#1875 of 11K

86431

HCPCS Procedure Code

HCPCS code 86431 is the #1,875 most-billed Medicaid procedure code, with $12.4M in payments across 4.2M claims from 2018–2024. The national median cost per claim is $3.98. Costs vary widely — the 90th percentile is $8.00 per claim, 2.0× the median.

Total Paid

$12.4M

0.00% of all spending

Total Claims

4.2M

Providers

1,310

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for 86431? Based on 1,223 providers billing this code nationally.

Median

$3.98

Average

$4.95

Std Dev

$6.46

Max

$122.25

Percentile Distribution (Cost per Claim)

p10

$0.93

p25

$2.52

Median

$3.98

p75

$5.44

p90

$8.00

p95

$12.91

p99

$23.12

50% of providers bill between $2.52 and $5.44 per claim for this code.

90% bill between $0.93 and $8.00.

Top 1% bill above $23.12.

About This Procedure

HCPCS code 86431 was billed by 1,310 providers across 4.2M claims, totaling $12.4M in Medicaid payments from 2018–2024. This code was used for 4.0M unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$3.98

Providers Billing

1,223

National Spending

$12.4M

Avg/Median Ratio

1.24×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 86431

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Unilab Corporation West Hills, CA · Clinical Medical Laboratory	$668K	$1.88	0.5× median	Below Median
2	Laboratory Corporation Of America Holdings Dublin, OH · Clinical Medical Laboratory	$663K	$4.33	1.1× median	Above Median
3	Laboratory Corporation Of America Holdings Burlington, NC · Clinical Medical Laboratory	$615K	$3.23	0.8× median	Below Median
4	Laboratory Corporation Of America Holdings Raritan, NJ · Clinical Medical Laboratory	$462K	$1.68	0.4× median	Below Median
5	Bioreference Health Llc Elmwood Park, NJ · Clinical Medical Laboratory	$433K	$3.05	0.8× median	Below Median
6	Quest Diagnostics Incorporated Clifton, NJ · Clinical Medical Laboratory	$399K	$2.95	0.7× median	Below Median
7	Quest Diagnostics Llc Il Wood Dale, IL · Clinical Medical Laboratory	$275K	$4.17	1.0× median	Above Median
8	Labone Llc Lenexa, KS · Clinical Medical Laboratory	$243K	$4.71	1.2× median	Above Median
9	Laboratory Corporation Of America Holdings Birmingham, AL · Clinical Medical Laboratory	$235K	$2.83	0.7× median	Below Median
10	Sonora Quest Laboratories Llc Phoenix, AZ · Clinical Medical Laboratory	$207K	$2.85	0.7× median	Below Median
11	Laboratory Corporation Of America Seattle, WA · Clinical Medical Laboratory	$201K	$4.12	1.0× median	Above Median
12	Quest Diagnostics Clinical Laboratories Inc Tucker, GA · Clinical Medical Laboratory	$193K	$2.94	0.7× median	Below Median
13	Clinical Pathology Laboratories, Inc. Austin, TX · Clinical Medical Laboratory	$156K	$2.76	0.7× median	Below Median
14	Quest Diagnostics Clinical Laboratories Inc Irving, TX · Clinical Medical Laboratory	$151K	$2.88	0.7× median	Below Median
15	Laboratory Corporation Of America San Diego, CA · Clinical Medical Laboratory	$144K	$0.68	0.2× median	Below Median
16	Quest Diagnostics Llc Marlborough, MA · Clinical Medical Laboratory	$136K	$2.29	0.6× median	Below Median
17	1598747651	$134K	$5.36	1.3× median	Above Median
18	1245494517	$130K	$1.65	0.4× median	Below Median
19	Laboratory Corporation Of America Holdings Burlington, NC · Clinical Medical Laboratory	$122K	$3.76	0.9× median	Below Median
20	1881626943	$109K	$2.00	0.5× median	Below Median

Showing top 20 of 1,310 providers billing this code

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