#5212 of 11K

94681

HCPCS Procedure Code

HCPCS code 94681 is the #5,212 most-billed Medicaid procedure code, with $260K in payments across 8,733 claims from 2018–2024. The national median cost per claim is $24.79. Costs vary widely — the 90th percentile is $100.70 per claim, 4.1× the median.

Total Paid

$260K

0.00% of all spending

Total Claims

8,733

Providers

Avg Cost/Claim

$30

National Cost Distribution

How much do providers bill per claim for 94681? Based on 35 providers billing this code nationally.

Median

$24.79

Average

$42.76

Std Dev

$53.60

Max

$272.22

Percentile Distribution (Cost per Claim)

p10

$6.70

p25

$13.12

Median

$24.79

p75

$38.31

p90

$100.70

p95

$132.53

p99

$231.57

50% of providers bill between $13.12 and $38.31 per claim for this code.

90% bill between $6.70 and $100.70.

Top 1% bill above $231.57.

About This Procedure

HCPCS code 94681 was billed by 37 providers across 8,733 claims, totaling $260K in Medicaid payments from 2018–2024. This code was used for 7,898 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$24.79

Providers Billing

National Spending

$260K

Avg/Median Ratio

1.72×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 94681

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1396862116	$47K	$108.60	4.4× median	Top 10%
2	1417967712	$24K	$52.11	2.1× median	Above 75th
3	Medical University Hospital Authority Charleston, SC · General Acute Care Hospital	$21K	$272.22	11.0× median	Top 1%
4	1053667972	$20K	$28.15	1.1× median	Above Median
5	1700830494	$19K	$26.99	1.1× median	Above Median
6	1457527475	$18K	$21.96	0.9× median	Below Median
7	1508278177	$16K	$15.92	0.6× median	Below Median
8	1467494070	$14K	$15.02	0.6× median	Below Median
9	1295923720	$13K	$38.22	1.5× median	Above Median
10	Children's Hospital Corporation Boston, MA · Clinic/Center	$9K	$152.65	6.2× median	Top 10%
11	1871975920	$8K	$13.35	0.5× median	Below Median
12	1265546048	$8K	$123.90	5.0× median	Top 10%
13	The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital	$5K	$36.98	1.5× median	Above Median
14	1740555267	$4K	$21.60	0.9× median	Below Median
15	1629042304	$4K	$11.75	0.5× median	Below Median
16	1922262104	$4K	$6.67	0.3× median	Below Median
17	1508817396	$4K	$28.90	1.2× median	Above Median
18	1073566550	$3K	$28.77	1.2× median	Above Median
19	Presbyterian Healthcare Services Albuquerque, NM · Emergency Medicine	$3K	$88.85	3.6× median	Above 75th
20	1992797724	$3K	$37.33	1.5× median	Above Median

Showing top 20 of 37 providers billing this code

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