78226
HCPCS Procedure Code
HCPCS code 78226 is the #3,519 most-billed Medicaid procedure code, with $1.6M in payments across 27K claims from 2018–2024. The national median cost per claim is $22.78. Costs vary widely — the 90th percentile is $253.73 per claim, 11.1× the median.
Total Paid
$1.6M
0.00% of all spending
Total Claims
27K
Providers
118
Avg Cost/Claim
$58
National Cost Distribution
How much do providers bill per claim for 78226? Based on 117 providers billing this code nationally.
Median
$22.78
Average
$81.77
Std Dev
$109.75
Max
$634.80
Percentile Distribution (Cost per Claim)
50% of providers bill between $19.17 and $154.51 per claim for this code.
90% bill between $14.94 and $253.73.
Top 1% bill above $389.95.
About This Procedure
HCPCS code 78226 was billed by 118 providers across 27K claims, totaling $1.6M in Medicaid payments from 2018–2024. This code was used for 26K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$22.78
Providers Billing
117
National Spending
$1.6M
Avg/Median Ratio
3.59×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 78226
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1720023997 | $215K |
| 2 | Oakwood Healthcare, Inc. Dearborn, MI · General Acute Care Hospital | $161K |
| 3 | Baptist Healthcare System Inc Corbin, KY · General Acute Care Hospital | $134K |
| 4 | 1619038247 | $118K |
| 5 | 1619931466 | $115K |
| 6 | Beverly Radiology Medical Group Iii Los Angeles, CA · Radiology, Diagnostic Radiology | $107K |
| 7 | 1487608931 | $81K |
| 8 | 1679529978 | $78K |
| 9 | 1447231956 | $62K |
| 10 | 1740283324 | $60K |
| 11 | 1699704254 | $36K |
| 12 | 1639124142 | $27K |
| 13 | 1215394036 | $24K |
| 14 | 1487605168 | $19K |
| 15 | Charleston Area Medical Center Inc Charleston, WV · General Acute Care Hospital | $18K |
| 16 | 1730264128 | $17K |
| 17 | William Beaumont Hospital Royal Oak, MI · Internal Medicine, Cardiovascular Disease | $17K |
| 18 | 1598875460 | $16K |
| 19 | 1144872052 | $15K |
| 20 | 1689282147 | $15K |
Showing top 20 of 118 providers billing this code