#4995 of 11K

J3486

HCPCS Procedure Code

HCPCS code J3486 is the #4,995 most-billed Medicaid procedure code, with $325K in payments across 21K claims from 2018–2024. The national median cost per claim is $14.42. Costs vary widely — the 90th percentile is $37.37 per claim, 2.6× the median.

Total Paid

$325K

0.00% of all spending

Total Claims

21K

Providers

Avg Cost/Claim

$15

National Cost Distribution

How much do providers bill per claim for J3486? Based on 78 providers billing this code nationally.

Median

$14.42

Average

$18.14

Std Dev

$15.57

Max

$67.97

Percentile Distribution (Cost per Claim)

p10

$0.89

p25

$6.55

Median

$14.42

p75

$27.31

p90

$37.37

p95

$46.48

p99

$61.68

50% of providers bill between $6.55 and $27.31 per claim for this code.

90% bill between $0.89 and $37.37.

Top 1% bill above $61.68.

About This Procedure

HCPCS code J3486 was billed by 99 providers across 21K claims, totaling $325K in Medicaid payments from 2018–2024. This code was used for 15K unique beneficiaries.

Fraud Risk Context

Injectable drug codes carry high per-claim costs and have been involved in drug diversion and upcoding schemes.

Source: HHS OIG Reports

Risk Assessment

Billing Statistics

Median Cost/Claim

$14.42

Providers Billing

National Spending

$325K

Avg/Median Ratio

1.26×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for J3486

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1134194038	$73K	$67.97	4.7× median	Top 1%
2	Alameda Health System Oakland, CA · General Acute Care Hospital	$54K	$43.70	3.0× median	Top 10%
3	1417947490	$50K	$22.65	1.6× median	Above Median
4	Uofl Health-louisville Inc Louisville, KY · Psychiatric Hospital	$28K	$30.30	2.1× median	Above 75th
5	1861439952	$12K	$14.89	1.0× median	Above Median
6	1225082209	$11K	$16.08	1.1× median	Above Median
7	1427536325	$8K	$27.53	1.9× median	Above 75th
8	University Of Cincinnati Medical Center, Llc Cincinnati, OH · General Acute Care Hospital	$8K	$12.01	0.8× median	Below Median
9	The Moses H. Cone Memorial Hospital Operating Corporation Greensboro, NC · General Acute Care Hospital	$6K	$14.26	1.0× median	Below Median
10	1295181477	$5K	$36.21	2.5× median	Above 75th
11	1154795581	$5K	$9.47	0.7× median	Below Median
12	1154317964	$5K	$30.66	2.1× median	Above 75th
13	1639523004	$5K	$34.55	2.4× median	Above 75th
14	1518951300	$4K	$26.64	1.8× median	Above Median
15	Ohiohealth Corporation Columbus, OH · General Acute Care Hospital	$4K	$10.29	0.7× median	Below Median
16	New York City Health And Hospitals Corporation Brooklyn, NY · Internal Medicine	$4K	$14.99	1.0× median	Above Median
17	1346230323	$3K	$23.19	1.6× median	Above Median
18	Ohiohealth Corporation Columbus, OH · General Acute Care Hospital	$3K	$10.25	0.7× median	Below Median
19	1720088354	$3K	$38.61	2.7× median	Top 10%
20	Miami Valley Hospital Dayton, OH · General Acute Care Hospital	$2K	$10.90	0.8× median	Below Median

Showing top 20 of 99 providers billing this code

Related Procedures

J3490Unclassified drugs$510.2M J3489Injection, zoledronic acid, one milligram$3.0M J3480$2.7M

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