This provider's $8.7M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 479% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 253% 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 | $300.86 | $86.86 | 3.46x | $214.00 | $166.5K | 2.4K | 1.7K |
| 2015 | $493.68 | $180.92 | 2.73x | $312.76 | $587.6K | 7.3K | 3.9K |
| 2016 | $369.54 | $134.97 | 2.74x | $234.57 | $700.2K | 8.3K | 3.7K |
| 2017 | $380.02 | $130.28 | 2.92x | $249.74 | $668.9K | 8.9K | 4.0K |
| 2018 | $443.84 | $168.15 | 2.64x | $275.69 | $715.9K | 8.2K | 3.3K |
| 2019 | $391.88 | $149.66 | 2.62x | $242.22 | $1.3M | 8.3K | 3.4K |
| 2020 | $553.52 | $202.36 | 2.74x | $351.16 | $1.3M | 7.2K | 3.1K |
| 2021 | $394.71 | $147.04 | 2.68x | $247.67 | $1.2M | 6.8K | 2.8K |
| 2022 | $472.33 | $158.56 | 2.98x | $313.77 | $1.2M | 6.5K | 2.4K |
| 2023 | $403.89 | $137.62 | 2.93x | $266.27 | $964.6K | 5.7K | 2.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 6.1K | $4.5M | $731.67 | 1.50x |
| 67028 | Injection of drug into eye | 14.0K | $1.1M | $76.06 | 8.37x |
| 92134 | Diagnostic imaging of retina | 18.6K | $543.0K | $29.16 | 2.93x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 6.0K | $502.1K | $83.19 | 2.33x |
| J2778 | Injection, ranibizumab, 0.1 mg | 1.3K | $355.7K | $283.40 | 1.47x |
| J9035 | Injection, bevacizumab, 10 mg | 5.2K | $295.2K | $56.47 | 7.02x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 3.8K | $280.2K | $74.37 | 2.83x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 3.0K | $257.2K | $85.48 | 2.69x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 3.5K | $202.1K | $58.55 | 2.29x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 381 | $141.9K | $372.33 | 3.22x |
| 92250 | Photography of the retina | 2.6K | $109.3K | $41.42 | 3.04x |
| 66821 | Removal of recurring cataract in lens capsule using laser | 542 | $99.4K | $183.38 | 3.76x |
| 92242 | Imaging of blood vessels in back of eye using fluorescein and indocyanine-green dye | 439 | $74.9K | $170.55 | 2.54x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.1K | $58.3K | $50.87 | 2.94x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 149 | $52.2K | $350.22 | 2.47x |
| 92240 | Examination of eye using an endoscope | 217 | $37.2K | $171.54 | 1.75x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 325 | $35.7K | $109.94 | 2.08x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 336 | $34.7K | $103.36 | 1.98x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 63 | $26.3K | $417.50 | 3.59x |
| 92083 | Measurement of field of vision during daylight conditions | 300 | $13.4K | $44.59 | 2.71x |
This provider submits charges 2.88 times higher than what Medicare actually pays.
A markup ratio of 2.88x means for every $100 Medicare pays, this provider initially charges $288. 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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