#2278 of 11K

81295

HCPCS Procedure Code

HCPCS code 81295 is the #2,278 most-billed Medicaid procedure code, with $7.2M in payments across 74K claims from 2018–2024. The national median cost per claim is $59.11. Costs vary widely — the 90th percentile is $407.18 per claim, 6.9× the median.

Total Paid

$7.2M

0.00% of all spending

Total Claims

74K

Providers

Avg Cost/Claim

$97

National Cost Distribution

How much do providers bill per claim for 81295? Based on 52 providers billing this code nationally.

Median

$59.11

Average

$149.55

Std Dev

$205.67

Max

$900.58

Percentile Distribution (Cost per Claim)

p10

$2.97

p25

$16.84

Median

$59.11

p75

$198.96

p90

$407.18

p95

$583.23

p99

$841.69

50% of providers bill between $16.84 and $198.96 per claim for this code.

90% bill between $2.97 and $407.18.

Top 1% bill above $841.69.

About This Procedure

HCPCS code 81295 was billed by 66 providers across 74K claims, totaling $7.2M in Medicaid payments from 2018–2024. This code was used for 66K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$59.11

Providers Billing

National Spending

$7.2M

Avg/Median Ratio

2.53×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 81295

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Invitae Corporation San Francisco, CA · Clinical Medical Laboratory	$970K	$51.48	0.9× median	Below Median
2	Myriad Genetic Laboratories, Inc. Salt Lake City, UT · Clinical Medical Laboratory	$921K	$134.56	2.3× median	Above Median
3	1013973866	$839K	$55.14	0.9× median	Below Median
4	Speciality Screening Llc Wauwatosa, WI · Clinical Medical Laboratory	$776K	$416.33	7.0× median	Top 10%
5	1861568784	$658K	$94.25	1.6× median	Above Median
6	1790023547	$534K	$208.20	3.5× median	Above 75th
7	Bioconfirm Laboratories Llc Doraville, GA · Clinical Medical Laboratory	$525K	$231.65	3.9× median	Above 75th
8	1689971822	$428K	$407.25	6.9× median	Top 10%
9	1740733708	$275K	$41.75	0.7× median	Below Median
10	1003221904	$238K	$406.52	6.9× median	Above 75th
11	1659726487	$201K	$771.23	13.0× median	Top 10%
12	1639577091	$156K	$173.08	2.9× median	Above Median
13	1457977209	$96K	$246.79	4.2× median	Above 75th
14	1730628439	$89K	$900.58	15.2× median	Top 1%
15	Laboratory Corporation Of America Holdings Research Triangle Park, NC · Clinical Medical Laboratory	$72K	$60.30	1.0× median	Above Median
16	Crestar Labs Llc Spring Hill, TN · Clinical Medical Laboratory	$57K	$162.50	2.7× median	Above Median
17	1902347891	$50K	$785.11	13.3× median	Top 10%
18	1649225632	$30K	$128.54	2.2× median	Above Median
19	Genedx Llc Gaithersburg, MD · Medical Genetics, Ph.D. Medical Genetics	$26K	$87.70	1.5× median	Above Median
20	1346641875	$24K	$70.95	1.2× median	Above Median

Showing top 20 of 66 providers billing this code

Related Procedures

81292$11.5M 81298$9.5M 81291$2.7M 81290$2.3M 81301$2.1M

← All procedures Top providers →