This provider's $5.7M in total Medicare payments ranks in the 97th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 183% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 61% in 2015
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 | $221.74 | $95.67 | 2.32x | $126.07 | $248.0K | 3.3K | 2.1K |
| 2015 | $244.67 | $95.33 | 2.57x | $149.34 | $398.2K | 4.3K | 2.7K |
| 2016 | $309.10 | $107.03 | 2.89x | $202.07 | $521.8K | 5.3K | 3.2K |
| 2017 | $258.01 | $97.43 | 2.65x | $160.58 | $425.6K | 4.6K | 2.7K |
| 2018 | $274.94 | $104.82 | 2.62x | $170.12 | $563.6K | 5.3K | 3.0K |
| 2019 | $278.75 | $104.67 | 2.66x | $174.08 | $600.5K | 5.1K | 2.7K |
| 2020 | $270.63 | $99.62 | 2.72x | $171.01 | $626.7K | 4.6K | 2.2K |
| 2021 | $285.44 | $108.68 | 2.63x | $176.76 | $806.5K | 5.4K | 2.5K |
| 2022 | $286.13 | $105.82 | 2.70x | $180.31 | $769.2K | 5.3K | 2.5K |
| 2023 | $304.46 | $105.76 | 2.88x | $198.70 | $701.5K | 5.3K | 2.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 4.4K | $3.2M | $736.94 | 1.91x |
| 67028 | Injection of drug into eye | 6.0K | $518.6K | $85.85 | 5.89x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 4.9K | $452.5K | $92.59 | 2.78x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 5.0K | $449.0K | $90.20 | 2.55x |
| 92134 | Diagnostic imaging of retina | 11.0K | $353.3K | $32.18 | 2.78x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 4.2K | $121.9K | $29.05 | 2.75x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.0K | $114.1K | $56.23 | 2.44x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 1.4K | $89.8K | $66.49 | 2.72x |
| 92250 | Photography of the retina | 1.7K | $66.6K | $39.60 | 4.21x |
| J9035 | Injection, bevacizumab, 10 mg | 1.2K | $65.9K | $56.98 | 2.63x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 1.8K | $59.4K | $32.78 | 2.86x |
| 92202 | Extended examination of eye with drawing of optic nerve and surrounding area (macula) | 2.7K | $32.7K | $12.03 | 3.36x |
| 92083 | Measurement of field of vision during daylight conditions | 421 | $20.9K | $49.66 | 2.68x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 217 | $18.5K | $85.25 | 2.82x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 522 | $17.6K | $33.70 | 1.98x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 144 | $16.6K | $115.37 | 3.01x |
| 76512 | Ultrasound of eye disease, growth, or structure | 264 | $14.2K | $53.79 | 4.03x |
| 92133 | Diagnostic imaging of optic nerve of eye | 383 | $11.4K | $29.86 | 3.14x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 52 | $6.0K | $115.86 | 2.23x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 14 | $5.5K | $391.19 | 4.41x |
This provider submits charges 2.57 times higher than what Medicare actually pays.
A markup ratio of 2.57x means for every $100 Medicare pays, this provider initially charges $257. 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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