This provider averages 54 services per working day
Based on 136.2K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $25.1M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 54 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 51% from 2014 to 2023.
71% 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 80% in 2022
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 | $357.75 | $176.65 | 2.03x | $181.10 | $2.2M | 12.2K | 20 |
| 2015 | $402.05 | $186.22 | 2.16x | $215.83 | $2.0M | 10.7K | 19 |
| 2016 | $441.86 | $197.48 | 2.24x | $244.38 | $2.2M | 10.9K | 19 |
| 2017 | $489.72 | $211.66 | 2.31x | $278.06 | $2.1M | 10.0K | 16 |
| 2018 | $539.13 | $231.90 | 2.32x | $307.23 | $2.6M | 11.1K | 17 |
| 2019 | $552.33 | $239.61 | 2.31x | $312.72 | $2.3M | 9.7K | 17 |
| 2020 | $586.12 | $252.33 | 2.32x | $333.79 | $2.2M | 8.8K | 14 |
| 2021 | $529.82 | $234.36 | 2.26x | $295.46 | $2.2M | 9.6K | 15 |
| 2022 | $493.97 | $200.42 | 2.46x | $293.55 | $4.0M | 20.1K | 16 |
| 2023 | $260.49 | $98.25 | 2.65x | $162.24 | $3.3M | 33.2K | 15 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 23.8K | $17.7M | $740.48 | 2.29x |
| 67028 | Injection of drug into eye | 21.2K | $1.7M | $82.59 | 3.03x |
| J2778 | Injection, ranibizumab, 0.1 mg | 3.7K | $1.1M | $286.39 | 2.33x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 26.7K | $781.4K | $29.27 | 3.30x |
| 92134 | Imaging of retina | 25.0K | $724.3K | $28.97 | 1.46x |
| J9035 | Injection, bevacizumab, 10 mg | 11.7K | $648.1K | $55.43 | 3.95x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 8.3K | $436.2K | $52.56 | 1.52x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 4.1K | $312.4K | $75.47 | 1.46x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 2.6K | $300.8K | $114.15 | 1.43x |
| J3590 | Unclassified biologics | 143 | $247.1K | $1.7K | 3.26x |
| 67041 | Removal of membrane of retina | 152 | $136.6K | $898.86 | 1.58x |
| 92250 | Photography of the retina | 2.9K | $127.8K | $43.33 | 1.50x |
| 67108 | Repair of detached retina with drainage and removal of eye fluid between lens and retina | 131 | $121.7K | $928.70 | 1.59x |
| 67228 | Destruction of leaking blood vessels of retina using laser | 351 | $109.4K | $311.61 | 1.50x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 116 | $107.2K | $924.06 | 1.38x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 658 | $103.2K | $156.78 | 2.12x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 1.2K | $92.2K | $76.54 | 1.50x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 1.3K | $73.1K | $57.01 | 1.48x |
| 67040 | Laser destruction of eye fluid (vitreous) between the lens and retina | 75 | $64.9K | $864.82 | 1.40x |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 643 | $47.8K | $74.36 | 1.50x |
This provider submits charges 2.33 times higher than what Medicare actually pays.
A markup ratio of 2.33x means for every $100 Medicare pays, this provider initially charges $233. 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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