#3554 of 11K

86430

HCPCS Procedure Code

HCPCS code 86430 is the #3,554 most-billed Medicaid procedure code, with $1.5M in payments across 438K claims from 2018–2024. The national median cost per claim is $4.43.

Total Paid

$1.5M

0.00% of all spending

Total Claims

438K

Providers

472

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for 86430? Based on 459 providers billing this code nationally.

Median

$4.43

Average

$4.74

Std Dev

$5.28

Max

$65.11

Percentile Distribution (Cost per Claim)

p10

$0.51

p25

$2.50

Median

$4.43

p75

$5.36

p90

$7.10

p95

$10.52

p99

$23.76

50% of providers bill between $2.50 and $5.36 per claim for this code.

90% bill between $0.51 and $7.10.

Top 1% bill above $23.76.

About This Procedure

HCPCS code 86430 was billed by 472 providers across 438K claims, totaling $1.5M in Medicaid payments from 2018–2024. This code was used for 401K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$4.43

Providers Billing

459

National Spending

$1.5M

Avg/Median Ratio

1.07×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 86430

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1972625499	$242K	$5.16	1.2× median	Above Median
2	Northwell Health Laboratories New Hyde Park, NY · Clinical Medical Laboratory	$158K	$5.24	1.2× median	Above Median
3	Sunrise Medical Laboratories, Inc. Hicksville, NY · Clinical Medical Laboratory	$76K	$3.02	0.7× median	Below Median
4	Unm Hospital Albuquerque, NM · General Acute Care Hospital	$50K	$12.15	2.7× median	Top 10%
5	1144202003	$49K	$5.36	1.2× median	Above 75th
6	Accurate Diagnostics Labs, Inc. South Plainfield, NJ · Clinical Medical Laboratory	$41K	$2.51	0.6× median	Below Median
7	1235186800	$38K	$2.07	0.5× median	Below Median
8	1861404121	$35K	$6.38	1.4× median	Above 75th
9	1932414463	$35K	$4.22	1.0× median	Below Median
10	Henry Ford Health St. John Hospital Chicago, IL · Clinic/Center, Ambulatory Surgical	$29K	$3.55	0.8× median	Below Median
11	Nyu Langone Hospitals New York, NY · Clinic/Center, Oncology	$26K	$4.89	1.1× median	Above Median
12	University Of Rochester Rochester, NY · General Acute Care Hospital	$25K	$5.29	1.2× median	Above Median
13	1164402038	$22K	$4.99	1.1× median	Above Median
14	Ashland Hospital Corporation Ashland, KY · Clinic/Center, Rural Health	$20K	$4.91	1.1× median	Above Median
15	St Elizabeth Medical Center, Inc Edgewood, KY · Portable X-Ray and/or Other Portable Diagnostic Imaging Supplier	$19K	$5.53	1.2× median	Above 75th
16	1942226006	$18K	$4.08	0.9× median	Below Median
17	1427120336	$18K	$3.86	0.9× median	Below Median
18	1073587937	$17K	$3.78	0.9× median	Below Median
19	Berkshire Medical Center, Inc Pittsfield, MA · General Acute Care Hospital	$14K	$4.58	1.0× median	Above Median
20	1073518007	$14K	$18.00	4.1× median	Top 10%

Showing top 20 of 472 providers billing this code

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