This provider averages 81 services per working day
Based on 201.3K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $44.2M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 81 services per working day raises questions about billing patterns.
79% 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 | $573.87 | $241.85 | 2.37x | $332.02 | $3.8M | 15.6K | 19 |
| 2015 | $606.65 | $256.34 | 2.37x | $350.31 | $4.1M | 16.1K | 19 |
| 2016 | $634.41 | $268.20 | 2.37x | $366.21 | $4.8M | 17.7K | 18 |
| 2017 | $634.08 | $270.16 | 2.35x | $363.92 | $4.6M | 17.2K | 18 |
| 2018 | $667.91 | $284.25 | 2.35x | $383.66 | $5.0M | 17.5K | 15 |
| 2019 | $699.94 | $298.31 | 2.35x | $401.63 | $4.8M | 16.2K | 17 |
| 2020 | $697.42 | $291.11 | 2.40x | $406.31 | $4.2M | 14.5K | 17 |
| 2021 | $692.18 | $288.88 | 2.40x | $403.30 | $4.4M | 15.1K | 14 |
| 2022 | $494.92 | $205.15 | 2.41x | $289.77 | $4.2M | 20.4K | 17 |
| 2023 | $198.71 | $83.94 | 2.37x | $114.77 | $4.3M | 50.9K | 15 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 47.0K | $34.8M | $740.96 | 1.97x |
| 67028 | Injection of drug into eye | 27.1K | $2.0M | $75.16 | 7.82x |
| J2778 | Injection, ranibizumab, 0.1 mg | 5.5K | $1.6M | $289.39 | 2.02x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 43.0K | $1.2M | $28.65 | 1.53x |
| 92012 | Established patient problem focused exam of visual system | 16.7K | $967.4K | $57.96 | 2.40x |
| 92014 | Established patient complete exam of visual system | 12.1K | $945.7K | $78.45 | 2.57x |
| 92134 | Imaging of retina | 31.1K | $873.5K | $28.09 | 5.16x |
| J3590 | Unclassified biologics | 1.1K | $323.1K | $300.05 | 1.72x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 3.2K | $222.9K | $69.93 | 4.47x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 2.0K | $208.1K | $105.65 | 3.22x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 2.9K | $169.8K | $58.90 | 2.51x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 195 | $169.3K | $868.30 | 3.95x |
| 92250 | Photography of the retina | 4.4K | $152.2K | $34.23 | 5.08x |
| 99205 | New patient office or other outpatient visit, 60-74 minutes | 804 | $110.1K | $136.91 | 3.18x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 241 | $90.2K | $374.39 | 4.40x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 791 | $53.8K | $68.03 | 3.29x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 90 | $51.8K | $575.72 | 4.44x |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 198 | $49.1K | $247.82 | 1.97x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 1.1K | $19.5K | $18.50 | 3.31x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 635 | $14.8K | $23.36 | 3.01x |
This provider submits charges 2.37 times higher than what Medicare actually pays.
A markup ratio of 2.37x means for every $100 Medicare pays, this provider initially charges $237. 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 |
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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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