This provider averages 128 services per working day
Based on 319.7K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $38.3M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 128 services per working day raises questions about billing patterns.
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 | $210.82 | $87.10 | 2.42x | $123.72 | $3.3M | 37.7K | 32 |
| 2015 | $217.29 | $88.04 | 2.47x | $129.25 | $3.2M | 36.3K | 33 |
| 2016 | $242.82 | $94.10 | 2.58x | $148.72 | $3.0M | 31.5K | 32 |
| 2017 | $219.55 | $81.93 | 2.68x | $137.62 | $3.0M | 36.6K | 35 |
| 2018 | $306.39 | $121.68 | 2.52x | $184.71 | $3.7M | 30.6K | 35 |
| 2019 | $374.81 | $159.37 | 2.35x | $215.44 | $5.0M | 31.5K | 31 |
| 2020 | $427.40 | $179.26 | 2.38x | $248.14 | $5.0M | 27.8K | 32 |
| 2021 | $444.34 | $190.41 | 2.33x | $253.93 | $4.8M | 25.0K | 29 |
| 2022 | $468.89 | $199.55 | 2.35x | $269.34 | $4.2M | 20.9K | 28 |
| 2023 | $146.29 | $76.25 | 1.92x | $70.04 | $3.2M | 41.8K | 19 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 25.5K | $18.6M | $732.18 | 1.86x |
| J2778 | Injection, ranibizumab, 0.1 mg | 29.8K | $8.5M | $285.37 | 2.05x |
| 67028 | Injection of drug into eye | 31.7K | $2.7M | $84.07 | 4.98x |
| 92012 | Established patient problem focused exam of visual system | 19.0K | $1.2M | $63.12 | 2.75x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 34.9K | $1.0M | $29.12 | 1.54x |
| 92134 | Imaging of retina | 31.7K | $962.7K | $30.37 | 4.09x |
| 92014 | Established patient complete exam of visual system | 9.2K | $816.1K | $88.82 | 3.08x |
| J9035 | Injection, bevacizumab, 10 mg | 11.2K | $643.5K | $57.42 | 1.58x |
| 92250 | Photography of the retina | 13.7K | $618.8K | $45.30 | 3.68x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 4.5K | $362.6K | $80.21 | 3.12x |
| J3300 | Injection, triamcinolone acetonide, preservative free, 1 mg | 88.3K | $256.6K | $2.91 | 2.22x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 1.9K | $251.7K | $130.73 | 1.56x |
| 67210 | Destruction of growth of retina using a laser | 618 | $236.9K | $383.34 | 3.53x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 1.8K | $183.3K | $103.36 | 2.88x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 470 | $182.4K | $388.09 | 3.91x |
| 67040 | Destruction of eye fluid (vitreous) between lens and retina and all of retina using a laser | 198 | $163.9K | $827.69 | 4.29x |
| 67042 | Removal of membrane from the retina, pars plana approach with removal of internal limiting membrane of retina | 173 | $159.6K | $922.56 | 3.89x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.2K | $140.1K | $117.32 | 2.31x |
| 66984 | Removal of cataract with insertion of lens, simple | 342 | $132.5K | $387.30 | 4.47x |
| 66821 | Removal of recurring cataract in lens capsule using a laser | 516 | $122.3K | $237.09 | 5.53x |
This provider submits charges 2.39 times higher than what Medicare actually pays.
A markup ratio of 2.39x means for every $100 Medicare pays, this provider initially charges $239. 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 WA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| David Spinak, MD | Silverdale, WA | $34.8M | ✓ 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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