This provider's $7.6M in total Medicare payments ranks in the 97th percentile of Ophthalmology providers nationally.
Their average markup ratio of 6.69x is significantly above the specialty median of 2.9x.
Medicare payments to this provider grew 146% from 2014 to 2023.
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 | $1.7K | $223.48 | 7.76x | $1.5K | $451.7K | 4.8K | 2.1K |
| 2015 | $2.1K | $219.91 | 9.59x | $1.9K | $572.4K | 5.7K | 2.3K |
| 2016 | $3.0K | $250.93 | 11.81x | $2.7K | $615.7K | 6.1K | 2.5K |
| 2017 | $1.7K | $181.06 | 9.52x | $1.5K | $597.0K | 6.6K | 2.7K |
| 2018 | $2.4K | $246.39 | 9.88x | $2.2K | $621.8K | 7.2K | 2.7K |
| 2019 | $2.1K | $200.91 | 10.48x | $1.9K | $664.1K | 7.6K | 3.1K |
| 2020 | $2.5K | $226.83 | 10.96x | $2.3K | $734.6K | 7.7K | 3.2K |
| 2021 | $2.8K | $252.65 | 11.10x | $2.6K | $1.0M | 8.8K | 3.7K |
| 2022 | $3.0K | $331.70 | 9.10x | $2.7K | $1.2M | 9.4K | 3.9K |
| 2023 | $2.1K | $182.98 | 11.65x | $1.9K | $1.1M | 9.5K | 4.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 4.2K | $3.1M | $738.11 | 2.93x |
| 67028 | Injection of drug into eye | 13.1K | $1.1M | $85.85 | 19.64x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 13.1K | $682.3K | $52.23 | 3.61x |
| 92134 | Diagnostic imaging of retina | 21.3K | $616.1K | $28.91 | 5.61x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 6.4K | $560.1K | $87.26 | 3.51x |
| J9035 | Injection, bevacizumab, 10 mg | 9.3K | $466.0K | $49.85 | 1.78x |
| 67042 | Removal of membrane from the retina, pars plana approach | 239 | $209.8K | $877.71 | 13.15x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 110 | $101.8K | $925.41 | 13.97x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 268 | $94.1K | $350.95 | 13.72x |
| 65800 | Aspiration of eye fluid | 790 | $75.4K | $95.45 | 13.81x |
| J3590 | Unclassified biologics | 32 | $65.7K | $2.1K | 2.43x |
| 67113 | Repair of detached retina and drainage of eye fluid between lens and retina | 59 | $57.6K | $976.13 | 12.67x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 104 | $55.5K | $533.89 | 17.31x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 338 | $39.8K | $117.62 | 3.94x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 486 | $39.1K | $80.55 | 8.81x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 330 | $36.2K | $109.74 | 2.60x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 465 | $33.5K | $72.04 | 3.83x |
| 76512 | Ultrasound of eye disease, growth, or structure | 605 | $29.3K | $48.38 | 17.33x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 40 | $27.0K | $675.52 | 12.96x |
| J2778 | Injection, ranibizumab, 0.1 mg | 80 | $24.9K | $310.85 | 2.30x |
This provider submits charges 6.69 times higher than what Medicare actually pays.
A markup ratio of 6.69x means for every $100 Medicare pays, this provider initially charges $669. 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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