This provider's $4.5M in total Medicare payments ranks in the 96th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 283% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 80% in 2015
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 | $127.96 | $63.62 | 2.01x | $64.34 | $146.7K | 2.3K | 1.6K |
| 2015 | $190.55 | $110.18 | 1.73x | $80.37 | $263.4K | 3.3K | 1.9K |
| 2016 | $186.31 | $106.98 | 1.74x | $79.33 | $317.8K | 3.7K | 1.7K |
| 2017 | $182.76 | $103.13 | 1.77x | $79.63 | $375.8K | 4.1K | 1.8K |
| 2018 | $303.80 | $134.31 | 2.26x | $169.49 | $625.1K | 5.4K | 2.2K |
| 2019 | $269.49 | $123.55 | 2.18x | $145.94 | $601.2K | 5.4K | 2.1K |
| 2020 | $254.21 | $102.91 | 2.47x | $151.30 | $504.5K | 4.3K | 1.8K |
| 2021 | $310.25 | $128.12 | 2.42x | $182.13 | $557.3K | 4.6K | 1.7K |
| 2022 | $387.96 | $113.98 | 3.40x | $273.98 | $578.3K | 4.6K | 1.5K |
| 2023 | $430.17 | $131.46 | 3.27x | $298.71 | $561.7K | 4.7K | 1.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2.8K | $2.1M | $736.18 | 1.94x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 9.8K | $863.9K | $88.11 | 2.88x |
| 92134 | Diagnostic imaging of retina | 15.4K | $499.5K | $32.36 | 2.87x |
| 67028 | Injection of drug into eye | 5.2K | $431.7K | $82.82 | 2.86x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 3.4K | $303.1K | $89.73 | 2.93x |
| J9035 | Injection, bevacizumab, 10 mg | 1.9K | $108.6K | $57.38 | 1.72x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 379 | $41.3K | $108.93 | 2.36x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 470 | $39.2K | $83.35 | 2.51x |
| 92250 | Photography of the retina | 653 | $30.7K | $47.09 | 2.60x |
| 92083 | Measurement of field of vision during daylight conditions | 494 | $24.5K | $49.62 | 2.50x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 354 | $23.1K | $65.19 | 1.91x |
| J2778 | Injection, ranibizumab, 0.1 mg | 70 | $20.5K | $292.35 | 1.51x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 231 | $12.6K | $54.46 | 1.99x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 393 | $9.3K | $23.70 | 2.25x |
| 92133 | Diagnostic imaging of optic nerve of eye | 292 | $9.1K | $31.04 | 2.38x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 29 | $8.3K | $285.64 | 5.48x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 14 | $5.8K | $413.55 | 2.00x |
| 76512 | Ultrasound of eye disease, growth, or structure | 75 | $5.2K | $68.77 | 2.07x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 33 | $4.1K | $122.83 | 2.50x |
| 92020 | Examination of cornea and iris using lens device and slit lamp | 184 | $4.0K | $21.66 | 2.58x |
This provider submits charges 2.39 times higher than what Medicare actually pays.
A markup ratio of 2.39x means for every $100 Medicare pays, this provider initially charges $239. 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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