#3309 of 11K

86635

HCPCS Procedure Code

HCPCS code 86635 is the #3,309 most-billed Medicaid procedure code, with $2.0M in payments across 246K claims from 2018–2024. The national median cost per claim is $6.15. Costs vary widely — the 90th percentile is $20.50 per claim, 3.3× the median.

Total Paid

$2.0M

0.00% of all spending

Total Claims

246K

Providers

118

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for 86635? Based on 109 providers billing this code nationally.

Median

$6.15

Average

$10.46

Std Dev

$23.60

Max

$236.84

Percentile Distribution (Cost per Claim)

p10

$0.71

p25

$2.13

Median

$6.15

p75

$11.65

p90

$20.50

p95

$24.88

p99

$59.82

50% of providers bill between $2.13 and $11.65 per claim for this code.

90% bill between $0.71 and $20.50.

Top 1% bill above $59.82.

About This Procedure

HCPCS code 86635 was billed by 118 providers across 246K claims, totaling $2.0M in Medicaid payments from 2018–2024. This code was used for 211K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$6.15

Providers Billing

109

National Spending

$2.0M

Avg/Median Ratio

1.70×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 86635

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Sonora Quest Laboratories Llc Phoenix, AZ · Clinical Medical Laboratory	$583K	$9.21	1.5× median	Above Median
2	1780620526	$287K	$29.43	4.8× median	Top 10%
3	Unilab Corporation West Hills, CA · Clinical Medical Laboratory	$282K	$12.26	2.0× median	Above 75th
4	1881626943	$126K	$20.94	3.4× median	Top 10%
5	1891873303	$109K	$7.25	1.2× median	Above Median
6	1457341851	$58K	$8.67	1.4× median	Above Median
7	Laboratory Corporation Of America San Diego, CA · Clinical Medical Laboratory	$46K	$3.85	0.6× median	Below Median
8	Laboratory Corporation Of America Phoenix, AZ · Clinical Medical Laboratory	$46K	$1.37	0.2× median	Below Median
9	1104829159	$38K	$10.17	1.7× median	Above Median
10	Permanente Medical Group, Inc. Richmond, CA · Clinical Medical Laboratory	$33K	$19.84	3.2× median	Above 75th
11	Unilab Corporation Sacramento, CA · Clinical Medical Laboratory	$25K	$4.99	0.8× median	Below Median
12	1700949336	$23K	$10.18	1.7× median	Above Median
13	1023253556	$19K	$19.38	3.2× median	Above 75th
14	1124130653	$18K	$25.08	4.1× median	Top 10%
15	1538157508	$16K	$5.57	0.9× median	Below Median
16	Bakersfield Memorial Hospital Bakersfield, CA · General Acute Care Hospital	$15K	$10.15	1.7× median	Above Median
17	Quest Diagnostics Incorporated Las Vegas, NV · Clinical Medical Laboratory	$15K	$5.11	0.8× median	Below Median
18	1396287082	$14K	$4.93	0.8× median	Below Median
19	1700910189	$14K	$20.60	3.3× median	Top 10%
20	1588663769	$14K	$15.22	2.5× median	Above 75th

Showing top 20 of 118 providers billing this code

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