This provider's $5.0M in total Medicare payments ranks in the 96th percentile of Ophthalmology providers nationally.
Their average markup ratio of 5.99x is significantly above the specialty median of 2.9x.
Medicare payments to this provider grew 3335% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 5382% in 2017
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 | $218.35 | $80.58 | 2.71x | $137.77 | $27.0K | 377 | 329 |
| 2015 | $226.67 | $60.91 | 3.72x | $165.76 | $4.4K | 73 | 67 |
| 2016 | $251.00 | $77.54 | 3.24x | $173.46 | $1.2K | 16 | 16 |
| 2017 | $489.29 | $114.57 | 4.27x | $374.72 | $68.0K | 860 | 715 |
| 2018 | $1.3K | $237.23 | 5.33x | $1.0K | $352.6K | 3.5K | 1.9K |
| 2019 | $1.2K | $222.13 | 5.29x | $953.34 | $729.6K | 6.6K | 3.0K |
| 2020 | $1.1K | $202.26 | 5.39x | $887.28 | $913.8K | 7.9K | 3.1K |
| 2021 | $975.15 | $194.66 | 5.01x | $780.49 | $1.0M | 8.7K | 3.1K |
| 2022 | $634.75 | $119.15 | 5.33x | $515.60 | $900.7K | 8.4K | 3.1K |
| 2023 | $847.49 | $151.93 | 5.58x | $695.56 | $927.4K | 8.9K | 3.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J2778 | Injection, ranibizumab, 0.1 mg | 5.8K | $1.4M | $239.25 | 3.34x |
| J0178 | Injection, aflibercept, 1 mg | 1.8K | $1.3M | $724.69 | 2.76x |
| 67028 | Injection of drug into eye | 9.5K | $807.9K | $84.83 | 15.26x |
| 92134 | Diagnostic imaging of retina | 15.5K | $438.8K | $28.23 | 11.84x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.8K | $168.9K | $60.42 | 2.61x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.4K | $153.5K | $112.43 | 2.70x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 1.7K | $146.1K | $83.88 | 2.90x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 1.8K | $107.3K | $59.55 | 2.69x |
| J9035 | Injection, bevacizumab, 10 mg | 1.7K | $97.7K | $56.04 | 4.98x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 59 | $52.2K | $884.96 | 6.65x |
| 67042 | Removal of membrane from the retina, pars plana approach | 53 | $45.8K | $863.63 | 6.20x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 389 | $38.5K | $99.02 | 2.97x |
| 92250 | Photography of the retina | 1.1K | $36.3K | $33.16 | 4.61x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 389 | $32.0K | $82.36 | 2.82x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 128 | $31.4K | $245.40 | 12.25x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 75 | $26.7K | $356.07 | 4.53x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 331 | $24.8K | $74.97 | 4.40x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 218 | $16.0K | $73.39 | 2.91x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 60 | $8.9K | $149.04 | 2.67x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 11 | $7.0K | $638.90 | 6.68x |
This provider submits charges 5.99 times higher than what Medicare actually pays.
A markup ratio of 5.99x means for every $100 Medicare pays, this provider initially charges $599. 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 TN for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Roy Wallace, MD | Nashville, TN | $48.8M | ✓ Clear |
| Carl Awh, M.D. | Nashville, TN | $48.0M | ✓ Clear |
| David Reichstein, M.D | Nashville, TN | $40.5M | ✓ Clear |
| Brandon Busbee, M.D. | Nashville, TN | $40.2M | ✓ Clear |
| Franco Recchia, MD | Nashville, TN | $39.8M | ✓ 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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