This provider's $7.2M in total Medicare payments ranks in the 97th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 130% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 64% in 2015
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 | $350.95 | $157.16 | 2.23x | $193.79 | $299.0K | 2.5K | 1.4K |
| 2015 | $576.16 | $257.81 | 2.23x | $318.35 | $489.7K | 3.8K | 1.8K |
| 2016 | $600.93 | $236.43 | 2.54x | $364.50 | $777.6K | 4.9K | 2.4K |
| 2017 | $483.77 | $190.95 | 2.53x | $292.82 | $821.9K | 5.4K | 2.7K |
| 2018 | $517.41 | $213.20 | 2.43x | $304.21 | $819.9K | 5.6K | 2.7K |
| 2019 | $496.08 | $195.73 | 2.53x | $300.35 | $804.1K | 5.7K | 2.6K |
| 2020 | $479.68 | $191.71 | 2.50x | $287.97 | $761.7K | 5.2K | 2.6K |
| 2021 | $493.40 | $205.35 | 2.40x | $288.05 | $842.0K | 5.3K | 2.2K |
| 2022 | $435.76 | $166.06 | 2.62x | $269.70 | $856.3K | 5.8K | 2.5K |
| 2023 | $574.82 | $214.39 | 2.68x | $360.43 | $688.5K | 5.8K | 2.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 4.2K | $3.1M | $737.46 | 1.49x |
| J2778 | Injection, ranibizumab, 0.1 mg | 4.8K | $1.3M | $269.85 | 2.10x |
| 67028 | Injection of drug into eye | 9.8K | $832.0K | $84.92 | 3.37x |
| 92134 | Diagnostic imaging of retina | 16.4K | $531.6K | $32.49 | 2.79x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 3.0K | $268.8K | $88.86 | 2.33x |
| 67042 | Removal of membrane from the retina, pars plana approach | 194 | $173.1K | $892.17 | 2.46x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 446 | $120.6K | $270.34 | 4.44x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 886 | $104.3K | $117.76 | 2.40x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.9K | $103.9K | $55.56 | 2.37x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 870 | $96.2K | $110.62 | 2.34x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 832 | $90.5K | $108.73 | 2.36x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 236 | $82.7K | $350.56 | 3.13x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 657 | $56.6K | $86.13 | 2.28x |
| 92242 | Imaging of blood vessels in back of eye using fluorescein and indocyanine-green dye | 272 | $52.6K | $193.39 | 2.04x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 99 | $37.8K | $382.00 | 2.89x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 883 | $30.9K | $35.03 | 5.28x |
| 92250 | Photography of the retina | 623 | $28.8K | $46.16 | 2.80x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 1.0K | $27.2K | $26.70 | 4.78x |
| 92201 | Extended examination of eye with drawing of retina | 1.1K | $20.0K | $18.43 | 5.96x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 26 | $16.9K | $648.32 | 2.48x |
This provider submits charges 2.17 times higher than what Medicare actually pays.
A markup ratio of 2.17x means for every $100 Medicare pays, this provider initially charges $217. 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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