This provider's $8.7M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 6851% from 2017 to 2023.
62% 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 3676% 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 |
|---|---|---|---|---|---|---|---|
| 2017 | $432.00 | $134.58 | 3.21x | $297.42 | $15.4K | 117 | 115 |
| 2018 | $1.1K | $218.10 | 4.98x | $866.95 | $580.5K | 5.0K | 2.6K |
| 2019 | $1.7K | $311.26 | 5.41x | $1.4K | $2.4M | 13.3K | 4.8K |
| 2020 | $1.4K | $261.39 | 5.42x | $1.2K | $2.6M | 12.2K | 4.1K |
| 2021 | $1.1K | $254.75 | 4.50x | $891.01 | $1.1M | 6.0K | 4.0K |
| 2022 | $773.68 | $201.07 | 3.85x | $572.61 | $914.7K | 5.6K | 3.1K |
| 2023 | $1.0K | $285.04 | 3.63x | $750.36 | $1.1M | 6.5K | 3.0K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 7.3K | $5.4M | $735.01 | 2.48x |
| 67028 | Injection of drug into eye | 11.9K | $1.0M | $85.19 | 9.06x |
| 92134 | Diagnostic imaging of retina | 14.7K | $439.8K | $29.88 | 4.02x |
| J2778 | Injection, ranibizumab, 0.1 mg | 1.4K | $342.4K | $239.63 | 2.88x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 2.8K | $223.9K | $81.38 | 2.26x |
| J3490 | Unclassified drugs | 122 | $215.7K | $1.8K | 2.81x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.3K | $142.7K | $112.48 | 2.43x |
| 67041 | Removal of membrane from the retina | 181 | $125.2K | $691.96 | 4.78x |
| J3590 | Unclassified biologics | 1.9K | $116.2K | $60.29 | 2.22x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 186 | $104.7K | $562.68 | 5.56x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.9K | $101.4K | $52.07 | 2.39x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 283 | $91.8K | $324.28 | 6.87x |
| 67042 | Removal of membrane from the retina, pars plana approach | 104 | $69.2K | $665.36 | 5.66x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 80 | $51.5K | $643.52 | 6.22x |
| 92250 | Photography of the retina | 1.6K | $51.3K | $31.66 | 5.51x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 491 | $38.8K | $78.95 | 3.38x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 143 | $37.3K | $260.94 | 7.27x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 781 | $26.5K | $33.88 | 2.54x |
| J9035 | Injection, bevacizumab, 10 mg | 436 | $25.3K | $58.12 | 1.66x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 243 | $22.4K | $92.34 | 3.88x |
This provider submits charges 3.56 times higher than what Medicare actually pays.
A markup ratio of 3.56x means for every $100 Medicare pays, this provider initially charges $356. 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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