#1236 of 11K

81406

HCPCS Procedure Code

HCPCS code 81406 is the #1,236 most-billed Medicaid procedure code, with $31.9M in payments across 289K claims from 2018–2024. The national median cost per claim is $50.07. Costs vary widely — the 90th percentile is $334.87 per claim, 6.7× the median.

Total Paid

$31.9M

0.00% of all spending

Total Claims

289K

Providers

140

Avg Cost/Claim

$110

National Cost Distribution

How much do providers bill per claim for 81406? Based on 96 providers billing this code nationally.

Median

$50.07

Average

$150.44

Std Dev

$309.63

Max

$1,839.37

Percentile Distribution (Cost per Claim)

p10

$2.85

p25

$9.18

Median

$50.07

p75

$114.73

p90

$334.87

p95

$738.73

p99

$1,722.71

50% of providers bill between $9.18 and $114.73 per claim for this code.

90% bill between $2.85 and $334.87.

Top 1% bill above $1,722.71.

About This Procedure

HCPCS code 81406 was billed by 140 providers across 289K claims, totaling $31.9M in Medicaid payments from 2018–2024. This code was used for 232K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$50.07

Providers Billing

National Spending

$31.9M

Avg/Median Ratio

3.00×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 81406

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Myriad Genetic Laboratories, Inc. Salt Lake City, UT · Clinical Medical Laboratory	$9.0M	$124.21	2.5× median	Above 75th
2	1790023547	$5.3M	$710.79	14.2× median	Top 10%
3	1316311863	$2.9M	$961.14	19.2× median	Top 10%
4	Invitae Corporation San Francisco, CA · Clinical Medical Laboratory	$2.2M	$43.36	0.9× median	Below Median
5	Genedx Llc Gaithersburg, MD · Medical Genetics, Ph.D. Medical Genetics	$1.8M	$79.24	1.6× median	Above Median
6	1689971822	$1.5M	$822.54	16.4× median	Top 10%
7	1013973866	$1.5M	$80.66	1.6× median	Above Median
8	Speciality Screening Llc Wauwatosa, WI · Clinical Medical Laboratory	$1.0M	$393.81	7.9× median	Top 10%
9	Natera Inc. San Carlos, CA · Clinical Medical Laboratory	$865K	$29.78	0.6× median	Below Median
10	1902347891	$701K	$1,839.37	36.7× median	Top 1%
11	1861568784	$700K	$164.52	3.3× median	Above 75th
12	1659726487	$458K	$613.76	12.3× median	Top 10%
13	1326484569	$360K	$38.03	0.8× median	Below Median
14	1518415991	$344K	$29.61	0.6× median	Below Median
15	Bioconfirm Laboratories Llc Doraville, GA · Clinical Medical Laboratory	$317K	$129.60	2.6× median	Above 75th
16	1184045619	$279K	$29.89	0.6× median	Below Median
17	1063892396	$264K	$254.68	5.1× median	Above 75th
18	Crestar Labs Llc Spring Hill, TN · Clinical Medical Laboratory	$231K	$312.11	6.2× median	Above 75th
19	1003221904	$229K	$217.72	4.3× median	Above 75th
20	1629109137	$226K	$1,120.07	22.4× median	Top 10%

Showing top 20 of 140 providers billing this code

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