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#5120 of 11K

94626

HCPCS Procedure Code

HCPCS code 94626 is the #5,120 most-billed Medicaid procedure code, with $285K in payments across 3,267 claims from 2018–2024. The national median cost per claim is $30.07. Costs vary widely — the 90th percentile is $105.97 per claim, 3.5× the median.

Total Paid

$285K

0.00% of all spending

Total Claims

3,267

Providers

7

Avg Cost/Claim

$87

National Cost Distribution

How much do providers bill per claim for 94626? Based on 7 providers billing this code nationally.

Median

$30.07

Average

$44.02

Std Dev

$45.99

Max

$112.58

Percentile Distribution (Cost per Claim)

p10
$3.68
p25
$6.88
Median
$30.07
p75
$74.45
p90
$105.97
p95
$109.27
p99
$111.92

50% of providers bill between $6.88 and $74.45 per claim for this code.

90% bill between $3.68 and $105.97.

Top 1% bill above $111.92.

About This Procedure

HCPCS code 94626 was billed by 7 providers across 3,267 claims, totaling $285K in Medicaid payments from 2018–2024. This code was used for 592 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$30.07

Providers Billing

7

National Spending

$285K

Avg/Median Ratio

1.46×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 94626

#ProviderTotal Paid
11336553171$244K
21275944027$33K
3Unm Hospital

Albuquerque, NM · General Acute Care Hospital

$6K
41477569838$812
51447571658$758
6County Of Santa Clara

San Jose, CA · Case Manager/Care Coordinator

$543
7The New York And Presbyterian Hospital

New York, NY · General Acute Care Hospital

$465

Showing top 7 of 7 providers billing this code