Cost analysis for CPT J1096 — Dexamethasone, lacrimal ophthalmic insert, 0.1 mg
Average Medicare Payment
$99.25
2023 data
Total Payments (2023)
$32.1M
Services (2023)
322.7K
Price Change (2019–2023)
-12.9%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2019 | $113.98 | $658.6K | 8.6K | — |
| 2020 | $110.87 | $8.1M | 73.1K | -2.7% |
| 2021 | $107.43 | $25.9M | 238.8K | -3.1% |
| 2022 | $104.47 | $26.9M | 257.7K | -2.8% |
| 2023 | $99.25 | $32.1M | 322.7K | -5.0% |
The most expensive state pays 1.1x more than the cheapest for this procedure. PA averages $103.10 vs LA at $96.83.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| PA | $103.10 | $1.2M | 11.6K | 12 |
| FL | $100.84 | $2.6M | 25.3K | 35 |
| WA | $100.59 | $21.7K | 216 | 1 |
| CO | $100.34 | $15.3K | 152 | 1 |
| AR | $99.92 | $141.0K | 1.4K | 4 |
| TN | $99.64 | $384.9K | 3.9K | 4 |
| KS | $99.40 | $745.7K | 7.5K | 4 |
| IN | $99.36 | $581.3K | 5.8K | 7 |
| SC | $99.34 | $1.1M | 10.7K | 7 |
| MA | $99.32 | $945.4K | 9.5K | 5 |
| DE | $99.32 | $488.2K | 4.9K | 1 |
| MS | $99.31 | $1.4M | 13.7K | 9 |
| CA | $99.29 | $1.7M | 17.2K | 19 |
| NE | $99.28 | $166.9K | 1.7K | 2 |
| NJ | $99.27 | $3.9M | 39.4K | 24 |
| IL | $99.27 | $935.0K | 9.4K | 10 |
| VA | $99.26 | $2.6M | 25.9K | 10 |
| OK | $99.25 | $269.8K | 2.7K | 3 |
| IA | $99.24 | $485.6K | 4.9K | 3 |
| CT | $99.22 | $430.3K | 4.3K | 3 |
| WI | $99.21 | $565.7K | 5.7K | 7 |
| NY | $99.16 | $1.6M | 16.0K | 7 |
| MI | $99.15 | $432.3K | 4.4K | 9 |
| AL | $99.12 | $261.0K | 2.6K | 3 |
| OH | $99.11 | $621.3K | 6.3K | 8 |
| NM | $99.11 | $473.7K | 4.8K | 2 |
| AZ | $99.09 | $3.3M | 33.8K | 20 |
| MD | $99.06 | $582.1K | 5.9K | 6 |
| TX | $98.93 | $1.7M | 17.3K | 21 |
| KY | $98.93 | $162.6K | 1.6K | 5 |
| MO | $98.81 | $734.4K | 7.4K | 9 |
| GA | $98.76 | $465.5K | 4.7K | 8 |
| WY | $98.73 | $96.9K | 981 | 1 |
| NH | $98.72 | $162.1K | 1.6K | 1 |
| RI | $98.60 | $154.8K | 1.6K | 1 |
| NC | $98.50 | $516.5K | 5.2K | 4 |
| NV | $97.10 | $139.4K | 1.4K | 2 |
| LA | $96.83 | $93.3K | 964 | 3 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Eye Surgical Specialists Of New Jersey | Ambulatory Surgical Center | NJ | $889.1K | 9.0K | $98.91 |
| Roanoke Valley Center For Sight Llc | Ambulatory Surgical Center | VA | $871.0K | 8.8K | $99.28 |
| Long Island Ambulatory Surgery Center, Llc | Ambulatory Surgical Center | NY | $746.8K | 7.5K | $99.24 |
| Barnet Dulaney Perkins Eye Center, Pc | Ambulatory Surgical Center | AZ | $582.6K | 5.9K | $99.15 |
| Island Eye Surgicenter Llc | Ambulatory Surgical Center | NY | $572.8K | 5.8K | $99.00 |
| Center For Visual Surgical Excellence, Llc | Ambulatory Surgical Center | VA | $516.4K | 5.2K | $99.34 |
| Ocean County Eye Associates Llc | Ambulatory Surgical Center | NJ | $501.9K | 5.0K | $99.51 |
| Delaware Surgery Center, Llc | Ambulatory Surgical Center | DE | $488.2K | 4.9K | $99.32 |
| Doctors Surgery Center, Inc | Ambulatory Surgical Center | TX | $435.9K | 4.4K | $98.72 |
| The Center For Specialized Surgery, Lp | Ambulatory Surgical Center | PA | $435.9K | 4.4K | $99.21 |
| Ambulatory Surgical Center Of Morris County Llc | Ambulatory Surgical Center | NJ | $418.5K | 4.2K | $99.57 |
| Eye Surgery Limited Llc | Ambulatory Surgical Center | VA | $415.2K | 4.2K | $99.44 |
| Greenville Surgery Center Lp | Ambulatory Surgical Center | SC | $412.9K | 4.2K | $99.45 |
| Spring Park Surgery Center L L C | Ambulatory Surgical Center | IA | $411.5K | 4.1K | $99.33 |
| Novamed Eye Surgery Center Of Overland Park, Llc | Ambulatory Surgical Center | KS | $402.6K | 4.1K | $99.31 |
| Specialty Surgery & Laser Center | Ambulatory Surgical Center | MS | $396.0K | 4.0K | $99.19 |
| Arizona Institute Of Eye Surgery Llc | Ambulatory Surgical Center | AZ | $394.9K | 4.0K | $99.22 |
| Fillmore Eye Clinic Incorporated | Ambulatory Surgical Center | NM | $387.2K | 3.9K | $99.17 |
| Advanced Eye Surgery Center, Llc | Ambulatory Surgical Center | FL | $376.5K | 3.8K | $99.39 |
| West Suburban Eye Surgery Center Llc | Ambulatory Surgical Center | MA | $371.7K | 3.7K | $99.29 |
Based on the data, CPT J1096 shows a 1.1x variation in pricing across states — relatively consistent by Medicare standards.
Costs have decreased 12.9% since 2019. 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.