This provider averages 70 services per working day
Based on 69.6K total services over 4 years (250 working days/year). Learn about impossible service volumes →
This provider's $8.4M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
Averaging 70 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 2403% from 2020 to 2023.
61% 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 1217% in 2021
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 |
|---|---|---|---|---|---|---|---|
| 2020 | $358.86 | $142.48 | 2.52x | $216.38 | $149.3K | 1.0K | 9 |
| 2021 | $454.52 | $190.32 | 2.39x | $264.20 | $2.0M | 10.3K | 19 |
| 2022 | $438.00 | $175.01 | 2.50x | $262.99 | $2.6M | 14.7K | 17 |
| 2023 | $183.51 | $85.88 | 2.14x | $97.63 | $3.7M | 43.5K | 16 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 7.2K | $5.1M | $710.75 | 1.69x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 31.6K | $915.8K | $29.01 | 1.55x |
| 67028 | Injection of drug into eye | 7.8K | $738.6K | $94.40 | 6.57x |
| 92134 | Imaging of retina | 10.8K | $343.7K | $31.69 | 4.13x |
| J2778 | Injection, ranibizumab, 0.1 mg | 1.5K | $315.6K | $213.23 | 2.41x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 3.1K | $295.3K | $94.30 | 2.02x |
| J9035 | Injection, bevacizumab, 10 mg | 4.3K | $225.0K | $51.93 | 2.03x |
| J3490 | Unclassified drugs | 67 | $135.0K | $2.0K | 4.33x |
| J3590 | Unclassified biologics | 102 | $73.8K | $723.88 | 1.84x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 942 | $62.5K | $66.36 | 2.04x |
| J7999 | Compounded drug, not otherwise classified | 665 | $48.7K | $73.16 | 2.32x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 367 | $43.0K | $117.28 | 2.21x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 189 | $30.2K | $159.94 | 1.37x |
| 92014 | Established patient complete exam of visual system | 279 | $26.7K | $95.62 | 1.77x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 141 | $14.1K | $100.33 | 2.66x |
| 67228 | Destruction of leaking blood vessels of retina using laser | 56 | $13.2K | $236.01 | 7.77x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 19 | $8.2K | $429.15 | 3.26x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 119 | $6.7K | $56.60 | 1.77x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 37 | $3.6K | $96.24 | 2.05x |
| 99215 | Established patient outpatient visit, total time 40-54 minutes | 25 | $3.4K | $134.57 | 1.73x |
This provider submits charges 2.31 times higher than what Medicare actually pays.
A markup ratio of 2.31x means for every $100 Medicare pays, this provider initially charges $231. 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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