#2898 of 11K

95874

HCPCS Procedure Code

HCPCS code 95874 is the #2,898 most-billed Medicaid procedure code, with $3.1M in payments across 166K claims from 2018–2024. The national median cost per claim is $11.29. Costs vary widely — the 90th percentile is $40.16 per claim, 3.6× the median.

Total Paid

$3.1M

0.00% of all spending

Total Claims

166K

Providers

321

Avg Cost/Claim

$19

National Cost Distribution

How much do providers bill per claim for 95874? Based on 296 providers billing this code nationally.

Median

$11.29

Average

$18.30

Std Dev

$19.48

Max

$146.87

Percentile Distribution (Cost per Claim)

p10

$2.57

p25

$6.02

Median

$11.29

p75

$25.32

p90

$40.16

p95

$55.32

p99

$79.38

50% of providers bill between $6.02 and $25.32 per claim for this code.

90% bill between $2.57 and $40.16.

Top 1% bill above $79.38.

About This Procedure

HCPCS code 95874 was billed by 321 providers across 166K claims, totaling $3.1M in Medicaid payments from 2018–2024. This code was used for 142K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$11.29

Providers Billing

296

National Spending

$3.1M

Avg/Median Ratio

1.62×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 95874

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Children's Hospital Of Wisconsin, Inc. Milwaukee, WI · Dentist, Pediatric Dentistry	$344K	$111.85	9.9× median	Top 1%
2	Froedtert Memorial Lutheran Hospital, Inc. Milwaukee, WI · Clinic/Center, Radiology	$273K	$37.82	3.3× median	Above 75th
3	1508819228	$270K	$44.45	3.9× median	Top 10%
4	University Of Wisconsin Hospitals And Clinics Authority Madison, WI · General Acute Care Hospital	$158K	$39.71	3.5× median	Above 75th
5	1699720086	$118K	$8.93	0.8× median	Below Median
6	University Of Kentucky Lexington, KY · General Acute Care Hospital	$95K	$75.17	6.7× median	Top 10%
7	State Of Mississippi - University Of Mississippi Medical Center Jackson, MS · General Acute Care Hospital	$87K	$8.43	0.7× median	Below Median
8	1326098005	$86K	$57.98	5.1× median	Top 10%
9	Norton Hospitals, Inc Louisville, KY · General Acute Care Hospital	$85K	$146.87	13.0× median	Top 1%
10	1033548581	$73K	$31.17	2.8× median	Above 75th
11	1669617197	$69K	$26.18	2.3× median	Above 75th
12	1629356431	$45K	$10.54	0.9× median	Below Median
13	1053795187	$39K	$35.75	3.2× median	Above 75th
14	1508804105	$39K	$17.49	1.5× median	Above Median
15	1518913656	$38K	$14.00	1.2× median	Above Median
16	1275782435	$34K	$10.15	0.9× median	Below Median
17	1376593442	$34K	$39.91	3.5× median	Above 75th
18	1558355487	$32K	$29.25	2.6× median	Above 75th
19	1508166711	$30K	$62.68	5.6× median	Top 10%
20	Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital	$30K	$29.53	2.6× median	Above 75th

Showing top 20 of 321 providers billing this code

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