This provider averages 160 services per working day
Based on 399.1K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $59.3M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 160 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 476328% from 2014 to 2023.
66% 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 62181% 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 | $79.85 | $29.22 | 2.73x | $50.63 | $1.8K | 62 | 3 |
| 2015 | $509.80 | $256.99 | 1.98x | $252.81 | $1.1M | 4.4K | 16 |
| 2016 | $529.27 | $265.82 | 1.99x | $263.45 | $4.1M | 15.5K | 21 |
| 2017 | $539.53 | $267.10 | 2.02x | $272.43 | $5.2M | 19.5K | 23 |
| 2018 | $565.97 | $286.79 | 1.97x | $279.18 | $6.6M | 23.1K | 24 |
| 2019 | $595.48 | $307.83 | 1.93x | $287.65 | $8.2M | 26.6K | 21 |
| 2020 | $623.14 | $324.83 | 1.92x | $298.31 | $8.3M | 25.7K | 22 |
| 2021 | $637.31 | $339.46 | 1.88x | $297.85 | $8.8M | 26.1K | 20 |
| 2022 | $420.40 | $211.89 | 1.98x | $208.51 | $8.2M | 38.6K | 21 |
| 2023 | $66.33 | $39.33 | 1.69x | $27.00 | $8.6M | 219.5K | 15 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 52.6K | $39.1M | $743.75 | 1.65x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 222.5K | $6.5M | $29.13 | 1.42x |
| J2778 | Injection, ranibizumab, 0.1 mg | 20.4K | $5.6M | $271.78 | 1.72x |
| 67028 | Injection of drug into eye | 35.1K | $3.0M | $84.40 | 5.89x |
| J3490 | Unclassified drugs | 615 | $1.1M | $1.8K | 1.90x |
| 92134 | Imaging of retina | 32.6K | $918.8K | $28.15 | 2.81x |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 1.9K | $475.0K | $251.34 | 1.62x |
| J3590 | Unclassified biologics | 7.5K | $362.8K | $48.33 | 2.12x |
| 92012 | Established patient problem focused exam of visual system | 5.6K | $332.4K | $59.85 | 2.49x |
| 92250 | Photography of the retina | 7.6K | $255.7K | $33.46 | 3.44x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 273 | $233.9K | $856.95 | 2.60x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 3.0K | $227.9K | $76.18 | 2.59x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 2.1K | $221.1K | $107.59 | 2.57x |
| 67108 | Repair of detached retina with drainage and removal of eye fluid between lens and retina | 233 | $210.5K | $903.57 | 2.76x |
| 67036 | Removal of eye fluid (vitreous) between lens and retina | 220 | $132.4K | $601.71 | 3.62x |
| 92004 | New patient complete exam of visual system | 926 | $90.6K | $97.83 | 2.47x |
| 92014 | Established patient complete exam of visual system | 1.0K | $82.3K | $80.05 | 2.62x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 1.6K | $76.1K | $47.77 | 3.58x |
| 67145 | Photocoagulation treatment to prevent detachment of retina | 216 | $68.4K | $316.62 | 3.29x |
| 67041 | Removal of membrane from the retina | 63 | $55.1K | $875.27 | 2.20x |
This provider submits charges 1.91 times higher than what Medicare actually pays.
A markup ratio of 1.91x means for every $100 Medicare pays, this provider initially charges $191. 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 NE for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| John Welch, MD | Hastings, NE | $94.8M | ✓ 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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