This provider's $13.7M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 414% from 2014 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 64% in 2023
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 |
|---|---|---|---|---|---|---|---|
| 2014 | $626.33 | $146.77 | 4.27x | $479.56 | $616.6K | 4.2K | 17 |
| 2015 | $665.41 | $153.11 | 4.35x | $512.30 | $668.8K | 4.4K | 18 |
| 2016 | $765.00 | $178.46 | 4.29x | $586.54 | $621.1K | 3.5K | 17 |
| 2017 | $728.87 | $205.05 | 3.55x | $523.82 | $895.0K | 4.4K | 16 |
| 2018 | $756.19 | $222.03 | 3.41x | $534.16 | $1.3M | 6.0K | 20 |
| 2019 | $704.51 | $220.98 | 3.19x | $483.53 | $1.2M | 5.4K | 18 |
| 2020 | $718.45 | $234.97 | 3.06x | $483.48 | $1.5M | 6.3K | 17 |
| 2021 | $760.04 | $252.03 | 3.02x | $508.01 | $1.8M | 7.0K | 20 |
| 2022 | $757.81 | $203.32 | 3.73x | $554.49 | $1.9M | 9.5K | 21 |
| 2023 | $365.35 | $97.07 | 3.76x | $268.28 | $3.2M | 32.7K | 24 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 11.4K | $8.4M | $731.05 | 1.85x |
| 67028 | Injection of drug into eye | 8.7K | $955.3K | $110.20 | 12.55x |
| 92134 | Imaging of retina | 18.8K | $710.6K | $37.86 | 5.58x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 22.6K | $653.7K | $28.97 | 2.47x |
| 66984 | Removal of cataract with insertion of prosthetic lens | 886 | $445.0K | $502.31 | 11.28x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 4.8K | $348.3K | $72.99 | 2.90x |
| 92014 | Established patient complete exam of visual system | 2.8K | $289.0K | $104.84 | 2.63x |
| 67041 | Removal of membrane of retina | 199 | $234.0K | $1.2K | 7.27x |
| 92004 | New patient complete exam of visual system | 1.8K | $233.7K | $132.63 | 2.23x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 1.4K | $222.2K | $157.13 | 1.92x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 2.3K | $182.0K | $78.76 | 3.19x |
| 67108 | Repair of detached retina with drainage and removal of eye fluid between lens and retina | 98 | $122.0K | $1.2K | 9.18x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 1.1K | $119.0K | $112.23 | 3.48x |
| J9035 | Injection, bevacizumab, 10 mg | 2.0K | $114.3K | $55.84 | 2.63x |
| J7999 | Compounded drug, not otherwise classified | 1.2K | $89.2K | $75.62 | 1.83x |
| J3590 | Unclassified biologics | 47 | $84.0K | $1.8K | 2.45x |
| 66821 | Removal of recurring cataract in lens capsule using a laser | 243 | $78.8K | $324.38 | 6.23x |
| 67036 | Removal of eye fluid (vitreous) between lens and retina | 83 | $71.7K | $864.21 | 9.16x |
| 67042 | Removal of membrane from the retina, pars plana approach with removal of internal limiting membrane of retina | 51 | $57.7K | $1.1K | 9.25x |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 211 | $51.4K | $243.77 | 1.48x |
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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