This provider averages 53 services per working day
Based on 131.6K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $25.7M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 53 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 80% from 2014 to 2023.
68% 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 209% in 2016
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 | $393.36 | $117.87 | 3.34x | $275.49 | $1.9M | 16.1K | 14 |
| 2015 | $279.27 | $73.66 | 3.79x | $205.61 | $677.8K | 9.2K | 16 |
| 2016 | $630.88 | $217.62 | 2.90x | $413.26 | $2.1M | 9.6K | 20 |
| 2017 | $672.83 | $232.06 | 2.90x | $440.77 | $2.3M | 10.0K | 17 |
| 2018 | $614.10 | $208.90 | 2.94x | $405.20 | $2.7M | 12.8K | 18 |
| 2019 | $685.10 | $229.74 | 2.98x | $455.36 | $3.3M | 14.2K | 17 |
| 2020 | $783.09 | $259.85 | 3.01x | $523.24 | $3.1M | 12.1K | 15 |
| 2021 | $784.42 | $263.82 | 2.97x | $520.60 | $3.2M | 12.0K | 14 |
| 2022 | $837.24 | $270.22 | 3.10x | $567.02 | $3.0M | 11.3K | 15 |
| 2023 | $436.00 | $140.19 | 3.11x | $295.81 | $3.4M | 24.4K | 21 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 23.6K | $17.4M | $737.44 | 2.79x |
| J2778 | Injection, ranibizumab, 0.1 mg | 7.7K | $2.1M | $271.64 | 2.46x |
| 67028 | Injection of drug into eye | 17.4K | $1.6M | $92.54 | 6.83x |
| 92014 | Established patient complete exam of visual system | 10.2K | $944.7K | $92.17 | 2.39x |
| 92134 | Imaging of retina | 24.6K | $780.2K | $31.76 | 3.84x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 6.4K | $380.2K | $59.51 | 2.55x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 12.8K | $360.6K | $28.22 | 2.30x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 2.1K | $332.0K | $157.59 | 2.75x |
| J7999 | Compounded drug, not otherwise classified | 4.3K | $280.3K | $65.63 | 1.94x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 3.2K | $276.3K | $86.55 | 2.62x |
| J3490 | Unclassified drugs | 85 | $168.3K | $2.0K | 2.59x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 152 | $145.1K | $954.83 | 4.77x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.0K | $124.2K | $123.86 | 2.63x |
| J9035 | Injection, bevacizumab, 10 mg | 2.2K | $116.4K | $51.81 | 2.89x |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 514 | $110.7K | $215.39 | 3.25x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 5.7K | $108.3K | $19.16 | 5.64x |
| 67108 | Repair of detached retina with drainage and removal of eye fluid between lens and retina | 66 | $65.7K | $994.70 | 4.83x |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 525 | $63.2K | $120.36 | 2.24x |
| 67036 | Removal of eye fluid (vitreous) between lens and retina | 73 | $54.6K | $747.76 | 3.93x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 640 | $52.5K | $82.02 | 3.49x |
This provider submits charges 3.04 times higher than what Medicare actually pays.
A markup ratio of 3.04x means for every $100 Medicare pays, this provider initially charges $304. 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 |
|---|---|---|---|
| Charles Sung, MD | Kennewick, WA | $38.3M | ✓ Clear |
| 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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