85004
HCPCS Procedure Code
HCPCS code 85004 is the #4,033 most-billed Medicaid procedure code, with $912K in payments across 336K claims from 2018–2024. The national median cost per claim is $2.83. Costs vary widely — the 90th percentile is $6.53 per claim, 2.3× the median.
Total Paid
$912K
0.00% of all spending
Total Claims
336K
Providers
191
Avg Cost/Claim
$3
National Cost Distribution
How much do providers bill per claim for 85004? Based on 170 providers billing this code nationally.
Median
$2.83
Average
$3.23
Std Dev
$2.40
Max
$13.45
Percentile Distribution (Cost per Claim)
50% of providers bill between $1.35 and $4.87 per claim for this code.
90% bill between $0.33 and $6.53.
Top 1% bill above $9.12.
About This Procedure
HCPCS code 85004 was billed by 191 providers across 336K claims, totaling $912K in Medicaid payments from 2018–2024. This code was used for 295K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$2.83
Providers Billing
170
National Spending
$912K
Avg/Median Ratio
1.14×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 85004
| # | Provider | Total Paid |
|---|---|---|
| 1 | Laboratory Corporation Of America Holdings Burlington, NC · Clinical Medical Laboratory | $95K |
| 2 | 1407813660 | $60K |
| 3 | 1003810375 | $56K |
| 4 | 1740213446 | $38K |
| 5 | Quest Diagnostics Massachusetts Llc Marlborough, MA · Clinical Medical Laboratory | $36K |
| 6 | 1639173099 | $35K |
| 7 | Quest Diagnostics Incorporated Md Baltimore, MD · Clinical Medical Laboratory | $32K |
| 8 | Maimonides Medical Center Brooklyn, NY · General Acute Care Hospital | $32K |
| 9 | Quest Diagnostics Llc Il Wood Dale, IL · Clinical Medical Laboratory | $30K |
| 10 | Quest Diagnostics Incorporated Clifton, NJ · Clinical Medical Laboratory | $26K |
| 11 | Orchard Laboratories Corp West Bloomfield, MI · Clinical Medical Laboratory | $25K |
| 12 | University Of Kentucky Lexington, KY · General Acute Care Hospital | $22K |
| 13 | Labone Llc Lenexa, KS · Clinical Medical Laboratory | $21K |
| 14 | Laboratory Corporation Of America Holdings Raritan, NJ · Clinical Medical Laboratory | $20K |
| 15 | 1841242542 | $20K |
| 16 | Laboratory Corporation Of America Tampa, FL · Clinical Medical Laboratory | $19K |
| 17 | Laboratory Corporation Of America Holdings Dublin, OH · Clinical Medical Laboratory | $19K |
| 18 | 1487099958 | $18K |
| 19 | Laboratory Corporation Of America Holdings Birmingham, AL · Clinical Medical Laboratory | $17K |
| 20 | 1427133685 | $16K |
Showing top 20 of 191 providers billing this code