This provider's $28.6M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
61% of their billing comes from a single procedure code (J0178 — Injection, aflibercept, 1 mg).
AI-generated analysis based on Medicare payment data.
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 | $629.27 | $246.54 | 2.55x | $382.73 | $2.4M | 9.6K | 18 |
| 2015 | $776.93 | $281.03 | 2.76x | $495.90 | $2.6M | 9.4K | 20 |
| 2016 | $821.40 | $287.44 | 2.86x | $533.96 | $3.2M | 11.2K | 19 |
| 2017 | $844.15 | $285.77 | 2.95x | $558.38 | $3.1M | 10.8K | 21 |
| 2018 | $855.60 | $290.84 | 2.94x | $564.76 | $3.1M | 10.7K | 19 |
| 2019 | $881.89 | $297.84 | 2.96x | $584.05 | $3.1M | 10.5K | 18 |
| 2020 | $932.44 | $307.66 | 3.03x | $624.78 | $2.8M | 9.0K | 18 |
| 2021 | $923.91 | $304.97 | 3.03x | $618.94 | $2.7M | 8.9K | 18 |
| 2022 | $591.42 | $208.83 | 2.83x | $382.59 | $2.7M | 12.9K | 18 |
| 2023 | $250.11 | $99.56 | 2.51x | $150.55 | $2.9M | 29.3K | 18 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 23.3K | $17.3M | $742.97 | 2.83x |
| J2778 | Injection, ranibizumab, 0.1 mg | 20.5K | $5.8M | $280.68 | 2.04x |
| 67028 | Injection of drug into eye | 15.2K | $1.3M | $88.74 | 6.02x |
| 92014 | Established patient complete exam of visual system | 11.6K | $1.0M | $89.73 | 2.52x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 24.2K | $704.9K | $29.08 | 2.02x |
| 92134 | Imaging of retina | 14.1K | $441.5K | $31.35 | 3.19x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 246 | $229.9K | $934.67 | 4.91x |
| 67113 | Complex repair of detached retina and drainage of eye fluid between lens and retina | 188 | $211.0K | $1.1K | 4.32x |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 1.4K | $169.7K | $120.36 | 2.53x |
| 92012 | Established patient problem focused exam of visual system | 2.3K | $148.7K | $63.62 | 2.45x |
| 67041 | Removal of membrane of retina | 159 | $145.7K | $916.40 | 4.38x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 903 | $142.6K | $157.92 | 1.78x |
| 67040 | Destruction of eye fluid (vitreous) between lens and retina and all of retina using a laser | 170 | $130.6K | $767.95 | 5.68x |
| J3490 | Unclassified drugs | 69 | $122.1K | $1.8K | 2.59x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 1.0K | $122.0K | $119.40 | 3.04x |
| 92250 | Photography of the retina | 2.3K | $100.3K | $44.03 | 3.52x |
| J9035 | Injection, bevacizumab, 10 mg | 1.8K | $98.0K | $55.52 | 3.68x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 638 | $75.4K | $118.18 | 2.50x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 70 | $68.1K | $973.26 | 5.28x |
| 99205 | New patient office or other outpatient visit, 60-74 minutes | 414 | $64.0K | $154.57 | 2.33x |
This provider submits charges 2.85 times higher than what Medicare actually pays.
A markup ratio of 2.85x means for every $100 Medicare pays, this provider initially charges $285. 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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