This provider averages 67 services per working day
Based on 167.6K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $29.5M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 67 services per working day raises questions about billing patterns.
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 | $289.86 | $158.40 | 1.83x | $131.46 | $3.0M | 19.1K | 21 |
| 2015 | $273.38 | $136.74 | 2.00x | $136.64 | $2.7M | 19.4K | 22 |
| 2016 | $395.07 | $159.65 | 2.47x | $235.42 | $2.8M | 17.6K | 21 |
| 2017 | $396.11 | $159.29 | 2.49x | $236.82 | $2.8M | 17.4K | 19 |
| 2018 | $417.09 | $165.91 | 2.51x | $251.18 | $3.0M | 17.9K | 21 |
| 2019 | $406.47 | $186.87 | 2.18x | $219.60 | $2.9M | 15.3K | 21 |
| 2020 | $368.37 | $241.12 | 1.53x | $127.25 | $3.0M | 12.6K | 21 |
| 2021 | $359.85 | $239.10 | 1.51x | $120.75 | $3.2M | 13.2K | 17 |
| 2022 | $319.54 | $235.71 | 1.36x | $83.83 | $3.0M | 12.9K | 18 |
| 2023 | $221.36 | $142.78 | 1.55x | $78.58 | $3.1M | 22.0K | 23 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 26.3K | $19.5M | $740.32 | 1.55x |
| J2778 | Injection, ranibizumab, 0.1 mg | 6.2K | $1.8M | $299.20 | 1.52x |
| 67028 | Injection of drug into eye | 17.1K | $1.6M | $92.77 | 3.36x |
| 92134 | Imaging of retina | 33.4K | $1.2M | $34.85 | 3.10x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 11.2K | $1.0M | $90.51 | 2.42x |
| 67210 | Destruction of growth of retina using a laser | 1.0K | $456.3K | $451.78 | 2.87x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 21.0K | $433.5K | $20.64 | 4.22x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 2.6K | $336.6K | $131.48 | 2.39x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 5.4K | $325.8K | $60.62 | 2.60x |
| J9035 | Injection, bevacizumab, 10 mg | 7.3K | $299.9K | $40.91 | 1.55x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 1.9K | $293.1K | $157.59 | 1.85x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 3.1K | $281.1K | $89.63 | 3.02x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 408 | $245.0K | $600.60 | 4.40x |
| 92012 | Established patient problem focused exam of visual system | 3.3K | $226.6K | $69.25 | 2.09x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 7.3K | $212.3K | $29.01 | 1.41x |
| 76512 | 2d ultrasound scan of eye tissue and structures | 3.2K | $179.9K | $56.87 | 3.00x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 204 | $161.2K | $790.01 | 4.65x |
| J3490 | Unclassified drugs | 88 | $153.5K | $1.7K | 1.39x |
| 92201 | Extended exam of the back part of the eye with retinal drawing | 6.9K | $146.0K | $21.24 | 1.98x |
| 92250 | Photography of the retina | 2.8K | $144.4K | $52.18 | 3.15x |
This provider submits charges 1.93 times higher than what Medicare actually pays.
A markup ratio of 1.93x means for every $100 Medicare pays, this provider initially charges $193. 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 NJ for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Howard Fine, MD MHSC | New Brunswick, NJ | $44.5M | ✓ Clear |
| Robert Barone, MD | Newton, NJ | $43.3M | ✓ Clear |
| Jonathan Prenner, MD | New Brunswick, NJ | $43.1M | ✓ Clear |
| Sumit Shah, M.D. | New Brunswick, NJ | $37.0M | ✓ Clear |
| David Kim, M.D. | Union, NJ | $36.1M | ✓ 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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