This provider's $11.2M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
60% of their billing comes from a single procedure code (J0178 — Injection, aflibercept, 1 mg).
AI-generated analysis based on Medicare payment data.
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 | $1.1K | $333.37 | 3.43x | $810.51 | $934.8K | 5.9K | 2.4K |
| 2015 | $1.3K | $365.61 | 3.69x | $983.27 | $1.2M | 6.3K | 2.6K |
| 2016 | $1.0K | $276.78 | 3.71x | $750.46 | $1.3M | 7.1K | 2.7K |
| 2017 | $1.4K | $319.92 | 4.35x | $1.1K | $1.3M | 6.8K | 2.6K |
| 2018 | $910.40 | $239.00 | 3.81x | $671.40 | $1.1M | 5.9K | 2.3K |
| 2019 | $954.29 | $244.59 | 3.90x | $709.70 | $1.1M | 5.7K | 2.3K |
| 2020 | $1.4K | $334.87 | 4.19x | $1.1K | $1.0M | 4.8K | 2.0K |
| 2021 | $1.4K | $326.90 | 4.19x | $1.0K | $1.2M | 5.5K | 2.3K |
| 2022 | $1.4K | $336.38 | 4.12x | $1.0K | $1.0M | 4.8K | 2.0K |
| 2023 | $966.62 | $328.74 | 2.94x | $637.88 | $963.8K | 4.8K | 1.8K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 9.0K | $6.7M | $744.80 | 2.81x |
| 67028 | Injection of drug into eye | 13.1K | $1.1M | $86.96 | 5.99x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 10.9K | $962.6K | $87.98 | 2.57x |
| J2778 | Injection, ranibizumab, 0.1 mg | 3.0K | $891.0K | $293.77 | 1.94x |
| 92134 | Diagnostic imaging of retina | 15.1K | $469.0K | $30.99 | 3.23x |
| 67113 | Repair of detached retina and drainage of eye fluid between lens and retina | 167 | $186.7K | $1.1K | 4.33x |
| 67042 | Removal of membrane from the retina, pars plana approach | 188 | $178.6K | $949.75 | 4.81x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 1.1K | $129.9K | $119.47 | 3.05x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 722 | $84.9K | $117.53 | 2.51x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 80 | $82.3K | $1.0K | 5.00x |
| 92250 | Photography of the retina | 1.6K | $69.1K | $42.81 | 3.62x |
| J3490 | Unclassified drugs | 31 | $56.0K | $1.8K | 2.26x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 353 | $55.6K | $157.54 | 2.29x |
| J9035 | Injection, bevacizumab, 10 mg | 734 | $39.6K | $53.97 | 2.98x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 47 | $19.1K | $405.64 | 4.38x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 165 | $17.9K | $108.19 | 2.50x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 167 | $17.4K | $104.41 | 2.44x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 31 | $12.7K | $411.12 | 3.82x |
| 67041 | Removal of membrane from the retina | 14 | $12.5K | $890.33 | 4.50x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 15 | $11.7K | $779.04 | 2.28x |
This provider submits charges 3.15 times higher than what Medicare actually pays.
A markup ratio of 3.15x means for every $100 Medicare pays, this provider initially charges $315. 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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