Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
DSMT GRP 2-4 PER 30M
Birmingham, AL
See all hospitals reporting HCPCS G0109 →Price type
Affinity Hospital LLC’s median price of $97 is 267% above the median hospital's median price ($26), higher than 95% of the 1,851 hospitals reporting HCPCS G0109. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 13 payers, 22 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Tricare node tricare facility · fee schedule · outpatient | $13 | $13 | — | — | — | $13 – $13 |
| 2 | Humana node humana mcr adv facility · fee schedule · outpatient | $15 | $15 | — | — | — | $15 – $15 |
| 3 | UnitedHealthcare node uhc mcr adv facility · per diem · outpatient | $15 | $15 | — | — | — | $15 – $15 |
| 4 | Cigna Healthspring node cigna healthspring mcr adv facility · fee schedule · outpatient | $15 | $15 | — | — | — | $15 – $15 |
| 5 | Devoted node devoted health mcr adv facility · fee schedule · outpatient | $15 | $15 | — | — | — | $15 – $15 |
| 6 | Optum node united optum va ccn facility · fee schedule · outpatient | $15 | $15 | — | — | — | $15 – $15 |
| 7 | Aetna node aetna mcr adv facility · fee schedule · outpatient | $15 | $15 | — | — | — | $15 – $15 |
| 8 | Clover node clover health mcr adv facility · fee schedule · outpatient | $15 | $15 | — | — | — | $15 – $15 |
| 9 | WellCare node wellcare mcr adv facility · fee schedule · outpatient | $15 | $15 | — | — | — | $15 – $15 |
| 10 | WellCare node wellcare ambetter marketplace facility · fee schedule · outpatient | $22 | $22 | — | — | — | $22 – $22 |
| 11 | Cigna cigna all facility · fee schedule · outpatient | $28 | $28 | — | — | — | $28 – $28 |
| 12 | Aetna aetna all facility · per diem · outpatient | $77 | $77 | — | — | — | $77 – $77 |
| 13 | Bcbs Al bcbs al all facility · other · outpatient | $79 | $79 | — | — | — | $79 – $79 |
| 14 | UnitedHealthcare uhc iex facility · per diem · outpatient | $97 | $97 | — | — | — | $97 – $97 |
| 15 | Optum optum health facility · percent of total billed charges · outpatientfrom % of charges | $124 | $124 | — | — | — | $124 – $124 |
| 16 | UnitedHealthcare uhc apa facility · per diem · outpatient | $144 | $144 | — | — | — | $144 – $144 |
| 17 | First Health first health facility · other · outpatient | $166 | $166 | — | — | — | $166 – $166 |
| 18 | MultiPlan multiplan primary facility · percent of total billed charges · inpatientfrom % of charges | $168 | $168 | — | — | — | $168 – $168 |
| 19 | MultiPlan multiplan primary facility · percent of total billed charges · outpatientfrom % of charges | $171 | $171 | — | — | — | $171 – $171 |
| 20 | MultiPlan multiplan complementary facility · percent of total billed charges · inpatientfrom % of charges | $193 | $193 | — | — | — | $193 – $193 |
| 21 | MultiPlan multiplan complementary facility · percent of total billed charges · outpatientfrom % of charges | $193 | $193 | — | — | — | $193 – $193 |
| 22 | First Health first health work comp al facility · percent of total billed charges · outpatientfrom % of charges | $216 | $216 | — | — | — | $216 – $216 |
Last updated: Apr 1, 2026
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