This provider averages 60 services per working day
Based on 150.8K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $33.4M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 60 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 73% from 2014 to 2023.
70% 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 | $363.63 | $174.52 | 2.08x | $189.11 | $2.2M | 12.7K | 17 |
| 2015 | $348.10 | $167.64 | 2.08x | $180.46 | $2.4M | 14.3K | 17 |
| 2016 | $399.48 | $195.86 | 2.04x | $203.62 | $2.8M | 14.4K | 17 |
| 2017 | $417.87 | $208.09 | 2.01x | $209.78 | $3.0M | 14.5K | 16 |
| 2018 | $436.71 | $222.06 | 1.97x | $214.65 | $3.5M | 15.9K | 15 |
| 2019 | $449.25 | $225.12 | 2.00x | $224.13 | $3.8M | 16.9K | 16 |
| 2020 | $489.60 | $245.67 | 1.99x | $243.93 | $3.8M | 15.3K | 12 |
| 2021 | $497.24 | $250.30 | 1.99x | $246.94 | $4.2M | 16.6K | 16 |
| 2022 | $512.40 | $250.86 | 2.04x | $261.54 | $3.9M | 15.4K | 14 |
| 2023 | $594.12 | $259.15 | 2.29x | $334.97 | $3.8M | 14.7K | 16 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 31.5K | $23.3M | $740.13 | 1.71x |
| 92014 | Established patient complete exam of visual system | 30.1K | $2.8M | $91.37 | 1.80x |
| J2778 | Injection, ranibizumab, 0.1 mg | 9.2K | $2.6M | $287.03 | 1.78x |
| 67028 | Injection of drug into eye | 19.9K | $1.7M | $84.47 | 5.90x |
| 92134 | Imaging of retina | 40.2K | $1.3M | $33.09 | 3.42x |
| 92012 | Established patient problem focused exam of visual system | 9.4K | $616.8K | $65.91 | 1.75x |
| J3590 | Unclassified biologics | 102 | $215.8K | $2.1K | 1.98x |
| 67228 | Destruction of leaking blood vessels of retina using laser | 307 | $158.5K | $516.16 | 4.17x |
| 92250 | Photography of the retina | 2.4K | $113.2K | $47.17 | 2.83x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 225 | $93.5K | $415.38 | 4.02x |
| 67145 | Photocoagulation treatment to prevent detachment of retina | 248 | $93.4K | $376.65 | 4.41x |
| J9035 | Injection, bevacizumab, 10 mg | 1.7K | $92.9K | $55.46 | 1.71x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 60 | $60.5K | $1.0K | 2.60x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 453 | $51.6K | $113.81 | 2.08x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 1.7K | $33.0K | $19.51 | 3.67x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 441 | $30.4K | $68.94 | 1.55x |
| 92235 | Imaging of blood vessels in back of eye using fluorescein dye | 305 | $25.1K | $82.35 | 3.75x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 22 | $15.6K | $710.29 | 4.40x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 648 | $13.5K | $20.80 | 4.37x |
| 76512 | Ultrasound of eye disease, growth, or structure | 201 | $12.9K | $64.15 | 4.28x |
This provider submits charges 2.05 times higher than what Medicare actually pays.
A markup ratio of 2.05x means for every $100 Medicare pays, this provider initially charges $205. 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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