This provider's $8.1M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 56% 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 | $337.83 | $258.13 | 1.31x | $79.70 | $558.4K | 7.4K | 3.7K |
| 2015 | $299.27 | $214.45 | 1.40x | $84.82 | $653.5K | 8.5K | 3.9K |
| 2016 | $239.24 | $165.92 | 1.44x | $73.32 | $664.0K | 9.0K | 4.0K |
| 2017 | $238.84 | $162.09 | 1.47x | $76.75 | $725.6K | 8.4K | 3.6K |
| 2018 | $231.62 | $154.02 | 1.50x | $77.60 | $830.6K | 9.0K | 3.6K |
| 2019 | $280.14 | $200.81 | 1.40x | $79.33 | $893.7K | 9.0K | 3.5K |
| 2020 | $310.11 | $213.72 | 1.45x | $96.39 | $927.5K | 8.8K | 3.3K |
| 2021 | $300.53 | $201.54 | 1.49x | $98.99 | $1.0M | 9.2K | 3.1K |
| 2022 | $342.82 | $230.29 | 1.49x | $112.53 | $986.0K | 9.0K | 2.9K |
| 2023 | $256.85 | $151.44 | 1.70x | $105.41 | $870.9K | 8.4K | 2.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 4.5K | $3.3M | $739.63 | 1.55x |
| 67028 | Injection of drug into eye | 18.8K | $1.5M | $78.31 | 1.55x |
| 92134 | Diagnostic imaging of retina | 25.1K | $701.9K | $27.98 | 1.49x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 8.9K | $436.6K | $49.26 | 1.58x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 5.7K | $399.8K | $69.83 | 1.47x |
| J9035 | Injection, bevacizumab, 10 mg | 11.9K | $391.5K | $32.77 | 1.34x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 1.0K | $359.1K | $344.01 | 1.50x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 586 | $216.9K | $370.10 | 1.35x |
| 92250 | Photography of the retina | 2.1K | $98.0K | $47.59 | 1.51x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 597 | $93.6K | $156.81 | 1.55x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 121 | $79.3K | $655.47 | 1.35x |
| J7999 | Compounded drug, not otherwise classified | 1.3K | $76.5K | $60.56 | 1.35x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 651 | $62.6K | $96.09 | 1.49x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 169 | $58.1K | $343.50 | 1.48x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 748 | $58.1K | $77.61 | 1.52x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 1.6K | $45.8K | $28.49 | 1.50x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 679 | $44.6K | $65.74 | 1.72x |
| 67042 | Removal of membrane from the retina, pars plana approach | 45 | $38.3K | $850.55 | 1.31x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 540 | $29.2K | $54.12 | 1.51x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina, with removal of vitreous fluid | 32 | $28.2K | $880.63 | 1.47x |
This provider submits charges 1.52 times higher than what Medicare actually pays.
A markup ratio of 1.52x means for every $100 Medicare pays, this provider initially charges $152. This is lower 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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