Treatment of behavior impacting health in group setting, each additional 30 minutes
Medicare pricing data for 202 providers across 16 states
This procedure has a 11.4x markup — hospitals charge $46.89 but Medicare allows only $4.13. Uninsured patients may face bills 11.4 times higher than what insurance negotiates. 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, each additional 30 minutes (HCPCS code 96165) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $4.13, but hospitals typically charge $46.89 — a 11.4x 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 $4.13, your out-of-pocket cost would be approximately $0.83. 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 11.4x more than what Medicare allows for this procedure. Medicare actually pays $3.13 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| California | $4 | $23 | 20 | 10,537 | +4.1% |
| Washington | $4 | $16 | 15 | 1,666 | +3.9% |
| Minnesota | $4 | $71 | 17 | 1,841 | +2.2% |
| Arizona | $4 | $72 | 10 | 8,157 | +0.5% |
| Colorado | $4 | $25 | 9 | 219 | -0.5% |
| Wisconsin | $4 | $36 | 14 | 3,024 | -1.0% |
| New Hampshire | $4 | $13 | 3 | 781 | -1.5% |
| Florida | $4 | $84 | 18 | 7,211 | -1.9% |
| Pennsylvania | $4 | $21 | 5 | 72 | -1.9% |
| Texas | $4 | $8 | 4 | 183 | -2.2% |
| North Dakota | $4 | $14 | 1 | 71 | -3.1% |
| Michigan | $4 | $9 | 3 | 24 | -3.6% |
| Tennessee | $4 | $11 | 6 | 1,202 | -5.8% |
| Ohio | $4 | $36 | 8 | 442 | -6.1% |
| Utah | $4 | $43 | 8 | 404 | -9.7% |
| Oregon | $4 | $15 | 23 | 2,137 | -9.9% |
⚠️ 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