81242
HCPCS Procedure Code
HCPCS code 81242 is the #3,167 most-billed Medicaid procedure code, with $2.3M in payments across 180K claims from 2018–2024. The national median cost per claim is $7.24. Costs vary widely — the 90th percentile is $45.42 per claim, 6.3× the median.
Total Paid
$2.3M
0.00% of all spending
Total Claims
180K
Providers
82
Avg Cost/Claim
$13
National Cost Distribution
How much do providers bill per claim for 81242? Based on 60 providers billing this code nationally.
Median
$7.24
Average
$15.98
Std Dev
$19.18
Max
$92.74
Percentile Distribution (Cost per Claim)
50% of providers bill between $3.26 and $19.93 per claim for this code.
90% bill between $0.65 and $45.42.
Top 1% bill above $74.20.
About This Procedure
HCPCS code 81242 was billed by 82 providers across 180K claims, totaling $2.3M in Medicaid payments from 2018–2024. This code was used for 159K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$7.24
Providers Billing
60
National Spending
$2.3M
Avg/Median Ratio
2.21×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 81242
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1114222817 | $582K |
| 2 | 1790023547 | $390K |
| 3 | 1689975021 | $229K |
| 4 | Myriad Women's Health, Inc. South San Francisco, CA · Clinical Medical Laboratory | $223K |
| 5 | Natera Inc. San Carlos, CA · Clinical Medical Laboratory | $140K |
| 6 | Laboratory Corporation Of America Holdings Burlington, NC · Clinical Medical Laboratory | $115K |
| 7 | 1063892396 | $72K |
| 8 | 1518415991 | $58K |
| 9 | 1326484569 | $56K |
| 10 | Laboratory Corporation Of America Holdings Research Triangle Park, NC · Clinical Medical Laboratory | $54K |
| 11 | Laboratory Corporation Of America Holdings Dublin, OH · Clinical Medical Laboratory | $52K |
| 12 | Bioconfirm Laboratories Llc Doraville, GA · Clinical Medical Laboratory | $43K |
| 13 | 1013973866 | $40K |
| 14 | Laboratory Corporation Of America Holdings Birmingham, AL · Clinical Medical Laboratory | $37K |
| 15 | 1639577091 | $32K |
| 16 | 1659726487 | $29K |
| 17 | Laboratory Corporation Of America Holdings Raritan, NJ · Clinical Medical Laboratory | $24K |
| 18 | Bioreference Health Llc Elmwood Park, NJ · Clinical Medical Laboratory | $15K |
| 19 | 1275971707 | $13K |
| 20 | Crestar Labs Llc Spring Hill, TN · Clinical Medical Laboratory | $12K |
Showing top 20 of 82 providers billing this code