81257
HCPCS Procedure Code
HCPCS code 81257 is the #1,776 most-billed Medicaid procedure code, with $14.1M in payments across 672K claims from 2018–2024. The national median cost per claim is $34.25. Costs vary widely — the 90th percentile is $77.37 per claim, 2.3× the median.
Total Paid
$14.1M
0.00% of all spending
Total Claims
672K
Providers
79
Avg Cost/Claim
$21
National Cost Distribution
How much do providers bill per claim for 81257? Based on 70 providers billing this code nationally.
Median
$34.25
Average
$53.88
Std Dev
$106.24
Max
$791.72
Percentile Distribution (Cost per Claim)
50% of providers bill between $15.66 and $61.14 per claim for this code.
90% bill between $4.44 and $77.37.
Top 1% bill above $565.48.
About This Procedure
HCPCS code 81257 was billed by 79 providers across 672K claims, totaling $14.1M in Medicaid payments from 2018–2024. This code was used for 592K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$34.25
Providers Billing
70
National Spending
$14.1M
Avg/Median Ratio
1.57×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 81257
| # | Provider | Total Paid |
|---|---|---|
| 1 | Natera Inc. San Carlos, CA · Clinical Medical Laboratory | $5.5M |
| 2 | 1598314437 | $2.7M |
| 3 | 1689975021 | $723K |
| 4 | 1114222817 | $722K |
| 5 | Myriad Women's Health, Inc. South San Francisco, CA · Clinical Medical Laboratory | $575K |
| 6 | 1235528225 | $563K |
| 7 | Laboratory Corporation Of America Holdings Burlington, NC · Clinical Medical Laboratory | $550K |
| 8 | Laboratory Corporation Of America Holdings Research Triangle Park, NC · Clinical Medical Laboratory | $297K |
| 9 | 1104829159 | $265K |
| 10 | 1790023547 | $249K |
| 11 | Unilab Corporation West Hills, CA · Clinical Medical Laboratory | $218K |
| 12 | Laboratory Corporation Of America Holdings Raritan, NJ · Clinical Medical Laboratory | $180K |
| 13 | Laboratory Corporation Of America Holdings Birmingham, AL · Clinical Medical Laboratory | $157K |
| 14 | Laboratory Corporation Of America Holdings Dublin, OH · Clinical Medical Laboratory | $134K |
| 15 | Quest Diagnostics Incorporated Clifton, NJ · Clinical Medical Laboratory | $115K |
| 16 | 1063892396 | $96K |
| 17 | New York City Health And Hospitals Corporation Elmhurst, NY · Internal Medicine | $91K |
| 18 | Laboratory Corporation Of America Tampa, FL · Clinical Medical Laboratory | $78K |
| 19 | Quest Diagnostics Clinical Laboratories Inc Miramar, FL · Clinical Medical Laboratory | $71K |
| 20 | 1518415991 | $66K |
Showing top 20 of 79 providers billing this code