This provider's $9.0M 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 | $446.40 | $229.53 | 1.94x | $216.87 | $825.6K | 5.6K | 2.3K |
| 2015 | $571.57 | $260.62 | 2.19x | $310.95 | $876.9K | 5.3K | 2.3K |
| 2016 | $649.44 | $258.31 | 2.51x | $391.13 | $945.3K | 5.6K | 2.4K |
| 2017 | $463.47 | $213.16 | 2.17x | $250.31 | $882.9K | 5.1K | 2.2K |
| 2018 | $410.61 | $191.21 | 2.15x | $219.40 | $1.0M | 5.8K | 2.2K |
| 2019 | $488.25 | $206.77 | 2.36x | $281.48 | $1.2M | 5.9K | 2.0K |
| 2020 | $365.35 | $182.67 | 2.00x | $182.68 | $1.0M | 5.0K | 1.8K |
| 2021 | $320.28 | $145.22 | 2.21x | $175.06 | $1.0M | 4.8K | 1.5K |
| 2022 | $295.50 | $135.09 | 2.19x | $160.41 | $924.6K | 4.5K | 1.4K |
| 2023 | $358.73 | $159.46 | 2.25x | $199.27 | $355.3K | 2.9K | 960 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 7.1K | $5.3M | $746.78 | 1.47x |
| J2778 | Injection, ranibizumab, 0.1 mg | 3.9K | $1.1M | $284.91 | 1.93x |
| 67028 | Injection of drug into eye | 12.1K | $1.1M | $88.54 | 3.67x |
| 92134 | Diagnostic imaging of retina | 17.2K | $565.2K | $32.90 | 2.79x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 3.2K | $277.4K | $87.99 | 2.27x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.5K | $137.6K | $54.59 | 2.37x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 620 | $67.9K | $109.57 | 2.25x |
| 67042 | Removal of membrane from the retina, pars plana approach | 70 | $66.7K | $952.21 | 2.24x |
| 92250 | Photography of the retina | 1.1K | $58.3K | $54.38 | 2.41x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 81 | $51.9K | $640.26 | 2.04x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 383 | $47.5K | $124.02 | 2.47x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 381 | $46.6K | $122.34 | 2.22x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 37 | $37.9K | $1.0K | 2.80x |
| 92240 | Examination of eye using an endoscope | 93 | $35.0K | $376.24 | 2.23x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 308 | $25.5K | $82.87 | 2.26x |
| 92242 | Imaging of blood vessels in back of eye using fluorescein and indocyanine-green dye | 95 | $17.4K | $183.47 | 2.01x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 556 | $16.0K | $28.85 | 1.62x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 28 | $15.5K | $555.22 | 3.13x |
| J9035 | Injection, bevacizumab, 10 mg | 211 | $11.5K | $54.32 | 1.86x |
| 76512 | Ultrasound of eye disease, growth, or structure | 184 | $10.8K | $58.44 | 2.69x |
This provider submits charges 1.96 times higher than what Medicare actually pays.
A markup ratio of 1.96x means for every $100 Medicare pays, this provider initially charges $196. This is lower 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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