This provider's $8.5M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 359% 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 | $745.40 | $219.45 | 3.40x | $525.95 | $309.2K | 4.2K | 1.6K |
| 2015 | $737.77 | $211.62 | 3.49x | $526.15 | $393.3K | 4.2K | 1.7K |
| 2016 | $725.70 | $204.74 | 3.54x | $520.96 | $581.2K | 6.0K | 2.3K |
| 2017 | $1.1K | $258.71 | 4.37x | $872.29 | $697.7K | 6.8K | 2.3K |
| 2018 | $662.84 | $183.67 | 3.61x | $479.17 | $685.1K | 7.4K | 2.5K |
| 2019 | $826.60 | $210.78 | 3.92x | $615.82 | $747.2K | 9.1K | 2.8K |
| 2020 | $332.89 | $131.46 | 2.53x | $201.43 | $982.3K | 8.5K | 2.4K |
| 2021 | $415.38 | $144.11 | 2.88x | $271.27 | $1.2M | 9.5K | 3.0K |
| 2022 | $445.25 | $123.08 | 3.62x | $322.17 | $1.4M | 11.0K | 2.8K |
| 2023 | $467.72 | $129.85 | 3.60x | $337.87 | $1.4M | 10.7K | 2.6K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 6.1K | $4.4M | $730.30 | 1.57x |
| 67028 | Injection of drug into eye | 16.3K | $1.4M | $87.22 | 10.10x |
| 92134 | Diagnostic imaging of retina | 24.7K | $765.2K | $30.93 | 3.30x |
| J7999 | Compounded drug, not otherwise classified | 9.0K | $600.0K | $66.66 | 1.50x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 3.7K | $304.1K | $82.17 | 2.31x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.3K | $154.0K | $118.57 | 2.38x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.3K | $145.5K | $63.47 | 2.73x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 84 | $90.9K | $1.1K | 4.75x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 1.5K | $89.3K | $59.94 | 2.19x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 978 | $87.3K | $89.27 | 1.80x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 204 | $73.9K | $362.09 | 5.08x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 3.8K | $73.3K | $19.19 | 4.22x |
| 92202 | Extended examination of eye with drawing of optic nerve and surrounding area (macula) | 3.6K | $41.9K | $11.80 | 6.86x |
| J3590 | Unclassified biologics | 786 | $41.8K | $53.19 | 1.92x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 357 | $33.8K | $94.77 | 2.95x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 1.3K | $28.9K | $21.58 | 4.03x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 147 | $22.1K | $150.57 | 2.52x |
| 99203 | New patient outpatient visit, total time 30-44 minutes | 193 | $15.2K | $78.64 | 2.51x |
| 67042 | Removal of membrane from the retina, pars plana approach | 11 | $10.0K | $908.57 | 5.49x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 102 | $10.0K | $97.63 | 2.06x |
This provider submits charges 3.37 times higher than what Medicare actually pays.
A markup ratio of 3.37x means for every $100 Medicare pays, this provider initially charges $337. 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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