#3996 of 11K

81250

HCPCS Procedure Code

HCPCS code 81250 is the #3,996 most-billed Medicaid procedure code, with $944K in payments across 76K claims from 2018–2024. The national median cost per claim is $11.58. Costs vary widely — the 90th percentile is $50.69 per claim, 4.4× the median.

Total Paid

$944K

0.00% of all spending

Total Claims

76K

Providers

Avg Cost/Claim

$12

National Cost Distribution

How much do providers bill per claim for 81250? Based on 31 providers billing this code nationally.

Median

$11.58

Average

$19.16

Std Dev

$20.76

Max

$83.24

Percentile Distribution (Cost per Claim)

p10

$1.41

p25

$5.31

Median

$11.58

p75

$19.64

p90

$50.69

p95

$55.74

p99

$75.20

50% of providers bill between $5.31 and $19.64 per claim for this code.

90% bill between $1.41 and $50.69.

Top 1% bill above $75.20.

About This Procedure

HCPCS code 81250 was billed by 37 providers across 76K claims, totaling $944K in Medicaid payments from 2018–2024. This code was used for 71K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$11.58

Providers Billing

National Spending

$944K

Avg/Median Ratio

1.65×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 81250

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1114222817	$365K	$13.92	1.2× median	Above Median
2	Natera Inc. San Carlos, CA · Clinical Medical Laboratory	$274K	$11.58	1.0× median	Above Median
3	1518415991	$79K	$9.06	0.8× median	Below Median
4	1326484569	$56K	$14.95	1.3× median	Above Median
5	Invitae Corporation San Francisco, CA · Clinical Medical Laboratory	$39K	$11.48	1.0× median	Below Median
6	Sherman Abrams Laboratory Inc Brooklyn, NY · Clinical Medical Laboratory	$25K	$19.75	1.7× median	Above 75th
7	Myriad Women's Health, Inc. South San Francisco, CA · Clinical Medical Laboratory	$22K	$10.66	0.9× median	Below Median
8	Bioreference Health Llc Elmwood Park, NJ · Clinical Medical Laboratory	$18K	$13.69	1.2× median	Above Median
9	Quest Diagnostics Clinical Laboratories Inc Miramar, FL · Clinical Medical Laboratory	$10K	$18.66	1.6× median	Above Median
10	Speciality Screening Llc Wauwatosa, WI · Clinical Medical Laboratory	$10K	$56.44	4.9× median	Top 10%
11	1659726487	$9K	$83.24	7.2× median	Top 1%
12	1689975021	$9K	$39.46	3.4× median	Above 75th
13	1609388842	$6K	$49.15	4.2× median	Above 75th
14	1235234402	$6K	$8.06	0.7× median	Below Median
15	1457977209	$5K	$41.12	3.6× median	Above 75th
16	1063619922	$2K	$1.49	0.1× median	Below Median
17	1336100858	$2K	$8.52	0.7× median	Below Median
18	1558067199	$1K	$50.69	4.4× median	Top 10%
19	1447843750	$1K	$1.01	0.1× median	Below Median
20	1043271539	$936	$55.05	4.8× median	Top 10%

Showing top 20 of 37 providers billing this code

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