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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
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Methodology•Download Data
  1. Home
  2. Providers
  3. Rajiv Rathod
👁️
MDIndividual

Rajiv Rathod, MD

NPI: 1821201351
Santa Ana, CA
10 years of data
Ophthalmology
$27.8M
Total Payments
202
Beneficiaries
160.6K
Services
2.26x
Markup Ratio

Peer Comparison

99th
percentile in specialty
This provider$27.8M
Specialty median$383.7K

📋 Key Findings

1Billed $27.8M over 10 years
22.26x markup ratio (above median)
399th percentile in Ophthalmology by payments
464 services/day — unusually high
56 procedures with >3x markup

This provider averages 64 services per working day

Based on 160.6K total services over 10 years (250 working days/year). Learn about impossible service volumes →

🔎 Data Analysis

This provider's $27.8M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.

Averaging 64 services per working day raises questions about billing patterns.

Medicare payments to this provider grew 156% from 2014 to 2023.

AI-generated analysis based on Medicare payment data.

Annual Medicare Payments

Annual Services Provided

Avg Payment per Service

Markup Ratio Over Time

Submitted Charges vs. Medicare Payments

Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.

YearAvg SubmittedAvg PaidMarkup RatioGap per ServiceTotal PaymentsServicesBeneficiaries
2014$385.05$170.792.25x$214.26$1.7M9.7K19
2015$371.63$162.122.29x$209.51$1.7M10.4K21
2016$363.33$157.382.31x$205.95$1.8M11.4K19
2017$383.01$164.732.33x$218.28$2.3M14.2K23
2018$349.86$154.442.27x$195.42$2.5M16.4K21
2019$370.52$160.792.30x$209.73$3.0M18.5K19
2020$443.52$197.122.25x$246.40$2.9M14.8K20
2021$455.72$209.632.17x$246.09$3.8M17.9K19
2022$467.55$208.872.24x$258.68$3.9M18.6K21
2023$337.62$148.532.27x$189.09$4.3M28.6K20

Top Procedures (20)

