This provider's $8.7M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 276% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 62% in 2016
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 | $332.53 | $207.64 | 1.60x | $124.89 | $293.9K | 3.5K | 1.6K |
| 2015 | $229.34 | $132.61 | 1.73x | $96.73 | $351.2K | 4.1K | 2.0K |
| 2016 | $345.84 | $167.92 | 2.06x | $177.92 | $568.2K | 6.4K | 2.8K |
| 2017 | $238.06 | $139.27 | 1.71x | $98.79 | $906.3K | 8.8K | 3.2K |
| 2018 | $231.44 | $134.93 | 1.72x | $96.51 | $825.2K | 8.4K | 3.4K |
| 2019 | $449.96 | $196.56 | 2.29x | $253.40 | $982.3K | 9.2K | 3.4K |
| 2020 | $250.46 | $125.26 | 2.00x | $125.20 | $1.0M | 9.3K | 3.5K |
| 2021 | $487.77 | $137.26 | 3.55x | $350.51 | $1.4M | 12.1K | 4.0K |
| 2022 | $462.49 | $138.35 | 3.34x | $324.14 | $1.2M | 10.6K | 3.6K |
| 2023 | $663.10 | $135.51 | 4.89x | $527.59 | $1.1M | 9.5K | 3.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 5.1K | $3.8M | $730.80 | 2.04x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 16.8K | $1.8M | $106.73 | 1.95x |
| 67028 | Injection of drug into eye | 9.7K | $944.6K | $97.04 | 5.14x |
| 92134 | Diagnostic imaging of retina | 18.9K | $699.4K | $36.95 | 4.82x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 2.4K | $241.8K | $101.95 | 1.91x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.5K | $199.1K | $135.09 | 1.83x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 8.5K | $189.4K | $22.33 | 2.12x |
| J2778 | Injection, ranibizumab, 0.1 mg | 602 | $166.9K | $277.26 | 1.79x |
| J9035 | Injection, bevacizumab, 10 mg | 2.4K | $141.8K | $58.19 | 1.73x |
| 92202 | Extended examination of eye with drawing of optic nerve and surrounding area (macula) | 8.3K | $116.3K | $13.92 | 5.85x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 1.2K | $105.4K | $91.25 | 2.55x |
| 92250 | Photography of the retina | 1.6K | $82.8K | $52.59 | 2.35x |
| J7999 | Compounded drug, not otherwise classified | 744 | $50.3K | $67.65 | 5.08x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 103 | $40.9K | $396.72 | 5.06x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 245 | $38.5K | $157.06 | 2.35x |
| 92201 | Extended examination of eye with drawing of retina | 1.6K | $33.7K | $21.59 | 3.87x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 1.3K | $30.3K | $24.19 | 2.19x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 222 | $25.6K | $115.19 | 2.14x |
| 76512 | Ultrasound of eye disease, growth, or structure | 317 | $20.0K | $62.98 | 3.65x |
| 67041 | Removal of membrane from the retina | 11 | $11.5K | $1.0K | 2.58x |
This provider submits charges 2.67 times higher than what Medicare actually pays.
A markup ratio of 2.67x means for every $100 Medicare pays, this provider initially charges $267. 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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