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Market snapshot

J0178 in HI CY2024

Medicare Part B FFS · CY2024 · as published by CMS

J0178 — Injection, aflibercept, 1 mg

Billing groups
3
Named-group FFS services
4,046
FFS of Medicare
47%
Services YoY
-20.7%
FFS enrollment -0.8%
Estimated all-Medicare volume FFS + estimated MA estimate
~8,702 services

4,046 observed fee-for-service (46%) · ~4,656 estimated Medicare Advantage. Scaled from the observed floor by each state’s fee-for-service share (FFS share as of 2024) — scaled estimate — assumes MA utilization mirrors FFS; not an observation. How we scale

Named-group submitted charges
$5.3M
Named-group allowed amount
$3.3M
Named-group Medicare payments
$2.6M
Avg charge / svc
$1,303
Avg allowed / svc
$810
Avg payment / svc
$646
Average charge per group
$1,272 3 groups · avg submitted charge / service $1,571
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Specialty market — Ophthalmology: 4,046 services — specialty benchmark suppressed (fewer than 11 groups) — showing state benchmark. See Ophthalmology across all states →

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Data year: CY2024 CY2023 CY2022 🔒 CY2021 🔒 CY2020 🔒
Physician groups ranked by J0178 services, CY2024
#Physician group City Specialty Providers J0178 svcs Submitted charges Avg charge Medicare $ locked column Share of specialty*Share of state* Phone
1 RETINA CONSULTANTS OF HAWAII INC HONOLULU OPHTHALMOLOGY 5 3,316 $4,218,900 $1,272 premium 50.6% (808) 487-8928
2 RETINA INSTITUTE OF HAWAII LLC HONOLULU OPHTHALMOLOGY 6 368 $486,000 $1,321 premium 5.6% (808) 955-0255
3 EUGENE WM NG MD LLC HILO OPHTHALMOLOGY 7 362 $568,586 $1,571 premium 5.5% (808) 356-3820

*"Share of specialty" is the group's share of disclosed Medicare-FFS services for the primary code among groups with the SAME modal specialty in the state; "share of state" is the same figure against the whole state. Specialty is each group's modal member specialty from CMS's clinician register — a multi-specialty group carries one label. Where fewer than 11 groups share the specialty in the state, the specialty share renders "—" — the specialty benchmark is suppressed (fewer than 11 groups) and the state share alongside is the benchmark. Group figures sum clinicians affiliated with exactly one group. See Methods.

Comparing against an all-payer estimate?

These are exact counts from Medicare fee-for-service claims — roughly a third to half of most procedure markets, depending on payer mix. Modeled all-payer databases project the remainder statistically; we publish the audited floor and label it as such. Same market, different denominator. How the numbers reconcile →