This provider's $10.2M 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 | $277.25 | $210.64 | 1.32x | $66.61 | $873.3K | 9.6K | 4.7K |
| 2015 | $323.50 | $234.93 | 1.38x | $88.57 | $890.9K | 9.8K | 4.9K |
| 2016 | $256.64 | $186.91 | 1.37x | $69.73 | $926.2K | 9.7K | 4.7K |
| 2017 | $262.40 | $197.50 | 1.33x | $64.90 | $1.1M | 10.7K | 5.5K |
| 2018 | $294.15 | $212.37 | 1.39x | $81.78 | $1.2M | 11.0K | 5.4K |
| 2019 | $249.79 | $183.31 | 1.36x | $66.48 | $1.1M | 10.4K | 5.2K |
| 2020 | $246.89 | $178.01 | 1.39x | $68.88 | $895.2K | 8.6K | 4.5K |
| 2021 | $306.85 | $233.63 | 1.31x | $73.22 | $1.1M | 9.6K | 4.6K |
| 2022 | $353.79 | $261.91 | 1.35x | $91.88 | $1.2M | 9.8K | 4.6K |
| 2023 | $316.65 | $226.39 | 1.40x | $90.26 | $1.1M | 9.5K | 4.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 3.2K | $2.3M | $738.60 | 1.27x |
| 67028 | Injection of drug into eye | 17.1K | $1.5M | $88.12 | 1.39x |
| 66984 | Removal of cataract with insertion of lens | 3.4K | $1.4M | $427.43 | 1.35x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 13.0K | $1.1M | $82.32 | 1.56x |
| 92134 | Diagnostic imaging of retina | 28.1K | $860.2K | $30.56 | 1.44x |
| J7999 | Compounded drug, not otherwise classified | 9.9K | $641.7K | $65.12 | 1.31x |
| 66821 | Removal of recurring cataract in lens capsule using laser | 1.8K | $455.9K | $257.14 | 1.37x |
| 66982 | Removal of cataract with insertion of lens | 466 | $277.7K | $595.84 | 1.40x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 4.9K | $266.2K | $54.54 | 1.45x |
| 67041 | Removal of membrane from the retina | 176 | $163.0K | $926.22 | 1.31x |
| J9035 | Injection, bevacizumab, 10 mg | 2.8K | $147.0K | $52.00 | 1.34x |
| 92136 | Measurement of corneal curvature and depth of eye | 3.5K | $145.6K | $41.11 | 1.42x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.3K | $138.6K | $108.39 | 1.60x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 1.1K | $103.6K | $94.56 | 1.64x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 1.5K | $96.1K | $62.54 | 1.43x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 1.0K | $90.3K | $86.99 | 1.49x |
| J3590 | Unclassified biologics | 47 | $85.5K | $1.8K | 1.27x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 81 | $83.5K | $1.0K | 1.37x |
| 67042 | Removal of membrane from the retina, pars plana approach | 79 | $75.9K | $960.95 | 1.30x |
| 92083 | Measurement of field of vision during daylight conditions | 1.5K | $70.9K | $45.75 | 1.44x |
This provider submits charges 1.38 times higher than what Medicare actually pays.
A markup ratio of 1.38x means for every $100 Medicare pays, this provider initially charges $138. 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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