This provider's $5.8M 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 | $389.33 | $147.61 | 2.64x | $241.72 | $634.0K | 5.1K | 2.4K |
| 2015 | $840.40 | $320.33 | 2.62x | $520.07 | $660.2K | 4.9K | 2.3K |
| 2016 | $619.93 | $228.19 | 2.72x | $391.74 | $626.3K | 5.0K | 2.3K |
| 2017 | $546.55 | $195.66 | 2.79x | $350.89 | $625.4K | 4.7K | 2.0K |
| 2018 | $432.06 | $148.64 | 2.91x | $283.42 | $617.8K | 4.9K | 2.2K |
| 2019 | $518.60 | $186.28 | 2.78x | $332.32 | $757.8K | 5.0K | 2.2K |
| 2020 | $424.91 | $149.06 | 2.85x | $275.85 | $458.7K | 3.3K | 1.7K |
| 2021 | $543.31 | $200.10 | 2.72x | $343.21 | $532.2K | 3.8K | 1.9K |
| 2022 | $417.25 | $148.24 | 2.81x | $269.01 | $488.6K | 3.6K | 1.6K |
| 2023 | $388.98 | $135.00 | 2.88x | $253.98 | $409.3K | 3.3K | 1.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 4.2K | $3.2M | $745.00 | 2.23x |
| 67028 | Injection of drug into eye | 8.4K | $733.9K | $87.46 | 7.27x |
| 92134 | Diagnostic imaging of retina | 15.3K | $505.6K | $32.98 | 2.85x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 4.1K | $234.6K | $56.91 | 2.68x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 2.5K | $230.5K | $91.13 | 2.86x |
| J9035 | Injection, bevacizumab, 10 mg | 3.5K | $196.4K | $56.28 | 2.44x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.5K | $182.8K | $124.12 | 2.73x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 1.5K | $125.1K | $83.54 | 2.69x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 839 | $105.0K | $125.19 | 3.73x |
| J2778 | Injection, ranibizumab, 0.1 mg | 333 | $99.4K | $298.59 | 2.39x |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 274 | $68.3K | $249.40 | 2.34x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 41 | $42.8K | $1.0K | 2.64x |
| 67041 | Removal of membrane from the retina | 26 | $24.6K | $947.83 | 2.57x |
| 67042 | Removal of membrane from the retina, pars plana approach | 25 | $23.7K | $948.63 | 2.77x |
| 92250 | Photography of the retina | 562 | $22.1K | $39.38 | 3.77x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 29 | $11.7K | $402.25 | 2.58x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 94 | $11.5K | $122.81 | 2.57x |
| 76512 | Ultrasound of eye disease, growth, or structure | 148 | $9.6K | $64.94 | 2.86x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 12 | $8.6K | $718.54 | 2.61x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 69 | $5.1K | $73.34 | 3.12x |
This provider submits charges 3.05 times higher than what Medicare actually pays.
A markup ratio of 3.05x means for every $100 Medicare pays, this provider initially charges $305. 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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