This provider's $7.7M in total Medicare payments ranks in the 99th percentile of Gastroenterology providers nationally.
This provider's billing patterns fall within normal ranges for their specialty.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 238% in 2021
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 |
|---|---|---|---|---|---|---|---|
| 2014 | $663.43 | $174.25 | 3.81x | $489.18 | $926.0K | 7.7K | 3.4K |
| 2015 | $667.47 | $158.84 | 4.20x | $508.63 | $1.0M | 7.7K | 3.6K |
| 2016 | $768.25 | $181.58 | 4.23x | $586.67 | $1.2M | 8.8K | 3.9K |
| 2017 | $770.77 | $180.21 | 4.28x | $590.56 | $1.2M | 8.9K | 3.9K |
| 2018 | $503.01 | $138.37 | 3.64x | $364.64 | $971.0K | 8.1K | 3.7K |
| 2019 | $452.41 | $125.49 | 3.61x | $326.92 | $856.2K | 6.2K | 2.8K |
| 2020 | $607.57 | $146.62 | 4.14x | $460.95 | $115.0K | 1.0K | 882 |
| 2021 | $689.58 | $167.47 | 4.12x | $522.11 | $389.1K | 2.7K | 1.7K |
| 2022 | $868.55 | $222.69 | 3.90x | $645.86 | $580.0K | 3.8K | 2.3K |
| 2023 | $575.38 | $127.16 | 4.52x | $448.22 | $377.1K | 3.7K | 2.1K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 5.0K | $3.7M | $752.99 | 2.79x |
| 67028 | Injection of drug into eye | 11.2K | $934.1K | $83.14 | 10.99x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 9.5K | $809.0K | $85.30 | 2.50x |
| J2778 | Injection, ranibizumab, 0.1 mg | 2.2K | $624.8K | $288.21 | 3.75x |
| 92134 | Diagnostic imaging of retina | 18.5K | $583.1K | $31.49 | 4.11x |
| J9035 | Injection, bevacizumab, 10 mg | 3.3K | $181.9K | $55.79 | 4.09x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 2.8K | $174.8K | $63.49 | 2.16x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.3K | $156.3K | $117.46 | 2.59x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 518 | $78.2K | $150.87 | 1.87x |
| 67042 | Removal of membrane from the retina, pars plana approach | 81 | $77.0K | $951.13 | 6.08x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 731 | $57.8K | $79.06 | 4.42x |
| 92250 | Photography of the retina | 1.3K | $56.8K | $42.71 | 3.91x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 99 | $41.2K | $416.29 | 4.62x |
| J3590 | Unclassified biologics | 22 | $39.8K | $1.8K | 3.56x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 181 | $28.1K | $155.20 | 2.39x |
| 76512 | Ultrasound of eye disease, growth, or structure | 397 | $24.4K | $61.55 | 5.87x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 334 | $17.2K | $51.54 | 2.48x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 402 | $11.7K | $29.03 | 3.70x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 15 | $9.7K | $644.34 | 8.02x |
| 67515 | Injection of medication or substance into membrane covering eyeball | 104 | $7.8K | $74.57 | 3.14x |
This provider submits charges 4.02 times higher than what Medicare actually pays.
A markup ratio of 4.02x means for every $100 Medicare pays, this provider initially charges $402. 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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