This provider's $9.7M 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 | $419.32 | $196.78 | 2.13x | $222.54 | $903.5K | 5.4K | 2.2K |
| 2015 | $419.08 | $168.91 | 2.48x | $250.17 | $994.9K | 6.0K | 2.3K |
| 2016 | $419.40 | $138.63 | 3.03x | $280.77 | $1.2M | 7.3K | 2.8K |
| 2017 | $622.11 | $173.15 | 3.59x | $448.96 | $1.3M | 9.1K | 3.2K |
| 2018 | $340.05 | $125.92 | 2.70x | $214.13 | $973.6K | 8.9K | 2.9K |
| 2019 | $351.24 | $136.24 | 2.58x | $215.00 | $939.5K | 7.4K | 2.3K |
| 2020 | $302.30 | $119.62 | 2.53x | $182.68 | $867.6K | 6.5K | 1.9K |
| 2021 | $398.35 | $155.10 | 2.57x | $243.25 | $904.7K | 6.4K | 2.0K |
| 2022 | $369.03 | $120.89 | 3.05x | $248.14 | $841.6K | 6.2K | 1.8K |
| 2023 | $309.68 | $112.32 | 2.76x | $197.36 | $784.3K | 5.9K | 1.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 6.4K | $4.7M | $733.32 | 1.87x |
| J2778 | Injection, ranibizumab, 0.1 mg | 6.1K | $1.7M | $273.91 | 2.17x |
| 67028 | Injection of drug into eye | 17.9K | $1.4M | $79.24 | 9.87x |
| 92134 | Diagnostic imaging of retina | 19.2K | $630.4K | $32.92 | 5.92x |
| J9035 | Injection, bevacizumab, 10 mg | 5.0K | $275.1K | $55.10 | 1.80x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 3.9K | $207.4K | $53.87 | 2.11x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 2.4K | $205.7K | $85.70 | 2.07x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 2.1K | $178.0K | $84.18 | 1.84x |
| 92250 | Photography of the retina | 2.5K | $123.1K | $49.54 | 2.32x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 612 | $62.8K | $102.55 | 2.07x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 140 | $54.7K | $391.01 | 3.03x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 880 | $52.5K | $59.61 | 2.15x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 86 | $32.7K | $380.72 | 5.25x |
| 67042 | Removal of membrane from the retina, pars plana approach | 23 | $25.1K | $1.1K | 3.18x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 301 | $24.1K | $80.08 | 2.88x |
| 99204 | New patient outpatient visit, total time 45-59 minutes | 146 | $17.2K | $118.14 | 1.98x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 459 | $15.9K | $34.70 | 2.22x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 312 | $8.9K | $28.46 | 1.76x |
| 92083 | Measurement of field of vision during daylight conditions | 131 | $6.3K | $47.96 | 2.71x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 281 | $6.2K | $22.00 | 2.37x |
This provider submits charges 3.4 times higher than what Medicare actually pays.
A markup ratio of 3.4x means for every $100 Medicare pays, this provider initially charges $340. 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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