81228
HCPCS Procedure Code
HCPCS code 81228 is the #5,193 most-billed Medicaid procedure code, with $265K in payments across 2K claims from 2018–2024. The national median cost per claim is $196.14. Costs vary widely — the 90th percentile is $684.88 per claim, 3.5× the median.
Total Paid
$265K
0.00% of all spending
Total Claims
2K
Providers
11
Avg Cost/Claim
$148
National Cost Distribution
How much do providers bill per claim for 81228? Based on 10 providers billing this code nationally.
Median
$196.14
Average
$300.66
Std Dev
$289.52
Max
$800.54
Percentile Distribution (Cost per Claim)
50% of providers bill between $56.06 and $520.04 per claim for this code.
90% bill between $19.99 and $684.88.
Top 1% bill above $788.97.
About This Procedure
HCPCS code 81228 was billed by 11 providers across 2K claims, totaling $265K in Medicaid payments from 2018–2024. This code was used for 2K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$196.14
Providers Billing
10
National Spending
$265K
Avg/Median Ratio
1.53×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 81228
| # | Provider | Total Paid |
|---|---|---|
| 1 | Genedx Llc Gaithersburg, MD · Medical Genetics, Ph.D. Medical Genetics | $113K |
| 2 | Northwell Health Laboratories New Hyde Park, NY · Clinical Medical Laboratory | $41K |
| 3 | 1386148971 | $24K |
| 4 | 1306875877 | $23K |
| 5 | 1518415991 | $22K |
| 6 | 1376709535 | $14K |
| 7 | Children's Hospital Corporation Boston, MA · Clinic/Center | $14K |
| 8 | The General Hospital Corporation Boston, MA · General Acute Care Hospital | $9K |
| 9 | 1235234535 | $5K |
| 10 | Bioreference Health Llc Elmwood Park, NJ · Clinical Medical Laboratory | $250 |
| 11 | 1033495221 | $0 |
Showing top 11 of 11 providers billing this code