This provider's $7.2M 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.
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 | $338.50 | $178.81 | 1.89x | $159.69 | $609.9K | 4.8K | 1.9K |
| 2015 | $365.33 | $194.70 | 1.88x | $170.63 | $658.9K | 4.7K | 1.8K |
| 2016 | $448.29 | $219.15 | 2.05x | $229.14 | $753.3K | 5.2K | 1.9K |
| 2017 | $379.22 | $158.81 | 2.39x | $220.41 | $759.8K | 5.3K | 2.0K |
| 2018 | $399.66 | $167.69 | 2.38x | $231.97 | $772.3K | 5.1K | 1.9K |
| 2019 | $579.07 | $244.53 | 2.37x | $334.54 | $759.8K | 4.9K | 1.7K |
| 2020 | $306.29 | $153.85 | 1.99x | $152.44 | $675.6K | 4.1K | 1.6K |
| 2021 | $392.42 | $172.49 | 2.28x | $219.93 | $827.1K | 4.7K | 1.6K |
| 2022 | $288.97 | $127.75 | 2.26x | $161.22 | $766.0K | 4.5K | 1.6K |
| 2023 | $293.88 | $130.10 | 2.26x | $163.78 | $590.9K | 4.6K | 1.8K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 5.4K | $4.0M | $742.60 | 1.48x |
| J2778 | Injection, ranibizumab, 0.1 mg | 2.8K | $803.6K | $283.25 | 1.93x |
| 67028 | Injection of drug into eye | 8.8K | $766.9K | $86.93 | 3.46x |
| 92134 | Diagnostic imaging of retina | 18.1K | $581.2K | $32.07 | 2.84x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 4.9K | $434.4K | $89.27 | 2.31x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 4.8K | $266.8K | $56.14 | 2.34x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 812 | $89.9K | $110.66 | 2.27x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 569 | $52.5K | $92.23 | 2.31x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 71 | $32.9K | $463.40 | 2.91x |
| 92250 | Photography of the retina | 607 | $25.6K | $42.14 | 2.94x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 168 | $21.0K | $124.88 | 2.45x |
| 67042 | Removal of membrane from the retina, pars plana approach | 20 | $18.2K | $908.09 | 2.35x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 174 | $16.3K | $93.66 | 2.24x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 11 | $10.4K | $944.49 | 3.03x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 333 | $9.7K | $29.08 | 1.61x |
| 76512 | Ultrasound of eye disease, growth, or structure | 134 | $7.1K | $53.02 | 2.56x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 13 | $5.8K | $446.13 | 2.97x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 90 | $5.4K | $59.52 | 2.02x |
| J9035 | Injection, bevacizumab, 10 mg | 39 | $2.0K | $52.31 | 1.91x |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 17 | $1.2K | $69.22 | 3.13x |
This provider submits charges 1.98 times higher than what Medicare actually pays.
A markup ratio of 1.98x means for every $100 Medicare pays, this provider initially charges $198. 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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