This provider's $5.9M 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 | $913.12 | $251.51 | 3.63x | $661.61 | $495.8K | 4.1K | 2.0K |
| 2015 | $755.42 | $216.03 | 3.50x | $539.39 | $590.3K | 4.5K | 2.0K |
| 2016 | $806.28 | $234.80 | 3.43x | $571.48 | $591.9K | 4.1K | 1.8K |
| 2017 | $774.91 | $207.61 | 3.73x | $567.30 | $655.2K | 4.5K | 2.0K |
| 2018 | $819.09 | $232.27 | 3.53x | $586.82 | $650.9K | 4.4K | 1.9K |
| 2019 | $837.33 | $234.84 | 3.57x | $602.49 | $609.2K | 3.9K | 1.8K |
| 2020 | $871.00 | $223.75 | 3.89x | $647.25 | $490.8K | 3.3K | 1.6K |
| 2021 | $464.53 | $149.35 | 3.11x | $315.18 | $619.7K | 4.0K | 1.7K |
| 2022 | $872.31 | $227.38 | 3.84x | $644.93 | $631.8K | 4.1K | 1.8K |
| 2023 | $435.57 | $144.36 | 3.02x | $291.21 | $556.7K | 4.1K | 1.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 4.3K | $3.2M | $735.89 | 1.67x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 7.7K | $708.3K | $91.68 | 2.08x |
| 67028 | Injection of drug into eye | 6.5K | $564.5K | $86.25 | 8.48x |
| 92134 | Diagnostic imaging of retina | 11.8K | $393.8K | $33.35 | 11.36x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 5.6K | $378.8K | $68.09 | 2.01x |
| 67042 | Removal of membrane from the retina, pars plana approach | 171 | $166.4K | $973.37 | 5.03x |
| J2778 | Injection, ranibizumab, 0.1 mg | 499 | $150.4K | $301.50 | 1.81x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 832 | $100.1K | $120.37 | 2.09x |
| 92250 | Photography of the retina | 1.9K | $85.4K | $45.90 | 5.77x |
| J7999 | Compounded drug, not otherwise classified | 680 | $44.4K | $65.22 | 1.59x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 404 | $35.3K | $87.30 | 6.09x |
| 92240 | Examination of eye using an endoscope | 108 | $22.6K | $208.98 | 2.76x |
| 92242 | Imaging of blood vessels in back of eye using fluorescein and indocyanine-green dye | 103 | $22.5K | $218.63 | 2.97x |
| J3590 | Unclassified biologics | 266 | $13.6K | $51.31 | 1.95x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 13 | $10.2K | $784.18 | 5.51x |
| 76512 | Ultrasound of eye disease, growth, or structure | 38 | $2.5K | $64.80 | 6.45x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 67 | $2.0K | $29.19 | 1.88x |
| Q9977 | Compounded Drug, Not Otherwise Classified | 28 | $1.5K | $54.57 | 1.82x |
| J9035 | Injection, bevacizumab, 10 mg | 28 | $1.4K | $51.69 | 1.92x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 30 | $646.00 | $21.53 | 4.96x |
This provider submits charges 3.25 times higher than what Medicare actually pays.
A markup ratio of 3.25x means for every $100 Medicare pays, this provider initially charges $325. 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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