This provider's $10.2M in total Medicare payments ranks in the 98th 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 | $299.48 | $159.78 | 1.87x | $139.70 | $1.0M | 7.3K | 2.4K |
| 2015 | $321.36 | $180.56 | 1.78x | $140.80 | $1.1M | 7.3K | 2.3K |
| 2016 | $320.90 | $142.09 | 2.26x | $178.81 | $1.2M | 7.7K | 2.5K |
| 2017 | $308.54 | $131.26 | 2.35x | $177.28 | $1.0M | 7.9K | 2.7K |
| 2018 | $228.51 | $109.59 | 2.09x | $118.92 | $1.1M | 8.0K | 2.6K |
| 2019 | $248.42 | $126.60 | 1.96x | $121.82 | $1.2M | 7.7K | 2.4K |
| 2020 | $236.23 | $124.45 | 1.90x | $111.78 | $992.2K | 6.2K | 2.1K |
| 2021 | $259.17 | $122.81 | 2.11x | $136.36 | $983.9K | 6.4K | 2.1K |
| 2022 | $420.00 | $232.60 | 1.81x | $187.40 | $885.2K | 6.2K | 2.2K |
| 2023 | $452.82 | $244.04 | 1.86x | $208.78 | $749.5K | 5.9K | 2.1K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 8.1K | $6.0M | $740.25 | 1.53x |
| 67028 | Injection of drug into eye | 17.0K | $1.4M | $81.63 | 3.81x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 9.1K | $823.8K | $90.11 | 1.62x |
| 92134 | Diagnostic imaging of retina | 21.9K | $696.0K | $31.75 | 5.34x |
| J9035 | Injection, bevacizumab, 10 mg | 6.4K | $353.9K | $55.19 | 1.50x |
| J2778 | Injection, ranibizumab, 0.1 mg | 1.1K | $312.4K | $294.99 | 1.58x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 4.0K | $263.2K | $65.25 | 1.57x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 654 | $70.9K | $108.48 | 1.72x |
| J3590 | Unclassified biologics | 30 | $55.3K | $1.8K | 1.59x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 93 | $52.9K | $568.56 | 2.11x |
| J3490 | Unclassified drugs | 28 | $46.0K | $1.6K | 1.66x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 303 | $24.1K | $79.57 | 3.09x |
| 92250 | Photography of the retina | 456 | $23.4K | $51.25 | 2.73x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 189 | $13.3K | $70.43 | 2.33x |
| 92083 | Measurement of field of vision during daylight conditions | 204 | $9.8K | $48.24 | 2.69x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 294 | $8.2K | $28.05 | 1.53x |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 23 | $5.7K | $248.99 | 1.41x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 203 | $4.3K | $21.02 | 6.55x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 203 | $3.8K | $18.51 | 3.72x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 60 | $3.3K | $55.57 | 1.70x |
This provider submits charges 2.13 times higher than what Medicare actually pays.
A markup ratio of 2.13x means for every $100 Medicare pays, this provider initially charges $213. 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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