81404
HCPCS Procedure Code
HCPCS code 81404 is the #1,864 most-billed Medicaid procedure code, with $12.6M in payments across 187K claims from 2018–2024. The national median cost per claim is $48.77. Costs vary widely — the 90th percentile is $253.16 per claim, 5.2× the median.
Total Paid
$12.6M
0.00% of all spending
Total Claims
187K
Providers
125
Avg Cost/Claim
$67
National Cost Distribution
How much do providers bill per claim for 81404? Based on 88 providers billing this code nationally.
Median
$48.77
Average
$98.04
Std Dev
$132.80
Max
$802.24
Percentile Distribution (Cost per Claim)
50% of providers bill between $17.68 and $133.82 per claim for this code.
90% bill between $5.58 and $253.16.
Top 1% bill above $658.66.
About This Procedure
HCPCS code 81404 was billed by 125 providers across 187K claims, totaling $12.6M in Medicaid payments from 2018–2024. This code was used for 149K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$48.77
Providers Billing
88
National Spending
$12.6M
Avg/Median Ratio
2.01×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 81404
| # | Provider | Total Paid |
|---|---|---|
| 1 | Natera Inc. San Carlos, CA · Clinical Medical Laboratory | $1.8M |
| 2 | 1013973866 | $1.6M |
| 3 | Genedx Llc Gaithersburg, MD · Medical Genetics, Ph.D. Medical Genetics | $1.5M |
| 4 | Invitae Corporation San Francisco, CA · Clinical Medical Laboratory | $1.4M |
| 5 | 1790023547 | $1.2M |
| 6 | Myriad Genetic Laboratories, Inc. Salt Lake City, UT · Clinical Medical Laboratory | $694K |
| 7 | 1689971822 | $570K |
| 8 | 1063892396 | $551K |
| 9 | 1184045619 | $285K |
| 10 | 1861568784 | $248K |
| 11 | 1518415991 | $220K |
| 12 | Crestar Labs Llc Spring Hill, TN · Clinical Medical Laboratory | $219K |
| 13 | Bioconfirm Laboratories Llc Doraville, GA · Clinical Medical Laboratory | $202K |
| 14 | Speciality Screening Llc Wauwatosa, WI · Clinical Medical Laboratory | $190K |
| 15 | 1326484569 | $178K |
| 16 | 1639577091 | $171K |
| 17 | 1003221904 | $167K |
| 18 | Myriad Women's Health, Inc. South San Francisco, CA · Clinical Medical Laboratory | $138K |
| 19 | 1659726487 | $125K |
| 20 | 1902347891 | $111K |
Showing top 20 of 125 providers billing this code