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 | $284.39 | $172.38 | 1.65x | $112.01 | $723.1K | 8.0K | 1.7K |
| 2015 | $291.70 | $174.72 | 1.67x | $116.98 | $792.9K | 8.4K | 1.7K |
| 2016 | $323.02 | $198.39 | 1.63x | $124.63 | $859.8K | 7.8K | 1.5K |
| 2017 | $308.76 | $192.13 | 1.61x | $116.63 | $903.0K | 7.5K | 1.4K |
| 2018 | $308.75 | $186.67 | 1.65x | $122.08 | $933.8K | 7.0K | 1.3K |
| 2019 | $326.64 | $196.61 | 1.66x | $130.03 | $968.5K | 6.7K | 1.2K |
| 2020 | $327.36 | $193.51 | 1.69x | $133.85 | $852.9K | 5.9K | 1.0K |
| 2021 | $311.92 | $182.26 | 1.71x | $129.66 | $825.6K | 5.5K | 1.0K |
| 2022 | $273.65 | $154.95 | 1.77x | $118.70 | $692.9K | 4.9K | 908 |
| 2023 | $273.82 | $151.18 | 1.81x | $122.64 | $382.7K | 4.4K | 896 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 5.5K | $4.1M | $749.75 | 1.33x |
| 67028 | Injection of drug into eye | 15.3K | $1.2M | $80.38 | 4.25x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 17.6K | $1.1M | $63.60 | 2.06x |
| 92134 | Diagnostic imaging of retina | 17.4K | $544.6K | $31.26 | 2.37x |
| J2778 | Injection, ranibizumab, 0.1 mg | 1.5K | $439.7K | $299.50 | 1.40x |
| J9035 | Injection, bevacizumab, 10 mg | 7.6K | $403.5K | $53.29 | 1.41x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 519 | $56.0K | $107.88 | 2.13x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 538 | $15.7K | $29.13 | 1.61x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 96 | $9.3K | $97.19 | 1.98x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 20 | $1.6K | $78.95 | 2.23x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 11 | $576.10 | $52.37 | 2.18x |
This provider submits charges 1.97 times higher than what Medicare actually pays.
A markup ratio of 1.97x means for every $100 Medicare pays, this provider initially charges $197. This is lower 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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