Treatment of behavior impacting health, initial 30 minutes
Medicare pricing data for 1,097 providers across 38 states
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
Treatment of behavior impacting health, initial 30 minutes (HCPCS code 96158) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $59.51, but hospitals typically charge $192.84 — a 3.2x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $59.51, your out-of-pocket cost would be approximately $11.90. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 3.2x more than what Medicare allows for this procedure. Medicare actually pays $45.61 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Delaware | $67 | $174 | 10 | 537 | +12.2% |
| New York | $65 | $225 | 20 | 830 | +9.8% |
| New Jersey | $65 | $205 | 16 | 216 | +9.1% |
| Maryland | $64 | $179 | 41 | 1,258 | +8.2% |
| California | $63 | $218 | 118 | 6,425 | +6.3% |
| Illinois | $62 | $161 | 45 | 1,642 | +4.2% |
| Arizona | $61 | $110 | 41 | 2,311 | +2.8% |
| Florida | $61 | $197 | 59 | 1,425 | +2.1% |
| Montana | $61 | $178 | 2 | 14 | +1.7% |
| Massachusetts | $60 | $236 | 2 | 186 | +0.4% |
| Louisiana | $60 | $117 | 6 | 122 | +0.1% |
| Pennsylvania | $60 | $193 | 35 | 969 | -0.0% |
| Maine | $59 | $138 | 7 | 522 | -0.3% |
| Minnesota | $59 | $202 | 51 | 987 | -1.1% |
| Connecticut | $59 | $137 | 5 | 103 | -1.6% |
| Kansas | $58 | $176 | 7 | 110 | -2.4% |
| North Carolina | $58 | $177 | 25 | 370 | -2.4% |
| Missouri | $58 | $217 | 29 | 771 | -2.5% |
| Colorado | $58 | $370 | 55 | 799 | -2.6% |
| Oregon | $58 | $184 | 120 | 1,305 | -3.0% |
| Washington | $58 | $162 | 34 | 475 | -3.3% |
| Texas | $58 | $201 | 43 | 376 | -3.4% |
| New Hampshire | $57 | $89 | 3 | 21 | -3.8% |
| Michigan | $57 | $217 | 26 | 228 | -4.2% |
| Virginia | $57 | $130 | 18 | 798 | -4.4% |
| Ohio | $57 | $175 | 45 | 664 | -4.5% |
| West Virginia | $57 | $179 | 11 | 73 | -4.6% |
| Wisconsin | $57 | $340 | 48 | 1,709 | -4.7% |
| North Dakota | $56 | $104 | 7 | 12 | -5.8% |
| Alabama | $55 | $142 | 2 | 36 | -7.1% |
| Idaho | $55 | $122 | 3 | 75 | -7.1% |
| Nevada | $54 | $77 | 4 | 1,027 | -9.2% |
| Tennessee | $54 | $169 | 27 | 1,046 | -9.6% |
| Georgia | $54 | $142 | 18 | 335 | -9.9% |
| Indiana | $53 | $145 | 15 | 272 | -10.5% |
| Kentucky | $53 | $172 | 3 | 18 | -10.7% |
| Oklahoma | $47 | $75 | 1 | 81 | -20.7% |
| Utah | $47 | $179 | 48 | 1,158 | -20.7% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber