This provider's $22.7M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 287% from 2014 to 2023.
71% 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 78% in 2016
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 | $327.29 | $137.44 | 2.38x | $189.85 | $851.3K | 6.2K | 32 |
| 2015 | $487.30 | $169.32 | 2.88x | $317.98 | $1.0M | 6.0K | 28 |
| 2016 | $640.40 | $173.82 | 3.68x | $466.58 | $1.8M | 10.3K | 25 |
| 2017 | $639.54 | $164.52 | 3.89x | $475.02 | $2.1M | 12.7K | 25 |
| 2018 | $633.84 | $172.42 | 3.68x | $461.42 | $2.3M | 13.1K | 20 |
| 2019 | $687.96 | $204.10 | 3.37x | $483.86 | $2.7M | 13.3K | 20 |
| 2020 | $611.96 | $228.84 | 2.67x | $383.12 | $2.8M | 12.4K | 20 |
| 2021 | $635.03 | $233.78 | 2.72x | $401.25 | $2.9M | 12.3K | 19 |
| 2022 | $610.54 | $226.36 | 2.70x | $384.18 | $3.0M | 13.3K | 18 |
| 2023 | $454.93 | $156.96 | 2.90x | $297.97 | $3.3M | 21.0K | 22 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 21.6K | $15.8M | $730.79 | 2.03x |
| 67028 | Injection of drug into eye | 19.2K | $1.5M | $75.79 | 14.44x |
| 92134 | Imaging of retina | 28.4K | $806.3K | $28.35 | 5.22x |
| J2778 | Injection, ranibizumab, 0.1 mg | 2.4K | $717.2K | $298.94 | 1.88x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 5.7K | $410.1K | $72.38 | 2.50x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 1.9K | $303.3K | $156.99 | 1.91x |
| J3590 | Unclassified biologics | 6.2K | $286.1K | $46.50 | 1.50x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 9.0K | $258.5K | $28.73 | 1.39x |
| 67228 | Destruction of leaking blood vessels of retina using laser | 762 | $256.2K | $336.26 | 4.90x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 2.8K | $246.2K | $88.54 | 3.38x |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 834 | $208.6K | $250.06 | 1.52x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.9K | $203.0K | $109.62 | 2.07x |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 828 | $185.9K | $224.51 | 3.10x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 3.6K | $185.6K | $50.95 | 2.65x |
| J3490 | Unclassified drugs | 97 | $163.3K | $1.7K | 2.13x |
| 67041 | Removal of membrane from the retina | 173 | $150.5K | $869.66 | 4.70x |
| 67210 | Destruction of growth of retina using a laser | 390 | $147.4K | $377.89 | 3.95x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 4.2K | $138.8K | $33.25 | 3.91x |
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | 755 | $126.3K | $167.31 | 2.14x |
| 67145 | Photocoagulation treatment to prevent detachment of retina | 214 | $74.9K | $350.09 | 3.43x |
This provider submits charges 3.09 times higher than what Medicare actually pays.
A markup ratio of 3.09x means for every $100 Medicare pays, this provider initially charges $309. 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 IN for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Drew Sommerville, MD | Evansville, IN | $35.4M | ✓ 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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