This provider's $19.3M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 136% from 2014 to 2023.
70% 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 | $251.68 | $102.17 | 2.46x | $149.51 | $1.3M | 12.6K | 17 |
| 2015 | $381.60 | $158.97 | 2.40x | $222.63 | $1.5M | 9.5K | 16 |
| 2016 | $399.24 | $169.10 | 2.36x | $230.14 | $1.8M | 10.7K | 16 |
| 2017 | $395.42 | $160.35 | 2.47x | $235.07 | $1.7M | 10.5K | 17 |
| 2018 | $403.00 | $169.16 | 2.38x | $233.84 | $1.7M | 10.3K | 15 |
| 2019 | $386.31 | $162.04 | 2.38x | $224.27 | $2.0M | 12.4K | 17 |
| 2020 | $512.21 | $218.42 | 2.35x | $293.79 | $1.9M | 8.5K | 14 |
| 2021 | $521.64 | $226.61 | 2.30x | $295.03 | $2.0M | 9.0K | 18 |
| 2022 | $549.30 | $231.07 | 2.38x | $318.23 | $2.4M | 10.2K | 15 |
| 2023 | $616.14 | $249.84 | 2.47x | $366.30 | $3.0M | 12.1K | 20 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 18.0K | $13.4M | $740.35 | 2.03x |
| 67028 | Injection of drug into eye | 12.0K | $1.0M | $86.53 | 5.78x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 11.9K | $1.0M | $85.98 | 2.09x |
| J3490 | Unclassified drugs | 292 | $587.2K | $2.0K | 2.42x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 3.0K | $475.7K | $158.04 | 1.90x |
| 92134 | Imaging of retina | 14.9K | $435.3K | $29.13 | 2.75x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 4.4K | $378.5K | $86.67 | 2.07x |
| 67041 | Removal of membrane of retina | 415 | $367.0K | $884.25 | 3.84x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 14.8K | $278.8K | $18.90 | 3.70x |
| 92250 | Photography of the retina | 5.1K | $244.5K | $48.01 | 3.12x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.7K | $192.6K | $110.55 | 2.26x |
| J7999 | Compounded drug, not otherwise classified | 2.4K | $154.8K | $63.46 | 3.73x |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 1.2K | $140.8K | $120.36 | 2.49x |
| J2778 | Injection, ranibizumab, 0.1 mg | 445 | $138.0K | $310.15 | 2.26x |
| 67108 | Repair of detached retina with drainage and removal of eye fluid between lens and retina | 94 | $88.7K | $943.82 | 4.03x |
| 67113 | Complex repair of detached retina and drainage of eye fluid between lens and retina | 74 | $80.6K | $1.1K | 3.85x |
| 92202 | Extended exam of the back part of the eye with optic nerve drawing | 5.7K | $65.7K | $11.63 | 6.02x |
| J9035 | Injection, bevacizumab, 10 mg | 1.2K | $61.0K | $52.83 | 1.92x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 869 | $54.1K | $62.22 | 2.41x |
| 67036 | Removal of eye fluid (vitreous) between lens and retina | 68 | $40.7K | $598.07 | 4.51x |
This provider submits charges 2.4 times higher than what Medicare actually pays.
A markup ratio of 2.4x means for every $100 Medicare pays, this provider initially charges $240. 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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