Lucentis (ranibizumab) cost per injection and what the patient owes

$26.384 per 0.1 mg is Part B's ASP+6% rate for Q4 2026. Once the $283 Part B deductible is met, the patient owes the remaining 20% coinsurance on the drug and its administration, with no annual out-of-pocket maximum to cap it. Full explanation: How Medicare Part B drug cost sharing works →

Medicare pays J2778 per 0.1 mg billing unit, not per vial or per treatment session. Lucentis comes in two strengths, each its own single-dose syringe or vial: 0.5 mg for wet AMD, macular edema after retinal vein occlusion and myopic CNV, and 0.3 mg for diabetic macular edema and diabetic retinopathy. The injection itself is always 67028, reported per eye: RT or LT on the line, or once with modifier 50 at 150% when both eyes are injected at the same visit. At the reference one-eye 0.5 mg dose (5 units), the drug alone allows $131.92; adding 67028 ($114.23) brings the claim to $246.15 allowed, and the patient's 20% coinsurance after the deductible is $49.23 ($26.38 for the drug plus $22.85 for the injection).

The 0.3 mg dose (3 units) prices the same way on a smaller drug line: $79.15 allowed for the drug, plus the same $114.23 for 67028, for $193.38 allowed and a $38.68 coinsurance ($15.83 for the drug plus $22.85 for the injection).

At a visit where both eyes are treated at the 0.5 mg dose, the claim carries two drug lines and one procedure line: J2778 for 5 units RT, J2778 for 5 units LT, and 67028 with modifier 50, paid at 150% of the single-eye rate ($171.35 instead of $114.23). Medicare allows $131.92 plus $131.92 plus $171.35, or $435.19, and the patient's 20% coinsurance is $26.38 plus $26.38 plus $34.27, or $87.04.

Wet AMD's labeled schedule is monthly with no stopping point, so the claim above recurs. At 12 injections a year in one eye, before the 2% sequester, Medicare allows $2,953.80 for the year at the $246.15 one-eye rate.

Each product's payment limit is its own code's ASP+6%, and a claim priced under the wrong code prices at the wrong product's rate. Byooviz and Cimerli are Lucentis's biosimilars, billed under their own Q-codes at the same 0.1 mg unit: at the 0.5 mg dose, Byooviz allows $1,247.45 against Lucentis's $131.92, and Cimerli allows $405.65; Byooviz's rate now sits far above the reference product's. Avastin (off-label, repackaged bevacizumab, J9035) carries no ASP+6% entry in this quarter's ranibizumab pricing file and is omitted from this table. Lucentis itself is on the preferred list at several payers in our coverage corpus: BCBS Arkansas names Byooviz, Lucentis, Pavblu and Vabysmo as preferred, and UnitedHealthcare's preferred list includes Lucentis alongside Avastin, Cimerli, Eylea, Eylea HD, Pavblu and Vabysmo, while typically excluding Byooviz from coverage.

For the reference patient (0.5 mg, one eye, drug + the 67028 injection), Medicare allows $246.15, and the Part B coinsurance on that is $49.23. Plans A, B, C, D, F, G, M and N cover that coinsurance in full, so those patients owe nothing per dose once the $283 deductible is met. Plans K and L do not. Because wet AMD is dosed monthly (approximately every 28 days) with no less-frequent maintenance built into the labeled schedule, the deductible column is not a first-doses-of-the-year question: it recurs on whichever claim in the year still falls before the deductible is met. The dose that lands before the deductible is met costs a Plan K patient $246.15; the dose after it costs $24.61. Unequal charges from one injection to the next, not one recurring number. See what each Medigap plan (A–N) owes on this claim →

Only the letters that leave this patient a balance are listed. The full A–N grid, the high-deductible variants, Plan N’s office-visit carve-out and the MACRA restriction on Plans C and F are at Medigap Plans A–N.

Payers outside Medicare negotiate their own rate for J2778, not ASP+6%. Our corpus holds published rates from all 37 payer files on file, including Aetna, UnitedHealthcare, Cigna, Anthem, Regence, Premera and Kaiser. Aetna’s all-states median is $66.86 per 0.1 mg unit against Medicare’s $26.384, putting the 0.5 mg per-eye dose at $334.30 before benefits. Rates move by state as well as by payer, which is why the estimator above takes one. The 67028 injection procedure carries its own commercial copay or coinsurance separate from the drug line; the Genentech Ophthalmology Co-pay Program, where the patient is commercially eligible, brings the drug cost to $0 up to $15,000 a year and adds up to $1,000 a year toward that 67028 copay. What the patient owes then depends on their specific benefits. Full explanation: How commercial drug reimbursement works →

Medicare pays the same ASP+6% rate for the Lucentis drug itself regardless of setting. The 67028 intravitreal injection is reported per eye regardless of which indication is being treated, so the procedure code doesn't change by diagnosis. Intravitreal injections are short in-office procedures typically billed under the physician fee schedule's non-facility rate rather than a hospital-outpatient facility fee. Some commercial payers apply a site-of-care rule to ranibizumab; our coverage corpus shows 6 of 27 payers carry an explicit site-of-care rule. Our data doesn't carry a Lucentis-specific hospital-outpatient facility rate, so this estimator only prices the office/physician-fee-schedule path.

Place of service (POS) is what drives that rate split. POS 11 (office) prices the admin code at the non-facility physician fee schedule rate, which is the path this estimator prices. A site-of-care rule that sends the same claim to POS 19 (off-campus hospital outpatient), POS 22 (hospital outpatient) or POS 24 (ambulatory surgical center) moves the admin code to the facility rate instead: a different number for the same CPT code. Confirm the POS on the claim before comparing an admin-fee estimate against what a payer actually paid.

The ranibizumab payment limit fell sharply across eight quarters as Byooviz and Cimerli entered the market: in 2025 Q1 $123.98 per 0.1 mg, and in 2026 Q4 $26.384. Applied to the same one-eye 0.5 mg dose, the Q3 2026 rate ($51.09 per 0.1 mg) allowed $255.45 for the drug; the Q4 2026 rate allows $131.92. Use the quarter that is actually in effect for the claim's date of service.

On a commercial plan, the Genentech Ophthalmology Co-pay Program can take the drug cost down to $0 for the patient, up to $15,000 a year, and adds up to $1,000 a year toward the 67028 injection administration copay. It excludes Medicaid, Medicare and other government program patients.

There is a free-drug route from the manufacturer: the Genentech Patient Foundation ships Lucentis at no cost to qualifying uninsured patients, at or below 400% of the federal poverty level, but it covers only the drug, not the 67028 procedure or an office-visit fee. On Medicare, neither program applies: the Genentech Ophthalmology Co-pay Program excludes federal program patients by design, and the Genentech Patient Foundation excludes Medicare as well as commercial and Medicaid coverage. Three foundation funds cover macular and retinal disease diagnoses that overlap Lucentis's indications: HealthWell Foundation's Macular Degeneration fund (up to $4,000 a year) and Good Days' two retinal-disease funds. All three are closed as of their last status check. Medigap is the only route that reliably reduces the Part B coinsurance on Medicare. See every program for this patient, with current status →

Sources: CMS ASP pricing files (Q4 2026); Medicare physician fee schedule (67028, national non-facility); Medicare Part B deductible (2026); Medicare Rights Center 2026 Medigap plan benefits chart; 37 commercial payer published price files; the Genentech Ophthalmology Co-pay Program and Genentech Patient Foundation terms and status (the site's programs bundle, generated from the live programs corpus).

Reviewed September 20, 2026 by Erin Rose, CareCost Estimate founder. Methodology →