J1428
Eteplirsen (Exondys 51) injection, 10 mg
Eteplirsen (Exondys 51) injection, 10 mg is the #738 most-billed Medicaid procedure code, with $92.3M in payments across 4K claims from 2018–2024. The national median cost per claim is $20,923.17.
Total Paid
$92.3M
0.01% of all spending
Total Claims
4K
Providers
1
Avg Cost/Claim
$21K
National Cost Distribution
How much do providers bill per claim for J1428? Based on 1 providers billing this code nationally.
Median
$20,923.17
Average
$20,923.17
Std Dev
—
Max
$20,923.17
Percentile Distribution (Cost per Claim)
50% of providers bill between $20,923.17 and $20,923.17 per claim for this code.
90% bill between $20,923.17 and $20,923.17.
Top 1% bill above $20,923.17.
About This Procedure
HCPCS code J1428 (Eteplirsen (Exondys 51) injection, 10 mg) was billed by 1 providers across 4K claims, totaling $92.3M in Medicaid payments from 2018–2024. This code was used for 915 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
$20,923.17
Providers Billing
1
National Spending
$92.3M
Avg/Median Ratio
1.00×
Normal distribution
Provider Coverage
We have 1 providers billing this code in our dataset. Individual provider breakdowns are available for top-spending procedure codes.