This provider's $8.0M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 13677% from 2014 to 2023.
61% of their billing comes from a single procedure code (J0178 — Injection, aflibercept, 1 mg).
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 544% in 2015
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
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 | $296.52 | $63.71 | 4.65x | $232.81 | $8.4K | 148 | 118 |
| 2015 | $469.99 | $179.22 | 2.62x | $290.77 | $54.3K | 448 | 292 |
| 2016 | $498.87 | $148.93 | 3.35x | $349.94 | $138.9K | 1.6K | 1.3K |
| 2017 | $1.3K | $252.84 | 5.11x | $1.0K | $548.2K | 5.6K | 2.7K |
| 2018 | $1.4K | $275.94 | 5.06x | $1.1K | $821.8K | 7.0K | 3.4K |
| 2019 | $1.3K | $252.20 | 5.08x | $1.0K | $1.1M | 8.6K | 4.0K |
| 2020 | $885.44 | $229.22 | 3.86x | $656.22 | $1.2M | 8.6K | 3.8K |
| 2021 | $921.19 | $236.80 | 3.89x | $684.39 | $1.4M | 9.9K | 4.2K |
| 2022 | $1.2K | $323.74 | 3.75x | $891.53 | $1.5M | 9.5K | 4.0K |
| 2023 | $545.03 | $154.16 | 3.54x | $390.87 | $1.2M | 8.7K | 3.6K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 6.6K | $4.8M | $729.26 | 2.06x |
| 67028 | Injection of drug into eye | 11.7K | $916.1K | $78.34 | 13.21x |
| 92134 | Diagnostic imaging of retina | 17.4K | $490.2K | $28.13 | 5.45x |
| J3590 | Unclassified biologics | 4.1K | $245.9K | $59.33 | 1.44x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 2.9K | $223.4K | $76.89 | 2.34x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 3.9K | $196.2K | $50.93 | 2.58x |
| J3490 | Unclassified drugs | 89 | $160.4K | $1.8K | 1.38x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.4K | $153.9K | $110.74 | 1.93x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 3.0K | $100.1K | $33.88 | 3.84x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 111 | $98.7K | $889.28 | 7.07x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 264 | $96.0K | $363.82 | 3.30x |
| 67042 | Removal of membrane from the retina, pars plana approach | 108 | $91.8K | $849.61 | 4.53x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 1.1K | $84.2K | $79.10 | 3.79x |
| 67041 | Removal of membrane from the retina | 71 | $61.2K | $861.63 | 4.85x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 530 | $37.8K | $71.35 | 2.75x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 142 | $35.6K | $251.03 | 6.12x |
| 92202 | Extended examination of eye with drawing of optic nerve and surrounding area (macula) | 2.9K | $31.7K | $10.89 | 4.23x |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 108 | $25.5K | $236.25 | 2.86x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 648 | $24.4K | $37.72 | 3.71x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 35 | $23.6K | $674.07 | 4.68x |
This provider submits charges 3.75 times higher than what Medicare actually pays.
A markup ratio of 3.75x means for every $100 Medicare pays, this provider initially charges $375. 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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