#5971 of 11K

86804

HCPCS Procedure Code

HCPCS code 86804 is the #5,971 most-billed Medicaid procedure code, with $112K in payments across 17K claims from 2018–2024. The national median cost per claim is $7.89. Costs vary widely — the 90th percentile is $15.84 per claim, 2.0× the median.

Total Paid

$112K

0.00% of all spending

Total Claims

17K

Providers

Avg Cost/Claim

National Cost Distribution

How much do providers bill per claim for 86804? Based on 46 providers billing this code nationally.

Median

$7.89

Average

$9.93

Std Dev

$10.97

Max

$70.70

Percentile Distribution (Cost per Claim)

p10

$1.78

p25

$4.39

Median

$7.89

p75

$12.26

p90

$15.84

p95

$21.92

p99

$51.51

50% of providers bill between $4.39 and $12.26 per claim for this code.

90% bill between $1.78 and $15.84.

Top 1% bill above $51.51.

About This Procedure

HCPCS code 86804 was billed by 56 providers across 17K claims, totaling $112K in Medicaid payments from 2018–2024. This code was used for 16K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$7.89

Providers Billing

National Spending

$112K

Avg/Median Ratio

1.26×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 86804

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Laboratory Corporation Of America Holdings Burlington, NC · Clinical Medical Laboratory	$23K	$10.37	1.3× median	Above Median
2	Laboratory Corporation Of America Holdings Dublin, OH · Clinical Medical Laboratory	$9K	$10.91	1.4× median	Above Median
3	Laboratory Corporation Of America Holdings Raritan, NJ · Clinical Medical Laboratory	$9K	$5.99	0.8× median	Below Median
4	Orchard Laboratories Corp West Bloomfield, MI · Clinical Medical Laboratory	$8K	$5.75	0.7× median	Below Median
5	1154348696	$7K	$6.43	0.8× median	Below Median
6	1770880924	$7K	$3.04	0.4× median	Below Median
7	1609869916	$6K	$22.93	2.9× median	Top 10%
8	Lifescan Labs Of Illinois Llc Skokie, IL · Clinical Medical Laboratory	$6K	$10.63	1.3× median	Above Median
9	1750381281	$4K	$2.21	0.3× median	Below Median
10	1598747651	$4K	$16.74	2.1× median	Top 10%
11	1396905055	$3K	$12.32	1.6× median	Above 75th
12	1043271539	$3K	$6.33	0.8× median	Below Median
13	1144213885	$3K	$10.27	1.3× median	Above Median
14	1699779017	$3K	$12.05	1.5× median	Above Median
15	1598760795	$2K	$6.26	0.8× median	Below Median
16	1740211028	$2K	$70.70	9.0× median	Top 1%
17	1689682999	$2K	$12.07	1.5× median	Above Median
18	Laboratory Corporation Of America Seattle, WA · Clinical Medical Laboratory	$2K	$9.82	1.2× median	Above Median
19	Laboratory Corporation Of America Tampa, FL · Clinical Medical Laboratory	$1K	$1.96	0.2× median	Below Median
20	1437156346	$1K	$13.99	1.8× median	Above 75th

Showing top 20 of 56 providers billing this code

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