This provider's $6.7M in total Medicare payments ranks in the 97th 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 | $1.3K | $386.15 | 3.28x | $882.18 | $740.0K | 6.1K | 2.8K |
| 2015 | $1.1K | $306.68 | 3.46x | $755.32 | $607.4K | 4.8K | 1.9K |
| 2016 | $1.2K | $307.70 | 3.74x | $844.13 | $621.1K | 5.0K | 1.8K |
| 2017 | $802.92 | $250.52 | 3.21x | $552.40 | $585.3K | 4.6K | 1.8K |
| 2018 | $1.3K | $363.44 | 3.70x | $979.64 | $691.6K | 5.3K | 1.9K |
| 2019 | $1.1K | $324.39 | 3.26x | $733.15 | $715.9K | 5.4K | 1.9K |
| 2020 | $876.69 | $279.24 | 3.14x | $597.45 | $624.6K | 4.7K | 1.6K |
| 2021 | $743.85 | $236.22 | 3.15x | $507.63 | $715.0K | 5.3K | 2.0K |
| 2022 | $1.0K | $279.81 | 3.58x | $721.92 | $751.7K | 5.8K | 2.2K |
| 2023 | $666.17 | $199.75 | 3.34x | $466.42 | $654.0K | 5.9K | 2.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 4.3K | $3.2M | $741.96 | 1.86x |
| 67028 | Injection of drug into eye | 10.7K | $845.5K | $79.11 | 6.10x |
| 92134 | Diagnostic imaging of retina | 19.8K | $558.3K | $28.26 | 3.26x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 6.1K | $471.9K | $76.76 | 2.84x |
| J2778 | Injection, ranibizumab, 0.1 mg | 1.6K | $451.0K | $287.24 | 1.73x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 3.4K | $283.8K | $82.53 | 2.36x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 2.1K | $233.9K | $109.67 | 2.72x |
| J7999 | Compounded drug, not otherwise classified | 2.8K | $181.3K | $64.72 | 1.94x |
| 67042 | Removal of membrane from the retina, pars plana approach | 116 | $103.5K | $892.57 | 3.92x |
| 67113 | Repair of detached retina and drainage of eye fluid between lens and retina | 68 | $75.6K | $1.1K | 4.50x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 100 | $64.1K | $640.65 | 4.37x |
| 67041 | Removal of membrane from the retina | 69 | $59.4K | $861.01 | 4.06x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 46 | $39.4K | $855.47 | 4.72x |
| J3590 | Unclassified biologics | 607 | $31.8K | $52.41 | 1.91x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 77 | $29.1K | $378.29 | 3.97x |
| J9035 | Injection, bevacizumab, 10 mg | 326 | $16.8K | $51.64 | 1.94x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 19 | $14.0K | $735.14 | 3.40x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 155 | $11.7K | $75.32 | 3.32x |
| 67039 | Laser destruction of eye fluid (vitreous) between the lens and retina | 12 | $11.1K | $926.82 | 3.45x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 30 | $10.4K | $346.03 | 3.76x |
This provider submits charges 2.77 times higher than what Medicare actually pays.
A markup ratio of 2.77x means for every $100 Medicare pays, this provider initially charges $277. 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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