#2290 of 11K

00104

HCPCS Procedure Code

HCPCS code 00104 is the #2,290 most-billed Medicaid procedure code, with $7.1M in payments across 134K claims from 2018–2024. The national median cost per claim is $51.82. Costs vary widely — the 90th percentile is $119.44 per claim, 2.3× the median.

Total Paid

$7.1M

0.00% of all spending

Total Claims

134K

Providers

124

Avg Cost/Claim

$53

National Cost Distribution

How much do providers bill per claim for 00104? Based on 122 providers billing this code nationally.

Median

$51.82

Average

$62.92

Std Dev

$59.86

Max

$528.63

Percentile Distribution (Cost per Claim)

p10

$10.60

p25

$25.25

Median

$51.82

p75

$88.50

p90

$119.44

p95

$143.73

p99

$200.41

50% of providers bill between $25.25 and $88.50 per claim for this code.

90% bill between $10.60 and $119.44.

Top 1% bill above $200.41.

About This Procedure

HCPCS code 00104 was billed by 124 providers across 134K claims, totaling $7.1M in Medicaid payments from 2018–2024. This code was used for 58K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$51.82

Providers Billing

122

National Spending

$7.1M

Avg/Median Ratio

1.21×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 00104

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Hennepin Healthcare System Inc Minneapolis, MN · General Acute Care Hospital	$1.7M	$59.42	1.1× median	Above Median
2	1851389613	$602K	$47.48	0.9× median	Below Median
3	1417401266	$354K	$182.55	3.5× median	Top 10%
4	1356858419	$337K	$70.95	1.4× median	Above Median
5	1285660704	$293K	$87.73	1.7× median	Above Median
6	1124430244	$268K	$95.89	1.9× median	Above 75th
7	1265836068	$259K	$123.44	2.4× median	Top 10%
8	1558314427	$239K	$38.55	0.7× median	Below Median
9	1649264706	$233K	$88.75	1.7× median	Above 75th
10	1053354233	$218K	$90.50	1.7× median	Above 75th
11	1477554814	$192K	$65.27	1.3× median	Above Median
12	1801874573	$162K	$18.16	0.4× median	Below Median
13	1689619280	$148K	$27.42	0.5× median	Below Median
14	1508133497	$139K	$36.32	0.7× median	Below Median
15	1962431668	$135K	$85.52	1.7× median	Above Median
16	1760095806	$122K	$94.72	1.8× median	Above 75th
17	1255934501	$119K	$51.11	1.0× median	Below Median
18	1215932413	$102K	$21.82	0.4× median	Below Median
19	1083154249	$97K	$64.10	1.2× median	Above Median
20	1649570870	$97K	$59.50	1.1× median	Above Median

Showing top 20 of 124 providers billing this code

Related Procedures

0101$66.0M 0111$41.2M 0100$11.7M 0112$9.5M 0113$3.5M

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