⚠️ This provider averages 217 services per working day — physically unusual for an individual practitioner
Based on 542.8K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $94.8M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 217 services per working day raises questions about billing patterns.
72% of their billing comes from a single procedure code (J0178 — Injection, aflibercept, 1 mg).
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 | $497.05 | $262.47 | 1.89x | $234.58 | $9.2M | 34.9K | 18 |
| 2015 | $555.37 | $284.32 | 1.95x | $271.05 | $8.9M | 31.4K | 17 |
| 2016 | $586.82 | $301.09 | 1.95x | $285.73 | $8.0M | 26.5K | 19 |
| 2017 | $593.96 | $303.17 | 1.96x | $290.79 | $8.1M | 26.9K | 18 |
| 2018 | $593.81 | $305.74 | 1.94x | $288.07 | $8.8M | 28.7K | 17 |
| 2019 | $634.99 | $329.50 | 1.93x | $305.49 | $10.5M | 31.9K | 17 |
| 2020 | $614.44 | $320.31 | 1.92x | $294.13 | $10.2M | 32.0K | 17 |
| 2021 | $630.87 | $334.55 | 1.89x | $296.32 | $10.4M | 31.1K | 17 |
| 2022 | $352.84 | $178.19 | 1.98x | $174.65 | $10.4M | 58.6K | 18 |
| 2023 | $71.98 | $42.36 | 1.70x | $29.62 | $10.2M | 240.9K | 14 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 91.3K | $68.4M | $749.36 | 1.64x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 255.2K | $7.4M | $29.08 | 1.45x |
| J2778 | Injection, ranibizumab, 0.1 mg | 21.2K | $5.9M | $276.60 | 1.72x |
| 67028 | Injection of drug into eye | 61.9K | $5.0M | $81.49 | 5.80x |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 6.0K | $1.5M | $250.44 | 1.64x |
| 92134 | Imaging of retina | 51.5K | $1.4M | $28.02 | 2.76x |
| J3490 | Unclassified drugs | 766 | $1.4M | $1.8K | 1.89x |
| J3590 | Unclassified biologics | 19.1K | $878.2K | $45.94 | 2.09x |
| 92014 | Established patient complete exam of visual system | 8.1K | $667.1K | $81.92 | 2.54x |
| 92004 | New patient complete exam of visual system | 4.6K | $459.3K | $99.42 | 2.47x |
| 92250 | Photography of the retina | 12.3K | $456.6K | $37.11 | 3.14x |
| 67041 | Removal of membrane of retina | 329 | $284.9K | $866.04 | 2.54x |
| 92012 | Established patient problem focused exam of visual system | 4.1K | $236.5K | $57.30 | 2.41x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 182 | $163.7K | $899.21 | 2.55x |
| 67108 | Repair of detached retina with drainage and removal of eye fluid between lens and retina | 108 | $107.0K | $991.01 | 2.61x |
| J7999 | Compounded drug, not otherwise classified | 2.1K | $81.8K | $38.61 | 2.59x |
| 92235 | Imaging of blood vessels in back of eye using fluorescein dye | 946 | $76.8K | $81.17 | 2.37x |
| 67145 | Photocoagulation treatment to prevent detachment of retina | 215 | $75.2K | $349.61 | 2.79x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 178 | $74.0K | $415.57 | 3.12x |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 1.7K | $55.0K | $31.56 | 2.39x |
This provider submits charges 1.91 times higher than what Medicare actually pays.
A markup ratio of 1.91x means for every $100 Medicare pays, this provider initially charges $191. This is lower than the national average.
Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.
Other Ophthalmology providers in NE for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| William Terrell, M.D. | Hastings, NE | $59.3M | ✓ Clear |
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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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