#3063 of 11K

36226

HCPCS Procedure Code

HCPCS code 36226 is the #3,063 most-billed Medicaid procedure code, with $2.6M in payments across 4,370 claims from 2018–2024. The national median cost per claim is $196.87. Costs vary widely — the 90th percentile is $2,310.53 per claim, 11.7× the median.

Total Paid

$2.6M

0.00% of all spending

Total Claims

4,370

Providers

Avg Cost/Claim

$598

National Cost Distribution

How much do providers bill per claim for 36226? Based on 44 providers billing this code nationally.

Median

$196.87

Average

$654.38

Std Dev

$935.54

Max

$3,896.15

Percentile Distribution (Cost per Claim)

p10

$106.90

p25

$131.84

Median

$196.87

p75

$761.64

p90

$2,310.53

p95

$2,710.60

p99

$3,547.36

50% of providers bill between $131.84 and $761.64 per claim for this code.

90% bill between $106.90 and $2,310.53.

Top 1% bill above $3,547.36.

About This Procedure

HCPCS code 36226 was billed by 47 providers across 4,370 claims, totaling $2.6M in Medicaid payments from 2018–2024. This code was used for 3,256 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$196.87

Providers Billing

National Spending

$2.6M

Avg/Median Ratio

3.32×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 36226

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1780694380	$921K	$2,033.52	10.3× median	Above 75th
2	University Of Kentucky Lexington, KY · General Acute Care Hospital	$238K	$2,453.41	12.5× median	Top 10%
3	University Medical Center, Inc Louisville, KY · Student in an Organized Health Care Education/Training Program	$222K	$3,896.15	19.8× median	Top 1%
4	1043275787	$188K	$1,120.46	5.7× median	Above 75th
5	1770717811	$183K	$184.60	0.9× median	Below Median
6	1477582526	$165K	$1,124.77	5.7× median	Above 75th
7	Ohiohealth Corporation Columbus, OH · General Acute Care Hospital	$155K	$940.10	4.8× median	Above 75th
8	1992041461	$63K	$781.74	4.0× median	Above 75th
9	1114215944	$60K	$138.34	0.7× median	Below Median
10	1699761379	$52K	$128.94	0.7× median	Below Median
11	1649217514	$51K	$2,429.25	12.3× median	Top 10%
12	University Hospital Newark, NJ · General Acute Care Hospital	$37K	$3,085.00	15.7× median	Top 10%
13	1336188291	$33K	$2,755.99	14.0× median	Top 10%
14	1316022312	$30K	$1,451.18	7.4× median	Above 75th
15	1417315300	$27K	$184.87	0.9× median	Below Median
16	1396814166	$17K	$427.85	2.2× median	Above Median
17	1326091448	$16K	$155.83	0.8× median	Below Median
18	1194093229	$15K	$282.38	1.4× median	Above Median
19	1457021438	$14K	$754.94	3.8× median	Above Median
20	1619935525	$12K	$111.05	0.6× median	Below Median

Showing top 20 of 47 providers billing this code

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