#2445 of 11K

81227

HCPCS Procedure Code

HCPCS code 81227 is the #2,445 most-billed Medicaid procedure code, with $5.8M in payments across 417K claims from 2018–2024. The national median cost per claim is $13.02. Costs vary widely — the 90th percentile is $99.31 per claim, 7.6× the median.

Total Paid

$5.8M

0.00% of all spending

Total Claims

417K

Providers

121

Avg Cost/Claim

$14

National Cost Distribution

How much do providers bill per claim for 81227? Based on 80 providers billing this code nationally.

Median

$13.02

Average

$30.00

Std Dev

$41.21

Max

$163.76

Percentile Distribution (Cost per Claim)

p10

$1.31

p25

$3.35

Median

$13.02

p75

$33.94

p90

$99.31

p95

$132.09

p99

$141.24

50% of providers bill between $3.35 and $33.94 per claim for this code.

90% bill between $1.31 and $99.31.

Top 1% bill above $141.24.

About This Procedure

HCPCS code 81227 was billed by 121 providers across 417K claims, totaling $5.8M in Medicaid payments from 2018–2024. This code was used for 375K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$13.02

Providers Billing

National Spending

$5.8M

Avg/Median Ratio

2.30×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 81227

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1235363052	$4.5M	$13.00	1.0× median	Below Median
2	1467850859	$395K	$14.58	1.1× median	Above Median
3	Millennium Health Llc San Diego, CA · Clinical Medical Laboratory	$170K	$39.71	3.0× median	Above 75th
4	Gravity Diagnostics, Llc Covington, KY · Clinical Medical Laboratory	$71K	$21.23	1.6× median	Above Median
5	1821360017	$54K	$116.85	9.0× median	Top 10%
6	1639541295	$51K	$33.77	2.6× median	Above Median
7	Accu Reference Medical Lab, Llc Linden, NJ · Clinical Medical Laboratory	$46K	$25.26	1.9× median	Above Median
8	1437585262	$45K	$14.28	1.1× median	Above Median
9	1750373908	$41K	$15.58	1.2× median	Above Median
10	1124438528	$31K	$12.73	1.0× median	Below Median
11	Speciality Screening Llc Wauwatosa, WI · Clinical Medical Laboratory	$28K	$163.76	12.6× median	Top 1%
12	1043271539	$27K	$58.27	4.5× median	Above 75th
13	1790021517	$27K	$86.62	6.7× median	Above 75th
14	1760840482	$25K	$135.26	10.4× median	Top 10%
15	Rca Laboratory Services, Llc Glen Allen, VA · Clinical Medical Laboratory	$23K	$68.16	5.2× median	Above 75th
16	1497175905	$22K	$21.38	1.6× median	Above Median
17	1215272406	$17K	$10.55	0.8× median	Below Median
18	1669836227	$17K	$17.51	1.3× median	Above Median
19	1730628439	$17K	$132.02	10.1× median	Top 10%
20	1275971707	$16K	$6.80	0.5× median	Below Median

Showing top 20 of 121 providers billing this code

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