This provider's $9.9M in total Medicare payments ranks in the 98th 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 | $778.11 | $253.24 | 3.07x | $524.87 | $902.3K | 10.9K | 7.0K |
| 2015 | $773.11 | $229.57 | 3.37x | $543.54 | $1.0M | 10.5K | 5.5K |
| 2016 | $913.53 | $223.85 | 4.08x | $689.68 | $988.0K | 10.7K | 5.6K |
| 2017 | $886.67 | $205.26 | 4.32x | $681.41 | $943.8K | 11.0K | 5.9K |
| 2018 | $867.98 | $201.18 | 4.31x | $666.80 | $821.4K | 9.8K | 5.3K |
| 2019 | $919.13 | $217.33 | 4.23x | $701.80 | $963.1K | 10.3K | 5.6K |
| 2020 | $678.13 | $176.48 | 3.84x | $501.65 | $928.0K | 8.2K | 4.3K |
| 2021 | $792.62 | $197.47 | 4.01x | $595.15 | $1.1M | 9.3K | 4.8K |
| 2022 | $1.0K | $260.65 | 3.87x | $748.30 | $1.2M | 10.0K | 4.6K |
| 2023 | $1.1K | $274.96 | 4.10x | $853.09 | $1.1M | 9.3K | 4.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 6.1K | $4.5M | $734.64 | 1.94x |
| 67028 | Injection of drug into eye | 13.6K | $1.1M | $83.60 | 12.53x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 18.5K | $940.6K | $50.89 | 2.05x |
| J2778 | Injection, ranibizumab, 0.1 mg | 2.5K | $678.3K | $272.63 | 2.23x |
| 92134 | Diagnostic imaging of retina | 29.4K | $425.0K | $14.47 | 17.17x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 3.9K | $313.5K | $79.62 | 1.96x |
| J3490 | Unclassified drugs | 125 | $230.5K | $1.8K | 2.81x |
| 67042 | Removal of membrane from the retina, pars plana approach | 231 | $204.6K | $885.59 | 3.61x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 5.2K | $190.2K | $36.76 | 9.05x |
| J9035 | Injection, bevacizumab, 10 mg | 2.9K | $156.5K | $53.47 | 2.35x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 128 | $113.7K | $888.33 | 5.87x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 256 | $100.8K | $393.70 | 5.08x |
| 67113 | Repair of detached retina and drainage of eye fluid between lens and retina | 82 | $88.4K | $1.1K | 3.27x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 238 | $88.1K | $370.11 | 4.33x |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 334 | $83.0K | $248.56 | 1.92x |
| 67040 | Laser destruction of eye fluid (vitreous) between the lens and retina | 102 | $83.0K | $813.64 | 3.69x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 1.0K | $81.8K | $81.51 | 2.24x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 830 | $79.0K | $95.23 | 2.48x |
| 92250 | Photography of the retina | 4.9K | $78.2K | $15.86 | 9.44x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 1.2K | $61.9K | $53.76 | 2.14x |
This provider submits charges 4.29 times higher than what Medicare actually pays.
A markup ratio of 4.29x means for every $100 Medicare pays, this provider initially charges $429. 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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