This provider's $4.8M 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.
Notable: Payments increased 102% in 2018
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 | $695.59 | $196.45 | 3.54x | $499.14 | $750.4K | 8.9K | 2.9K |
| 2015 | $500.08 | $166.74 | 3.00x | $333.34 | $522.6K | 6.0K | 3.2K |
| 2016 | $219.38 | $130.05 | 1.69x | $89.33 | $443.8K | 4.4K | 2.0K |
| 2017 | $442.37 | $113.73 | 3.89x | $328.64 | $163.4K | 2.4K | 1.0K |
| 2018 | $325.40 | $142.49 | 2.28x | $182.91 | $330.7K | 4.8K | 1.4K |
| 2019 | $541.19 | $174.74 | 3.10x | $366.45 | $417.3K | 5.0K | 1.7K |
| 2020 | $401.02 | $140.26 | 2.86x | $260.76 | $482.3K | 5.6K | 2.3K |
| 2021 | $443.72 | $158.55 | 2.80x | $285.17 | $634.9K | 7.2K | 2.1K |
| 2022 | $379.42 | $134.02 | 2.83x | $245.40 | $591.5K | 6.8K | 2.1K |
| 2023 | $283.81 | $133.76 | 2.12x | $150.05 | $478.2K | 6.2K | 2.0K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 1.7K | $1.3M | $744.67 | 1.88x |
| 67028 | Injection of drug into eye | 12.6K | $977.1K | $77.78 | 4.24x |
| 92134 | Diagnostic imaging of retina | 15.9K | $476.2K | $30.04 | 3.50x |
| J9035 | Injection, bevacizumab, 10 mg | 8.0K | $454.9K | $56.55 | 1.80x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 6.8K | $401.5K | $59.33 | 2.55x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 4.2K | $353.3K | $84.33 | 2.56x |
| J2778 | Injection, ranibizumab, 0.1 mg | 1.2K | $316.6K | $262.56 | 2.47x |
| 92250 | Photography of the retina | 3.0K | $113.1K | $38.19 | 3.79x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 880 | $100.7K | $114.41 | 3.03x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 244 | $84.8K | $347.57 | 4.96x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 512 | $52.4K | $102.31 | 2.15x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 661 | $50.1K | $75.73 | 3.25x |
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | 235 | $40.1K | $170.79 | 2.34x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 257 | $37.4K | $145.38 | 3.06x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 47 | $18.6K | $395.35 | 3.56x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 30 | $12.2K | $405.12 | 3.75x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 339 | $6.8K | $20.18 | 1.74x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 194 | $5.6K | $29.04 | 1.68x |
| 65800 | Aspiration of eye fluid | 51 | $4.6K | $90.61 | 3.46x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 221 | $4.1K | $18.53 | 1.83x |
This provider submits charges 2.82 times higher than what Medicare actually pays.
A markup ratio of 2.82x means for every $100 Medicare pays, this provider initially charges $282. 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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