Dexamethasone, lacrimal ophthalmic insert, 0.1 mg
Medicare pricing data for 454 providers across 39 states
Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Dexamethasone, lacrimal ophthalmic insert, 0.1 mg (HCPCS code J1096) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $124.74, but hospitals typically charge $305.85 — a 2.5x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $124.74, your out-of-pocket cost would be approximately $24.95. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 2.5x more than what Medicare allows for this procedure. Medicare actually pays $99.47 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| South Dakota | $141 | $198 | 3 | 112 | +12.7% |
| Pennsylvania | $129 | $402 | 21 | 11,792 | +3.8% |
| Florida | $127 | $191 | 67 | 25,704 | +1.5% |
| Washington | $126 | $194 | 1 | 216 | +1.2% |
| Arkansas | $125 | $150 | 5 | 1,443 | +0.5% |
| Tennessee | $125 | $375 | 9 | 3,900 | +0.0% |
| Indiana | $125 | $687 | 10 | 5,930 | -0.0% |
| Illinois | $125 | $542 | 12 | 9,448 | -0.1% |
| Nebraska | $125 | $144 | 2 | 1,681 | -0.1% |
| Massachusetts | $125 | $232 | 5 | 9,518 | -0.1% |
| Virginia | $125 | $182 | 13 | 25,923 | -0.1% |
| New York | $125 | $219 | 16 | 16,192 | -0.2% |
| South Carolina | $125 | $164 | 10 | 10,757 | -0.2% |
| Mississippi | $125 | $239 | 11 | 13,666 | -0.2% |
| California | $125 | $395 | 29 | 17,295 | -0.2% |
| Delaware | $124 | $400 | 1 | 4,916 | -0.2% |
| Alabama | $124 | $299 | 6 | 2,692 | -0.3% |
| New Mexico | $124 | $185 | 2 | 4,780 | -0.3% |
| Arizona | $124 | $325 | 26 | 33,832 | -0.3% |
| Connecticut | $124 | $295 | 4 | 4,341 | -0.3% |
| Kansas | $124 | $225 | 8 | 7,633 | -0.3% |
| Michigan | $124 | $254 | 15 | 4,490 | -0.3% |
| New Jersey | $124 | $234 | 32 | 39,485 | -0.3% |
| Wisconsin | $124 | $401 | 7 | 5,702 | -0.4% |
| Iowa | $124 | $174 | 3 | 4,893 | -0.4% |
| Missouri | $124 | $638 | 11 | 7,492 | -0.4% |
| Ohio | $124 | $343 | 12 | 6,340 | -0.4% |
| Oklahoma | $124 | $491 | 6 | 2,782 | -0.4% |
| Texas | $124 | $369 | 43 | 17,739 | -0.5% |
| Kentucky | $124 | $469 | 7 | 1,653 | -0.5% |
| Maryland | $124 | $242 | 9 | 5,936 | -0.5% |
| Georgia | $124 | $311 | 9 | 4,749 | -0.6% |
| Wyoming | $124 | $151 | 1 | 981 | -0.7% |
| Rhode Island | $124 | $278 | 1 | 1,570 | -0.8% |
| North Carolina | $124 | $835 | 5 | 5,252 | -0.9% |
| Colorado | $123 | $321 | 4 | 176 | -1.3% |
| New Hampshire | $123 | $492 | 1 | 1,642 | -1.8% |
| Nevada | $122 | $359 | 3 | 1,464 | -2.3% |
| Louisiana | $122 | $211 | 8 | 1,056 | -2.5% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber