#3787 of 11K

26055

HCPCS Procedure Code

HCPCS code 26055 is the #3,787 most-billed Medicaid procedure code, with $1.2M in payments across 3,452 claims from 2018–2024. The national median cost per claim is $469.37. Costs vary widely — the 90th percentile is $998.65 per claim, 2.1× the median.

Total Paid

$1.2M

0.00% of all spending

Total Claims

3,452

Providers

Avg Cost/Claim

$339

National Cost Distribution

How much do providers bill per claim for 26055? Based on 26 providers billing this code nationally.

Median

$469.37

Average

$469.34

Std Dev

$317.30

Max

$1,105.78

Percentile Distribution (Cost per Claim)

p10

$147.72

p25

$228.63

Median

$469.37

p75

$608.65

p90

$998.65

p95

$1,058.35

p99

$1,098.07

50% of providers bill between $228.63 and $608.65 per claim for this code.

90% bill between $147.72 and $998.65.

Top 1% bill above $1,098.07.

About This Procedure

HCPCS code 26055 was billed by 26 providers across 3,452 claims, totaling $1.2M in Medicaid payments from 2018–2024. This code was used for 2,307 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$469.37

Providers Billing

National Spending

$1.2M

Avg/Median Ratio

1.00×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 26055

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Montefiore Medical Center Bronx, NY · General Acute Care Hospital	$254K	$1,074.92	2.3× median	Top 10%
2	1891930392	$158K	$259.87	0.6× median	Below Median
3	1881690949	$111K	$612.71	1.3× median	Above 75th
4	Yale New Haven Hospital New Haven, CT · General Acute Care Hospital	$97K	$555.47	1.2× median	Above Median
5	State Of Connecticut Farmington, CT · Counselor, Professional	$86K	$567.75	1.2× median	Above Median
6	Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital	$59K	$517.36	1.1× median	Above Median
7	Unm Hospital Albuquerque, NM · General Acute Care Hospital	$51K	$729.66	1.6× median	Above 75th
8	1265931653	$47K	$275.81	0.6× median	Below Median
9	1457813107	$40K	$206.85	0.4× median	Below Median
10	Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent	$38K	$220.00	0.5× median	Below Median
11	1891912432	$29K	$509.74	1.1× median	Above Median
12	1932411493	$27K	$988.65	2.1× median	Above 75th
13	Norton Hospitals, Inc Louisville, KY · General Acute Care Hospital	$25K	$429.01	0.9× median	Below Median
14	1962938332	$24K	$254.54	0.5× median	Below Median
15	1134418577	$22K	$29.08	0.1× median	Below Median
16	The Metrohealth System Cleveland, OH · General Acute Care Hospital	$20K	$596.46	1.3× median	Above Median
17	1669584983	$18K	$148.80	0.3× median	Below Median
18	The Cooper Health System Camden, NJ · General Acute Care Hospital	$14K	$1,105.78	2.4× median	Top 1%
19	Tucson Medical Center Tucson, AZ · Clinic/Center, Hearing and Speech	$13K	$1,008.66	2.1× median	Top 10%
20	Albert Einstein Medical Center Phila, PA · General Acute Care Hospital	$11K	$553.80	1.2× median	Above Median

Showing top 20 of 26 providers billing this code

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