J0178Injection, aflibercept, 1 mg
$16.5M
22.4K services$735.34/svc1.44x markup
J2778Injection, ranibizumab, 0.1 mg
$3.1M
10.6K services$292.95/svc1.47x markup
67028Injection of drug into eye⚠ 11.9x markup
$1.5M
15.7K services$92.30/svc11.87x markup
92014Established patient complete exam of visual system
$1.1M
10.5K services$102.52/svc1.80x markup
99214Established patient office or other outpatient visit, 30-39 minutes
$941.3K
10.3K services$91.80/svc2.01x markup
92134Imaging of retina⚠ 4.4x markup
$916.9K
26.0K services$35.26/svc4.38x markup
J7312Injection, dexamethasone, intravitreal implant, 0.1 mg
$865.3K
5.5K services$157.42/svc1.36x markup
92226Examination of eye by ophthalmoscope with retinal drawing⚠ 3.7x markup
$420.3K
19.5K services$21.59/svc3.67x markup
92235Exam of retinal blood vessels using a special camera after injection of a dye
$374.8K
3.9K services$95.20/svc2.77x markup
92201Extended exam of the back part of the eye with retinal drawing⚠ 4.3x markup
$270.5K
13.0K services$20.80/svc4.33x markup
J2777Injection, faricimab-svoa, 0.1 mg
$251.4K
8.7K services$28.89/svc1.73x markup
99204New patient office or other outpatient visit, 45-59 minutes
$235.7K
1.8K services$129.34/svc1.70x markup
J3490Unclassified drugs
$189.2K
100 services$1.9K/svc1.90x markup
J2781Injection, pegcetacoplan, intravitreal, 1 mg
$153.5K
1.3K services$120.36/svc1.66x markup
92250Photography of the retina⚠ 4.2x markup
$139.6K
3.0K services$47.03/svc4.23x markup
67145Photocoagulation treatment to prevent detachment of retina⚠ 3.3x markup
$137.8K
334 services$412.52/svc3.30x markup
67041Removal of membrane of retina
$130.4K
132 services$988.11/svc2.55x markup
J7314Injection, fluocinolone acetonide, intravitreal implant (yutiq), 0.01 mg
$111.2K
270 services$411.72/svc1.46x markup
99215Established patient office or other outpatient visit, 40-54 minutes
$107.8K
822 services$131.16/svc1.60x markup
99205New patient office or other outpatient visit, 60-74 minutes
$106.6K
605 services$176.17/svc1.42x markup
Show detailed table ▾
CodeDescriptionServicesPaymentsAvg/ServiceMarkup
J0178Injection, aflibercept, 1 mg22.4K$16.5M$735.341.44x
J2778Injection, ranibizumab, 0.1 mg10.6K$3.1M$292.951.47x
67028Injection of drug into eye15.7K$1.5M$92.3011.87x
92014Established patient complete exam of visual system10.5K$1.1M$102.521.80x
99214Established patient office or other outpatient visit, 30-39 minutes10.3K$941.3K$91.802.01x
92134Imaging of retina26.0K$916.9K$35.264.38x
J7312Injection, dexamethasone, intravitreal implant, 0.1 mg5.5K$865.3K$157.421.36x
92226Examination of eye by ophthalmoscope with retinal drawing19.5K$420.3K$21.593.67x
92235Exam of retinal blood vessels using a special camera after injection of a dye3.9K$374.8K$95.202.77x
92201Extended exam of the back part of the eye with retinal drawing13.0K$270.5K$20.804.33x
J2777Injection, faricimab-svoa, 0.1 mg8.7K$251.4K$28.891.73x
99204New patient office or other outpatient visit, 45-59 minutes1.8K$235.7K$129.341.70x
J3490Unclassified drugs100$189.2K$1.9K1.90x
J2781Injection, pegcetacoplan, intravitreal, 1 mg1.3K$153.5K$120.361.66x
92250Photography of the retina3.0K$139.6K$47.034.23x
67145Photocoagulation treatment to prevent detachment of retina334$137.8K$412.523.30x
67041Removal of membrane of retina132$130.4K$988.112.55x
J7314Injection, fluocinolone acetonide, intravitreal implant (yutiq), 0.01 mg270$111.2K$411.721.46x
99215Established patient office or other outpatient visit, 40-54 minutes822$107.8K$131.161.60x
99205New patient office or other outpatient visit, 60-74 minutes605$106.6K$176.171.42x

Markup Analysis

Charge-to-Payment Ratio

2.26x

This provider submits charges 2.26 times higher than what Medicare actually pays.

What This Means

A markup ratio of 2.26x means for every $100 Medicare pays, this provider initially charges $226. This is higher than the national average.

Location

Santa Ana, CA

Provider Verification

Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.

Similar Providers

Other Ophthalmology providers in CA for peer comparison.

Rajiv Rathod (you)
$27.8M
Nathan Steinle, M.D.
$63.1M
Stephen Couvillion, MD
$47.7M
Margaret Chang, M.D.
$47.6M
David Boyer, MD
$47.5M
Alessandro Castellarin, M.D.
$46.9M
Show detailed table ▾
ProviderLocationTotal PaymentsStatus
Nathan Steinle, M.D.Santa Barbara, CA$63.1M✓ Clear
Stephen Couvillion, MDSanta Barbara, CA$47.7M✓ Clear
Margaret Chang, M.D.Sacramento, CA$47.6M✓ Clear
David Boyer, MDLos Angeles, CA$47.5M✓ Clear
Alessandro Castellarin, M.D.Santa Barbara, CA$46.9M✓ Clear

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Data Sources

  • • Centers for Medicare & Medicaid Services (CMS)
  • • Medicare Provider Utilization and Payment Data (2014-2023)
  • • National Plan and Provider Enumeration System (NPPES)

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.

Believe this data is inaccurate? Dispute this data