#3823 of 11K

15004

HCPCS Procedure Code

HCPCS code 15004 is the #3,823 most-billed Medicaid procedure code, with $1.1M in payments across 7,630 claims from 2018–2024. The national median cost per claim is $153.50.

Total Paid

$1.1M

0.00% of all spending

Total Claims

7,630

Providers

Avg Cost/Claim

$147

National Cost Distribution

How much do providers bill per claim for 15004? Based on 34 providers billing this code nationally.

Median

$153.50

Average

$184.38

Std Dev

$154.87

Max

$868.37

Percentile Distribution (Cost per Claim)

p10

$56.90

p25

$97.55

Median

$153.50

p75

$224.29

p90

$283.50

p95

$379.96

p99

$742.38

50% of providers bill between $97.55 and $224.29 per claim for this code.

90% bill between $56.90 and $283.50.

Top 1% bill above $742.38.

About This Procedure

HCPCS code 15004 was billed by 34 providers across 7,630 claims, totaling $1.1M in Medicaid payments from 2018–2024. This code was used for 5,321 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$153.50

Providers Billing

National Spending

$1.1M

Avg/Median Ratio

1.20×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 15004

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1215904909	$302K	$137.05	0.9× median	Below Median
2	1073087680	$207K	$162.06	1.1× median	Above Median
3	1043402522	$90K	$97.30	0.6× median	Below Median
4	1033163092	$70K	$149.45	1.0× median	Below Median
5	1013283803	$61K	$284.80	1.9× median	Top 10%
6	1861439952	$61K	$486.58	3.2× median	Top 10%
7	1972086924	$36K	$181.63	1.2× median	Above Median
8	1194346734	$34K	$92.53	0.6× median	Below Median
9	1720110968	$30K	$322.54	2.1× median	Top 10%
10	1598708513	$26K	$868.37	5.7× median	Top 1%
11	University Physicians Incorporated Aurora, CO · Anesthesiology	$20K	$245.02	1.6× median	Above 75th
12	1770796096	$19K	$196.97	1.3× median	Above Median
13	1013013002	$16K	$55.64	0.4× median	Below Median
14	1225725278	$15K	$107.42	0.7× median	Below Median
15	1952796484	$14K	$150.95	1.0× median	Below Median
16	1518916311	$14K	$280.48	1.8× median	Above 75th
17	1578938684	$14K	$156.04	1.0× median	Above Median
18	1699484816	$12K	$142.62	0.9× median	Below Median
19	1912951963	$12K	$59.84	0.4× median	Below Median
20	1235326760	$12K	$98.30	0.6× median	Below Median

Showing top 20 of 34 providers billing this code

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