Treatment of behavior impacting health in group setting, initial 30 minutes
Medicare pricing data for 129 providers across 16 states
This procedure has a 5.6x markup — hospitals charge $51.48 but Medicare allows only $9.16. Uninsured patients may face bills 5.6 times higher than what insurance negotiates. This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. 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 in group setting, initial 30 minutes (HCPCS code 96164) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $9.16, but hospitals typically charge $51.48 — a 5.6x 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 $9.16, your out-of-pocket cost would be approximately $1.83. 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 5.6x more than what Medicare allows for this procedure. Medicare actually pays $6.79 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Florida | $10 | $35 | 6 | 860 | +7.6% |
| Minnesota | $10 | $145 | 11 | 412 | +5.3% |
| Washington | $9 | $36 | 8 | 377 | +1.4% |
| Arizona | $9 | $115 | 9 | 1,188 | +1.2% |
| California | $9 | $30 | 11 | 3,948 | +0.5% |
| Colorado | $9 | $54 | 9 | 53 | -3.2% |
| Pennsylvania | $9 | $42 | 6 | 45 | -3.5% |
| New Hampshire | $9 | $23 | 3 | 150 | -4.0% |
| Wisconsin | $9 | $75 | 9 | 501 | -4.3% |
| Michigan | $9 | $19 | 3 | 13 | -5.6% |
| Texas | $9 | $18 | 5 | 78 | -6.1% |
| Tennessee | $9 | $23 | 6 | 360 | -7.0% |
| North Dakota | $8 | $29 | 1 | 39 | -7.3% |
| Oregon | $8 | $30 | 18 | 513 | -9.7% |
| Ohio | $8 | $35 | 3 | 12 | -10.3% |
| Utah | $8 | $97 | 8 | 126 | -11.9% |
⚠️ 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