This provider's $12.1M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 154349% from 2016 to 2023.
76% of their billing comes from a single procedure code (J0178 — Injection, aflibercept, 1 mg).
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 3942% in 2018
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.
| Year | Avg Submitted | Avg Paid | Markup Ratio | Gap per Service | Total Payments | Services | Beneficiaries |
|---|---|---|---|---|---|---|---|
| 2016 | $164.92 | $36.32 | 4.54x | $128.60 | $2.2K | 60 | 3 |
| 2017 | $149.52 | $31.27 | 4.78x | $118.25 | $6.7K | 215 | 5 |
| 2018 | $344.94 | $134.68 | 2.56x | $210.26 | $271.8K | 2.0K | 11 |
| 2019 | $297.03 | $113.37 | 2.62x | $183.66 | $1.1M | 9.6K | 18 |
| 2020 | $293.57 | $110.28 | 2.66x | $183.29 | $1.3M | 11.5K | 18 |
| 2021 | $458.41 | $195.74 | 2.34x | $262.67 | $2.9M | 14.6K | 17 |
| 2022 | $613.75 | $258.53 | 2.37x | $355.22 | $3.3M | 12.7K | 15 |
| 2023 | $638.08 | $262.19 | 2.43x | $375.89 | $3.4M | 12.8K | 17 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 12.9K | $9.2M | $716.42 | 2.04x |
| 67028 | Injection of drug into eye | 8.1K | $744.4K | $91.43 | 5.82x |
| 92134 | Imaging of retina | 10.4K | $302.4K | $29.03 | 2.86x |
| J3490 | Unclassified drugs | 139 | $277.0K | $2.0K | 2.40x |
| J7999 | Compounded drug, not otherwise classified | 3.3K | $240.8K | $72.28 | 4.11x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 3.2K | $198.6K | $61.88 | 2.43x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 1.8K | $155.7K | $86.78 | 2.08x |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 1.0K | $124.6K | $120.36 | 2.49x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 1.3K | $124.5K | $92.54 | 1.95x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.0K | $119.0K | $115.78 | 2.16x |
| 67113 | Complex repair of detached retina and drainage of eye fluid between lens and retina | 102 | $97.4K | $955.24 | 4.40x |
| 67041 | Removal of membrane of retina | 100 | $87.9K | $879.48 | 3.98x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 553 | $85.9K | $155.29 | 1.93x |
| 67036 | Removal of eye fluid (vitreous) between lens and retina | 106 | $70.8K | $667.51 | 4.04x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 1.2K | $69.6K | $58.64 | 2.56x |
| 92202 | Extended exam of the back part of the eye with optic nerve drawing | 5.4K | $64.1K | $11.89 | 5.89x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 43 | $41.4K | $961.96 | 4.23x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 1.9K | $36.2K | $19.04 | 3.68x |
| 92250 | Photography of the retina | 638 | $22.6K | $35.50 | 4.23x |
| J3300 | Injection, triamcinolone acetonide, preservative free, 1 mg | 8.9K | $14.9K | $1.67 | 2.11x |
This provider submits charges 2.44 times higher than what Medicare actually pays.
A markup ratio of 2.44x means for every $100 Medicare pays, this provider initially charges $244. This is higher than the national average.
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Last Updated: February 2026 (data through 2023, the latest CMS release)
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.
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