#2320 of 11K

81201

HCPCS Procedure Code

HCPCS code 81201 is the #2,320 most-billed Medicaid procedure code, with $6.7M in payments across 39K claims from 2018–2024. The national median cost per claim is $132.35. Costs vary widely — the 90th percentile is $672.35 per claim, 5.1× the median.

Total Paid

$6.7M

0.00% of all spending

Total Claims

39K

Providers

Avg Cost/Claim

$172

National Cost Distribution

How much do providers bill per claim for 81201? Based on 43 providers billing this code nationally.

Median

$132.35

Average

$227.96

Std Dev

$281.68

Max

$1,048.62

Percentile Distribution (Cost per Claim)

p10

$5.74

p25

$28.00

Median

$132.35

p75

$265.02

p90

$672.35

p95

$887.42

p99

$991.56

50% of providers bill between $28.00 and $265.02 per claim for this code.

90% bill between $5.74 and $672.35.

Top 1% bill above $991.56.

About This Procedure

HCPCS code 81201 was billed by 61 providers across 39K claims, totaling $6.7M in Medicaid payments from 2018–2024. This code was used for 34K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$132.35

Providers Billing

National Spending

$6.7M

Avg/Median Ratio

1.72×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 81201

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1013973866	$1.4M	$125.56	0.9× median	Below Median
2	1184045619	$748K	$151.05	1.1× median	Above Median
3	1689971822	$683K	$502.15	3.8× median	Above 75th
4	1861568784	$647K	$268.14	2.0× median	Above 75th
5	1790023547	$594K	$261.90	2.0× median	Above Median
6	Bioconfirm Laboratories Llc Doraville, GA · Clinical Medical Laboratory	$474K	$209.59	1.6× median	Above Median
7	1003221904	$345K	$714.90	5.4× median	Top 10%
8	Invitae Corporation San Francisco, CA · Clinical Medical Laboratory	$286K	$136.95	1.0× median	Above Median
9	Crestar Labs Llc Spring Hill, TN · Clinical Medical Laboratory	$249K	$338.91	2.6× median	Above 75th
10	1659726487	$231K	$888.52	6.7× median	Top 10%
11	1639577091	$164K	$183.95	1.4× median	Above Median
12	1902347891	$146K	$479.78	3.6× median	Above 75th
13	1457977209	$101K	$474.59	3.6× median	Above 75th
14	1508215922	$91K	$152.15	1.1× median	Above Median
15	Laboratory Corporation Of America Holdings Research Triangle Park, NC · Clinical Medical Laboratory	$81K	$96.53	0.7× median	Below Median
16	Speciality Screening Llc Wauwatosa, WI · Clinical Medical Laboratory	$74K	$91.28	0.7× median	Below Median
17	1730628439	$58K	$1,048.62	7.9× median	Top 1%
18	1275971707	$50K	$61.03	0.5× median	Below Median
19	1710409545	$40K	$912.75	6.9× median	Top 10%
20	1245657675	$29K	$23.66	0.2× median	Below Median

Showing top 20 of 61 providers billing this code

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