This provider's $10.0M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
62% of their billing comes from a single procedure code (J0178 — Injection, aflibercept, 1 mg).
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 | $436.67 | $240.70 | 1.81x | $195.97 | $760.7K | 6.0K | 2.7K |
| 2015 | $591.91 | $314.30 | 1.88x | $277.61 | $810.6K | 5.9K | 2.6K |
| 2016 | $496.51 | $253.59 | 1.96x | $242.92 | $821.0K | 6.2K | 2.7K |
| 2017 | $559.98 | $279.98 | 2.00x | $280.00 | $936.8K | 6.5K | 2.5K |
| 2018 | $419.79 | $210.94 | 1.99x | $208.85 | $1.2M | 7.0K | 2.5K |
| 2019 | $593.84 | $225.04 | 2.64x | $368.80 | $1.2M | 6.9K | 2.5K |
| 2020 | $569.80 | $221.48 | 2.57x | $348.32 | $1.2M | 6.4K | 2.2K |
| 2021 | $326.08 | $143.66 | 2.27x | $182.42 | $1.1M | 6.0K | 2.1K |
| 2022 | $618.23 | $188.07 | 3.29x | $430.16 | $1.0M | 5.6K | 2.1K |
| 2023 | $395.68 | $116.96 | 3.38x | $278.72 | $984.0K | 5.8K | 2.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 8.4K | $6.2M | $740.40 | 1.82x |
| 67028 | Injection of drug into eye | 12.8K | $1.1M | $85.10 | 2.94x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 8.2K | $747.8K | $91.41 | 2.94x |
| 92134 | Diagnostic imaging of retina | 21.9K | $712.0K | $32.56 | 2.76x |
| J2778 | Injection, ranibizumab, 0.1 mg | 1.1K | $317.1K | $285.40 | 1.62x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 2.2K | $174.6K | $80.83 | 2.53x |
| J9035 | Injection, bevacizumab, 10 mg | 2.9K | $159.9K | $55.77 | 1.56x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 1.4K | $127.6K | $88.30 | 2.57x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 1.0K | $113.4K | $108.87 | 2.73x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 103 | $106.9K | $1.0K | 2.67x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 61 | $50.2K | $823.70 | 1.91x |
| 67040 | Laser destruction of eye fluid (vitreous) between the lens and retina | 40 | $38.2K | $954.11 | 1.96x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 606 | $37.0K | $61.11 | 1.98x |
| 67042 | Removal of membrane from the retina, pars plana approach | 37 | $33.7K | $910.06 | 1.98x |
| 76512 | Ultrasound of eye disease, growth, or structure | 520 | $30.5K | $58.70 | 2.54x |
| 92250 | Photography of the retina | 551 | $27.9K | $50.72 | 2.35x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 328 | $19.5K | $59.32 | 2.73x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 13 | $5.6K | $431.91 | 3.26x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 92 | $2.3K | $25.47 | 2.12x |
| 92083 | Measurement of field of vision during daylight conditions | 48 | $2.3K | $48.53 | 2.55x |
This provider submits charges 2.13 times higher than what Medicare actually pays.
A markup ratio of 2.13x means for every $100 Medicare pays, this provider initially charges $213. 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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