81243
HCPCS Procedure Code
HCPCS code 81243 is the #1,491 most-billed Medicaid procedure code, with $21.3M in payments across 1.2M claims from 2018–2024. The national median cost per claim is $21.92. Costs vary widely — the 90th percentile is $60.51 per claim, 2.8× the median.
Total Paid
$21.3M
0.00% of all spending
Total Claims
1.2M
Providers
205
Avg Cost/Claim
$17
National Cost Distribution
How much do providers bill per claim for 81243? Based on 191 providers billing this code nationally.
Median
$21.92
Average
$32.64
Std Dev
$36.35
Max
$220.03
Percentile Distribution (Cost per Claim)
50% of providers bill between $10.62 and $44.72 per claim for this code.
90% bill between $3.20 and $60.51.
Top 1% bill above $185.11.
About This Procedure
HCPCS code 81243 was billed by 205 providers across 1.2M claims, totaling $21.3M in Medicaid payments from 2018–2024. This code was used for 1.1M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$21.92
Providers Billing
191
National Spending
$21.3M
Avg/Median Ratio
1.49×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 81243
| # | Provider | Total Paid |
|---|---|---|
| 1 | Natera Inc. San Carlos, CA · Clinical Medical Laboratory | $6.1M |
| 2 | 1689975021 | $1.8M |
| 3 | 1114222817 | $1.0M |
| 4 | Laboratory Corporation Of America Holdings Research Triangle Park, NC · Clinical Medical Laboratory | $1.0M |
| 5 | Myriad Women's Health, Inc. South San Francisco, CA · Clinical Medical Laboratory | $950K |
| 6 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $816K |
| 7 | Laboratory Corporation Of America Holdings Burlington, NC · Clinical Medical Laboratory | $776K |
| 8 | 1699095901 | $703K |
| 9 | Genedx Llc Gaithersburg, MD · Medical Genetics, Ph.D. Medical Genetics | $670K |
| 10 | 1235528225 | $616K |
| 11 | Laboratory Corporation Of America Holdings Raritan, NJ · Clinical Medical Laboratory | $526K |
| 12 | Bioreference Health Llc Elmwood Park, NJ · Clinical Medical Laboratory | $478K |
| 13 | Quest Diagnostics Incorporated Clifton, NJ · Clinical Medical Laboratory | $380K |
| 14 | 1326484569 | $317K |
| 15 | Unilab Corporation West Hills, CA · Clinical Medical Laboratory | $289K |
| 16 | Laboratory Corporation Of America Tampa, FL · Clinical Medical Laboratory | $287K |
| 17 | 1992356521 | $259K |
| 18 | 1669463014 | $230K |
| 19 | Laboratory Corporation Of America Holdings Research Triangle Park, NC · Clinical Medical Laboratory | $202K |
| 20 | Quest Diagnostics Clinical Laboratories Inc Miramar, FL · Clinical Medical Laboratory | $199K |
Showing top 20 of 205 providers billing this code