This provider's $11.9M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 20116% from 2014 to 2023.
69% 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 451% in 2016
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 | $613.80 | $92.50 | 6.64x | $521.30 | $15.2K | 164 | 4 |
| 2015 | $505.85 | $77.96 | 6.49x | $427.89 | $27.6K | 354 | 8 |
| 2016 | $253.93 | $72.02 | 3.53x | $181.91 | $152.0K | 2.1K | 14 |
| 2017 | $269.26 | $102.57 | 2.63x | $166.69 | $539.4K | 5.3K | 16 |
| 2018 | $290.86 | $126.03 | 2.31x | $164.83 | $745.4K | 5.9K | 13 |
| 2019 | $289.94 | $133.91 | 2.17x | $156.03 | $1.1M | 7.9K | 13 |
| 2020 | $365.69 | $178.81 | 2.05x | $186.88 | $1.4M | 8.1K | 12 |
| 2021 | $409.43 | $211.06 | 1.94x | $198.37 | $2.2M | 10.3K | 12 |
| 2022 | $369.61 | $188.08 | 1.97x | $181.53 | $2.7M | 14.5K | 17 |
| 2023 | $282.70 | $141.34 | 2.00x | $141.36 | $3.1M | 21.7K | 15 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 11.4K | $8.2M | $718.07 | 1.57x |
| 67028 | Injection of drug into eye | 10.3K | $848.3K | $82.54 | 7.04x |
| 92134 | Imaging of retina | 19.4K | $542.6K | $28.03 | 2.24x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 9.8K | $534.6K | $54.35 | 1.67x |
| J3590 | Unclassified biologics | 190 | $347.8K | $1.8K | 1.57x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 11.8K | $344.4K | $29.29 | 1.71x |
| J9035 | Injection, bevacizumab, 10 mg | 5.3K | $302.0K | $56.66 | 2.04x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 3.4K | $269.8K | $80.20 | 1.70x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.6K | $172.8K | $109.02 | 1.75x |
| 67036 | Removal of eye fluid (vitreous) between lens and retina | 204 | $87.8K | $430.24 | 4.43x |
| 67108 | Repair of detached retina with drainage and removal of eye fluid between lens and retina | 84 | $59.2K | $704.82 | 4.64x |
| 67041 | Removal of membrane of retina | 86 | $55.8K | $648.51 | 3.76x |
| 67145 | Photocoagulation treatment to prevent detachment of retina | 117 | $38.3K | $327.41 | 3.69x |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 531 | $36.8K | $69.28 | 1.80x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 107 | $26.4K | $246.40 | 4.98x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 316 | $25.0K | $79.16 | 1.83x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 38 | $14.8K | $390.49 | 5.65x |
| 99284 | Emergency department visit, problem of high severity | 125 | $10.3K | $82.45 | 2.24x |
| 92202 | Extended exam of the back part of the eye with optic nerve drawing | 874 | $9.6K | $11.02 | 1.82x |
| 76512 | 2d ultrasound scan of eye tissue and structures | 167 | $8.2K | $48.92 | 3.37x |
This provider submits charges 2.08 times higher than what Medicare actually pays.
A markup ratio of 2.08x means for every $100 Medicare pays, this provider initially charges $208. 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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