This provider averages 53 services per working day
Based on 133.2K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $19.2M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 53 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 891% from 2014 to 2023.
66% 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 172% in 2017
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 | $299.16 | $111.11 | 2.69x | $188.05 | $319.8K | 2.9K | 13 |
| 2015 | $303.22 | $111.67 | 2.72x | $191.55 | $439.9K | 3.9K | 13 |
| 2016 | $303.53 | $102.55 | 2.96x | $200.98 | $379.8K | 3.7K | 11 |
| 2017 | $369.48 | $193.04 | 1.91x | $176.44 | $1.0M | 5.3K | 17 |
| 2018 | $460.27 | $244.97 | 1.88x | $215.30 | $2.0M | 8.3K | 16 |
| 2019 | $483.83 | $259.99 | 1.86x | $223.84 | $2.3M | 8.8K | 14 |
| 2020 | $565.67 | $309.79 | 1.83x | $255.88 | $3.1M | 10.0K | 14 |
| 2021 | $740.82 | $285.63 | 2.59x | $455.19 | $3.2M | 11.3K | 15 |
| 2022 | $372.20 | $141.20 | 2.64x | $231.00 | $3.2M | 22.8K | 14 |
| 2023 | $153.63 | $56.46 | 2.72x | $97.17 | $3.2M | 56.1K | 14 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 17.1K | $12.5M | $735.20 | 2.03x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 60.3K | $1.8M | $29.23 | 2.57x |
| J2778 | Injection, ranibizumab, 0.1 mg | 4.0K | $1.1M | $264.61 | 1.94x |
| 67028 | Injection of drug into eye | 10.3K | $876.1K | $84.87 | 4.37x |
| 92014 | Established patient complete exam of visual system | 7.1K | $636.7K | $89.38 | 2.91x |
| 92134 | Imaging of retina | 16.4K | $496.9K | $30.24 | 3.62x |
| J3490 | Unclassified drugs | 217 | $369.8K | $1.7K | 2.29x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 3.8K | $314.0K | $82.10 | 2.88x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 3.2K | $168.2K | $53.23 | 2.04x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 1.9K | $152.0K | $78.41 | 2.58x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 2.0K | $133.8K | $66.12 | 2.42x |
| 92250 | Photography of the retina | 2.8K | $118.0K | $41.87 | 2.85x |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 750 | $90.3K | $120.36 | 2.55x |
| J3590 | Unclassified biologics | 37 | $63.7K | $1.7K | 2.58x |
| 92004 | New patient complete exam of visual system | 596 | $61.1K | $102.56 | 2.52x |
| 67228 | Destruction of leaking blood vessels of retina using laser | 117 | $61.1K | $522.34 | 3.20x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 510 | $59.9K | $117.54 | 2.70x |
| 67042 | Removal of membrane from the retina, pars plana approach | 56 | $49.9K | $891.34 | 3.92x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 63 | $43.3K | $686.72 | 3.90x |
| J9035 | Injection, bevacizumab, 10 mg | 644 | $34.0K | $52.75 | 1.70x |
This provider submits charges 2.31 times higher than what Medicare actually pays.
A markup ratio of 2.31x means for every $100 Medicare pays, this provider initially charges $231. 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 CA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Nathan Steinle, M.D. | Santa Barbara, CA | $63.1M | ✓ Clear |
| Stephen Couvillion, MD | Santa Barbara, CA | $47.7M | ✓ Clear |
| Margaret Chang, M.D. | Sacramento, CA | $47.6M | ✓ Clear |
| David Boyer, MD | Los Angeles, CA | $47.5M | ✓ Clear |
| Alessandro Castellarin, M.D. | Santa Barbara, CA | $46.9M | ✓ 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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