#1847 of 11K

80164

HCPCS Procedure Code

HCPCS code 80164 is the #1,847 most-billed Medicaid procedure code, with $12.8M in payments across 2.1M claims from 2018–2024. The national median cost per claim is $5.91. Costs vary widely — the 90th percentile is $14.23 per claim, 2.4× the median.

Total Paid

$12.8M

0.00% of all spending

Total Claims

2.1M

Providers

1,358

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for 80164? Based on 1,277 providers billing this code nationally.

Median

$5.91

Average

$8.23

Std Dev

$19.07

Max

$567.07

Percentile Distribution (Cost per Claim)

p10

$1.48

p25

$3.29

Median

$5.91

p75

$10.09

p90

$14.23

p95

$18.29

p99

$40.97

50% of providers bill between $3.29 and $10.09 per claim for this code.

90% bill between $1.48 and $14.23.

Top 1% bill above $40.97.

About This Procedure

HCPCS code 80164 was billed by 1,358 providers across 2.1M claims, totaling $12.8M in Medicaid payments from 2018–2024. This code was used for 1.8M unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$5.91

Providers Billing

1,277

National Spending

$12.8M

Avg/Median Ratio

1.39×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 80164

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Laboratory Corporation Of America Holdings Burlington, NC · Clinical Medical Laboratory	$720K	$7.72	1.3× median	Above Median
2	1790101681	$430K	$4.49	0.8× median	Below Median
3	Laboratory Corporation Of America Holdings Dublin, OH · Clinical Medical Laboratory	$386K	$6.90	1.2× median	Above Median
4	Sonora Quest Laboratories Llc Phoenix, AZ · Clinical Medical Laboratory	$314K	$7.06	1.2× median	Above Median
5	Unilab Corporation West Hills, CA · Clinical Medical Laboratory	$297K	$5.82	1.0× median	Below Median
6	Laboratory Corporation Of America Holdings Birmingham, AL · Clinical Medical Laboratory	$283K	$6.32	1.1× median	Above Median
7	Laboratory Corporation Of America Holdings Raritan, NJ · Clinical Medical Laboratory	$258K	$4.05	0.7× median	Below Median
8	Labone Llc Lenexa, KS · Clinical Medical Laboratory	$250K	$8.18	1.4× median	Above Median
9	Children's Hospital Of Wisconsin, Inc. Milwaukee, WI · Dentist, Pediatric Dentistry	$207K	$69.95	11.8× median	Top 1%
10	Quest Diagnostics Incorporated Clifton, NJ · Clinical Medical Laboratory	$179K	$7.83	1.3× median	Above Median
11	Quest Diagnostics Clinical Laboratories Inc Tucker, GA · Clinical Medical Laboratory	$171K	$6.64	1.1× median	Above Median
12	Clinical Pathology Laboratories, Inc. Austin, TX · Clinical Medical Laboratory	$166K	$5.06	0.9× median	Below Median
13	Quest Diagnostics Llc Il Wood Dale, IL · Clinical Medical Laboratory	$166K	$7.69	1.3× median	Above Median
14	1659373900	$159K	$6.81	1.2× median	Above Median
15	1871960195	$155K	$12.61	2.1× median	Above 75th
16	Lifescan Labs Of Illinois Llc Skokie, IL · Clinical Medical Laboratory	$143K	$7.58	1.3× median	Above Median
17	1750364345	$138K	$7.46	1.3× median	Above Median
18	Laboratory Corporation Of America Seattle, WA · Clinical Medical Laboratory	$130K	$7.81	1.3× median	Above Median
19	Quest Diagnostics Clinical Laboratories Inc Irving, TX · Clinical Medical Laboratory	$127K	$5.52	0.9× median	Below Median
20	Quest Diagnostics Llc Marlborough, MA · Clinical Medical Laboratory	$126K	$5.51	0.9× median	Below Median

Showing top 20 of 1,358 providers billing this code

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