J3357
Ustekinumab (Stelara) injection, 1 mg
Ustekinumab (Stelara) injection, 1 mg is the #1,486 most-billed Medicaid procedure code, with $21.4M in payments across 3K claims from 2018–2024. The national median cost per claim is $14,026.53.
Total Paid
$21.4M
0.00% of all spending
Total Claims
3K
Providers
7
Avg Cost/Claim
$8K
National Cost Distribution
How much do providers bill per claim for J3357? Based on 5 providers billing this code nationally.
Median
$14,026.53
Average
$14,013.23
Std Dev
$3,912.74
Max
$18,168.47
Percentile Distribution (Cost per Claim)
50% of providers bill between $13,760.42 and $16,312.19 per claim for this code.
90% bill between $10,183.28 and $17,425.96.
Top 1% bill above $18,094.22.
About This Procedure
HCPCS code J3357 (Ustekinumab (Stelara) injection, 1 mg) was billed by 7 providers across 3K claims, totaling $21.4M in Medicaid payments from 2018–2024. This code was used for 2K 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
$14,026.53
Providers Billing
5
National Spending
$21.4M
Avg/Median Ratio
1.00×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for J3357
| # | Provider | Total Paid |
|---|---|---|
| 1 | State Of Connecticut Farmington, CT · Counselor, Professional | $17.1M |
| 2 | 1134100134 | $2.1M |
| 3 | Mount Sinai Hospital New York, NY · Ambulance | $1.1M |
| 4 | Alameda Health System Oakland, CA · General Acute Care Hospital | $865K |
| 5 | Procare Pharmacy Direct, Llc. Monroeville, PA · Pharmacy, Community/Retail Pharmacy | $236K |
| 6 | 1699986331 | $0 |
| 7 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $0 |
Showing top 7 of 7 providers billing this code