This provider's $8.4M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
This provider's billing patterns fall within normal ranges for their specialty.
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 | $545.03 | $177.40 | 3.07x | $367.63 | $1.2M | 13.2K | 3.3K |
| 2015 | $518.11 | $152.68 | 3.39x | $365.43 | $969.4K | 11.7K | 3.2K |
| 2016 | $424.20 | $107.19 | 3.96x | $317.01 | $860.5K | 9.7K | 3.1K |
| 2017 | $403.20 | $134.50 | 3.00x | $268.70 | $814.4K | 9.3K | 3.0K |
| 2018 | $485.61 | $117.77 | 4.12x | $367.84 | $704.8K | 7.8K | 2.7K |
| 2019 | $405.63 | $133.61 | 3.04x | $272.02 | $779.0K | 7.4K | 2.7K |
| 2020 | $390.78 | $136.11 | 2.87x | $254.67 | $677.5K | 5.8K | 2.1K |
| 2021 | $420.57 | $143.44 | 2.93x | $277.13 | $790.9K | 5.7K | 2.1K |
| 2022 | $686.18 | $248.16 | 2.77x | $438.02 | $935.8K | 5.3K | 1.8K |
| 2023 | $680.96 | $251.99 | 2.70x | $428.97 | $754.8K | 4.7K | 1.6K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 9.9K | $3.7M | $374.92 | 2.27x |
| 67028 | Injection of drug into eye | 19.5K | $1.5M | $77.38 | 7.43x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 9.1K | $633.7K | $69.27 | 3.71x |
| 92134 | Diagnostic imaging of retina | 20.1K | $565.3K | $28.08 | 3.56x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 8.3K | $461.9K | $55.41 | 2.22x |
| J9035 | Injection, bevacizumab, 10 mg | 5.0K | $278.6K | $55.32 | 4.30x |
| J3590 | Unclassified biologics | 108 | $188.7K | $1.7K | 2.70x |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 801 | $173.1K | $216.16 | 2.37x |
| J3490 | Unclassified drugs | 94 | $166.2K | $1.8K | 2.49x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 1.9K | $141.9K | $73.88 | 1.69x |
| J2778 | Injection, ranibizumab, 0.1 mg | 736 | $112.1K | $152.36 | 2.38x |
| J7999 | Compounded drug, not otherwise classified | 1.5K | $109.3K | $71.89 | 4.88x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 270 | $102.5K | $379.60 | 4.05x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 1.0K | $95.3K | $93.54 | 2.54x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 207 | $27.3K | $132.01 | 2.00x |
| 67042 | Removal of membrane from the retina, pars plana approach | 24 | $27.3K | $1.1K | 3.03x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 254 | $25.9K | $102.00 | 1.78x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 65 | $25.7K | $395.46 | 6.04x |
| 92250 | Photography of the retina | 590 | $23.7K | $40.12 | 3.69x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 103 | $15.9K | $154.25 | 1.68x |
This provider submits charges 3.53 times higher than what Medicare actually pays.
A markup ratio of 3.53x means for every $100 Medicare pays, this provider initially charges $353. 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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