This provider's $8.9M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 198% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 62% in 2015
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 |
|---|---|---|---|---|---|---|---|
| 2014 | $365.47 | $106.33 | 3.44x | $259.14 | $429.8K | 5.9K | 2.8K |
| 2015 | $384.43 | $110.57 | 3.48x | $273.86 | $694.3K | 6.9K | 3.2K |
| 2016 | $384.43 | $109.42 | 3.51x | $275.01 | $607.5K | 7.3K | 3.5K |
| 2017 | $456.80 | $128.18 | 3.56x | $328.62 | $710.4K | 7.9K | 4.0K |
| 2018 | $386.47 | $110.78 | 3.49x | $275.69 | $788.8K | 9.1K | 4.4K |
| 2019 | $380.93 | $105.68 | 3.60x | $275.25 | $968.6K | 9.6K | 4.5K |
| 2020 | $454.32 | $124.45 | 3.65x | $329.87 | $985.7K | 9.2K | 4.1K |
| 2021 | $456.80 | $129.60 | 3.52x | $327.20 | $1.1M | 9.4K | 4.0K |
| 2022 | $871.83 | $199.36 | 4.37x | $672.47 | $1.3M | 9.2K | 4.0K |
| 2023 | $606.67 | $151.76 | 4.00x | $454.91 | $1.3M | 8.1K | 3.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 5.7K | $4.2M | $734.36 | 2.72x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 12.3K | $1.0M | $83.29 | 3.63x |
| 67028 | Injection of drug into eye | 11.1K | $914.6K | $82.56 | 8.48x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 8.7K | $745.7K | $85.77 | 4.00x |
| 92134 | Diagnostic imaging of retina | 23.3K | $727.9K | $31.20 | 4.23x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 3.9K | $314.3K | $80.15 | 4.87x |
| J9035 | Injection, bevacizumab, 10 mg | 4.8K | $270.9K | $56.87 | 1.76x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.7K | $205.1K | $120.93 | 3.84x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 2.5K | $158.0K | $61.94 | 3.81x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 559 | $62.9K | $112.54 | 3.69x |
| 92020 | Examination of cornea and iris using lens device and slit lamp | 2.1K | $42.9K | $20.79 | 3.70x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 2.3K | $41.9K | $18.59 | 3.66x |
| 67041 | Removal of membrane of retina | 41 | $35.9K | $874.99 | 4.25x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 1.6K | $34.5K | $21.30 | 3.52x |
| 92250 | Photography of the retina | 503 | $20.5K | $40.81 | 5.39x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 43 | $14.5K | $338.16 | 4.35x |
| 92201 | Extended examination of eye with drawing of retina | 571 | $10.4K | $18.21 | 4.12x |
| 76512 | Ultrasound of eye disease, growth, or structure | 196 | $10.3K | $52.67 | 5.22x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 11 | $9.8K | $888.46 | 4.78x |
| 92202 | Extended examination of eye with drawing of optic nerve and surrounding area (macula) | 701 | $8.1K | $11.54 | 5.89x |
This provider submits charges 3.79 times higher than what Medicare actually pays.
A markup ratio of 3.79x means for every $100 Medicare pays, this provider initially charges $379. 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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