This provider averages 69 services per working day
Based on 171.7K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $17.9M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 69 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 114% from 2014 to 2023.
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 | $333.74 | $104.70 | 3.19x | $229.04 | $1.5M | 14.1K | 19 |
| 2015 | $365.00 | $110.30 | 3.31x | $254.70 | $1.6M | 14.4K | 18 |
| 2016 | $405.32 | $116.04 | 3.49x | $289.28 | $1.5M | 13.3K | 20 |
| 2017 | $398.22 | $112.45 | 3.54x | $285.77 | $1.5M | 13.2K | 20 |
| 2018 | $349.50 | $109.55 | 3.19x | $239.95 | $1.5M | 13.4K | 19 |
| 2019 | $371.06 | $116.18 | 3.19x | $254.88 | $1.5M | 12.9K | 17 |
| 2020 | $414.38 | $130.15 | 3.18x | $284.23 | $1.6M | 12.5K | 16 |
| 2021 | $406.70 | $129.90 | 3.13x | $276.80 | $1.8M | 13.8K | 19 |
| 2022 | $365.03 | $116.40 | 3.14x | $248.63 | $2.3M | 19.5K | 20 |
| 2023 | $220.53 | $70.84 | 3.11x | $149.69 | $3.2M | 44.6K | 19 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 10.4K | $7.6M | $729.68 | 2.74x |
| J2778 | Injection, ranibizumab, 0.1 mg | 9.3K | $2.6M | $276.90 | 2.17x |
| 67028 | Injection of drug into eye | 21.3K | $1.7M | $79.93 | 7.49x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 35.1K | $1.0M | $28.94 | 2.87x |
| 92134 | Imaging of retina | 30.6K | $908.1K | $29.68 | 3.69x |
| 92014 | Established patient complete exam of visual system | 8.6K | $744.1K | $86.72 | 2.88x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 12.4K | $700.8K | $56.53 | 2.83x |
| J9035 | Injection, bevacizumab, 10 mg | 10.4K | $593.8K | $56.98 | 2.37x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 7.2K | $454.8K | $62.76 | 3.29x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 2.2K | $276.0K | $123.12 | 2.83x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 237 | $219.7K | $927.12 | 4.02x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 8.4K | $193.4K | $23.13 | 3.81x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 2.0K | $185.7K | $94.46 | 2.03x |
| J3590 | Unclassified biologics | 2.8K | $173.5K | $61.78 | 2.98x |
| 67108 | Repair of detached retina with drainage and removal of eye fluid between lens and retina | 141 | $141.0K | $999.69 | 3.93x |
| 92250 | Photography of the retina | 1.7K | $75.1K | $44.24 | 3.61x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 898 | $71.6K | $79.73 | 3.72x |
| 92202 | Extended exam of the back part of the eye with optic nerve drawing | 4.5K | $51.7K | $11.61 | 2.59x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 1.8K | $47.6K | $26.48 | 3.36x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 53 | $30.9K | $582.67 | 4.46x |
This provider submits charges 3.23 times higher than what Medicare actually pays.
A markup ratio of 3.23x means for every $100 Medicare pays, this provider initially charges $323. 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 MO for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Stephen Wiles, MD | Kansas City, MO | $44.4M | ✓ Clear |
| Mari Keithahn, M.D. | Columbia, MO | $44.2M | ✓ 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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