This provider's $4.6M in total Medicare payments ranks in the 96th 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 | $256.44 | $166.56 | 1.54x | $89.88 | $485.1K | 6.8K | 2.0K |
| 2015 | $261.28 | $168.02 | 1.56x | $93.26 | $507.7K | 7.3K | 2.1K |
| 2016 | $170.88 | $110.78 | 1.54x | $60.10 | $487.5K | 7.7K | 2.6K |
| 2017 | $129.46 | $79.87 | 1.62x | $49.59 | $436.9K | 8.0K | 2.4K |
| 2018 | $223.01 | $143.90 | 1.55x | $79.11 | $512.2K | 8.9K | 2.5K |
| 2019 | $159.85 | $100.04 | 1.60x | $59.81 | $537.4K | 9.1K | 2.7K |
| 2020 | $210.75 | $148.78 | 1.42x | $61.97 | $436.0K | 7.4K | 2.4K |
| 2021 | $169.71 | $93.70 | 1.81x | $76.01 | $421.2K | 6.6K | 2.4K |
| 2022 | $135.99 | $83.56 | 1.63x | $52.43 | $371.9K | 6.1K | 2.1K |
| 2023 | $266.88 | $118.15 | 2.26x | $148.73 | $390.4K | 6.1K | 2.1K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 67028 | Injection of drug into eye | 18.9K | $1.6M | $84.67 | 1.77x |
| J9035 | Injection, bevacizumab, 10 mg | 13.7K | $784.7K | $57.26 | 1.38x |
| 92134 | Diagnostic imaging of retina | 18.2K | $543.7K | $29.93 | 1.68x |
| 92250 | Photography of the retina | 7.2K | $407.4K | $56.85 | 1.53x |
| J7999 | Compounded drug, not otherwise classified | 4.9K | $320.0K | $65.62 | 1.53x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 4.7K | $271.0K | $57.19 | 1.65x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 358 | $133.0K | $371.57 | 1.43x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 992 | $104.2K | $105.00 | 1.55x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.6K | $98.9K | $60.16 | 1.80x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 507 | $59.6K | $117.46 | 1.67x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 104 | $57.7K | $554.48 | 1.58x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 498 | $38.3K | $76.96 | 1.88x |
| 76512 | Ultrasound of eye disease, growth, or structure | 521 | $28.2K | $54.10 | 1.65x |
| J0178 | Injection, aflibercept, 1 mg | 39 | $26.9K | $689.46 | 2.87x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 309 | $23.8K | $77.11 | 1.59x |
| 99214 | Established patient outpatient visit, total time 30-39 minutes | 286 | $23.3K | $81.51 | 2.06x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 49 | $19.9K | $405.37 | 1.48x |
| 67042 | Removal of membrane from the retina, pars plana approach | 13 | $11.2K | $860.59 | 1.46x |
| 67110 | Repair of detached retina by injection of air or gas | 11 | $8.0K | $726.69 | 1.36x |
| 92201 | Extended examination of eye with drawing of retina | 501 | $8.0K | $15.92 | 2.10x |
This provider submits charges 1.64 times higher than what Medicare actually pays.
A markup ratio of 1.64x means for every $100 Medicare pays, this provider initially charges $164. 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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