This provider's $15.9M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 10205% from 2014 to 2023.
72% 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 1026% in 2015
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 | $349.41 | $140.11 | 2.49x | $209.30 | $29.7K | 212 | 4 |
| 2015 | $331.85 | $111.61 | 2.97x | $220.24 | $334.4K | 3.0K | 13 |
| 2016 | $346.29 | $125.55 | 2.76x | $220.74 | $593.2K | 4.7K | 11 |
| 2017 | $397.83 | $165.45 | 2.40x | $232.38 | $1.1M | 6.4K | 13 |
| 2018 | $443.54 | $203.28 | 2.18x | $240.26 | $1.4M | 7.1K | 11 |
| 2019 | $621.33 | $269.11 | 2.31x | $352.22 | $2.3M | 8.5K | 11 |
| 2020 | $696.05 | $289.62 | 2.40x | $406.43 | $2.3M | 7.8K | 11 |
| 2021 | $704.21 | $291.94 | 2.41x | $412.27 | $2.4M | 8.4K | 11 |
| 2022 | $727.97 | $299.54 | 2.43x | $428.43 | $2.4M | 8.0K | 10 |
| 2023 | $483.48 | $190.39 | 2.54x | $293.09 | $3.1M | 16.1K | 11 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 15.6K | $11.4M | $732.19 | 2.04x |
| 67028 | Injection of drug into eye | 12.5K | $1.1M | $84.13 | 5.68x |
| J2778 | Injection, ranibizumab, 0.1 mg | 1.7K | $462.8K | $269.84 | 2.21x |
| 92134 | Imaging of retina | 16.3K | $456.2K | $27.94 | 3.33x |
| 92014 | Established patient complete exam of visual system | 5.2K | $429.4K | $83.11 | 2.64x |
| J3490 | Unclassified drugs | 232 | $409.4K | $1.8K | 2.55x |
| J7999 | Compounded drug, not otherwise classified | 6.2K | $393.7K | $63.77 | 1.92x |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 2.1K | $258.2K | $120.36 | 2.49x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 2.1K | $234.8K | $110.62 | 2.70x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 5.2K | $152.0K | $29.11 | 2.32x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 1.6K | $132.4K | $85.03 | 2.69x |
| 67041 | Removal of membrane from the retina | 142 | $117.5K | $827.69 | 4.23x |
| J3590 | Unclassified biologics | 418 | $99.3K | $237.63 | 2.17x |
| 67113 | Repair of detached retina and drainage of eye fluid between lens and retina | 79 | $85.2K | $1.1K | 4.64x |
| 67042 | Removal of membrane from the retina, pars plana approach | 63 | $52.7K | $836.99 | 4.18x |
| 67036 | Removal of eye fluid (vitreous) between lens and retina | 77 | $49.9K | $648.37 | 4.32x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 101 | $36.4K | $360.77 | 4.12x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 32 | $27.6K | $860.99 | 5.08x |
| J9035 | Injection, bevacizumab, 10 mg | 218 | $10.9K | $49.93 | 2.49x |
| Q9977 | Compounded Drug, Not Otherwise Classified | 127 | $6.7K | $52.85 | 1.89x |
This provider submits charges 2.43 times higher than what Medicare actually pays.
A markup ratio of 2.43x means for every $100 Medicare pays, this provider initially charges $243. 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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