This provider's $9.5M 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 | $397.39 | $190.61 | 2.08x | $206.78 | $823.3K | 6.2K | 2.8K |
| 2015 | $406.54 | $164.62 | 2.47x | $241.92 | $1.1M | 7.1K | 2.9K |
| 2016 | $435.91 | $165.79 | 2.63x | $270.12 | $1.1M | 7.3K | 2.9K |
| 2017 | $433.13 | $167.76 | 2.58x | $265.37 | $1.0M | 7.1K | 2.8K |
| 2018 | $378.53 | $153.42 | 2.47x | $225.11 | $987.5K | 6.7K | 2.8K |
| 2019 | $370.53 | $152.74 | 2.43x | $217.79 | $1.0M | 6.8K | 2.7K |
| 2020 | $235.10 | $127.41 | 1.85x | $107.69 | $834.9K | 5.4K | 2.4K |
| 2021 | $569.91 | $205.60 | 2.77x | $364.31 | $964.8K | 5.9K | 2.4K |
| 2022 | $572.14 | $279.31 | 2.05x | $292.83 | $943.1K | 5.4K | 2.5K |
| 2023 | $783.14 | $275.05 | 2.85x | $508.09 | $649.7K | 5.2K | 2.1K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 7.4K | $5.5M | $741.72 | 1.52x |
| 67028 | Injection of drug into eye | 13.5K | $1.1M | $82.74 | 3.85x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 10.4K | $942.5K | $90.34 | 1.62x |
| 92134 | Diagnostic imaging of retina | 20.6K | $652.6K | $31.68 | 5.35x |
| J2778 | Injection, ranibizumab, 0.1 mg | 1.4K | $402.9K | $298.03 | 1.58x |
| J9035 | Injection, bevacizumab, 10 mg | 3.7K | $201.7K | $55.24 | 1.48x |
| J3590 | Unclassified biologics | 73 | $133.2K | $1.8K | 1.45x |
| 67042 | Removal of membrane from the retina, pars plana approach | 123 | $117.4K | $954.84 | 3.14x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 1.8K | $115.3K | $65.63 | 1.52x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 645 | $70.0K | $108.58 | 1.70x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 647 | $58.4K | $90.28 | 1.72x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 659 | $44.0K | $66.78 | 1.52x |
| J3490 | Unclassified drugs | 24 | $42.4K | $1.8K | 3.22x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 66 | $27.9K | $422.55 | 2.84x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 260 | $20.7K | $79.70 | 3.10x |
| 67040 | Laser destruction of eye fluid (vitreous) between the lens and retina | 25 | $19.6K | $784.29 | 3.83x |
| 92250 | Photography of the retina | 276 | $14.8K | $53.51 | 2.62x |
| 92083 | Measurement of field of vision during daylight conditions | 274 | $13.2K | $48.21 | 2.70x |
| 99204 | New patient outpatient visit, total time 45-59 minutes | 102 | $12.3K | $120.29 | 1.69x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 392 | $11.4K | $29.15 | 1.48x |
This provider submits charges 2.12 times higher than what Medicare actually pays.
A markup ratio of 2.12x means for every $100 Medicare pays, this provider initially charges $212. 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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