This provider's $3.7M in total Medicare payments ranks in the 95th 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 | $346.53 | $104.65 | 3.31x | $241.88 | $372.0K | 4.9K | 2.3K |
| 2015 | $472.24 | $153.68 | 3.07x | $318.56 | $349.2K | 4.9K | 2.5K |
| 2016 | $264.06 | $84.28 | 3.13x | $179.78 | $425.5K | 5.5K | 2.8K |
| 2017 | $350.90 | $77.26 | 4.54x | $273.64 | $350.1K | 5.9K | 3.3K |
| 2018 | $198.76 | $74.66 | 2.66x | $124.10 | $357.0K | 4.5K | 2.3K |
| 2019 | $198.02 | $72.35 | 2.74x | $125.67 | $440.0K | 4.8K | 2.2K |
| 2020 | $248.49 | $81.39 | 3.05x | $167.10 | $355.1K | 4.1K | 1.9K |
| 2021 | $259.38 | $88.40 | 2.93x | $170.98 | $344.3K | 4.5K | 1.6K |
| 2022 | $292.19 | $88.52 | 3.30x | $203.67 | $352.9K | 4.4K | 1.5K |
| 2023 | $347.85 | $90.51 | 3.84x | $257.34 | $316.6K | 4.3K | 1.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2.1K | $1.5M | $740.23 | 4.06x |
| 67028 | Injection of drug into eye | 14.7K | $1.1M | $74.98 | 2.53x |
| 92134 | Diagnostic imaging of retina | 18.2K | $386.0K | $21.19 | 2.50x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 5.8K | $323.5K | $56.23 | 1.93x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 3.0K | $121.8K | $41.15 | 1.91x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 998 | $49.5K | $49.59 | 1.49x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 498 | $27.6K | $55.40 | 1.65x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 66 | $23.0K | $348.22 | 6.40x |
| 92250 | Photography of the retina | 1.1K | $19.6K | $17.34 | 1.54x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 36 | $13.1K | $364.99 | 2.40x |
| J9035 | Injection, bevacizumab, 10 mg | 215 | $12.5K | $58.06 | 3.51x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 427 | $8.7K | $20.41 | 1.94x |
| 76512 | Ultrasound of eye disease, growth, or structure | 231 | $8.4K | $36.29 | 1.71x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 18 | $7.1K | $392.93 | 2.70x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 87 | $4.7K | $54.24 | 1.83x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 209 | $4.5K | $21.71 | 1.72x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 152 | $4.5K | $29.62 | 1.63x |
| 99204 | New patient outpatient visit, total time 45-59 minutes | 12 | $1.3K | $107.25 | 1.34x |
| 99441 | Physician telephone patient service, 5-10 minutes of medical discussion | 24 | $703.11 | $29.30 | 1.43x |
| 92201 | Extended examination of eye with drawing of retina | 40 | $691.42 | $17.29 | 1.49x |
This provider submits charges 3.09 times higher than what Medicare actually pays.
A markup ratio of 3.09x means for every $100 Medicare pays, this provider initially charges $309. 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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