Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

#2288 of 11K

96574

HCPCS Procedure Code

HCPCS code 96574 is the #2,288 most-billed Medicaid procedure code, with $7.1M in payments across 36K claims from 2018–2024. The national median cost per claim is $54.12. Costs vary widely — the 90th percentile is $171.27 per claim, 3.2× the median.

Total Paid

$7.1M

0.00% of all spending

Total Claims

36K

Providers

7

Avg Cost/Claim

$198

National Cost Distribution

How much do providers bill per claim for 96574? Based on 3 providers billing this code nationally.

Median

$54.12

Average

$85.35

Std Dev

$103.20

Max

$200.56

Percentile Distribution (Cost per Claim)

p10
$11.91
p25
$27.74
Median
$54.12
p75
$127.34
p90
$171.27
p95
$185.91
p99
$197.63

50% of providers bill between $27.74 and $127.34 per claim for this code.

90% bill between $11.91 and $171.27.

Top 1% bill above $197.63.

About This Procedure

HCPCS code 96574 was billed by 7 providers across 36K claims, totaling $7.1M in Medicaid payments from 2018–2024. This code was used for 23K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$54.12

Providers Billing

3

National Spending

$7.1M

Avg/Median Ratio

1.58×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 96574

#ProviderTotal Paid
11568873727$7.1M
21215295480$1K
31790395747$54
41104871193$0
51033434477$0
61962823732$0
71679946198$0

Showing top 7 of 7 providers billing this code

Related Procedures