This provider averages 53 services per working day
Based on 105.2K total services over 8 years (250 working days/year). Learn about impossible service volumes →
This provider's $16.2M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 53 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 861% from 2016 to 2023.
68% 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 3117% in 2019
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 |
|---|---|---|---|---|---|---|---|
| 2016 | $995.56 | $333.75 | 2.98x | $661.81 | $439.6K | 1.3K | 5 |
| 2017 | $932.47 | $328.71 | 2.84x | $603.76 | $763.6K | 2.3K | 8 |
| 2018 | $213.65 | $62.28 | 3.43x | $151.37 | $27.4K | 440 | 5 |
| 2019 | $494.83 | $255.74 | 1.93x | $239.09 | $881.5K | 3.4K | 10 |
| 2020 | $522.99 | $275.26 | 1.90x | $247.73 | $2.8M | 10.2K | 13 |
| 2021 | $540.40 | $280.29 | 1.93x | $260.11 | $3.4M | 12.0K | 13 |
| 2022 | $339.16 | $172.75 | 1.96x | $166.41 | $3.7M | 21.6K | 12 |
| 2023 | $156.26 | $78.46 | 1.99x | $77.80 | $4.2M | 53.9K | 13 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 15.4K | $11.0M | $715.41 | 1.58x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 49.7K | $1.4M | $28.94 | 1.47x |
| 67028 | Injection of drug into eye | 8.6K | $785.4K | $90.91 | 6.24x |
| J3590 | Unclassified biologics | 424 | $778.2K | $1.8K | 1.50x |
| J2778 | Injection, ranibizumab, 0.1 mg | 1.6K | $466.8K | $286.23 | 2.42x |
| 92014 | Established patient complete exam of visual system | 4.9K | $447.9K | $91.82 | 3.73x |
| 92134 | Imaging of retina | 14.2K | $444.2K | $31.38 | 4.19x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 6.6K | $424.2K | $64.44 | 3.21x |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 522 | $130.4K | $249.83 | 1.44x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 1.0K | $92.4K | $90.41 | 3.25x |
| 92004 | New patient complete exam of visual system | 548 | $53.9K | $98.34 | 4.12x |
| 67108 | Repair of detached retina with drainage and removal of eye fluid between lens and retina | 50 | $45.9K | $917.14 | 4.03x |
| 92012 | Established patient problem focused exam of visual system | 447 | $30.2K | $67.63 | 3.60x |
| J9035 | Injection, bevacizumab, 10 mg | 379 | $21.6K | $56.96 | 2.52x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 105 | $16.5K | $156.79 | 1.41x |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 394 | $14.7K | $37.30 | 3.19x |
| 67036 | Removal of eye fluid (vitreous) between lens and retina | 22 | $14.4K | $656.20 | 3.71x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 24 | $10.5K | $438.53 | 3.58x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 21 | $5.5K | $259.93 | 3.83x |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 45 | $3.6K | $79.39 | 3.64x |
This provider submits charges 2.02 times higher than what Medicare actually pays.
A markup ratio of 2.02x means for every $100 Medicare pays, this provider initially charges $202. 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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