#2187 of 11K

P9604

HCPCS Procedure Code

HCPCS code P9604 is the #2,187 most-billed Medicaid procedure code, with $8.1M in payments across 5.0M claims from 2018–2024. The national median cost per claim is $0.81. Costs vary widely — the 90th percentile is $10.34 per claim, 12.8× the median.

Total Paid

$8.1M

0.00% of all spending

Total Claims

5.0M

Providers

612

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for P9604? Based on 434 providers billing this code nationally.

Median

$0.81

Average

$3.28

Std Dev

$6.45

Max

$64.48

Percentile Distribution (Cost per Claim)

p10

$0.02

p25

$0.17

Median

$0.81

p75

$3.06

p90

$10.34

p95

$16.23

p99

$19.81

50% of providers bill between $0.17 and $3.06 per claim for this code.

90% bill between $0.02 and $10.34.

Top 1% bill above $19.81.

About This Procedure

HCPCS code P9604 was billed by 612 providers across 5.0M claims, totaling $8.1M in Medicaid payments from 2018–2024. This code was used for 2.9M unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$0.81

Providers Billing

434

National Spending

$8.1M

Avg/Median Ratio

4.05×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for P9604

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1659322360	$1.2M	$2.85	3.5× median	Above Median
2	1598106163	$1.1M	$7.66	9.5× median	Above 75th
3	1093749087	$952K	$3.35	4.1× median	Above 75th
4	1659373900	$665K	$2.53	3.1× median	Above Median
5	Lifescan Labs Of Illinois Llc Skokie, IL · Clinical Medical Laboratory	$488K	$2.38	2.9× median	Above Median
6	1861404121	$298K	$2.87	3.5× median	Above Median
7	1750364345	$248K	$1.82	2.2× median	Above Median
8	1205509510	$213K	$11.92	14.7× median	Top 10%
9	Northwell Health Laboratories New Hyde Park, NY · Clinical Medical Laboratory	$190K	$2.89	3.6× median	Above Median
10	1144213885	$181K	$2.25	2.8× median	Above Median
11	1447345830	$174K	$2.23	2.8× median	Above Median
12	1073859930	$169K	$1.49	1.8× median	Above Median
13	Sonora Quest Laboratories Llc Phoenix, AZ · Clinical Medical Laboratory	$157K	$11.76	14.5× median	Top 10%
14	Quest Diagnostics Massachusetts Llc Marlborough, MA · Clinical Medical Laboratory	$150K	$1.94	2.4× median	Above Median
15	1396761680	$149K	$3.50	4.3× median	Above 75th
16	1427120336	$146K	$1.89	2.3× median	Above Median
17	1790101681	$105K	$0.16	0.2× median	Below Median
18	1265587000	$98K	$5.31	6.6× median	Above 75th
19	1487683058	$69K	$2.96	3.7× median	Above Median
20	Accu Reference Medical Lab, Llc Linden, NJ · Clinical Medical Laboratory	$67K	$3.17	3.9× median	Above 75th

Showing top 20 of 612 providers billing this code

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