97804
HCPCS Procedure Code
HCPCS code 97804 is the #2,769 most-billed Medicaid procedure code, with $3.8M in payments across 152K claims from 2018–2024. The national median cost per claim is $17.97. Costs vary widely — the 90th percentile is $64.13 per claim, 3.6× the median.
Total Paid
$3.8M
0.00% of all spending
Total Claims
152K
Providers
285
Avg Cost/Claim
$25
National Cost Distribution
How much do providers bill per claim for 97804? Based on 226 providers billing this code nationally.
Median
$17.97
Average
$27.90
Std Dev
$39.34
Max
$461.87
Percentile Distribution (Cost per Claim)
50% of providers bill between $6.43 and $35.58 per claim for this code.
90% bill between $1.16 and $64.13.
Top 1% bill above $125.14.
About This Procedure
HCPCS code 97804 was billed by 285 providers across 152K claims, totaling $3.8M in Medicaid payments from 2018–2024. This code was used for 127K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$17.97
Providers Billing
226
National Spending
$3.8M
Avg/Median Ratio
1.55×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for 97804
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1962587964 | $918K |
| 2 | 1295741635 | $252K |
| 3 | New York City Health And Hospitals Corporation New York, NY · Internal Medicine | $209K |
| 4 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $135K |
| 5 | Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital | $133K |
| 6 | 1124141163 | $128K |
| 7 | Holyoke Medical Center, Inc. Holyoke, MA · Clinic/Center, Adult Mental Health | $116K |
| 8 | 1538157508 | $107K |
| 9 | The Miriam Hospital Providence, RI · General Acute Care Hospital | $105K |
| 10 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $95K |
| 11 | Children's Hospital Corporation Boston, MA · Clinic/Center | $87K |
| 12 | The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital | $86K |
| 13 | Montefiore Medical Center Bronx, NY · Anesthesiology | $80K |
| 14 | 1922440684 | $79K |
| 15 | 1790131050 | $73K |
| 16 | 1407272636 | $56K |
| 17 | Carilion Medical Center Roanoke, VA · General Acute Care Hospital | $54K |
| 18 | 1952320061 | $50K |
| 19 | 1811167182 | $43K |
| 20 | 1255505566 | $36K |
Showing top 20 of 285 providers billing this code