This provider's $8.7M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 51% from 2014 to 2023.
64% 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 | $271.82 | $147.25 | 1.85x | $124.57 | $592.0K | 4.5K | 2.0K |
| 2015 | $278.01 | $146.00 | 1.90x | $132.01 | $738.8K | 5.4K | 1.9K |
| 2016 | $280.76 | $149.82 | 1.87x | $130.94 | $871.1K | 5.4K | 2.1K |
| 2017 | $279.09 | $147.85 | 1.89x | $131.24 | $887.3K | 5.1K | 1.8K |
| 2018 | $504.08 | $214.49 | 2.35x | $289.59 | $918.6K | 5.2K | 1.8K |
| 2019 | $273.57 | $138.61 | 1.97x | $134.96 | $943.8K | 5.7K | 2.0K |
| 2020 | $507.57 | $212.71 | 2.39x | $294.86 | $923.5K | 5.7K | 2.1K |
| 2021 | $425.17 | $181.55 | 2.34x | $243.62 | $989.3K | 6.2K | 2.5K |
| 2022 | $239.00 | $118.21 | 2.02x | $120.79 | $921.0K | 5.8K | 2.3K |
| 2023 | $238.89 | $109.87 | 2.17x | $129.02 | $894.0K | 5.9K | 2.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 7.5K | $5.5M | $740.07 | 1.45x |
| 67028 | Injection of drug into eye | 11.5K | $1.0M | $87.25 | 6.43x |
| 92134 | Diagnostic imaging of retina | 19.2K | $642.3K | $33.47 | 1.94x |
| J2778 | Injection, ranibizumab, 0.1 mg | 1.5K | $406.4K | $273.33 | 1.77x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 6.2K | $395.9K | $63.40 | 1.88x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 2.0K | $186.7K | $93.63 | 1.49x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.0K | $127.2K | $123.70 | 1.69x |
| J9035 | Injection, bevacizumab, 10 mg | 2.2K | $118.7K | $52.97 | 1.47x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 555 | $64.5K | $116.14 | 1.60x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 842 | $44.7K | $53.04 | 2.20x |
| 92250 | Photography of the retina | 990 | $39.5K | $39.89 | 2.58x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 42 | $38.4K | $914.03 | 3.02x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 292 | $28.6K | $97.85 | 1.47x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 201 | $23.8K | $118.23 | 2.00x |
| 76512 | Ultrasound of eye disease, growth, or structure | 223 | $11.5K | $51.42 | 4.32x |
| 92201 | Extended examination of eye with drawing of retina | 222 | $4.3K | $19.30 | 2.95x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 64 | $1.9K | $28.99 | 2.01x |
| 92202 | Extended examination of eye with drawing of optic nerve and surrounding area (macula) | 133 | $1.6K | $12.00 | 4.75x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 52 | $1.4K | $27.29 | 2.60x |
This provider submits charges 2.12 times higher than what Medicare actually pays.
A markup ratio of 2.12x means for every $100 Medicare pays, this provider initially charges $212. 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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