#2326 of 11K

C9257

HCPCS Procedure Code

HCPCS code C9257 is the #2,326 most-billed Medicaid procedure code, with $6.7M in payments across 110K claims from 2018–2024. The national median cost per claim is $22.28. Costs vary widely — the 90th percentile is $224.96 per claim, 10.1× the median.

Total Paid

$6.7M

0.00% of all spending

Total Claims

110K

Providers

Avg Cost/Claim

$61

National Cost Distribution

How much do providers bill per claim for C9257? Based on 78 providers billing this code nationally.

Median

$22.28

Average

$73.24

Std Dev

$136.13

Max

$609.09

Percentile Distribution (Cost per Claim)

p10

$2.27

p25

$6.02

Median

$22.28

p75

$51.80

p90

$224.96

p95

$423.38

p99

$579.86

50% of providers bill between $6.02 and $51.80 per claim for this code.

90% bill between $2.27 and $224.96.

Top 1% bill above $579.86.

About This Procedure

HCPCS code C9257 was billed by 92 providers across 110K claims, totaling $6.7M in Medicaid payments from 2018–2024. This code was used for 86K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$22.28

Providers Billing

National Spending

$6.7M

Avg/Median Ratio

3.29×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for C9257

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Rector & Visitors Of The University Of Virginia Charlottesville, VA · General Acute Care Hospital	$963K	$452.27	20.3× median	Top 10%
2	Sage River Counseling Seattle, WA · Counselor Mental Health	$771K	$418.28	18.8× median	Top 10%
3	1306883228	$729K	$212.52	9.5× median	Above 75th
4	Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital	$545K	$571.13	25.6× median	Top 10%
5	1457497992	$487K	$344.35	15.5× median	Top 10%
6	1679660617	$399K	$58.29	2.6× median	Above 75th
7	1376593442	$398K	$91.90	4.1× median	Above 75th
8	Froedtert Memorial Lutheran Hospital, Inc. Milwaukee, WI · Clinic/Center, Radiology	$392K	$156.85	7.0× median	Above 75th
9	University Of Wisconsin Hospitals And Clinics Authority Madison, WI · General Acute Care Hospital	$225K	$119.45	5.4× median	Above 75th
10	Ohio State University Hospitals Columbus, OH · General Acute Care Hospital	$202K	$53.66	2.4× median	Above 75th
11	1639101751	$193K	$31.45	1.4× median	Above Median
12	1598997009	$184K	$32.93	1.5× median	Above Median
13	University Of Colorado Hospital Authority Aurora, CO · General Acute Care Hospital	$149K	$551.01	24.7× median	Top 10%
14	1477083459	$98K	$28.19	1.3× median	Above Median
15	Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital	$83K	$15.37	0.7× median	Below Median
16	1457710014	$71K	$32.71	1.5× median	Above Median
17	The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital	$66K	$27.03	1.2× median	Above Median
18	1982958773	$65K	$9.18	0.4× median	Below Median
19	1558392563	$63K	$32.48	1.5× median	Above Median
20	1033531538	$57K	$59.32	2.7× median	Above 75th

Showing top 20 of 92 providers billing this code

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