This provider's $8.0M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 91% from 2014 to 2023.
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 | $594.56 | $159.26 | 3.73x | $435.30 | $507.2K | 5.5K | 2.9K |
| 2015 | $621.70 | $176.03 | 3.53x | $445.67 | $564.6K | 6.2K | 3.2K |
| 2016 | $594.60 | $139.63 | 4.26x | $454.97 | $602.4K | 7.0K | 3.7K |
| 2017 | $781.14 | $175.94 | 4.44x | $605.20 | $646.3K | 6.9K | 3.5K |
| 2018 | $640.80 | $146.12 | 4.39x | $494.68 | $720.3K | 7.4K | 3.8K |
| 2019 | $594.60 | $136.52 | 4.36x | $458.08 | $717.3K | 7.8K | 3.8K |
| 2020 | $768.70 | $174.57 | 4.40x | $594.13 | $959.5K | 8.8K | 4.1K |
| 2021 | $770.30 | $181.91 | 4.23x | $588.39 | $1.2M | 9.1K | 3.9K |
| 2022 | $798.10 | $165.26 | 4.83x | $632.84 | $1.1M | 8.6K | 3.7K |
| 2023 | $587.90 | $114.67 | 5.13x | $473.23 | $967.6K | 7.4K | 3.1K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 4.8K | $3.5M | $736.47 | 2.72x |
| 67028 | Injection of drug into eye | 10.1K | $822.3K | $81.42 | 8.60x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 7.6K | $693.5K | $91.17 | 3.76x |
| 92134 | Diagnostic imaging of retina | 17.1K | $528.8K | $31.01 | 4.26x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 7.3K | $444.5K | $60.86 | 3.88x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 4.6K | $376.2K | $82.55 | 4.72x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 3.6K | $285.3K | $78.58 | 3.84x |
| J9035 | Injection, bevacizumab, 10 mg | 4.0K | $223.7K | $56.61 | 1.81x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 2.0K | $214.0K | $107.38 | 3.86x |
| J2778 | Injection, ranibizumab, 0.1 mg | 824 | $212.5K | $257.93 | 2.33x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.1K | $112.5K | $54.52 | 3.74x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 240 | $82.3K | $342.97 | 9.62x |
| 92250 | Photography of the retina | 1.2K | $54.1K | $44.82 | 4.91x |
| 92020 | Examination of cornea and iris using lens device and slit lamp | 2.5K | $52.2K | $20.72 | 3.72x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 316 | $49.1K | $155.38 | 3.73x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 116 | $45.0K | $387.80 | 3.79x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 2.1K | $44.4K | $21.18 | 3.54x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 351 | $40.5K | $115.49 | 3.52x |
| 76512 | Ultrasound of eye disease, growth, or structure | 520 | $28.3K | $54.45 | 5.05x |
| 67041 | Removal of membrane from the retina | 29 | $26.4K | $909.26 | 4.09x |
This provider submits charges 3.88 times higher than what Medicare actually pays.
A markup ratio of 3.88x means for every $100 Medicare pays, this provider initially charges $388. 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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