#4298 of 11K

H1004

HCPCS Procedure Code

HCPCS code H1004 is the #4,298 most-billed Medicaid procedure code, with $685K in payments across 20K claims from 2018–2024. The national median cost per claim is $32.05.

Total Paid

$685K

0.00% of all spending

Total Claims

20K

Providers

Avg Cost/Claim

$34

National Cost Distribution

How much do providers bill per claim for H1004? Based on 41 providers billing this code nationally.

Median

$32.05

Average

$39.15

Std Dev

$18.75

Max

$108.89

Percentile Distribution (Cost per Claim)

p10

$24.09

p25

$28.56

Median

$32.05

p75

$46.57

p90

$52.15

p95

$53.11

p99

$108.89

50% of providers bill between $28.56 and $46.57 per claim for this code.

90% bill between $24.09 and $52.15.

Top 1% bill above $108.89.

About This Procedure

HCPCS code H1004 was billed by 42 providers across 20K claims, totaling $685K in Medicaid payments from 2018–2024. This code was used for 14K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$32.05

Providers Billing

National Spending

$685K

Avg/Median Ratio

1.22×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for H1004

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1477010064	$58K	$26.71	0.8× median	Below Median
2	1669622247	$57K	$28.56	0.9× median	Below Median
3	1811534209	$49K	$46.55	1.5× median	Above Median
4	1952460362	$44K	$40.18	1.3× median	Above Median
5	1467643130	$41K	$29.40	0.9× median	Below Median
6	1801356373	$38K	$24.09	0.8× median	Below Median
7	1538646344	$35K	$46.57	1.5× median	Above Median
8	1891865010	$30K	$37.67	1.2× median	Above Median
9	1336535038	$30K	$53.11	1.7× median	Top 10%
10	1952500605	$30K	$50.95	1.6× median	Above 75th
11	1487763124	$28K	$29.20	0.9× median	Below Median
12	1285606178	$27K	$33.23	1.0× median	Above Median
13	1780717801	$26K	$37.29	1.2× median	Above Median
14	1740263326	$25K	$23.85	0.7× median	Below Median
15	1417912999	$24K	$29.82	0.9× median	Below Median
16	1063086346	$21K	$52.15	1.6× median	Above 75th
17	1639123284	$18K	$27.91	0.9× median	Below Median
18	1457307597	$12K	$40.42	1.3× median	Above Median
19	1831774140	$12K	$34.06	1.1× median	Above Median
20	1003480385	$9K	$46.23	1.4× median	Above Median

Showing top 20 of 42 providers billing this code

Related Procedures

H1000Prenatal care, at-risk assessment$217.0M H1001$70.5M H1010$37.8M H1003$13.0M H1002$3.7M

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