This provider's $9.6M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 103% 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 | $710.29 | $280.69 | 2.53x | $429.60 | $576.6K | 5.4K | 2.4K |
| 2015 | $886.95 | $295.62 | 3.00x | $591.33 | $686.7K | 5.9K | 2.8K |
| 2016 | $589.24 | $194.36 | 3.03x | $394.88 | $700.0K | 6.5K | 3.1K |
| 2017 | $537.61 | $171.51 | 3.13x | $366.10 | $779.4K | 6.5K | 3.2K |
| 2018 | $341.13 | $132.11 | 2.58x | $209.02 | $929.9K | 6.9K | 3.3K |
| 2019 | $629.39 | $247.41 | 2.54x | $381.98 | $986.6K | 6.6K | 3.2K |
| 2020 | $491.31 | $184.39 | 2.66x | $306.92 | $1.2M | 7.1K | 3.3K |
| 2021 | $539.24 | $205.61 | 2.62x | $333.63 | $1.4M | 8.0K | 3.3K |
| 2022 | $467.56 | $163.56 | 2.86x | $304.00 | $1.2M | 6.9K | 3.0K |
| 2023 | $785.33 | $306.92 | 2.56x | $478.41 | $1.2M | 6.7K | 3.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 7.2K | $5.3M | $732.86 | 1.71x |
| 67028 | Injection of drug into eye | 15.8K | $1.3M | $82.14 | 4.37x |
| J2778 | Injection, ranibizumab, 0.1 mg | 1.8K | $498.2K | $274.82 | 1.82x |
| 92134 | Diagnostic imaging of retina | 16.4K | $465.3K | $28.34 | 2.44x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 5.1K | $401.7K | $79.42 | 2.11x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 3.4K | $267.0K | $79.71 | 2.37x |
| J9035 | Injection, bevacizumab, 10 mg | 3.8K | $211.0K | $55.11 | 2.81x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 3.3K | $190.9K | $57.85 | 2.13x |
| J7999 | Compounded drug, not otherwise classified | 2.5K | $160.5K | $64.83 | 4.58x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 492 | $159.9K | $325.05 | 4.75x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 3.0K | $153.5K | $51.86 | 2.17x |
| 67113 | Repair of detached retina and drainage of eye fluid between lens and retina | 132 | $147.5K | $1.1K | 3.03x |
| J3590 | Unclassified biologics | 24 | $52.9K | $2.2K | 1.86x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 134 | $47.1K | $351.15 | 2.92x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 496 | $44.8K | $90.39 | 2.48x |
| 67041 | Removal of membrane from the retina | 44 | $42.1K | $956.75 | 3.27x |
| 67042 | Removal of membrane from the retina, pars plana approach | 49 | $41.5K | $847.53 | 3.74x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 645 | $36.5K | $56.64 | 2.60x |
| 76512 | Ultrasound of eye disease, growth, or structure | 533 | $27.2K | $50.97 | 3.21x |
| 92250 | Photography of the retina | 686 | $21.7K | $31.68 | 2.55x |
This provider submits charges 2.34 times higher than what Medicare actually pays.
A markup ratio of 2.34x means for every $100 Medicare pays, this provider initially charges $234. 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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