This provider's $7.4M in total Medicare payments ranks in the 97th 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.
Notable: Payments increased 131% in 2022
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 |
|---|---|---|---|---|---|---|---|
| 2014 | $486.43 | $171.63 | 2.83x | $314.80 | $732.6K | 5.9K | 2.6K |
| 2015 | $450.47 | $158.86 | 2.84x | $291.61 | $765.3K | 5.9K | 2.6K |
| 2016 | $517.63 | $140.76 | 3.68x | $376.87 | $787.8K | 6.1K | 2.7K |
| 2017 | $362.19 | $115.62 | 3.13x | $246.57 | $793.2K | 6.0K | 2.7K |
| 2018 | $360.19 | $106.41 | 3.38x | $253.78 | $780.5K | 6.0K | 2.6K |
| 2019 | $502.54 | $128.68 | 3.91x | $373.86 | $805.2K | 6.1K | 2.5K |
| 2020 | $391.71 | $119.70 | 3.27x | $272.01 | $578.3K | 4.6K | 1.9K |
| 2021 | $366.84 | $110.15 | 3.33x | $256.69 | $395.3K | 3.1K | 1.7K |
| 2022 | $797.57 | $278.77 | 2.86x | $518.80 | $912.7K | 4.4K | 2.0K |
| 2023 | $712.08 | $293.64 | 2.43x | $418.44 | $868.5K | 5.4K | 2.6K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 5.7K | $4.2M | $740.05 | 1.93x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 10.3K | $1.0M | $97.85 | 2.41x |
| 67028 | Injection of drug into eye | 7.7K | $722.3K | $93.96 | 7.73x |
| 92134 | Diagnostic imaging of retina | 10.2K | $337.0K | $33.13 | 7.59x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 8.2K | $239.2K | $29.13 | 4.63x |
| J2778 | Injection, ranibizumab, 0.1 mg | 770 | $203.5K | $264.29 | 2.15x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 1.3K | $111.1K | $82.91 | 2.15x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 954 | $110.8K | $116.18 | 2.31x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.5K | $83.4K | $56.54 | 2.15x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 978 | $65.6K | $67.05 | 2.31x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 129 | $50.1K | $388.34 | 5.39x |
| J7999 | Compounded drug, not otherwise classified | 677 | $43.5K | $64.22 | 4.52x |
| 92083 | Measurement of field of vision during daylight conditions | 769 | $39.8K | $51.79 | 3.76x |
| J3590 | Unclassified biologics | 18 | $38.2K | $2.1K | 1.86x |
| J3490 | Unclassified drugs | 15 | $26.5K | $1.8K | 3.10x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 181 | $24.5K | $135.22 | 2.83x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 609 | $21.3K | $34.91 | 4.99x |
| 92202 | Extended examination of eye with drawing of optic nerve and surrounding area (macula) | 1.6K | $20.6K | $12.85 | 7.43x |
| 92250 | Photography of the retina | 356 | $16.0K | $44.91 | 4.45x |
| 92133 | Diagnostic imaging of optic nerve of eye | 442 | $13.5K | $30.50 | 9.58x |
This provider submits charges 3.03 times higher than what Medicare actually pays.
A markup ratio of 3.03x means for every $100 Medicare pays, this provider initially charges $303. 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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