#4005 of 11K

45381

HCPCS Procedure Code

HCPCS code 45381 is the #4,005 most-billed Medicaid procedure code, with $939K in payments across 5,092 claims from 2018–2024. The national median cost per claim is $160.60. Costs vary widely — the 90th percentile is $328.37 per claim, 2.0× the median.

Total Paid

$939K

0.00% of all spending

Total Claims

5,092

Providers

Avg Cost/Claim

$184

National Cost Distribution

How much do providers bill per claim for 45381? Based on 46 providers billing this code nationally.

Median

$160.60

Average

$184.64

Std Dev

$154.47

Max

$665.90

Percentile Distribution (Cost per Claim)

p10

$16.73

p25

$73.02

Median

$160.60

p75

$280.54

p90

$328.37

p95

$462.14

p99

$656.44

50% of providers bill between $73.02 and $280.54 per claim for this code.

90% bill between $16.73 and $328.37.

Top 1% bill above $656.44.

About This Procedure

HCPCS code 45381 was billed by 48 providers across 5,092 claims, totaling $939K in Medicaid payments from 2018–2024. This code was used for 4,632 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$160.60

Providers Billing

National Spending

$939K

Avg/Median Ratio

1.15×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 45381

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1316231020	$155K	$281.22	1.8× median	Above 75th
2	1225053523	$94K	$108.37	0.7× median	Below Median
3	1851369284	$90K	$290.35	1.8× median	Above 75th
4	1013470525	$78K	$243.66	1.5× median	Above Median
5	1912180969	$71K	$199.73	1.2× median	Above Median
6	Nyu Langone Hospitals New York, NY · Clinic/Center, Oncology	$64K	$491.86	3.1× median	Top 10%
7	The Cooper Health System Camden, NJ · General Acute Care Hospital	$61K	$288.05	1.8× median	Above 75th
8	The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital	$52K	$665.90	4.1× median	Top 1%
9	1457433955	$32K	$110.16	0.7× median	Below Median
10	1598758112	$27K	$337.76	2.1× median	Top 10%
11	1932202959	$21K	$84.58	0.5× median	Below Median
12	1013048461	$21K	$221.18	1.4× median	Above Median
13	1093713091	$20K	$291.61	1.8× median	Above 75th
14	1114483492	$18K	$278.52	1.7× median	Above Median
15	Unm Hospital Albuquerque, NM · General Acute Care Hospital	$16K	$273.73	1.7× median	Above Median
16	Yale New Haven Hospital New Haven, CT · General Acute Care Hospital	$16K	$373.00	2.3× median	Top 10%
17	1750356788	$14K	$70.64	0.4× median	Below Median
18	Summa Health System Akron, OH · General Acute Care Hospital	$11K	$644.89	4.0× median	Top 10%
19	1831592211	$11K	$83.08	0.5× median	Below Median
20	1699194423	$10K	$216.14	1.3× median	Above Median

Showing top 20 of 48 providers billing this code

Related Procedures

45380Colonoscopy with biopsy$679.7M 45385Colonoscopy with polyp removal, snare technique$417.6M 45378Colonoscopy, diagnostic$337.4M 45384$11.3M 45382$3.3M

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