Cost analysis for CPT J7170 — Injection, emicizumab-kxwh, 0.5 mg
Average Medicare Payment
$38.97
2023 data
Total Payments (2023)
$50.2M
Services (2023)
1.3M
Price Change (2019–2023)
-95.0%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2019 | $777.91 | $20.1M | 436.1K | — |
| 2020 | $10179.29 | $30.3M | 618.9K | +1208.5% |
| 2021 | $8039.01 | $37.9M | 811.1K | -21.0% |
| 2022 | $48.63 | $53.0M | 1.3M | -99.4% |
| 2023 | $38.97 | $50.2M | 1.3M | -19.9% |
The most expensive state pays 1.0x more than the cheapest for this procedure. GA averages $39.61 vs PA at $38.39.
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Accredo Health Group Inc | Pharmacy | PA | $20.1M | 523.7K | $38.41 |
| Caremark, L.L.C. | Pharmacy | CA | $7.4M | 192.2K | $38.32 |
| Red Chip Of Nevada | Pharmacy | CA | $7.0M | 177.5K | $39.62 |
| Hemophilia Of Georgia | Pharmacy | GA | $6.1M | 152.9K | $39.61 |
| Cascade Hemophilia Consortium | Pharmacy | MI | $5.1M | 129.6K | $39.60 |
| Procare Pharmacy Direct, Llc. | Pharmacy | PA | $4.5M | 117.8K | $38.26 |
Based on the data, CPT J7170 shows a 1.0x variation in pricing across states — relatively consistent by Medicare standards.
Costs have decreased 95% 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.