This provider's $7.9M 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 | $563.73 | $211.76 | 2.66x | $351.97 | $674.7K | 5.6K | 2.1K |
| 2015 | $650.76 | $217.21 | 3.00x | $433.55 | $784.0K | 5.5K | 1.8K |
| 2016 | $385.22 | $154.07 | 2.50x | $231.15 | $774.5K | 5.1K | 1.5K |
| 2017 | $676.32 | $213.47 | 3.17x | $462.85 | $755.0K | 4.7K | 1.5K |
| 2018 | $530.79 | $199.05 | 2.67x | $331.74 | $783.7K | 4.4K | 1.4K |
| 2019 | $686.94 | $212.53 | 3.23x | $474.41 | $842.6K | 4.8K | 1.5K |
| 2020 | $418.61 | $160.05 | 2.62x | $258.56 | $820.1K | 4.8K | 1.5K |
| 2021 | $422.82 | $161.67 | 2.62x | $261.15 | $857.1K | 5.0K | 1.5K |
| 2022 | $615.77 | $228.72 | 2.69x | $387.05 | $834.4K | 4.4K | 1.4K |
| 2023 | $946.05 | $308.44 | 3.07x | $637.61 | $788.7K | 4.5K | 1.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 4.6K | $3.4M | $739.85 | 2.30x |
| J2778 | Injection, ranibizumab, 0.1 mg | 4.8K | $1.4M | $291.37 | 2.49x |
| 67028 | Injection of drug into eye | 11.4K | $982.7K | $86.40 | 5.73x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 9.5K | $813.8K | $85.41 | 1.93x |
| 92134 | Diagnostic imaging of retina | 13.5K | $423.9K | $31.33 | 4.42x |
| J3490 | Unclassified drugs | 119 | $202.0K | $1.7K | 3.44x |
| J3590 | Unclassified biologics | 237 | $195.5K | $824.83 | 2.60x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 882 | $89.1K | $100.97 | 2.02x |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 314 | $78.8K | $250.92 | 2.19x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 434 | $68.1K | $156.95 | 2.00x |
| 67042 | Removal of membrane from the retina, pars plana approach | 62 | $58.7K | $946.27 | 4.02x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 512 | $38.7K | $75.55 | 1.86x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 494 | $36.7K | $74.21 | 2.76x |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 93 | $20.9K | $225.21 | 2.33x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 30 | $20.8K | $694.54 | 2.81x |
| J7999 | Compounded drug, not otherwise classified | 291 | $18.3K | $62.98 | 4.25x |
| 92250 | Photography of the retina | 307 | $13.2K | $43.03 | 2.92x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 424 | $12.4K | $29.28 | 2.15x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 68 | $8.2K | $121.00 | 1.83x |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 56 | $6.7K | $120.36 | 2.19x |
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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