Administration and interpretation of patient-focused health risk assessment
Medicare pricing data for 5,209 providers across 49 states
This procedure has a 10.9x markup — hospitals charge $27.38 but Medicare allows only $2.52. Uninsured patients may face bills 10.9 times higher than what insurance negotiates. Prices vary significantly by location — from $0 in North Dakota to $3 in District of Columbia. Where you get this procedure matters more than almost any other factor. 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
Administration and interpretation of patient-focused health risk assessment (HCPCS code 96160) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $2.52, but hospitals typically charge $27.38 — a 10.9x 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 $2.52, your out-of-pocket cost would be approximately $0.50. 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 10.9x more than what Medicare allows for this procedure. Medicare actually pays $1.82 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| District of Columbia | $3 | $28 | 10 | 522 | +27.4% |
| California | $3 | $20 | 199 | 7,849 | +25.8% |
| New Jersey | $3 | $23 | 121 | 3,451 | +22.6% |
| Alaska | $3 | $56 | 11 | 517 | +14.7% |
| Connecticut | $3 | $32 | 40 | 844 | +14.7% |
| Maryland | $3 | $49 | 229 | 15,436 | +14.3% |
| Massachusetts | $3 | $43 | 90 | 1,717 | +13.9% |
| New York | $3 | $27 | 358 | 6,713 | +9.9% |
| Washington | $3 | $16 | 50 | 1,599 | +9.5% |
| Colorado | $3 | $55 | 113 | 2,791 | +8.3% |
| Pennsylvania | $3 | $21 | 197 | 23,405 | +6.0% |
| Hawaii | $3 | $21 | 3 | 46 | +5.2% |
| Vermont | $3 | $17 | 12 | 76 | +5.2% |
| Rhode Island | $3 | $10 | 34 | 608 | +4.8% |
| Virginia | $3 | $33 | 101 | 5,741 | +4.8% |
| Delaware | $3 | $13 | 38 | 9,574 | +3.6% |
| Michigan | $3 | $16 | 210 | 5,467 | +2.8% |
| Maine | $3 | $15 | 1 | 53 | +2.4% |
| Nevada | $3 | $28 | 20 | 456 | +2.0% |
| Arizona | $3 | $52 | 142 | 6,063 | 0.0% |
| Florida | $3 | $13 | 331 | 14,245 | -0.4% |
| Texas | $3 | $20 | 530 | 15,869 | -0.8% |
| Utah | $3 | $14 | 16 | 592 | -0.8% |
| Missouri | $2 | $97 | 94 | 1,922 | -2.0% |
| Minnesota | $2 | $11 | 71 | 1,833 | -2.8% |
| Nebraska | $2 | $15 | 16 | 374 | -2.8% |
| Illinois | $2 | $14 | 286 | 8,487 | -3.2% |
| Montana | $2 | $12 | 18 | 1,769 | -3.2% |
| Oregon | $2 | $19 | 176 | 2,147 | -3.6% |
| Wisconsin | $2 | $38 | 20 | 153 | -3.6% |
| Ohio | $2 | $15 | 89 | 5,983 | -4.8% |
| South Carolina | $2 | $29 | 39 | 1,695 | -5.2% |
| Iowa | $2 | $30 | 48 | 363 | -5.6% |
| New Hampshire | $2 | $17 | 23 | 268 | -5.6% |
| New Mexico | $2 | $30 | 38 | 1,052 | -7.1% |
| North Carolina | $2 | $23 | 104 | 7,432 | -7.1% |
| Alabama | $2 | $18 | 90 | 4,152 | -7.1% |
| Georgia | $2 | $65 | 137 | 4,063 | -7.9% |
| Indiana | $2 | $15 | 190 | 6,034 | -9.1% |
| Tennessee | $2 | $107 | 232 | 3,625 | -9.1% |
| Kentucky | $2 | $29 | 143 | 4,134 | -10.3% |
| Louisiana | $2 | $48 | 157 | 3,527 | -11.5% |
| Idaho | $2 | $20 | 19 | 1,036 | -11.9% |
| Arkansas | $2 | $29 | 43 | 1,067 | -14.7% |
| West Virginia | $2 | $13 | 12 | 1,287 | -15.5% |
| Kansas | $2 | $30 | 43 | 1,466 | -19.0% |
| Mississippi | $2 | $79 | 68 | 465 | -27.8% |
| Oklahoma | $1 | $14 | 175 | 8,851 | -46.8% |
| North Dakota | $0 | $13 | 8 | 112 | -86.1% |
⚠️ 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