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 | $582.16 | $231.44 | 2.52x | $350.72 | $594.7K | 4.9K | 2.0K |
| 2015 | $449.19 | $171.94 | 2.61x | $277.25 | $592.3K | 4.9K | 2.0K |
| 2016 | $612.19 | $221.43 | 2.76x | $390.76 | $665.0K | 5.1K | 2.2K |
| 2017 | $362.70 | $127.04 | 2.86x | $235.66 | $675.7K | 5.2K | 2.0K |
| 2018 | $592.06 | $208.78 | 2.84x | $383.28 | $748.3K | 5.2K | 2.1K |
| 2019 | $621.88 | $208.70 | 2.98x | $413.18 | $900.3K | 5.6K | 2.2K |
| 2020 | $464.14 | $162.81 | 2.85x | $301.33 | $497.5K | 3.4K | 1.6K |
| 2021 | $419.05 | $148.14 | 2.83x | $270.91 | $468.5K | 3.3K | 1.6K |
| 2022 | $599.64 | $215.53 | 2.78x | $384.11 | $379.1K | 3.0K | 1.5K |
| 2023 | $338.88 | $112.77 | 3.01x | $226.11 | $395.2K | 3.5K | 1.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 4.6K | $3.4M | $741.46 | 2.25x |
| 67028 | Injection of drug into eye | 8.0K | $678.2K | $84.96 | 7.16x |
| 92134 | Diagnostic imaging of retina | 16.1K | $527.6K | $32.77 | 2.87x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 4.6K | $393.7K | $85.18 | 2.66x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 5.0K | $272.2K | $54.85 | 2.76x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.2K | $150.2K | $123.96 | 2.74x |
| J9035 | Injection, bevacizumab, 10 mg | 2.4K | $131.9K | $55.40 | 2.38x |
| J2778 | Injection, ranibizumab, 0.1 mg | 385 | $109.8K | $285.19 | 2.38x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 386 | $44.3K | $114.84 | 3.66x |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 128 | $31.8K | $248.78 | 2.35x |
| 67041 | Removal of membrane from the retina | 30 | $27.8K | $925.78 | 2.61x |
| 92250 | Photography of the retina | 636 | $23.6K | $37.12 | 3.99x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 23 | $22.6K | $980.75 | 2.69x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 25 | $19.1K | $764.70 | 2.34x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 30 | $17.2K | $573.09 | 3.17x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 40 | $15.8K | $394.08 | 2.79x |
| 92014 | Established patient complete exam of visual system | 118 | $10.7K | $90.56 | 2.93x |
| 76512 | Ultrasound of eye disease, growth, or structure | 156 | $10.1K | $64.97 | 2.86x |
| 67515 | Injection of medication or substance into membrane covering eyeball | 81 | $5.6K | $69.43 | 3.61x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 89 | $2.6K | $29.09 | 1.84x |
This provider submits charges 2.96 times higher than what Medicare actually pays.
A markup ratio of 2.96x means for every $100 Medicare pays, this provider initially charges $296. 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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