This provider's $7.8M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 18922% from 2019 to 2023.
62% 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 1843% in 2020
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 |
|---|---|---|---|---|---|---|---|
| 2019 | $229.44 | $77.75 | 2.95x | $151.69 | $15.9K | 204 | 6 |
| 2020 | $355.46 | $193.83 | 1.83x | $161.63 | $308.2K | 1.6K | 12 |
| 2021 | $414.78 | $233.09 | 1.78x | $181.69 | $1.6M | 7.0K | 17 |
| 2022 | $442.69 | $240.10 | 1.84x | $202.59 | $2.8M | 11.9K | 20 |
| 2023 | $220.20 | $115.09 | 1.91x | $105.11 | $3.0M | 26.2K | 18 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 6.8K | $4.8M | $709.35 | 1.52x |
| J2778 | Injection, ranibizumab, 0.1 mg | 5.7K | $1.2M | $212.60 | 2.20x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 16.4K | $468.6K | $28.61 | 1.57x |
| 67028 | Injection of drug into eye | 4.3K | $405.7K | $93.53 | 3.32x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 2.4K | $217.0K | $90.78 | 2.39x |
| 92014 | Established patient complete exam of visual system | 2.1K | $180.3K | $86.79 | 2.18x |
| 92134 | Imaging of retina | 6.0K | $170.6K | $28.64 | 3.36x |
| J3590 | Unclassified biologics | 307 | $60.1K | $195.92 | 2.22x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 77 | $41.8K | $542.84 | 2.59x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 358 | $40.6K | $113.53 | 2.41x |
| 92004 | New patient complete exam of visual system | 317 | $31.9K | $100.48 | 2.08x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 393 | $26.3K | $66.81 | 2.32x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 273 | $24.0K | $87.95 | 3.01x |
| 67113 | Complex repair of detached retina and drainage of eye fluid between lens and retina | 44 | $22.8K | $518.58 | 2.66x |
| 92250 | Photography of the retina | 826 | $21.8K | $26.42 | 5.00x |
| 67108 | Repair of detached retina with drainage and removal of eye fluid between lens and retina | 41 | $19.8K | $483.67 | 2.71x |
| 92012 | Established patient problem focused exam of visual system | 270 | $16.0K | $59.25 | 2.53x |
| 67145 | Photocoagulation treatment to prevent detachment of retina | 46 | $12.0K | $260.17 | 7.65x |
| 76512 | 2d ultrasound scan of eye tissue and structures | 89 | $3.1K | $34.68 | 3.75x |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 65 | $2.7K | $42.24 | 2.72x |
This provider submits charges 1.86 times higher than what Medicare actually pays.
A markup ratio of 1.86x means for every $100 Medicare pays, this provider initially charges $186. 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 MI for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Sandeep Randhawa, MD | Royal Oak, MI | $44.6M | ✓ Clear |
| Scott Sneed, MD | Traverse City, MI | $39.4M | ✓ Clear |
| Jeremy Wolfe, MD | Royal Oak, MI | $39.4M | ✓ Clear |
| Douglas Covert, MD, MPH | Traverse City, MI | $34.7M | ✓ 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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