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 | $926.94 | $309.94 | 2.99x | $617.00 | $870.2K | 8.9K | 4.7K |
| 2015 | $776.71 | $257.50 | 3.02x | $519.21 | $985.1K | 9.6K | 5.2K |
| 2016 | $873.61 | $247.21 | 3.53x | $626.40 | $1.1M | 11.5K | 5.8K |
| 2017 | $612.51 | $199.99 | 3.06x | $412.52 | $1.0M | 10.9K | 5.5K |
| 2018 | $772.38 | $228.86 | 3.37x | $543.52 | $968.0K | 10.3K | 5.0K |
| 2019 | $754.45 | $226.25 | 3.33x | $528.20 | $1.1M | 10.9K | 5.1K |
| 2020 | $786.46 | $241.86 | 3.25x | $544.60 | $934.2K | 9.9K | 4.1K |
| 2021 | $581.49 | $204.43 | 2.84x | $377.06 | $1.3M | 13.3K | 5.9K |
| 2022 | $560.77 | $188.27 | 2.98x | $372.50 | $1.0M | 9.5K | 3.8K |
| 2023 | $534.30 | $175.50 | 3.04x | $358.80 | $913.6K | 10.2K | 3.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 3.5K | $2.5M | $734.08 | 1.71x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 19.5K | $1.5M | $77.10 | 1.56x |
| 67028 | Injection of drug into eye | 17.5K | $1.4M | $80.64 | 4.68x |
| 92134 | Diagnostic imaging of retina | 29.0K | $830.2K | $28.66 | 2.89x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 7.3K | $590.3K | $80.87 | 1.49x |
| 67042 | Removal of membrane from the retina, pars plana approach | 615 | $540.2K | $878.40 | 3.93x |
| J9035 | Injection, bevacizumab, 10 mg | 8.9K | $492.1K | $55.00 | 1.82x |
| J2778 | Injection, ranibizumab, 0.1 mg | 1.7K | $437.2K | $257.35 | 1.94x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 2.3K | $240.4K | $104.37 | 1.42x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 344 | $228.7K | $664.78 | 4.21x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 3.0K | $174.0K | $57.50 | 1.69x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 953 | $149.9K | $157.32 | 1.91x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 1.7K | $131.2K | $76.26 | 3.21x |
| 66821 | Removal of recurring cataract in lens capsule using laser | 598 | $125.3K | $209.60 | 2.24x |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 532 | $115.1K | $216.28 | 1.48x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 275 | $98.8K | $359.18 | 3.48x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 257 | $94.0K | $365.93 | 3.55x |
| 92250 | Photography of the retina | 2.1K | $76.6K | $36.24 | 2.59x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 1.0K | $72.5K | $69.74 | 1.59x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 620 | $69.2K | $111.59 | 1.47x |
This provider submits charges 2.48 times higher than what Medicare actually pays.
A markup ratio of 2.48x means for every $100 Medicare pays, this provider initially charges $248. 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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