This provider's $25.4M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 59% from 2014 to 2023.
63% of their billing comes from a single procedure code (J0178 — Injection, aflibercept, 1 mg).
AI-generated analysis based on Medicare payment data.
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 | $564.12 | $215.61 | 2.62x | $348.51 | $2.1M | 9.6K | 17 |
| 2015 | $649.66 | $232.19 | 2.80x | $417.47 | $2.2M | 9.3K | 19 |
| 2016 | $672.96 | $236.52 | 2.85x | $436.44 | $2.0M | 8.6K | 15 |
| 2017 | $640.71 | $224.24 | 2.86x | $416.47 | $2.2M | 10.0K | 16 |
| 2018 | $670.59 | $229.56 | 2.92x | $441.03 | $2.7M | 11.5K | 17 |
| 2019 | $701.54 | $236.80 | 2.96x | $464.74 | $2.9M | 12.3K | 18 |
| 2020 | $735.92 | $246.33 | 2.99x | $489.59 | $2.5M | 10.1K | 17 |
| 2021 | $752.97 | $253.59 | 2.97x | $499.38 | $2.6M | 10.4K | 17 |
| 2022 | $713.69 | $230.78 | 3.09x | $482.91 | $2.9M | 12.6K | 19 |
| 2023 | $382.28 | $125.30 | 3.05x | $256.98 | $3.3M | 26.1K | 19 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 21.6K | $16.0M | $739.84 | 2.76x |
| J2778 | Injection, ranibizumab, 0.1 mg | 8.6K | $2.5M | $288.84 | 2.21x |
| 67028 | Injection of drug into eye | 15.6K | $1.5M | $94.53 | 6.25x |
| 92014 | Established patient complete exam of visual system | 8.9K | $845.1K | $94.58 | 2.50x |
| 92134 | Imaging of retina | 24.1K | $793.1K | $32.89 | 3.33x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 3.9K | $613.2K | $157.55 | 2.72x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 16.1K | $452.8K | $28.05 | 2.28x |
| J3490 | Unclassified drugs | 221 | $452.7K | $2.0K | 2.85x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 6.4K | $392.7K | $60.98 | 2.48x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 312 | $309.3K | $991.49 | 4.38x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 3.2K | $279.8K | $88.50 | 2.55x |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 1.1K | $244.1K | $213.02 | 3.29x |
| J7999 | Compounded drug, not otherwise classified | 3.4K | $220.5K | $65.34 | 1.95x |
| J3590 | Unclassified biologics | 945 | $165.3K | $174.92 | 2.63x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.1K | $137.2K | $121.76 | 2.72x |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 1.1K | $133.6K | $120.36 | 2.25x |
| 92004 | New patient complete exam of visual system | 844 | $94.0K | $111.34 | 2.59x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 1.0K | $64.0K | $61.57 | 2.61x |
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | 256 | $45.1K | $176.10 | 3.39x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 474 | $41.9K | $88.43 | 3.34x |
This provider submits charges 2.93 times higher than what Medicare actually pays.
A markup ratio of 2.93x means for every $100 Medicare pays, this provider initially charges $293. 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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