#4984 of 11K

81355

HCPCS Procedure Code

HCPCS code 81355 is the #4,984 most-billed Medicaid procedure code, with $328K in payments across 31K claims from 2018–2024. The national median cost per claim is $7.89. Costs vary widely — the 90th percentile is $58.66 per claim, 7.4× the median.

Total Paid

$328K

0.00% of all spending

Total Claims

31K

Providers

Avg Cost/Claim

$11

National Cost Distribution

How much do providers bill per claim for 81355? Based on 61 providers billing this code nationally.

Median

$7.89

Average

$18.34

Std Dev

$22.10

Max

$82.15

Percentile Distribution (Cost per Claim)

p10

$1.13

p25

$3.08

Median

$7.89

p75

$24.12

p90

$58.66

p95

$67.49

p99

$79.54

50% of providers bill between $3.08 and $24.12 per claim for this code.

90% bill between $1.13 and $58.66.

Top 1% bill above $79.54.

About This Procedure

HCPCS code 81355 was billed by 93 providers across 31K claims, totaling $328K in Medicaid payments from 2018–2024. This code was used for 27K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$7.89

Providers Billing

National Spending

$328K

Avg/Median Ratio

2.32×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 81355

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Millennium Health Llc San Diego, CA · Clinical Medical Laboratory	$67K	$18.09	2.3× median	Above Median
2	1821360017	$27K	$58.66	7.4× median	Top 10%
3	1124438528	$19K	$7.89	1.0× median	Above Median
4	Accu Reference Medical Lab, Llc Linden, NJ · Clinical Medical Laboratory	$18K	$15.79	2.0× median	Above Median
5	Gravity Diagnostics, Llc Covington, KY · Clinical Medical Laboratory	$17K	$12.54	1.6× median	Above Median
6	1639541295	$15K	$11.49	1.5× median	Above Median
7	Speciality Screening Llc Wauwatosa, WI · Clinical Medical Laboratory	$14K	$82.15	10.4× median	Top 1%
8	1437585262	$14K	$5.33	0.7× median	Below Median
9	1760840482	$12K	$68.25	8.6× median	Top 10%
10	1275971707	$12K	$6.27	0.8× median	Below Median
11	Rca Laboratory Services, Llc Glen Allen, VA · Clinical Medical Laboratory	$11K	$32.64	4.1× median	Above 75th
12	1497175905	$11K	$10.38	1.3× median	Above Median
13	1821409756	$10K	$20.07	2.5× median	Above Median
14	1215272406	$9K	$5.30	0.7× median	Below Median
15	1730628439	$8K	$66.61	8.4× median	Top 10%
16	1669836227	$7K	$7.26	0.9× median	Below Median
17	1831564483	$6K	$51.11	6.5× median	Above 75th
18	Crestar Labs Llc Spring Hill, TN · Clinical Medical Laboratory	$5K	$6.74	0.9× median	Below Median
19	1992095087	$4K	$16.82	2.1× median	Above Median
20	Empire City Laboratories, Inc Brooklyn, NY · Clinical Medical Laboratory	$4K	$12.06	1.5× median	Above Median

Showing top 20 of 93 providers billing this code

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