This provider's $6.2M in total Medicare payments ranks in the 97th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 471% from 2016 to 2023.
63% 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 351% in 2017
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 | $868.78 | $153.58 | 5.66x | $715.20 | $153.0K | 1.5K | 880 |
| 2017 | $521.51 | $205.90 | 2.53x | $315.61 | $690.0K | 5.7K | 2.2K |
| 2018 | $424.45 | $161.03 | 2.64x | $263.42 | $814.6K | 6.2K | 2.2K |
| 2019 | $410.72 | $151.61 | 2.71x | $259.11 | $881.1K | 5.8K | 1.9K |
| 2020 | $381.60 | $155.69 | 2.45x | $225.91 | $888.7K | 5.7K | 1.9K |
| 2021 | $458.09 | $180.12 | 2.54x | $277.97 | $965.6K | 6.3K | 2.1K |
| 2022 | $323.63 | $114.74 | 2.82x | $208.89 | $965.8K | 6.3K | 2.0K |
| 2023 | $1.3K | $167.20 | 7.94x | $1.2K | $873.7K | 6.0K | 2.0K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 5.3K | $3.9M | $730.34 | 1.52x |
| 67028 | Injection of drug into eye | 10.3K | $886.4K | $86.34 | 9.75x |
| 92134 | Diagnostic imaging of retina | 14.5K | $428.9K | $29.65 | 3.77x |
| J9035 | Injection, bevacizumab, 10 mg | 4.7K | $269.4K | $57.13 | 2.11x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 2.2K | $183.9K | $83.45 | 3.50x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 2.0K | $123.1K | $60.87 | 3.01x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 743 | $77.2K | $103.93 | 3.35x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 502 | $57.9K | $115.30 | 3.45x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 146 | $54.6K | $374.10 | 4.63x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 600 | $49.3K | $82.13 | 3.65x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 173 | $43.9K | $253.82 | 4.33x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 480 | $29.2K | $60.82 | 3.32x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 28 | $25.2K | $901.56 | 2.79x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 347 | $24.3K | $69.96 | 2.95x |
| 67042 | Removal of membrane from the retina, pars plana approach | 25 | $21.7K | $868.50 | 2.78x |
| 92250 | Photography of the retina | 509 | $21.0K | $41.29 | 3.65x |
| 67041 | Removal of membrane of retina | 14 | $11.0K | $785.84 | 7.92x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 267 | $5.5K | $20.45 | 3.38x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 171 | $4.8K | $27.95 | 4.87x |
| 76512 | Ultrasound of eye disease, growth, or structure | 69 | $4.1K | $59.72 | 4.13x |
This provider submits charges 3.12 times higher than what Medicare actually pays.
A markup ratio of 3.12x means for every $100 Medicare pays, this provider initially charges $312. 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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