This provider's $33.3M 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 | $513.35 | $237.31 | 2.16x | $276.04 | $3.2M | 13.5K | 18 |
| 2015 | $567.93 | $261.68 | 2.17x | $306.25 | $3.3M | 12.6K | 17 |
| 2016 | $577.84 | $266.35 | 2.17x | $311.49 | $3.0M | 11.4K | 13 |
| 2017 | $639.18 | $298.82 | 2.14x | $340.36 | $2.8M | 9.4K | 11 |
| 2018 | $640.01 | $302.75 | 2.11x | $337.26 | $2.6M | 8.6K | 11 |
| 2019 | $707.52 | $331.59 | 2.13x | $375.93 | $2.7M | 8.2K | 12 |
| 2020 | $682.45 | $316.46 | 2.16x | $365.99 | $3.3M | 10.3K | 10 |
| 2021 | $699.25 | $312.15 | 2.24x | $387.10 | $4.5M | 14.4K | 16 |
| 2022 | $640.06 | $277.65 | 2.31x | $362.41 | $4.1M | 14.8K | 14 |
| 2023 | $530.02 | $199.70 | 2.65x | $330.32 | $3.8M | 18.8K | 15 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 27.3K | $20.3M | $741.52 | 1.69x |
| J2778 | Injection, ranibizumab, 0.1 mg | 27.6K | $7.8M | $284.53 | 1.97x |
| 67028 | Injection of drug into eye | 18.2K | $1.6M | $85.34 | 8.90x |
| J3490 | Unclassified drugs | 428 | $957.8K | $2.2K | 3.02x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 6.7K | $559.4K | $83.78 | 2.21x |
| 92134 | Imaging of retina | 18.1K | $536.4K | $29.60 | 4.73x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 10.4K | $302.3K | $29.12 | 1.91x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 3.1K | $274.2K | $88.42 | 2.07x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 2.0K | $226.4K | $113.72 | 2.20x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 121 | $115.1K | $951.06 | 4.63x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 581 | $89.6K | $154.13 | 1.95x |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 332 | $71.9K | $216.59 | 5.54x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 845 | $65.0K | $76.94 | 2.60x |
| 67041 | Removal of membrane of retina | 71 | $63.0K | $887.04 | 4.96x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 991 | $59.4K | $59.89 | 2.37x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 823 | $48.9K | $59.39 | 2.27x |
| 67036 | Removal of eye fluid (vitreous) between lens and retina | 65 | $44.6K | $686.30 | 4.87x |
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | 250 | $43.5K | $174.08 | 3.22x |
| 92250 | Photography of the retina | 934 | $40.4K | $43.23 | 2.78x |
| 67108 | Repair of detached retina with drainage and removal of eye fluid between lens and retina | 28 | $25.7K | $917.44 | 4.80x |
This provider submits charges 2.24 times higher than what Medicare actually pays.
A markup ratio of 2.24x means for every $100 Medicare pays, this provider initially charges $224. 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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