This provider's $22.7M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 253% from 2014 to 2023.
76% 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 | $327.99 | $137.44 | 2.39x | $190.55 | $1.1M | 7.7K | 12 |
| 2015 | $404.90 | $172.98 | 2.34x | $231.92 | $1.5M | 8.5K | 13 |
| 2016 | $422.25 | $181.82 | 2.32x | $240.43 | $1.7M | 9.4K | 15 |
| 2017 | $437.16 | $183.56 | 2.38x | $253.60 | $1.9M | 10.3K | 14 |
| 2018 | $463.80 | $201.10 | 2.31x | $262.70 | $2.2M | 11.2K | 14 |
| 2019 | $472.30 | $201.50 | 2.34x | $270.80 | $2.2M | 10.9K | 14 |
| 2020 | $558.74 | $240.18 | 2.33x | $318.56 | $2.5M | 10.4K | 15 |
| 2021 | $581.15 | $250.94 | 2.32x | $330.21 | $3.0M | 12.0K | 14 |
| 2022 | $589.90 | $243.92 | 2.42x | $345.98 | $2.9M | 12.0K | 15 |
| 2023 | $624.59 | $255.26 | 2.45x | $369.33 | $3.7M | 14.6K | 16 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 23.2K | $17.0M | $734.11 | 2.04x |
| 67028 | Injection of drug into eye | 14.1K | $1.3M | $89.43 | 5.59x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 10.2K | $880.5K | $86.47 | 2.08x |
| 92134 | Imaging of retina | 16.0K | $474.4K | $29.58 | 2.70x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 2.4K | $378.4K | $158.07 | 1.90x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 4.3K | $377.1K | $87.39 | 2.05x |
| J3490 | Unclassified drugs | 183 | $368.3K | $2.0K | 2.42x |
| 67041 | Removal of membrane of retina | 276 | $247.1K | $895.23 | 3.83x |
| J7999 | Compounded drug, not otherwise classified | 3.6K | $235.0K | $65.34 | 3.81x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 2.0K | $225.8K | $113.20 | 2.21x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 11.9K | $225.4K | $18.90 | 3.70x |
| 92250 | Photography of the retina | 4.3K | $203.2K | $47.70 | 3.14x |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 1.2K | $142.6K | $120.36 | 2.49x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 1.8K | $114.4K | $63.78 | 2.35x |
| J2778 | Injection, ranibizumab, 0.1 mg | 495 | $110.0K | $222.26 | 3.15x |
| 67036 | Removal of eye fluid (vitreous) between lens and retina | 123 | $76.6K | $622.89 | 4.33x |
| 92201 | Extended exam of the back part of the eye with retinal drawing | 3.8K | $70.6K | $18.53 | 3.78x |
| J9035 | Injection, bevacizumab, 10 mg | 988 | $52.4K | $53.08 | 1.88x |
| 67113 | Complex repair of detached retina and drainage of eye fluid between lens and retina | 51 | $48.1K | $942.98 | 4.45x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 742 | $43.3K | $58.42 | 2.57x |
This provider submits charges 2.36 times higher than what Medicare actually pays.
A markup ratio of 2.36x means for every $100 Medicare pays, this provider initially charges $236. 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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