This provider's $6.3M 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 | $529.78 | $152.54 | 3.47x | $377.24 | $565.3K | 8.4K | 5.4K |
| 2015 | $310.70 | $91.40 | 3.40x | $219.30 | $416.5K | 6.6K | 4.7K |
| 2016 | $342.13 | $95.17 | 3.59x | $246.96 | $339.0K | 4.9K | 3.4K |
| 2017 | $443.18 | $110.15 | 4.02x | $333.03 | $500.7K | 5.0K | 3.7K |
| 2018 | $481.66 | $123.24 | 3.91x | $358.42 | $556.8K | 5.0K | 3.4K |
| 2019 | $457.03 | $145.01 | 3.15x | $312.02 | $781.5K | 5.9K | 4.2K |
| 2020 | $459.21 | $145.40 | 3.16x | $313.81 | $734.0K | 5.4K | 3.7K |
| 2021 | $420.82 | $141.99 | 2.96x | $278.83 | $918.0K | 6.5K | 4.0K |
| 2022 | $445.11 | $130.50 | 3.41x | $314.61 | $774.6K | 5.9K | 3.4K |
| 2023 | $493.16 | $122.69 | 4.02x | $370.47 | $753.4K | 5.8K | 3.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2.6K | $1.9M | $728.27 | 1.51x |
| 66984 | Removal of cataract with insertion of lens | 4.5K | $923.4K | $203.57 | 4.43x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 5.8K | $462.9K | $80.20 | 2.47x |
| 67028 | Injection of drug into eye | 5.5K | $424.5K | $77.61 | 8.16x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 4.5K | $361.4K | $81.10 | 2.84x |
| 66821 | Removal of recurring cataract in lens capsule using laser | 1.5K | $218.2K | $145.86 | 3.79x |
| 92134 | Diagnostic imaging of retina | 6.9K | $201.9K | $29.14 | 2.94x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 3.2K | $187.3K | $58.21 | 2.23x |
| 0191T | Internal insertion of eye fluid drainage device | 557 | $164.9K | $296.08 | 5.69x |
| 92250 | Photography of the retina | 3.2K | $119.2K | $37.58 | 3.53x |
| J2778 | Injection, ranibizumab, 0.1 mg | 434 | $117.9K | $271.76 | 1.56x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.1K | $113.5K | $105.51 | 2.17x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.0K | $107.7K | $52.83 | 3.13x |
| 92136 | Measurement of corneal curvature and depth of eye | 2.6K | $93.3K | $36.43 | 6.83x |
| 66174 | Dilation to improve eye fluid flow | 143 | $83.8K | $585.72 | 3.15x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 1.1K | $83.0K | $77.81 | 2.71x |
| 92083 | Measurement of field of vision during daylight conditions | 1.9K | $76.9K | $41.56 | 2.92x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 748 | $74.3K | $99.36 | 2.09x |
| J9035 | Injection, bevacizumab, 10 mg | 1.3K | $72.1K | $55.41 | 7.22x |
| 92133 | Diagnostic imaging of optic nerve of eye | 2.6K | $64.7K | $24.87 | 3.42x |
This provider submits charges 3.27 times higher than what Medicare actually pays.
A markup ratio of 3.27x means for every $100 Medicare pays, this provider initially charges $327. 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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