81209
HCPCS Procedure Code
HCPCS code 81209 is the #3,136 most-billed Medicaid procedure code, with $2.4M in payments across 160K claims from 2018–2024. The national median cost per claim is $11.09. Costs vary widely — the 90th percentile is $43.73 per claim, 3.9× the median.
Total Paid
$2.4M
0.00% of all spending
Total Claims
160K
Providers
71
Avg Cost/Claim
$15
National Cost Distribution
How much do providers bill per claim for 81209? Based on 53 providers billing this code nationally.
Median
$11.09
Average
$22.48
Std Dev
$37.91
Max
$225.00
Percentile Distribution (Cost per Claim)
50% of providers bill between $5.23 and $22.96 per claim for this code.
90% bill between $0.92 and $43.73.
Top 1% bill above $179.17.
About This Procedure
HCPCS code 81209 was billed by 71 providers across 160K claims, totaling $2.4M in Medicaid payments from 2018–2024. This code was used for 141K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$11.09
Providers Billing
53
National Spending
$2.4M
Avg/Median Ratio
2.03×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 81209
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1790023547 | $588K |
| 2 | 1114222817 | $533K |
| 3 | 1689975021 | $251K |
| 4 | Myriad Women's Health, Inc. South San Francisco, CA · Clinical Medical Laboratory | $245K |
| 5 | 1326484569 | $125K |
| 6 | Natera Inc. San Carlos, CA · Clinical Medical Laboratory | $80K |
| 7 | Laboratory Corporation Of America Holdings Burlington, NC · Clinical Medical Laboratory | $76K |
| 8 | 1902347891 | $66K |
| 9 | Invitae Corporation San Francisco, CA · Clinical Medical Laboratory | $60K |
| 10 | 1518415991 | $47K |
| 11 | Laboratory Corporation Of America Holdings Dublin, OH · Clinical Medical Laboratory | $42K |
| 12 | Laboratory Corporation Of America Holdings Research Triangle Park, NC · Clinical Medical Laboratory | $42K |
| 13 | Laboratory Corporation Of America Holdings Birmingham, AL · Clinical Medical Laboratory | $36K |
| 14 | 1063892396 | $35K |
| 15 | Laboratory Corporation Of America Tampa, FL · Clinical Medical Laboratory | $29K |
| 16 | Laboratory Corporation Of America Holdings Raritan, NJ · Clinical Medical Laboratory | $21K |
| 17 | Sherman Abrams Laboratory Inc Brooklyn, NY · Clinical Medical Laboratory | $15K |
| 18 | Bioreference Health Llc Elmwood Park, NJ · Clinical Medical Laboratory | $15K |
| 19 | 1457977209 | $15K |
| 20 | 1265418669 | $11K |
Showing top 20 of 71 providers billing this code