This provider's $7.9M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
This provider's billing patterns fall within normal ranges for their specialty.
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 | $910.63 | $349.22 | 2.61x | $561.41 | $862.8K | 7.8K | 2.8K |
| 2015 | $578.74 | $202.52 | 2.86x | $376.22 | $741.6K | 7.2K | 2.7K |
| 2016 | $502.34 | $145.95 | 3.44x | $356.39 | $661.1K | 7.0K | 2.6K |
| 2017 | $507.08 | $150.26 | 3.37x | $356.82 | $756.2K | 7.3K | 2.5K |
| 2018 | $583.31 | $169.72 | 3.44x | $413.59 | $818.1K | 7.5K | 2.4K |
| 2019 | $612.69 | $174.76 | 3.51x | $437.93 | $809.9K | 7.2K | 2.2K |
| 2020 | $485.01 | $158.88 | 3.05x | $326.13 | $748.4K | 6.3K | 1.9K |
| 2021 | $363.48 | $128.15 | 2.84x | $235.33 | $862.6K | 7.3K | 2.1K |
| 2022 | $602.17 | $166.13 | 3.62x | $436.04 | $843.5K | 7.3K | 2.0K |
| 2023 | $515.64 | $159.67 | 3.23x | $355.97 | $752.2K | 6.8K | 2.1K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J2778 | Injection, ranibizumab, 0.1 mg | 8.7K | $2.3M | $265.54 | 2.34x |
| J0178 | Injection, aflibercept, 1 mg | 2.1K | $1.5M | $735.45 | 2.07x |
| 67028 | Injection of drug into eye | 14.1K | $1.3M | $94.36 | 10.35x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 11.5K | $852.7K | $74.15 | 3.43x |
| 92134 | Diagnostic imaging of retina | 14.5K | $419.5K | $28.94 | 3.48x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 4.8K | $267.2K | $55.50 | 2.42x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 3.2K | $230.4K | $72.46 | 2.44x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 2.7K | $225.5K | $83.05 | 1.99x |
| 92250 | Photography of the retina | 3.9K | $181.7K | $46.96 | 2.66x |
| J9035 | Injection, bevacizumab, 10 mg | 2.3K | $128.9K | $55.36 | 3.53x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 1.6K | $94.2K | $59.60 | 2.13x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 165 | $71.7K | $434.71 | 5.00x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 106 | $71.1K | $671.09 | 3.39x |
| J7999 | Compounded drug, not otherwise classified | 652 | $48.8K | $74.85 | 2.56x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 898 | $34.4K | $38.33 | 2.33x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 206 | $21.8K | $106.04 | 2.47x |
| 67042 | Removal of membrane from the retina, pars plana approach | 16 | $19.2K | $1.2K | 2.34x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 47 | $18.4K | $392.14 | 2.88x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 232 | $15.5K | $66.75 | 2.95x |
| 67041 | Removal of membrane from the retina | 11 | $11.6K | $1.1K | 2.28x |
This provider submits charges 3.88 times higher than what Medicare actually pays.
A markup ratio of 3.88x means for every $100 Medicare pays, this provider initially charges $388. 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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