This provider's $6.4M 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 | $355.66 | $161.25 | 2.21x | $194.41 | $505.1K | 5.5K | 2.6K |
| 2015 | $386.67 | $165.57 | 2.34x | $221.10 | $600.5K | 5.9K | 2.8K |
| 2016 | $204.84 | $92.22 | 2.22x | $112.62 | $602.7K | 6.3K | 3.1K |
| 2017 | $230.24 | $96.76 | 2.38x | $133.48 | $607.1K | 6.1K | 2.9K |
| 2018 | $214.52 | $91.68 | 2.34x | $122.84 | $701.7K | 7.0K | 3.2K |
| 2019 | $233.95 | $101.04 | 2.32x | $132.91 | $679.0K | 6.4K | 3.0K |
| 2020 | $298.60 | $125.74 | 2.37x | $172.86 | $664.9K | 5.5K | 2.5K |
| 2021 | $315.44 | $115.37 | 2.73x | $200.07 | $740.0K | 6.1K | 2.6K |
| 2022 | $297.03 | $107.87 | 2.75x | $189.16 | $777.8K | 6.4K | 2.6K |
| 2023 | $239.53 | $107.76 | 2.22x | $131.77 | $560.8K | 5.7K | 2.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 4.0K | $3.0M | $742.04 | 1.68x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 10.4K | $923.8K | $89.25 | 2.87x |
| 92134 | Diagnostic imaging of retina | 20.2K | $656.3K | $32.53 | 2.89x |
| 67028 | Injection of drug into eye | 7.8K | $651.4K | $83.35 | 2.89x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 8.8K | $584.9K | $66.37 | 2.66x |
| J9035 | Injection, bevacizumab, 10 mg | 2.3K | $130.1K | $55.92 | 1.93x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 1.2K | $104.7K | $86.51 | 2.53x |
| 92250 | Photography of the retina | 1.5K | $63.2K | $40.86 | 3.81x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 115 | $56.5K | $491.18 | 3.45x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 935 | $54.2K | $58.02 | 2.52x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 488 | $53.7K | $109.96 | 2.76x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 497 | $52.0K | $104.68 | 2.30x |
| 76512 | Ultrasound of eye disease, growth, or structure | 450 | $24.1K | $53.61 | 3.60x |
| J2778 | Injection, ranibizumab, 0.1 mg | 46 | $14.3K | $311.06 | 1.41x |
| 92083 | Measurement of field of vision during daylight conditions | 300 | $14.1K | $47.09 | 2.85x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 619 | $13.3K | $21.45 | 3.06x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 451 | $13.1K | $29.12 | 1.72x |
| 92133 | Diagnostic imaging of optic nerve of eye | 275 | $8.1K | $29.37 | 3.15x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 13 | $5.8K | $442.96 | 2.52x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 12 | $5.1K | $423.94 | 2.60x |
This provider submits charges 2.28 times higher than what Medicare actually pays.
A markup ratio of 2.28x means for every $100 Medicare pays, this provider initially charges $228. 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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