This provider averages 86 services per working day
Based on 214.0K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $43.5M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 86 services per working day raises questions about billing patterns.
61% 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 | $688.38 | $210.89 | 3.26x | $477.49 | $3.0M | 14.4K | 19 |
| 2015 | $763.45 | $232.57 | 3.28x | $530.88 | $4.0M | 17.1K | 22 |
| 2016 | $812.54 | $247.50 | 3.28x | $565.04 | $4.4M | 17.6K | 21 |
| 2017 | $840.48 | $253.38 | 3.32x | $587.10 | $4.4M | 17.6K | 22 |
| 2018 | $764.99 | $231.03 | 3.31x | $533.96 | $5.0M | 21.5K | 21 |
| 2019 | $847.77 | $250.74 | 3.38x | $597.03 | $5.1M | 20.3K | 20 |
| 2020 | $900.24 | $263.14 | 3.42x | $637.10 | $4.3M | 16.2K | 17 |
| 2021 | $879.31 | $256.07 | 3.43x | $623.24 | $4.5M | 17.7K | 18 |
| 2022 | $688.53 | $195.11 | 3.53x | $493.42 | $4.4M | 22.6K | 18 |
| 2023 | $309.51 | $89.80 | 3.45x | $219.71 | $4.4M | 49.2K | 20 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 35.2K | $26.3M | $746.39 | 3.26x |
| J2778 | Injection, ranibizumab, 0.1 mg | 28.6K | $7.9M | $275.24 | 3.27x |
| 67028 | Injection of drug into eye | 23.1K | $2.2M | $93.95 | 4.66x |
| 92012 | Established patient problem focused exam of visual system | 24.7K | $1.7M | $67.16 | 2.72x |
| 92134 | Imaging of retina | 43.1K | $1.4M | $33.56 | 4.31x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 38.0K | $1.1M | $29.22 | 2.50x |
| 92014 | Established patient complete exam of visual system | 7.0K | $656.5K | $93.52 | 2.82x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 3.6K | $461.6K | $127.66 | 2.71x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 190 | $216.9K | $1.1K | 5.99x |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 811 | $175.6K | $216.55 | 3.69x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 1.0K | $159.8K | $157.45 | 3.18x |
| J3590 | Unclassified biologics | 89 | $159.6K | $1.8K | 2.47x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 140 | $135.0K | $964.34 | 6.35x |
| 67036 | Removal of eye fluid (vitreous) between lens and retina | 171 | $115.4K | $674.60 | 6.05x |
| 67113 | Repair of detached retina and drainage of eye fluid between lens and retina | 84 | $105.7K | $1.3K | 5.90x |
| J3490 | Unclassified drugs | 54 | $100.7K | $1.9K | 3.66x |
| 67041 | Removal of membrane from the retina | 93 | $92.6K | $995.85 | 5.66x |
| 92250 | Photography of the retina | 1.4K | $75.1K | $54.57 | 3.94x |
| J9035 | Injection, bevacizumab, 10 mg | 1.3K | $73.1K | $56.43 | 3.16x |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 525 | $63.2K | $120.36 | 3.87x |
This provider submits charges 3.37 times higher than what Medicare actually pays.
A markup ratio of 3.37x means for every $100 Medicare pays, this provider initially charges $337. 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 PA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Richard Kaiser, MD | Plymouth Meeting, PA | $75.2M | ✓ Clear |
| Allen Ho, MD | Plymouth Meeting, PA | $67.7M | ✓ Clear |
| Carl Regillo, MD | Plymouth Meeting, PA | $63.5M | ✓ Clear |
| Marc Spirn, MD | Plymouth Meeting, PA | $63.4M | ✓ Clear |
| Mitchell Fineman, MD | Plymouth Meeting, PA | $61.7M | ✓ 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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