#2273 of 11K

54360

HCPCS Procedure Code

HCPCS code 54360 is the #2,273 most-billed Medicaid procedure code, with $7.2M in payments across 12K claims from 2018–2024. The national median cost per claim is $609.21. Costs vary widely — the 90th percentile is $1,263.72 per claim, 2.1× the median.

Total Paid

$7.2M

0.00% of all spending

Total Claims

12K

Providers

Avg Cost/Claim

$611

National Cost Distribution

How much do providers bill per claim for 54360? Based on 64 providers billing this code nationally.

Median

$609.21

Average

$685.37

Std Dev

$405.96

Max

$2,202.58

Percentile Distribution (Cost per Claim)

p10

$301.95

p25

$422.54

Median

$609.21

p75

$825.01

p90

$1,263.72

p95

$1,402.06

p99

$1,869.17

50% of providers bill between $422.54 and $825.01 per claim for this code.

90% bill between $301.95 and $1,263.72.

Top 1% bill above $1,869.17.

About This Procedure

HCPCS code 54360 was billed by 65 providers across 12K claims, totaling $7.2M in Medicaid payments from 2018–2024. This code was used for 11K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$609.21

Providers Billing

National Spending

$7.2M

Avg/Median Ratio

1.13×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 54360

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1639169774	$1.2M	$759.31	1.2× median	Above Median
2	1275988321	$1.0M	$609.69	1.0× median	Above Median
3	1861439952	$533K	$722.72	1.2× median	Above Median
4	Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children	$422K	$998.91	1.6× median	Above 75th
5	1093024101	$414K	$568.83	0.9× median	Below Median
6	1992720932	$383K	$536.87	0.9× median	Below Median
7	Seattle Children's Hospital Seattle, WA · Prosthetic/Orthotic Supplier	$346K	$827.03	1.4× median	Above 75th
8	1376593061	$311K	$455.56	0.7× median	Below Median
9	1154373843	$288K	$422.92	0.7× median	Below Median
10	1841573870	$210K	$602.26	1.0× median	Below Median
11	Vhs Childrens Hospital Of Michigan Inc Detroit, MI · Clinic/Center, Ambulatory Surgical	$186K	$1,673.36	2.7× median	Top 10%
12	Faculty Physicians And Surgeons Of Llusm Redlands, CA · Pediatrics	$141K	$706.43	1.2× median	Above Median
13	Norton Hospitals, Inc Louisville, KY · General Acute Care Hospital	$121K	$321.63	0.5× median	Below Median
14	1851868863	$121K	$608.72	1.0× median	Below Median
15	1295900439	$114K	$551.52	0.9× median	Below Median
16	1184280695	$100K	$421.41	0.7× median	Below Median
17	1073827101	$100K	$401.93	0.7× median	Below Median
18	1780109934	$89K	$1,057.01	1.7× median	Above 75th
19	1386709871	$64K	$1,367.42	2.2× median	Top 10%
20	1104816248	$61K	$579.94	1.0× median	Below Median

Showing top 20 of 65 providers billing this code

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