This provider's $3.8M in total Medicare payments ranks in the 95th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 17160% from 2016 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 662% in 2018
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 | $2.8K | $64.45 | 43.86x | $2.8K | $4.7K | 82 | 78 |
| 2017 | $6.9K | $103.93 | 66.34x | $6.8K | $18.0K | 197 | 188 |
| 2018 | $1.8K | $150.57 | 12.12x | $1.7K | $136.9K | 1.4K | 794 |
| 2019 | $466.52 | $192.62 | 2.42x | $273.90 | $496.7K | 4.6K | 1.5K |
| 2020 | $365.65 | $151.76 | 2.41x | $213.89 | $649.0K | 5.0K | 1.9K |
| 2021 | $423.34 | $180.03 | 2.35x | $243.31 | $843.9K | 5.6K | 1.6K |
| 2022 | $533.47 | $215.61 | 2.47x | $317.86 | $865.7K | 5.7K | 1.6K |
| 2023 | $664.49 | $110.93 | 5.99x | $553.56 | $811.1K | 5.7K | 1.6K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 3.3K | $2.3M | $718.41 | 1.63x |
| 67028 | Injection of drug into eye | 7.4K | $639.3K | $86.76 | 10.84x |
| 92134 | Diagnostic imaging of retina | 9.8K | $288.1K | $29.48 | 3.93x |
| J9035 | Injection, bevacizumab, 10 mg | 3.8K | $211.9K | $55.89 | 2.46x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.3K | $76.2K | $60.20 | 3.48x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 624 | $71.7K | $114.88 | 3.30x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 863 | $52.3K | $60.60 | 3.01x |
| J2778 | Injection, ranibizumab, 0.1 mg | 131 | $33.8K | $258.31 | 1.54x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 83 | $33.8K | $407.16 | 21.87x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 223 | $15.9K | $71.09 | 4.01x |
| 67041 | Removal of membrane from the retina | 50 | $15.7K | $313.25 | 25.07x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 18 | $7.4K | $408.48 | 3.22x |
| 92235 | Imaging of blood vessels in back of eye using fluorescein dye | 88 | $6.9K | $78.36 | 2.39x |
| 92250 | Photography of the retina | 156 | $5.3K | $33.66 | 4.24x |
| 76512 | Ultrasound of eye disease, growth, or structure | 112 | $4.6K | $40.84 | 7.18x |
| 67228 | Destruction of leaking blood vessels of retina using laser | 18 | $4.4K | $245.58 | 2.96x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 46 | $3.9K | $84.78 | 4.43x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 122 | $3.5K | $28.92 | 4.70x |
| 67113 | Repair of detached retina and drainage of eye fluid between lens and retina | 16 | $2.6K | $164.25 | 71.83x |
| 92014 | Established patient complete exam of visual system | 25 | $2.2K | $88.83 | 5.58x |
This provider submits charges 3.9 times higher than what Medicare actually pays.
A markup ratio of 3.9x means for every $100 Medicare pays, this provider initially charges $390. 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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