Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Utah for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Utah only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Utah (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Joshua Carlson (NPI 1093943086)

Field	Value
Entity Type	Individual
Organization	Joshua Carlson
Address	585 E Riverside Drive
City	St George
State	UT
ZIP	84790
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	June 29, 2009

Payer Source	Total Paid
Medicare	$2.6M
Medicaid	$0

Key Findings

This provider is effectively single-payer in scale: total Medicare revenue is $2.6M while Medicaid revenue is none, so operations and revenue risk are concentrated in the Medicare population rather than a mixed Medicaid/Medicare payer mix. That concentration should be treated as a Medicare-focused business profile for payer negotiations and utilization reviews.

Revenue concentration is extremely high in a small set of intravitreal therapy codes: J0178 accounts for 40.8% of Medicare revenue, J2777 accounts for 38.8%, and 67028 accounts for 6.3% — together the top 3 Medicare codes by revenue account for 85.9% of this provider's total Medicare revenue. This indicates financial dependence on a few high-volume drug/injection services rather than distributed E/M or ancillary revenue.

The code mix is characteristic of an active retina practice centered on intravitreal pharmacotherapy and retinal diagnostics: large volumes of J0178 (aflibercept) and J2777 (faricimab) reflect routine anti‑VEGF and related inhibitor injections, 67028 reflects isolated intravitreal injection procedures, and high-volume 92134 imaging supports ongoing monitoring of medically treated retinal disease. The presence of both frequent injection codes and extensive imaging activity points to an injection-clinic workflow with substantial follow-up and monitoring.

J2777 shows a comparatively strong national standing: 35K claims generating $1M in revenue and a national rank of #216 of 2039 providers (89th percentile, described as typical, unremarkable volume but high relative to peers). This suggests the provider is a high-volume user of faricimab relative to most peers nationally and likely manages a large population of medically treated retinal disease.

By contrast, J0178 (1.5K claims, $1.1M revenue) ranks #789 of 3204 providers (75th percentile, typical, unremarkable volume), indicating solid but not top-tier national volume for aflibercept injections. The practice participates meaningfully in aflibercept treatment but is not a dominant national outlier for that specific drug.

Diagnostic imaging is an outlier: 92134 has 2.4K claims, $68.6K revenue, and ranks #690 of 26868 providers (97th percentile; extreme outlier, far above typical national volume). That unusually high OCT/imaging throughput aligns with the heavy injection regimen and indicates strong capacity for high-frequency monitoring and follow-up care.

The provider also reports a measurable surgical retina footprint: 67042 (48 claims, $40.2K, rank #110 of 1087, 90th percentile) and 67036 (42 claims, $27.8K, rank #110 of 832, 87th percentile) indicate a modest but meaningful volume of posterior-segment surgical procedures alongside the injection practice. These procedure-level revenues show the practice performs discrete surgical interventions in addition to medical retina management.

Tenure is long enough to support established referral patterns: the NPI was enumerated 2009-06-29 (~17 years ago), which is consistent with a sustained presence in ST GEORGE, UT. The combination of long tenure, concentrated Medicare revenue ($2.6M), and high volumes for a few retina-specific codes suggests an entrenched retina specialist practice oriented around intravitreal therapy and high-frequency imaging.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

21 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	1,540	$690	$1.1M
J2777	Injection, faricimab‑svoa, 0.1 mg	35,040	$30	$1M
67028	The provider injects a medication into the vitreous chamber of the eye as an isolated procedure or a separate procedure unrelated to any other procedure being performed on the eye.	1,890	$90	$164.3K
92134	The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes.	2,450	$30	$68.6K
J7312	Injection, dexamethasone, intravitreal implant, 0.1 mg	360	$160	$56.4K
J9035	Injection, bevacizumab, 10 mg	790	$50	$42.9K
J2778	Injection, ranibizumab, 0.1 mg	230	$180	$41.9K
67042	In this procedure, the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina…	50	$840	$40.2K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	520	$60	$29.9K
67036	The provider removes vitreous fluid from the eye to access the posterior segment of the eye and introduce surgical instruments through incisions in the pars plana.	40	$660	$27.8K

Showing 1–10 of 21

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 21 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Utah Distribution

Joshua Carlson — 3 of 21 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Utah

Full comparison — all codes billed, vs. state median

21 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	7	40	620	$690	$683.2K
J2777	4	20	13,140	$30	$523.9K
J2778	10	10	870	$180	$224.3K
67028	6	60	440	$90	$61.7K
J7312	4	10	340	$160	$52.7K
67042	2	20	20	$1,100	$26.3K
67036	2	20	20	$1,010	$24.2K
67108	5	10	20	$1,090	$18.6K
J9035	2	10	110	$50	$17.5K
92014	252	330	140	$70	$16.6K

Showing 1–10 of 21

Related Providers

Other providers that share a Tax Identification Number (TIN) with Joshua Carlson, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ihc Health Services, Inc.	UT	Children's Hospital	$0	$129.5M
Banner Hospital Based Physicians Arizona LLC	AZ	Multi-Specialty Clinic/Center	$0	$77.8M
Ihc Health Services, Inc.	UT	General Acute Care Hospital	$0	$68.7M
Ihc Health Services, Inc.	UT	General Acute Care Hospital	$0	$65.8M
Ihc Health Services Inc	UT	General Acute Care Hospital	$0	$54.1M
Ihc Health Services, Inc.	UT	General Acute Care Hospital	$0	$44.3M
Ihc Health Services Inc	UT	Home Infusion Therapy Pharmacy	$0	$38.1M
Ihc Health Services Inc	UT	Durable Medical Equipment & Medical Supplies	$0	$26.9M
Ihc Health Services Inc	UT	General Acute Care Hospital	$0	$25.3M
Ihc Health Services, Inc.	UT	Clinical Medical Laboratory	$2.7M	$17.9M

Nearby Providers

Other providers in the same ZIP code as Joshua Carlson, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Southwest Utah Community Health Center	UT	Federally Qualified Health Center (FQHC)	$0	$7.3M
Zion Eye Institute, Inc	UT	Ambulatory Surgical Clinic/Center	$6.1M	$19.7K
Summit Behavior Services	UT	Counselor	$0	$5.4M
Ihc Health Services Inc	UT	Multi-Specialty Clinic/Center	$0	$4.4M
Ron Lord	UT	Ophthalmology Physician	$3.2M	$0
St George Surgical Center LP	UT	Ambulatory Surgical Clinic/Center	$2.5M	$0
Coral Desert Surgery Center LLC	UT	Ambulatory Surgical Clinic/Center	$2.5M	$17.8K
Ihc Health Services Inc	UT	Clinical Medical Laboratory	$2.4M	$42.7K
Jerry D Twiggs Md PC	UT	Pediatric Adolescent Medicine Physician	$0	$2.2M
Ihc Health Services Inc	UT	Pediatrics Physician	$0	$2.1M

Joshua Carlson — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References