This provider's $13.5M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
62% 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 | $681.02 | $259.39 | 2.63x | $421.63 | $1.3M | 10.9K | 4.5K |
| 2015 | $572.33 | $215.67 | 2.65x | $356.66 | $1.5M | 11.1K | 4.3K |
| 2016 | $676.27 | $216.34 | 3.13x | $459.93 | $1.3M | 10.1K | 4.0K |
| 2017 | $604.74 | $174.98 | 3.46x | $429.76 | $1.3M | 10.0K | 3.8K |
| 2018 | $690.88 | $213.36 | 3.24x | $477.52 | $1.3M | 10.4K | 4.2K |
| 2019 | $539.41 | $168.56 | 3.20x | $370.85 | $1.2M | 10.4K | 4.2K |
| 2020 | $537.36 | $188.21 | 2.86x | $349.15 | $1.2M | 8.8K | 3.4K |
| 2021 | $610.38 | $185.25 | 3.29x | $425.13 | $1.4M | 9.1K | 3.3K |
| 2022 | $600.91 | $189.92 | 3.16x | $410.99 | $1.5M | 9.0K | 3.0K |
| 2023 | $603.16 | $183.91 | 3.28x | $419.25 | $1.5M | 9.1K | 3.0K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 11.3K | $8.4M | $739.54 | 2.03x |
| 67028 | Injection of drug into eye | 13.9K | $1.0M | $74.20 | 6.74x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 14.4K | $760.0K | $52.64 | 2.56x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 10.5K | $715.0K | $68.17 | 3.30x |
| 92250 | Photography of the retina | 17.5K | $710.3K | $40.66 | 3.07x |
| 92134 | Diagnostic imaging of retina | 18.1K | $548.9K | $30.40 | 2.47x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 4.3K | $337.0K | $78.73 | 1.71x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 1.5K | $149.4K | $99.18 | 1.51x |
| J2778 | Injection, ranibizumab, 0.1 mg | 380 | $116.9K | $307.71 | 1.73x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 1.6K | $115.4K | $73.15 | 2.05x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 298 | $111.8K | $375.04 | 3.33x |
| J3590 | Unclassified biologics | 2.1K | $106.3K | $51.78 | 2.92x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 289 | $106.2K | $367.58 | 5.44x |
| 67220 | Destruction of vascular growth between retina and sclera, 1 or more sessions | 248 | $95.9K | $386.86 | 3.88x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 514 | $57.6K | $112.14 | 1.56x |
| 99203 | New patient outpatient visit, total time 30-44 minutes | 786 | $57.0K | $72.51 | 2.07x |
| 67105 | Repair of detached retina, 1 or more sessions | 69 | $30.1K | $435.71 | 2.75x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 92 | $27.5K | $298.47 | 3.35x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 1.0K | $20.2K | $20.06 | 2.49x |
| 67042 | Removal of membrane from the retina, pars plana approach | 14 | $12.1K | $867.67 | 3.17x |
This provider submits charges 2.61 times higher than what Medicare actually pays.
A markup ratio of 2.61x means for every $100 Medicare pays, this provider initially charges $261. 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 IA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Kyle Alliman, M.D. | West Des Moines, IA | $83.3M | ✓ Clear |
| David Saggau, MD | West Des Moines, IA | $73.8M | ✓ Clear |
| Jared Nielsen, M.D., M.S. | West Des Moines, IA | $68.1M | ✓ Clear |
| Alex Kartvelishvili, M.D. | Iowa City, IA | $45.0M | ✓ Clear |
| Michael Wadzinski, M.D. | Sioux City, IA | $37.7M | ✓ 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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