Cost analysis for CPT 86235 — Measurement of antibody for assessment of autoimmune disorder, any method
Average Medicare Payment
$17.38
2023 data
Total Payments (2023)
$26.9M
Services (2023)
1.5M
Price Change (2014–2023)
-23.3%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $22.65 | $24.9M | 1.1M | — |
| 2015 | $22.59 | $26.7M | 1.2M | -0.3% |
| 2016 | $22.49 | $29.3M | 1.3M | -0.4% |
| 2017 | $22.60 | $31.2M | 1.3M | +0.5% |
| 2018 | $21.22 | $30.2M | 1.4M | -6.1% |
| 2019 | $19.25 | $29.1M | 1.5M | -9.3% |
| 2020 | $17.57 | $24.0M | 1.4M | -8.7% |
| 2021 | $17.74 | $27.7M | 1.6M | +1.0% |
| 2022 | $17.48 | $26.4M | 1.5M | -1.5% |
| 2023 | $17.38 | $26.9M | 1.5M | -0.6% |
The most expensive state pays 1.1x more than the cheapest for this procedure. WY averages $17.57 vs WA at $16.46.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| WY | $17.57 | $2.6K | 150 | 1 |
| DC | $17.57 | $10.0K | 568 | 4 |
| NH | $17.57 | $4.4K | 253 | 3 |
| ND | $17.57 | $5.4K | 308 | 2 |
| MS | $17.57 | $3.1K | 179 | 2 |
| MA | $17.57 | $304.2K | 17.3K | 6 |
| CO | $17.56 | $150.4K | 8.6K | 6 |
| HI | $17.56 | $68.8K | 3.9K | 2 |
| NJ | $17.56 | $3.3M | 189.8K | 35 |
| NY | $17.56 | $1.4M | 82.2K | 43 |
| KS | $17.55 | $492.9K | 28.1K | 16 |
| FL | $17.55 | $2.2M | 125.3K | 38 |
| UT | $17.54 | $70.7K | 4.0K | 6 |
| CA | $17.53 | $4.7M | 267.7K | 62 |
| GA | $17.53 | $939.8K | 53.6K | 19 |
| SC | $17.53 | $109.4K | 6.2K | 16 |
| NC | $17.52 | $2.7M | 155.9K | 39 |
| IL | $17.52 | $590.0K | 33.7K | 29 |
| PA | $17.52 | $385.6K | 22.0K | 19 |
| AZ | $17.51 | $1.1M | 64.5K | 19 |
| SD | $17.51 | $23.9K | 1.4K | 3 |
| CT | $17.50 | $9.2K | 528 | 2 |
| TX | $17.50 | $3.2M | 180.9K | 72 |
| TN | $17.50 | $358.8K | 20.5K | 13 |
| AL | $17.49 | $908.8K | 52.0K | 24 |
| NV | $17.47 | $188.6K | 10.8K | 2 |
| OR | $17.47 | $100.6K | 5.8K | 8 |
| LA | $17.46 | $55.4K | 3.2K | 10 |
| MN | $17.46 | $234.5K | 13.4K | 21 |
| ID | $17.45 | $55.7K | 3.2K | 9 |
| NM | $17.45 | $59.2K | 3.4K | 3 |
| VA | $17.44 | $190.1K | 10.9K | 8 |
| PR | $17.43 | $7.4K | 424 | 5 |
| MD | $17.43 | $319.4K | 18.3K | 38 |
| WI | $17.41 | $202.6K | 11.6K | 19 |
| MO | $17.41 | $83.6K | 4.8K | 1 |
| KY | $17.40 | $137.3K | 7.9K | 11 |
| MI | $17.37 | $79.9K | 4.6K | 8 |
| RI | $17.37 | $5.8K | 336 | 1 |
| NE | $17.36 | $37.8K | 2.2K | 4 |
| IA | $17.32 | $106.6K | 6.2K | 15 |
| ME | $17.30 | $10.9K | 628 | 2 |
| AR | $17.29 | $117.3K | 6.8K | 16 |
| IN | $17.24 | $127.0K | 7.4K | 8 |
| OH | $16.91 | $974.3K | 57.6K | 36 |
| OK | $16.89 | $327.7K | 19.4K | 28 |
| WA | $16.46 | $297.7K | 18.1K | 11 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Laboratory Corporation Of America Holdings | Clinical Laboratory | NC | $2.3M | 129.1K | $17.53 |
| Laboratory Corporation Of America Holdings | Clinical Laboratory | NJ | $1.7M | 94.6K | $17.56 |
| Unilab Corporation | Clinical Laboratory | CA | $1.2M | 69.5K | $17.57 |
| Quest Diagnostics Clinical Laboratories Inc | Clinical Laboratory | FL | $1.2M | 66.7K | $17.57 |
| Exagen Inc. | Clinical Laboratory | CA | $1.1M | 62.3K | $17.55 |
| Quest Diagnostics Incorporated | Clinical Laboratory | NJ | $959.6K | 54.6K | $17.57 |
| Quest Diagnostics Clinical Laboratories Inc | Clinical Laboratory | GA | $827.8K | 47.2K | $17.54 |
| Quest Diagnostics Clinical Laboratories Inc | Clinical Laboratory | TX | $826.8K | 47.1K | $17.57 |
| Laboratory Corporation Of America Holdings | Clinical Laboratory | AL | $697.1K | 39.7K | $17.55 |
| Clinical Pathology Laboratories, Inc. | Clinical Laboratory | TX | $651.3K | 37.1K | $17.57 |
| Laboratory Corporation Of America | Clinical Laboratory | CA | $648.5K | 36.9K | $17.57 |
| Laboratory Corporation Of America Holdings | Clinical Laboratory | OH | $644.0K | 36.7K | $17.55 |
| Sonora Quest Laboratories Llc | Clinical Laboratory | AZ | $539.7K | 30.9K | $17.48 |
| Laboratory Corporation Of America | Clinical Laboratory | AZ | $489.6K | 27.9K | $17.56 |
| Bioreference Health, Llc | Clinical Laboratory | NJ | $440.4K | 25.1K | $17.54 |
| Laboratory Corporation Of America | Clinical Laboratory | TX | $434.6K | 24.7K | $17.56 |
| Quest Diagnostics Clinical Laboratories Inc | Clinical Laboratory | FL | $423.0K | 24.1K | $17.57 |
| Labone Llc | Clinical Laboratory | KS | $385.0K | 21.9K | $17.57 |
| Esoterix, Inc | Clinical Laboratory | CA | $316.0K | 18.0K | $17.57 |
| Quest Diagnostics Llc Il | Clinical Laboratory | IL | $309.6K | 17.6K | $17.57 |
Based on the data, CPT 86235 shows a 1.1x variation in pricing across states — relatively consistent by Medicare standards.
Costs have decreased 23.3% since 2014. Medicare's fee schedule attempts to standardize pricing, though some variation is expected due to geographic cost-of-living adjustments and practice expense differences.
This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.