Cost analysis for CPT J0178 — Injection, aflibercept, 1 mg
Average Medicare Payment
$685.28
2023 data
Total Payments (2023)
$2.4B
Services (2023)
3.4M
Price Change (2014–2023)
-10.3%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $763.70 | $950.0M | 1.2M | — |
| 2015 | $763.06 | $1.3B | 1.7M | -0.1% |
| 2016 | $762.64 | $1.6B | 2.1M | -0.1% |
| 2017 | $760.49 | $1.8B | 2.4M | -0.3% |
| 2018 | $753.02 | $1.9B | 2.5M | -1.0% |
| 2019 | $744.58 | $2.2B | 2.9M | -1.1% |
| 2020 | $736.72 | $2.3B | 3.1M | -1.1% |
| 2021 | $731.79 | $2.6B | 3.5M | -0.7% |
| 2022 | $711.84 | $2.7B | 3.7M | -2.7% |
| 2023 | $685.28 | $2.4B | 3.4M | -3.7% |
The most expensive state pays 1.0x more than the cheapest for this procedure. PR averages $691.90 vs GU at $663.24.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| PR | $691.90 | $138.4K | 200 | 2 |
| WY | $691.40 | $2.1M | 3.0K | 2 |
| VT | $690.55 | $3.7M | 5.3K | 5 |
| AZ | $690.25 | $37.5M | 54.3K | 51 |
| UT | $690.16 | $24.6M | 35.6K | 36 |
| MA | $690.04 | $70.3M | 101.8K | 85 |
| MN | $689.84 | $32.7M | 47.4K | 44 |
| KS | $689.12 | $37.1M | 53.9K | 28 |
| NM | $688.77 | $13.9M | 20.1K | 17 |
| FL | $688.77 | $204.4M | 296.8K | 250 |
| SD | $688.70 | $10.3M | 14.9K | 13 |
| AK | $688.53 | $2.7M | 4.0K | 4 |
| NE | $688.42 | $15.2M | 22.0K | 21 |
| PA | $688.25 | $121.1M | 176.0K | 140 |
| ME | $688.12 | $11.1M | 16.1K | 17 |
| NY | $688.02 | $159.4M | 231.7K | 230 |
| NJ | $687.99 | $59.0M | 85.7K | 85 |
| TX | $687.93 | $147.3M | 214.1K | 212 |
| CA | $687.83 | $200.6M | 291.7K | 310 |
| IN | $687.69 | $53.0M | 77.1K | 61 |
| NC | $687.62 | $86.3M | 125.6K | 98 |
| KY | $687.62 | $36.1M | 52.4K | 42 |
| VA | $687.56 | $87.1M | 126.7K | 76 |
| IA | $687.53 | $30.4M | 44.2K | 40 |
| SC | $687.49 | $48.8M | 71.0K | 46 |
| WV | $687.49 | $13.2M | 19.2K | 8 |
| AR | $687.44 | $16.1M | 23.5K | 30 |
| CO | $687.39 | $35.2M | 51.3K | 57 |
| IL | $687.38 | $95.7M | 139.2K | 139 |
| DC | $687.26 | $2.3M | 3.4K | 6 |
| MO | $687.00 | $41.7M | 60.7K | 61 |
| NV | $686.78 | $16.1M | 23.5K | 24 |
| RI | $686.63 | $8.4M | 12.3K | 14 |
| MD | $686.63 | $86.1M | 125.3K | 97 |
| OK | $686.21 | $22.4M | 32.7K | 28 |
| AL | $686.16 | $29.0M | 42.2K | 41 |
| CT | $686.12 | $30.7M | 44.7K | 43 |
| MI | $686.07 | $71.2M | 103.8K | 113 |
| ID | $685.97 | $13.0M | 19.0K | 24 |
| WI | $685.64 | $29.8M | 43.4K | 61 |
| WA | $684.92 | $56.1M | 82.0K | 94 |
| MS | $684.52 | $20.8M | 30.4K | 21 |
| OR | $684.44 | $38.0M | 55.6K | 61 |
| NH | $684.42 | $6.0M | 8.8K | 11 |
| GA | $684.42 | $46.2M | 67.6K | 66 |
| TN | $684.27 | $57.7M | 84.4K | 75 |
| VI | $684.05 | $84.8K | 124 | 1 |
| DE | $683.59 | $3.5M | 5.1K | 7 |
| MT | $683.21 | $12.6M | 18.4K | 19 |
| LA | $683.21 | $18.6M | 27.2K | 50 |
| ND | $678.44 | $6.7M | 9.8K | 15 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Torsten Wiegand | Ophthalmology | MA | $5.4M | 7.9K | $689.74 |
| Sandeep Randhawa | Ophthalmology | MI | $5.4M | 7.9K | $688.31 |
| Drew Sommerville | Ophthalmology | IN | $5.4M | 7.8K | $686.33 |
| Gary Miller | Ophthalmology | WV | $5.2M | 7.6K | $690.32 |
| David Reed | Ophthalmology | MA | $5.1M | 7.4K | $692.48 |
| Eric Jablon | Ophthalmology | SC | $4.9M | 7.0K | $692.64 |
| Joel Herring | Ophthalmology | MS | $4.7M | 6.8K | $686.64 |
| Sunil Gupta | Ophthalmology | FL | $4.6M | 6.7K | $683.21 |
| James Brown | Ophthalmology | MS | $4.4M | 6.4K | $684.93 |
| Paul Boeke | Ophthalmology | IA | $4.4M | 6.3K | $688.63 |
| David Dyer | Ophthalmology | KS | $4.3M | 6.2K | $692.92 |
| Shil Patel | Ophthalmology | NC | $4.3M | 6.2K | $686.69 |
| James Pate | Ophthalmology | NC | $4.2M | 6.2K | $686.57 |
| Randall Peairs | Ophthalmology | PA | $4.1M | 5.9K | $691.89 |
| Shalini Yalamanchi | Ophthalmology | CA | $4.0M | 5.8K | $687.30 |
| Rohit Lakhanpal | Ophthalmology | MD | $4.0M | 5.8K | $686.70 |
| Jonathan Jonisch | Ophthalmology | NY | $3.9M | 5.7K | $690.51 |
| John O'keefe | Ophthalmology | VA | $3.9M | 5.6K | $691.51 |
| Roy Arogyasami | Ophthalmology | NY | $3.8M | 5.6K | $689.77 |
| Nitin Gupta | Ophthalmology | NC | $3.8M | 5.6K | $685.86 |
Based on the data, CPT J0178 shows a 1.0x variation in pricing across states — relatively consistent by Medicare standards.
Costs have decreased 10.3% 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.