonia, MI professional · fee schedule · outpatient	1	$149	$149	—	—	—	$149 – $149

← Payers reporting HCPCS G9880 · Snapshot 20261111T120946Z-9134e7f7