This provider averages 63 services per working day
Based on 158.5K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $29.4M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 63 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 384% 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 176% 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 | $412.10 | $191.45 | 2.15x | $220.65 | $756.2K | 4.0K | 16 |
| 2015 | $318.49 | $172.18 | 1.85x | $146.31 | $2.1M | 12.1K | 17 |
| 2016 | $412.03 | $183.37 | 2.25x | $228.66 | $2.2M | 12.3K | 18 |
| 2017 | $454.24 | $208.52 | 2.18x | $245.72 | $2.8M | 13.2K | 19 |
| 2018 | $499.34 | $216.29 | 2.31x | $283.05 | $3.2M | 14.8K | 18 |
| 2019 | $550.23 | $234.38 | 2.35x | $315.85 | $3.4M | 14.7K | 17 |
| 2020 | $700.01 | $247.15 | 2.83x | $452.86 | $3.6M | 14.7K | 16 |
| 2021 | $1.4K | $263.05 | 5.24x | $1.1K | $3.9M | 15.0K | 16 |
| 2022 | $969.47 | $192.69 | 5.03x | $776.78 | $3.7M | 19.2K | 16 |
| 2023 | $433.97 | $95.04 | 4.57x | $338.93 | $3.7M | 38.5K | 16 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 28.7K | $21.2M | $737.96 | 3.23x |
| 67028 | Injection of drug into eye | 24.2K | $2.1M | $86.21 | 4.91x |
| 92134 | Imaging of retina | 36.1K | $1.1M | $30.79 | 3.82x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 31.1K | $899.6K | $28.89 | 1.38x |
| J3590 | Unclassified biologics | 10.9K | $640.9K | $58.95 | 3.66x |
| J2778 | Injection, ranibizumab, 0.1 mg | 2.0K | $590.0K | $297.83 | 1.94x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 5.6K | $467.6K | $84.17 | 3.38x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 2.5K | $385.4K | $157.30 | 2.85x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 6.9K | $375.6K | $54.62 | 3.47x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 405 | $356.0K | $878.94 | 4.06x |
| J3490 | Unclassified drugs | 196 | $352.9K | $1.8K | 3.89x |
| 92014 | Established patient complete exam of visual system | 2.8K | $229.2K | $82.49 | 4.46x |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 846 | $210.9K | $249.27 | 2.63x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 1.8K | $133.5K | $75.96 | 3.81x |
| 67210 | Destruction of growth of retina using a laser | 261 | $102.1K | $391.29 | 4.35x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 679 | $78.7K | $115.87 | 3.36x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 198 | $57.6K | $290.90 | 7.76x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 644 | $41.2K | $64.03 | 2.45x |
| 92250 | Photography of the retina | 821 | $34.6K | $42.18 | 3.41x |
| 67113 | Repair of detached retina and drainage of eye fluid between lens and retina | 26 | $24.3K | $934.94 | 3.74x |
This provider submits charges 3.34 times higher than what Medicare actually pays.
A markup ratio of 3.34x means for every $100 Medicare pays, this provider initially charges $334. 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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