43251
HCPCS Procedure Code
HCPCS code 43251 is the #3,205 most-billed Medicaid procedure code, with $2.2M in payments across 9K claims from 2018–2024. The national median cost per claim is $170.26. Costs vary widely — the 90th percentile is $661.28 per claim, 3.9× the median.
Total Paid
$2.2M
0.00% of all spending
Total Claims
9K
Providers
32
Avg Cost/Claim
$248
National Cost Distribution
How much do providers bill per claim for 43251? Based on 32 providers billing this code nationally.
Median
$170.26
Average
$281.95
Std Dev
$243.78
Max
$887.25
Percentile Distribution (Cost per Claim)
50% of providers bill between $100.09 and $451.12 per claim for this code.
90% bill between $35.44 and $661.28.
Top 1% bill above $840.83.
About This Procedure
HCPCS code 43251 was billed by 32 providers across 9K claims, totaling $2.2M in Medicaid payments from 2018–2024. This code was used for 8K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$170.26
Providers Billing
32
National Spending
$2.2M
Avg/Median Ratio
1.66×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 43251
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1457449621 | $655K |
| 2 | 1891928123 | $293K |
| 3 | 1265489157 | $177K |
| 4 | 1306068804 | $167K |
| 5 | 1861743601 | $148K |
| 6 | 1073588646 | $135K |
| 7 | 1134868045 | $134K |
| 8 | 1770559981 | $118K |
| 9 | 1861497380 | $81K |
| 10 | 1477527398 | $81K |
| 11 | 1053325647 | $46K |
| 12 | 1538597489 | $30K |
| 13 | Saint Mary's Hospital, Inc. Waterbury, CT · General Acute Care Hospital | $29K |
| 14 | 1376875518 | $22K |
| 15 | 1225053523 | $19K |
| 16 | The Cooper Health System Camden, NJ · General Acute Care Hospital | $12K |
| 17 | 1336606243 | $11K |
| 18 | 1356616064 | $9K |
| 19 | 1912180969 | $7K |
| 20 | 1508891508 | $7K |
Showing top 20 of 32 providers billing this code