This provider's $10.3M 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 | $520.90 | $205.16 | 2.54x | $315.74 | $752.0K | 6.8K | 3.2K |
| 2015 | $671.95 | $271.85 | 2.47x | $400.10 | $936.6K | 7.2K | 3.2K |
| 2016 | $693.00 | $266.26 | 2.60x | $426.74 | $977.4K | 7.2K | 3.1K |
| 2017 | $694.50 | $262.06 | 2.65x | $432.44 | $1.0M | 7.8K | 3.1K |
| 2018 | $582.72 | $212.39 | 2.74x | $370.33 | $1.0M | 7.4K | 3.1K |
| 2019 | $323.03 | $129.34 | 2.50x | $193.69 | $1.2M | 7.7K | 3.3K |
| 2020 | $724.07 | $249.53 | 2.90x | $474.54 | $1.1M | 7.1K | 2.9K |
| 2021 | $753.91 | $252.40 | 2.99x | $501.51 | $1.3M | 7.5K | 3.0K |
| 2022 | $715.24 | $272.15 | 2.63x | $443.09 | $1.1M | 6.1K | 2.6K |
| 2023 | $796.35 | $251.70 | 3.16x | $544.65 | $872.2K | 6.6K | 2.8K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 6.9K | $5.0M | $729.90 | 1.60x |
| J2778 | Injection, ranibizumab, 0.1 mg | 5.2K | $1.5M | $278.52 | 1.63x |
| 67028 | Injection of drug into eye | 15.8K | $1.3M | $81.12 | 6.14x |
| 92134 | Diagnostic imaging of retina | 21.9K | $645.1K | $29.46 | 3.39x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 7.1K | $396.2K | $55.88 | 3.85x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 3.1K | $234.7K | $76.27 | 3.30x |
| J3490 | Unclassified drugs | 123 | $220.6K | $1.8K | 1.57x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 2.2K | $212.1K | $94.47 | 3.56x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 3.1K | $157.4K | $50.55 | 3.66x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 138 | $128.8K | $933.52 | 3.15x |
| 67042 | Removal of membrane from the retina, pars plana approach | 149 | $126.0K | $845.54 | 2.75x |
| J3590 | Unclassified biologics | 2.1K | $111.6K | $54.34 | 2.43x |
| 67041 | Removal of membrane from the retina | 58 | $49.6K | $855.65 | 2.70x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 110 | $35.5K | $322.57 | 3.56x |
| 66821 | Removal of recurring cataract in lens capsule using laser | 156 | $29.1K | $186.53 | 3.65x |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 659 | $25.9K | $39.38 | 8.89x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 223 | $25.1K | $112.44 | 3.56x |
| J9035 | Injection, bevacizumab, 10 mg | 462 | $24.7K | $53.52 | 1.96x |
| 92250 | Photography of the retina | 404 | $18.2K | $44.96 | 3.56x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 215 | $17.9K | $83.09 | 3.62x |
This provider submits charges 2.57 times higher than what Medicare actually pays.
A markup ratio of 2.57x means for every $100 Medicare pays, this provider initially charges $257. This is higher 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 |
|---|---|---|---|
| John Welch, MD | Hastings, NE | $94.8M | ✓ Clear |
| 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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