Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

#5012 of 11K

J3411

HCPCS Procedure Code

HCPCS code J3411 is the #5,012 most-billed Medicaid procedure code, with $320K in payments across 175K claims from 2018–2024. The national median cost per claim is $1.52. Costs vary widely — the 90th percentile is $7.54 per claim, 5.0× the median.

Total Paid

$320K

0.00% of all spending

Total Claims

175K

Providers

415

Avg Cost/Claim

$2

National Cost Distribution

How much do providers bill per claim for J3411? Based on 285 providers billing this code nationally.

Median

$1.52

Average

$3.67

Std Dev

$8.73

Max

$73.09

Percentile Distribution (Cost per Claim)

p10
$0.03
p25
$0.27
Median
$1.52
p75
$3.51
p90
$7.54
p95
$10.95
p99
$58.68

50% of providers bill between $0.27 and $3.51 per claim for this code.

90% bill between $0.03 and $7.54.

Top 1% bill above $58.68.

About This Procedure

HCPCS code J3411 was billed by 415 providers across 175K claims, totaling $320K in Medicaid payments from 2018–2024. This code was used for 111K 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

$1.52

Providers Billing

285

National Spending

$320K

Avg/Median Ratio

2.41×

Highly skewed — outlier-driven

Top Providers Billing This Code

Ranked by total Medicaid payments for J3411

#ProviderTotal Paid
1University Of Utah

Salt Lake City, UT · Clinic/Center, Dental

$34K
2Boston Medical Center Corporation

Boston, MA · General Acute Care Hospital

$22K
3Providence Health & Services Washington

Anchorage, AK · General Acute Care Hospital

$14K
4Unm Hospital

Albuquerque, NM · General Acute Care Hospital

$13K
51720537178$11K
61538244918$10K
71396382685$10K
8St Elizabeth Medical Center, Inc

Edgewood, KY · Portable X-Ray and/or Other Portable Diagnostic Imaging Supplier

$8K
91043293608$8K
101467546135$7K
11University Medical Center, Inc

Louisville, KY · Student in an Organized Health Care Education/Training Program

$7K
12University Of Kentucky

Lexington, KY · General Acute Care Hospital

$7K
13Dallas County Hospital District

Dallas, TX · Clinic/Center, Ambulatory Surgical

$7K
14Uofl Health-louisville Inc

Louisville, KY · Psychiatric Hospital

$6K
15Norton Hospitals, Inc

Louisville, KY · General Acute Care Hospital

$5K
16Presbyterian Healthcare Services

Albuquerque, NM · Emergency Medicine

$5K
171265539498$5K
181447457775$5K
191417947490$4K
20Norton Hospitals Inc

Louisville, KY · General Acute Care Hospital

$4K

Showing top 20 of 415 providers billing this code