#3916 of 11K

81268

HCPCS Procedure Code

HCPCS code 81268 is the #3,916 most-billed Medicaid procedure code, with $1.0M in payments across 7K claims from 2018–2024. The national median cost per claim is $158.98.

Total Paid

$1.0M

0.00% of all spending

Total Claims

Providers

Avg Cost/Claim

$144

National Cost Distribution

How much do providers bill per claim for 81268? Based on 21 providers billing this code nationally.

Median

$158.98

Average

$159.67

Std Dev

$134.38

Max

$536.82

Percentile Distribution (Cost per Claim)

p10

$25.02

p25

$82.15

Median

$158.98

p75

$192.71

p90

$266.83

p95

$444.36

p99

$518.33

50% of providers bill between $82.15 and $192.71 per claim for this code.

90% bill between $25.02 and $266.83.

Top 1% bill above $518.33.

About This Procedure

HCPCS code 81268 was billed by 22 providers across 7K claims, totaling $1.0M in Medicaid payments from 2018–2024. This code was used for 5K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$158.98

Providers Billing

National Spending

$1.0M

Avg/Median Ratio

1.00×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 81268

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	University Medical Center, Inc Louisville, KY · Student in an Organized Health Care Education/Training Program	$161K	$169.00	1.1× median	Above Median
2	1164493847	$151K	$83.42	0.5× median	Below Median
3	Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children	$138K	$444.36	2.8× median	Top 10%
4	Hmh Hospitals Corporation Hackensack, NJ · Ambulance	$110K	$109.42	0.7× median	Below Median
5	Regents Of The University Of Michigan Ann Arbor, MI · Clinic/Center, End-Stage Renal Disease (ESRD) Treatment	$108K	$235.82	1.5× median	Above 75th
6	City Of Hope National Medical Center Duarte, CA · General Acute Care Hospital	$71K	$192.71	1.2× median	Above Median
7	Uofl Health-louisville Inc Louisville, KY · Psychiatric Hospital	$65K	$172.93	1.1× median	Above Median
8	1699884858	$64K	$266.83	1.7× median	Above 75th
9	Robert Wood Johnson University Hospital, Inc New Brunswick, NJ · General Acute Care Hospital	$34K	$58.01	0.4× median	Below Median
10	Egleston Children's Hospital At Emory University Inc. Atlanta, GA · Pediatrics Pediatric Emergency Medicine	$33K	$90.68	0.6× median	Below Median
11	Childrens Hospital Of Philadelphia Philadelphia, PA · General Acute Care Hospital Children	$27K	$536.82	3.4× median	Top 1%
12	Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital	$18K	$111.59	0.7× median	Below Median
13	The Milton S Hershey Medical Center Hershey, PA · General Acute Care Hospital	$12K	$178.13	1.1× median	Above Median
14	The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital	$10K	$228.45	1.4× median	Above 75th
15	Memorial Hospital For Cancer And Allied Diseases New York, NY · Pharmacy	$7K	$158.98	1.0× median	Above Median
16	Regents Of The University Of California San Diego, CA · General Acute Care Hospital	$3K	$167.82	1.1× median	Above Median
17	1497859649	$2K	$82.15	0.5× median	Below Median
18	The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital	$1K	$25.57	0.2× median	Below Median
19	Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital	$1K	$25.02	0.2× median	Below Median
20	1780653618	$264	$10.14	0.1× median	Below Median

Showing top 20 of 22 providers billing this code

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