#4054 of 11K

43237

HCPCS Procedure Code

HCPCS code 43237 is the #4,054 most-billed Medicaid procedure code, with $891K in payments across 3K claims from 2018–2024. The national median cost per claim is $114.53. Costs vary widely — the 90th percentile is $587.52 per claim, 5.1× the median.

Total Paid

$891K

0.00% of all spending

Total Claims

Providers

Avg Cost/Claim

$309

National Cost Distribution

How much do providers bill per claim for 43237? Based on 35 providers billing this code nationally.

Median

$114.53

Average

$256.58

Std Dev

$285.53

Max

$1,205.35

Percentile Distribution (Cost per Claim)

p10

$75.49

p25

$89.77

Median

$114.53

p75

$362.96

p90

$587.52

p95

$884.49

p99

$1,135.98

50% of providers bill between $89.77 and $362.96 per claim for this code.

90% bill between $75.49 and $587.52.

Top 1% bill above $1,135.98.

About This Procedure

HCPCS code 43237 was billed by 35 providers across 3K claims, totaling $891K in Medicaid payments from 2018–2024. This code was used for 3K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$114.53

Providers Billing

National Spending

$891K

Avg/Median Ratio

2.24×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for 43237

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Yale New Haven Hospital New Haven, CT · General Acute Care Hospital	$387K	$834.41	7.3× median	Top 10%
2	1629242698	$100K	$114.16	1.0× median	Below Median
3	Ohio State University Hospitals Columbus, OH · General Acute Care Hospital	$73K	$380.62	3.3× median	Above 75th
4	Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital	$64K	$526.24	4.6× median	Above 75th
5	1396825386	$52K	$576.28	5.0× median	Above 75th
6	Hartford Hospital Hartford, CT · General Acute Care Hospital	$41K	$1,001.33	8.7× median	Top 10%
7	1144471715	$29K	$234.32	2.0× median	Above Median
8	1174994826	$24K	$219.11	1.9× median	Above Median
9	Temple University Hospital Inc Philadelphia, PA · General Acute Care Hospital	$17K	$1,205.35	10.5× median	Top 1%
10	1386689248	$13K	$136.93	1.2× median	Above Median
11	The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital	$11K	$387.75	3.4× median	Above 75th
12	Regents Of The University Of Michigan Ann Arbor, MI · Clinic/Center, End-Stage Renal Disease (ESRD) Treatment	$8K	$470.11	4.1× median	Above 75th
13	1275833915	$8K	$89.16	0.8× median	Below Median
14	Spectrum Health Hospitals Grand Rapids, MI · General Acute Care Hospital	$8K	$595.01	5.2× median	Top 10%
15	1437529245	$6K	$91.09	0.8× median	Below Median
16	1801827639	$6K	$96.14	0.8× median	Below Median
17	1003996000	$6K	$114.53	1.0× median	Above Median
18	1518572551	$5K	$58.58	0.5× median	Below Median
19	1801851258	$4K	$345.30	3.0× median	Above Median
20	1083655567	$4K	$78.53	0.7× median	Below Median

Showing top 20 of 35 providers billing this code

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