This provider's $3.7M in total Medicare payments ranks in the 95th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 57359% from 2016 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 2423% in 2017
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 |
|---|---|---|---|---|---|---|---|
| 2016 | $68.64 | $44.97 | 1.53x | $23.67 | $1.1K | 26 | 23 |
| 2017 | $298.83 | $100.17 | 2.98x | $198.66 | $28.4K | 256 | 224 |
| 2018 | $535.33 | $202.82 | 2.64x | $332.51 | $222.3K | 1.8K | 1.4K |
| 2019 | $651.08 | $228.04 | 2.86x | $423.04 | $676.8K | 5.9K | 2.7K |
| 2020 | $568.96 | $209.04 | 2.72x | $359.92 | $497.9K | 5.4K | 2.2K |
| 2021 | $849.23 | $257.21 | 3.30x | $592.02 | $802.6K | 7.3K | 3.2K |
| 2022 | $757.91 | $224.15 | 3.38x | $533.76 | $803.9K | 7.6K | 3.0K |
| 2023 | $834.46 | $241.64 | 3.45x | $592.82 | $646.2K | 7.4K | 2.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 1.2K | $884.2K | $730.71 | 1.71x |
| 67028 | Injection of drug into eye | 6.0K | $508.7K | $84.18 | 2.72x |
| 92134 | Diagnostic imaging of retina | 11.8K | $355.9K | $30.24 | 2.96x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 3.4K | $312.6K | $90.65 | 2.48x |
| J2778 | Injection, ranibizumab, 0.1 mg | 1.2K | $279.4K | $232.09 | 2.07x |
| 67042 | Removal of membrane from the retina, pars plana approach | 362 | $217.1K | $599.86 | 3.10x |
| J9035 | Injection, bevacizumab, 10 mg | 3.1K | $181.6K | $57.83 | 2.21x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 161 | $153.9K | $956.04 | 3.66x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 787 | $94.3K | $119.83 | 2.57x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 244 | $85.8K | $351.71 | 2.51x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.3K | $84.5K | $63.14 | 3.09x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 959 | $62.8K | $65.45 | 2.60x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 387 | $61.4K | $158.61 | 1.77x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 366 | $56.4K | $154.23 | 2.57x |
| 67039 | Laser destruction of eye fluid (vitreous) between the lens and retina, focal | 65 | $49.3K | $758.92 | 5.17x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 63 | $41.1K | $652.14 | 4.58x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 355 | $39.7K | $111.71 | 2.46x |
| 92235 | Imaging of blood vessels in back of eye using fluorescein dye | 427 | $39.0K | $91.29 | 2.28x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 385 | $30.2K | $78.32 | 2.89x |
| 67113 | Repair of detached retina and drainage of eye fluid between lens and retina | 88 | $28.6K | $325.54 | 3.64x |
This provider submits charges 2.54 times higher than what Medicare actually pays.
A markup ratio of 2.54x means for every $100 Medicare pays, this provider initially charges $254. 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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