This provider's $5.7M in total Medicare payments ranks in the 97th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 198% from 2015 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 226% in 2016
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 |
|---|---|---|---|---|---|---|---|
| 2015 | $449.83 | $197.52 | 2.28x | $252.31 | $228.4K | 2.0K | 1.4K |
| 2016 | $539.22 | $198.68 | 2.71x | $340.54 | $745.1K | 6.0K | 2.9K |
| 2017 | $576.99 | $209.99 | 2.75x | $367.00 | $790.0K | 6.1K | 2.9K |
| 2018 | $574.41 | $195.05 | 2.94x | $379.36 | $762.9K | 5.6K | 2.7K |
| 2019 | $352.41 | $156.14 | 2.26x | $196.27 | $808.7K | 6.1K | 2.8K |
| 2020 | $341.23 | $117.72 | 2.90x | $223.51 | $697.1K | 5.5K | 2.3K |
| 2021 | $422.02 | $157.75 | 2.68x | $264.27 | $240.4K | 1.9K | 1.2K |
| 2022 | $414.58 | $138.46 | 2.99x | $276.12 | $768.4K | 4.7K | 2.8K |
| 2023 | $888.07 | $353.17 | 2.51x | $534.90 | $680.1K | 4.6K | 2.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 4.5K | $3.3M | $738.05 | 1.72x |
| 67028 | Injection of drug into eye | 8.8K | $719.6K | $81.65 | 3.43x |
| 92134 | Diagnostic imaging of retina | 13.0K | $385.5K | $29.65 | 3.51x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 4.9K | $239.9K | $49.29 | 2.84x |
| J2778 | Injection, ranibizumab, 0.1 mg | 572 | $145.5K | $254.33 | 2.05x |
| J9035 | Injection, bevacizumab, 10 mg | 2.5K | $137.2K | $55.87 | 1.57x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.0K | $110.9K | $106.54 | 2.90x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 1.4K | $94.2K | $66.15 | 3.49x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 1.3K | $88.5K | $69.40 | 2.80x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 842 | $71.1K | $84.42 | 2.24x |
| J7999 | Compounded drug, not otherwise classified | 847 | $61.8K | $72.99 | 3.22x |
| 92250 | Photography of the retina | 1.1K | $46.5K | $44.02 | 3.57x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 117 | $44.7K | $382.48 | 2.66x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 136 | $40.3K | $296.16 | 6.29x |
| J3490 | Unclassified drugs | 18 | $37.1K | $2.1K | 1.86x |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 130 | $32.6K | $250.49 | 2.13x |
| 67041 | Removal of membrane from the retina | 38 | $32.5K | $854.42 | 2.64x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 76 | $29.1K | $382.65 | 2.68x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 184 | $18.1K | $98.19 | 2.87x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 196 | $17.5K | $89.52 | 3.22x |
This provider submits charges 2.29 times higher than what Medicare actually pays.
A markup ratio of 2.29x means for every $100 Medicare pays, this provider initially charges $229. 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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