86738
HCPCS Procedure Code
HCPCS code 86738 is the #2,096 most-billed Medicaid procedure code, with $9.1M in payments across 761K claims from 2018–2024. The national median cost per claim is $12.43.
Total Paid
$9.1M
0.00% of all spending
Total Claims
761K
Providers
773
Avg Cost/Claim
$12
National Cost Distribution
How much do providers bill per claim for 86738? Based on 731 providers billing this code nationally.
Median
$12.43
Average
$12.43
Std Dev
$8.72
Max
$177.69
Percentile Distribution (Cost per Claim)
50% of providers bill between $10.99 and $14.01 per claim for this code.
90% bill between $4.52 and $16.25.
Top 1% bill above $35.57.
About This Procedure
HCPCS code 86738 was billed by 773 providers across 761K claims, totaling $9.1M in Medicaid payments from 2018–2024. This code was used for 687K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$12.43
Providers Billing
731
National Spending
$9.1M
Avg/Median Ratio
1.00×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 86738
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1164402038 | $552K |
| 2 | 1366413932 | $237K |
| 3 | 1447233861 | $232K |
| 4 | 1124060843 | $172K |
| 5 | Doctors Hospital At Renaissance, Ltd Edinburg, TX · Clinic/Center, Ambulatory Surgical | $156K |
| 6 | 1629006572 | $130K |
| 7 | Quest Diagnostics Incorporated Clifton, NJ · Clinical Medical Laboratory | $124K |
| 8 | 1033167614 | $122K |
| 9 | Laboratory Corporation Of America Holdings Burlington, NC · Clinical Medical Laboratory | $121K |
| 10 | 1225036346 | $119K |
| 11 | 1639173099 | $108K |
| 12 | Laboratory Corporation Of America Holdings Raritan, NJ · Clinical Medical Laboratory | $95K |
| 13 | 1568405793 | $92K |
| 14 | 1730276098 | $88K |
| 15 | 1932102167 | $87K |
| 16 | 1538139662 | $87K |
| 17 | 1477500015 | $87K |
| 18 | 1205978616 | $86K |
| 19 | 1780830737 | $80K |
| 20 | 1477876514 | $75K |
Showing top 20 of 773 providers billing this code