#6047 of 11K

97172

HCPCS Procedure Code

HCPCS code 97172 is the #6,047 most-billed Medicaid procedure code, with $102K in payments across 3,797 claims from 2018–2024. The national median cost per claim is $34.84.

Total Paid

$102K

0.00% of all spending

Total Claims

3,797

Providers

Avg Cost/Claim

$27

National Cost Distribution

How much do providers bill per claim for 97172? Based on 19 providers billing this code nationally.

Median

$34.84

Average

$34.60

Std Dev

$13.65

Max

$62.67

Percentile Distribution (Cost per Claim)

p10

$20.74

p25

$28.55

Median

$34.84

p75

$38.04

p90

$52.46

p95

$59.08

p99

$61.95

50% of providers bill between $28.55 and $38.04 per claim for this code.

90% bill between $20.74 and $52.46.

Top 1% bill above $61.95.

About This Procedure

HCPCS code 97172 was billed by 24 providers across 3,797 claims, totaling $102K in Medicaid payments from 2018–2024. This code was used for 3,617 unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$34.84

Providers Billing

National Spending

$102K

Avg/Median Ratio

0.99×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 97172

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1487658720	$20K	$34.78	1.0× median	Below Median
2	1801861190	$13K	$40.17	1.2× median	Above 75th
3	1336295138	$11K	$35.91	1.0× median	Above Median
4	Grossmont Hospital Corporation La Mesa, CA · General Acute Care Hospital	$8K	$62.67	1.8× median	Top 1%
5	1932134228	$8K	$18.60	0.5× median	Below Median
6	1689181778	$8K	$22.31	0.6× median	Below Median
7	1952461741	$5K	$21.75	0.6× median	Below Median
8	1548408735	$4K	$21.28	0.6× median	Below Median
9	1962574947	$4K	$50.91	1.5× median	Above 75th
10	1407813660	$4K	$41.73	1.2× median	Above 75th
11	1275993560	$4K	$34.84	1.0× median	Above Median
12	1689064214	$4K	$34.83	1.0× median	Below Median
13	1952394603	$3K	$58.68	1.7× median	Top 10%
14	1780685032	$1K	$34.84	1.0× median	Below Median
15	1003354895	$1K	$34.84	1.0× median	Above Median
16	1437445566	$1K	$34.84	1.0× median	Below Median
17	1811047921	$623	$4.83	0.1× median	Below Median
18	1689027955	$557	$34.84	1.0× median	Above Median
19	1679778021	$557	$34.84	1.0× median	Above Median
20	1184758161	$0	$0.00	0.0× median	Below Median

Showing top 20 of 24 providers billing this code

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