#2532 of 11K

81230

HCPCS Procedure Code

HCPCS code 81230 is the #2,532 most-billed Medicaid procedure code, with $5.1M in payments across 390K claims from 2018–2024. The national median cost per claim is $13.97. Costs vary widely — the 90th percentile is $73.54 per claim, 5.3× the median.

Total Paid

$5.1M

0.00% of all spending

Total Claims

390K

Providers

Avg Cost/Claim

$13

National Cost Distribution

How much do providers bill per claim for 81230? Based on 52 providers billing this code nationally.

Median

$13.97

Average

$29.72

Std Dev

$38.09

Max

$163.76

Percentile Distribution (Cost per Claim)

p10

$2.64

p25

$6.37

Median

$13.97

p75

$38.39

p90

$73.54

p95

$123.79

p99

$149.22

50% of providers bill between $6.37 and $38.39 per claim for this code.

90% bill between $2.64 and $73.54.

Top 1% bill above $149.22.

About This Procedure

HCPCS code 81230 was billed by 93 providers across 390K claims, totaling $5.1M in Medicaid payments from 2018–2024. This code was used for 353K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$13.97

Providers Billing

National Spending

$5.1M

Avg/Median Ratio

2.13×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 81230

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1235363052	$4.2M	$12.47	0.9× median	Below Median
2	1467850859	$256K	$10.35	0.7× median	Below Median
3	Millennium Health Llc San Diego, CA · Clinical Medical Laboratory	$243K	$38.01	2.7× median	Above Median
4	Gravity Diagnostics, Llc Covington, KY · Clinical Medical Laboratory	$55K	$23.91	1.7× median	Above Median
5	1821360017	$54K	$116.02	8.3× median	Top 10%
6	Speciality Screening Llc Wauwatosa, WI · Clinical Medical Laboratory	$28K	$163.76	11.7× median	Top 1%
7	1275971707	$27K	$14.07	1.0× median	Above Median
8	1760840482	$25K	$135.26	9.7× median	Top 10%
9	1043271539	$24K	$81.23	5.8× median	Top 10%
10	1497175905	$24K	$22.79	1.6× median	Above Median
11	1437585262	$21K	$16.31	1.2× median	Above Median
12	1639541295	$20K	$18.65	1.3× median	Above Median
13	Rca Laboratory Services, Llc Glen Allen, VA · Clinical Medical Laboratory	$18K	$63.35	4.5× median	Above 75th
14	1730628439	$17K	$133.28	9.5× median	Top 10%
15	1669836227	$15K	$14.93	1.1× median	Above Median
16	Empire City Laboratories, Inc Brooklyn, NY · Clinical Medical Laboratory	$14K	$23.78	1.7× median	Above Median
17	1740733708	$12K	$9.42	0.7× median	Below Median
18	1720409154	$12K	$8.78	0.6× median	Below Median
19	Crestar Labs Llc Spring Hill, TN · Clinical Medical Laboratory	$11K	$14.48	1.0× median	Above Median
20	1992095087	$9K	$39.55	2.8× median	Above 75th

Showing top 20 of 93 providers billing this code

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