81226
HCPCS Procedure Code
HCPCS code 81226 is the #1,591 most-billed Medicaid procedure code, with $18.3M in payments across 434K claims from 2018–2024. The national median cost per claim is $29.80. Costs vary widely — the 90th percentile is $248.41 per claim, 8.3× the median.
Total Paid
$18.3M
0.00% of all spending
Total Claims
434K
Providers
139
Avg Cost/Claim
$42
National Cost Distribution
How much do providers bill per claim for 81226? Based on 90 providers billing this code nationally.
Median
$29.80
Average
$74.83
Std Dev
$105.56
Max
$422.40
Percentile Distribution (Cost per Claim)
50% of providers bill between $7.90 and $88.12 per claim for this code.
90% bill between $2.45 and $248.41.
Top 1% bill above $400.12.
About This Procedure
HCPCS code 81226 was billed by 139 providers across 434K claims, totaling $18.3M in Medicaid payments from 2018–2024. This code was used for 390K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$29.80
Providers Billing
90
National Spending
$18.3M
Avg/Median Ratio
2.51×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 81226
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1235363052 | $13.6M |
| 2 | Millennium Health Llc San Diego, CA · Clinical Medical Laboratory | $1.4M |
| 3 | 1467850859 | $1.1M |
| 4 | Gravity Diagnostics, Llc Covington, KY · Clinical Medical Laboratory | $249K |
| 5 | 1750373908 | $144K |
| 6 | 1821360017 | $141K |
| 7 | 1639541295 | $127K |
| 8 | Accu Reference Medical Lab, Llc Linden, NJ · Clinical Medical Laboratory | $120K |
| 9 | 1437585262 | $118K |
| 10 | 1043271539 | $85K |
| 11 | 1124438528 | $74K |
| 12 | Speciality Screening Llc Wauwatosa, WI · Clinical Medical Laboratory | $73K |
| 13 | 1790021517 | $68K |
| 14 | 1790023547 | $68K |
| 15 | 1497175905 | $67K |
| 16 | 1760840482 | $64K |
| 17 | 1275971707 | $62K |
| 18 | Rca Laboratory Services, Llc Glen Allen, VA · Clinical Medical Laboratory | $60K |
| 19 | 1669836227 | $46K |
| 20 | 1215272406 | $45K |
Showing top 20 of 139 providers billing this code