This provider's $10.7M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 119% from 2014 to 2023.
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 | $402.96 | $284.44 | 1.42x | $118.52 | $669.6K | 6.7K | 2.9K |
| 2015 | $423.26 | $279.02 | 1.52x | $144.24 | $750.2K | 6.8K | 3.1K |
| 2016 | $351.92 | $240.55 | 1.46x | $111.37 | $820.0K | 7.3K | 3.0K |
| 2017 | $325.13 | $230.36 | 1.41x | $94.77 | $869.6K | 7.2K | 2.9K |
| 2018 | $284.91 | $186.63 | 1.53x | $98.28 | $989.9K | 7.9K | 3.0K |
| 2019 | $731.06 | $242.93 | 3.01x | $488.13 | $1.2M | 8.1K | 3.2K |
| 2020 | $663.73 | $217.52 | 3.05x | $446.21 | $1.2M | 8.4K | 3.6K |
| 2021 | $592.96 | $190.52 | 3.11x | $402.44 | $1.4M | 9.1K | 4.0K |
| 2022 | $768.48 | $231.73 | 3.32x | $536.75 | $1.4M | 9.1K | 3.8K |
| 2023 | $739.59 | $224.03 | 3.30x | $515.56 | $1.5M | 9.3K | 3.6K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 6.2K | $4.5M | $720.51 | 1.55x |
| 67028 | Injection of drug into eye | 17.3K | $1.5M | $89.44 | 4.34x |
| 66984 | Removal of cataract with insertion of lens | 2.1K | $967.3K | $469.35 | 2.36x |
| J7999 | Compounded drug, not otherwise classified | 9.1K | $585.6K | $64.34 | 3.62x |
| 92134 | Diagnostic imaging of retina | 17.5K | $561.0K | $32.11 | 2.38x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 8.7K | $495.5K | $57.16 | 1.76x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 4.5K | $427.7K | $94.01 | 2.44x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 3.2K | $264.9K | $83.73 | 2.26x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 176 | $178.0K | $1.0K | 2.34x |
| 66821 | Removal of recurring cataract in lens capsule using laser | 658 | $171.5K | $260.64 | 2.19x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 1.4K | $142.0K | $102.43 | 2.05x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 993 | $116.1K | $116.91 | 2.85x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 1.6K | $106.3K | $66.06 | 2.08x |
| 92136 | Measurement of corneal curvature and depth of eye | 2.2K | $93.1K | $41.69 | 2.94x |
| 67042 | Removal of membrane from the retina, pars plana approach | 89 | $84.8K | $953.29 | 1.94x |
| J9035 | Injection, bevacizumab, 10 mg | 1.7K | $83.8K | $50.51 | 2.10x |
| 66982 | Removal of cataract with insertion of lens | 130 | $78.9K | $607.01 | 3.54x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 200 | $66.3K | $331.47 | 3.17x |
| 67040 | Laser destruction of eye fluid (vitreous) between the lens and retina | 44 | $35.9K | $816.29 | 1.91x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 56 | $28.5K | $508.15 | 1.29x |
This provider submits charges 2.35 times higher than what Medicare actually pays.
A markup ratio of 2.35x means for every $100 Medicare pays, this provider initially charges $235. 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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