This provider's $3.4M in total Medicare payments ranks in the 94th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 4541% from 2015 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 187% in 2018
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 |
|---|---|---|---|---|---|---|---|
| 2015 | $525.98 | $104.40 | 5.04x | $421.58 | $14.6K | 131 | 126 |
| 2016 | $526.12 | $104.77 | 5.02x | $421.35 | $36.6K | 366 | 353 |
| 2017 | $756.76 | $195.68 | 3.87x | $561.08 | $101.6K | 1.2K | 867 |
| 2018 | $773.20 | $231.47 | 3.34x | $541.73 | $291.9K | 3.6K | 1.7K |
| 2019 | $574.66 | $182.82 | 3.14x | $391.84 | $489.7K | 5.5K | 2.6K |
| 2020 | $1.1K | $312.11 | 3.41x | $753.72 | $613.9K | 6.3K | 2.7K |
| 2021 | $652.91 | $205.95 | 3.17x | $446.96 | $568.9K | 5.8K | 2.3K |
| 2022 | $952.79 | $304.20 | 3.13x | $648.59 | $609.4K | 5.8K | 2.3K |
| 2023 | $619.86 | $216.58 | 2.86x | $403.28 | $677.8K | 6.0K | 2.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2.0K | $1.4M | $711.91 | 1.62x |
| 67028 | Injection of drug into eye | 6.6K | $529.3K | $80.65 | 6.40x |
| 92134 | Diagnostic imaging of retina | 13.1K | $357.6K | $27.27 | 2.90x |
| J9035 | Injection, bevacizumab, 10 mg | 4.3K | $244.9K | $57.08 | 1.49x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 4.4K | $235.9K | $53.42 | 1.64x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.4K | $149.4K | $109.03 | 1.71x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 1.7K | $136.6K | $79.11 | 1.64x |
| 67042 | Removal of membrane from the retina, pars plana approach | 232 | $104.7K | $451.24 | 4.07x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 222 | $84.3K | $379.62 | 3.25x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 131 | $49.6K | $378.61 | 4.59x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 110 | $27.0K | $245.33 | 5.10x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 57 | $23.4K | $409.75 | 4.71x |
| 67039 | Laser destruction of eye fluid (vitreous) between the lens and retina | 64 | $9.3K | $145.27 | 5.57x |
| 67113 | Repair of detached retina and drainage of eye fluid between lens and retina | 49 | $8.2K | $166.62 | 5.87x |
| 67040 | Laser destruction of eye fluid (vitreous) between the lens and retina | 67 | $7.9K | $117.89 | 7.12x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 42 | $5.9K | $140.96 | 1.67x |
| 76512 | Ultrasound of eye disease, growth, or structure | 105 | $4.2K | $40.18 | 4.74x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 79 | $4.1K | $52.01 | 2.33x |
| 92235 | Imaging of blood vessels in back of eye using fluorescein dye | 34 | $2.1K | $60.51 | 3.55x |
| 92250 | Photography of the retina | 40 | $1.1K | $27.39 | 4.24x |
This provider submits charges 2.74 times higher than what Medicare actually pays.
A markup ratio of 2.74x means for every $100 Medicare pays, this provider initially charges $274. 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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