This provider's $14.3M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
67% 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 | $403.30 | $188.19 | 2.14x | $215.11 | $1.3M | 10.3K | 3.4K |
| 2015 | $291.63 | $116.91 | 2.49x | $174.72 | $1.3M | 10.4K | 3.4K |
| 2016 | $247.01 | $115.94 | 2.13x | $131.07 | $1.3M | 10.0K | 3.4K |
| 2017 | $319.19 | $107.85 | 2.96x | $211.34 | $1.4M | 10.0K | 3.2K |
| 2018 | $448.97 | $148.93 | 3.01x | $300.04 | $1.6M | 11.4K | 3.8K |
| 2019 | $336.50 | $124.86 | 2.70x | $211.64 | $1.7M | 12.0K | 3.9K |
| 2020 | $254.52 | $121.89 | 2.09x | $132.63 | $1.5M | 9.4K | 3.5K |
| 2021 | $249.01 | $120.23 | 2.07x | $128.78 | $1.4M | 8.5K | 2.9K |
| 2022 | $252.57 | $121.16 | 2.08x | $131.41 | $1.4M | 8.6K | 2.5K |
| 2023 | $247.41 | $115.09 | 2.15x | $132.32 | $1.3M | 8.3K | 2.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 12.9K | $9.5M | $739.36 | 1.59x |
| 67028 | Injection of drug into eye | 30.4K | $2.6M | $84.44 | 7.35x |
| J3590 | Unclassified biologics | 15.3K | $748.6K | $48.81 | 1.63x |
| 92134 | Diagnostic imaging of retina | 25.3K | $728.0K | $28.79 | 2.50x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 6.8K | $291.1K | $42.53 | 2.37x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 1.1K | $72.8K | $68.45 | 2.07x |
| 92250 | Photography of the retina | 2.3K | $72.8K | $31.45 | 2.78x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 785 | $61.7K | $78.65 | 1.94x |
| J2778 | Injection, ranibizumab, 0.1 mg | 117 | $35.9K | $306.77 | 1.32x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 324 | $34.0K | $104.91 | 2.25x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 556 | $28.9K | $52.01 | 2.00x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 45 | $22.7K | $503.99 | 3.18x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 303 | $22.4K | $73.81 | 2.35x |
| J7999 | Compounded drug, not otherwise classified | 1.4K | $22.1K | $16.33 | 1.29x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 39 | $15.7K | $402.78 | 3.28x |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 59 | $14.7K | $248.71 | 1.67x |
| J3490 | Unclassified drugs | 233 | $8.6K | $36.90 | 1.44x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 86 | $8.6K | $99.91 | 1.84x |
| J9035 | Injection, bevacizumab, 10 mg | 88 | $4.7K | $53.77 | 2.03x |
| Q9977 | Compounded Drug, Not Otherwise Classified | 272 | $4.5K | $16.41 | 1.28x |
This provider submits charges 2.71 times higher than what Medicare actually pays.
A markup ratio of 2.71x means for every $100 Medicare pays, this provider initially charges $271. 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 IN for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Drew Sommerville, MD | Evansville, IN | $35.4M | ✓ 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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