Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Connecticut for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Connecticut only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Connecticut (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Retina Consultants PC (NPI 1093748071)

Field	Value
Entity Type	Organization
Organization	Retina Consultants PC
Address	191 Main St
City	Manchester
State	CT
ZIP	06042
Taxonomy	Ophthalmology Physician
NPI Enumerated	July 10, 2006

Payer Source	Total Paid
Medicaid	$25.8M
Medicare	$0

Key Findings

RETINA CONSULTANTS PC has no Medicare billing on file and reports $25.8M in lifetime Medicaid revenue, making its commercial/payer footprint effectively single‑payer with Medicaid as the dominant source of recorded revenue; the NPI was enumerated 2006-07-10 (~20 years ago), indicating long tenure in the market. This concentrated payer exposure should be considered when evaluating reimbursement risk and network negotiation leverage.

Revenue is highly concentrated in a small set of Medicaid codes: the precomputed top 3 Medicaid codes account for 84.8% of this provider's total Medicaid revenue, driven primarily by J0178, J2777, and 67028. Specifically, J0178 accounts for $18.2M (70.7% of Medicaid revenue), J2777 for $2.1M (8.1%), and 67028 for $1.5M (6.0%), so changes to reimbursement or utilization for these codes would materially affect overall revenue.

The code mix and volumes indicate a retina-focused, injection‑centric practice model: high-revenue drug codes such as J0178 (aflibercept, $18.2M), J2777 (faricimab, $2.1M), J2778 (ranibizumab, $1.3M) and procedural code 67028 (intravitreal injection, $1.5M) dominate revenue. Coupled with substantial imaging and follow-up visit codes (e.g., 92134, 92250, 92012, 92014), the pattern is consistent with routine, repeated intravitreal therapy plus diagnostic imaging and office-based follow-up.

Operational throughput is large: J0178 has 36.1K claims and 67028 has 48.2K claims, while retinal imaging 92134 shows 49.1K claims and intermediate established visits 92012 show 31.7K claims; these claim counts suggest a high-volume practice with frequent, repeat patient encounters and injection visits. High claim volumes for both drug administration and imaging imply significant clinic capacity and recurring visit cadence typical of chronic retinal disease management.

State-level competitive standing is dominant for several top codes: J0178 ranks #1 of 19 providers in-state (100th percentile; extreme outlier) and 67028 ranks #1 of 23 providers in-state (100th percentile; extreme outlier), indicating this entity is a statewide leader for high-volume aflibercept injections and intravitreal procedures. Multiple other codes (92012, 92134, 92226, 92202, 92250) are flagged as extreme outliers in percentile rank as well, reinforcing its outsized role in Medicaid retinal care within Connecticut.

Despite dominance on aflibercept and injection procedures, utilization of some biologics and services is more typical: J2777 (faricimab) generates $2.1M and is labeled a typical, unremarkable volume for that code in-state, while J2778 (ranibizumab) at $1.3M ranks #2 of 3 providers (50th percentile). The mix shows both market leadership in specific agents (notably aflibercept) and more routine participation with other newer or alternative therapies.

The provider shows adoption of multiple intravitreal biologics beyond aflibercept, including J2777 (faricimab, $2.1M), J2778 (ranibizumab, $1.3M), J9035 (bevacizumab, $28.3K), J0179 (brolucizumab, $13.5K) and J2781 (pegcetacoplan, $26.1K). This diversity of medication codes suggests clinical adoption of both established and newer retinal therapies, which may reflect responsiveness to evolving treatment options and payer coverage for high-cost agents.

From a revenue‑risk and strategy perspective, the provider’s heavy reliance on a single drug code is notable: J0178 alone represents $18.2M and 70.7% of its Medicaid revenue, so shifts in coverage policy, drug pricing, or prescribing patterns for aflibercept would disproportionately impact the practice. Given the absence of Medicare billing on file, any payer policy changes specific to Medicaid or state formulary shifts would have an outsized effect on this entity’s financial profile.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

29 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	36,110	$510	$18.2M
J2777	Injection, faricimab‑svoa, 0.1 mg	4,440	$470	$2.1M
67028	The provider injects a medication into the vitreous chamber of the eye as an isolated procedure or a separate procedure unrelated to any other procedure being performed on the eye.	48,230	$30	$1.5M
J2778	Injection, ranibizumab, 0.1 mg	2,750	$480	$1.3M
92250	Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,…	19,570	$30	$548K
92012	For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any…	31,740	$10	$412.7K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	20,380	$20	$407.6K
92134	The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes.	49,130	$10	$343.9K
67228	In retinopathy, tiny new vessels grow profusely and fibrous tissue proliferates in between the layers of the retina, which may extend into the optic nerve and vitreous, clear gel that fills the space…	1,310	$120	$157.1K
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	3,030	$50	$154.7K

Showing 1–10 of 29

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Connecticut providers billing the same CPT/HCPCS codes.

Claims Volume vs. Connecticut Distribution

Retina Consultants PC — 11 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Connecticut

Full comparison — all codes billed, vs. Connecticut median

29 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	Injection, aflibercept, 1 mg	1	20	1,420	$570	$2.4M
J2778	Injection, ranibizumab, 0.1 mg	2	10	2,750	$430	$1.4M
J2777	Injection, faricimab‑svoa, 0.1 mg	1	10	670	$570	$1M
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	627	1,590	740	$50	$331.8K
J9035	Injection, bevacizumab, 10 mg	8	20	600	$180	$329.8K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	1,295	1,710	750	$30	$243.3K
67028	The provider injects a medication into the vitreous chamber of the eye as an isolated procedure or a separate procedure unrelated to any other procedure being performed on the eye.	1	20	1,990	$40	$217.8K
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	37	480	150	$90	$100.9K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	183	380	220	$70	$99.8K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	8	410	700	$40	$99.1K

Showing 1–10 of 29

Related Providers

Other providers that share a Tax Identification Number (TIN) with Retina Consultants PC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ron Margolis	CT	Ophthalmology Physician	$3.5M	$0
Michael Ruddat	CT	Ophthalmology Physician	$2.7M	$0
Marion Stoj	CT	Ophthalmology Physician	$2.4M	$0
Scott Walter	CT	Retina Specialist (Ophthalmology) Physician	$1.8M	$0
Greg Budoff	CT	Retina Specialist (Ophthalmology) Physician	$705.2K	$0
Tavish Nanda	MA	Ophthalmology Physician	$490.9K	$0
Noam Rudnick	CT	Ophthalmology Physician	$243.4K	$0

Nearby Providers

Other providers in the same ZIP code as Retina Consultants PC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ambulance Service Of Manchester, LLC	CT	Land Ambulance	$3.3M	$20.4M
Community Child Guidance Clinic, Inc.	CT	Adolescent and Children Mental Health Clinic/Center	$0	$9.3M
Manchester Public Schools	CT	Local Education Agency (LEA)	$0	$6.5M
Peter Judson	CT	Ophthalmology Physician	$2.6M	$0
Jerry Neuwirth	CT	Ophthalmology Physician	$2.5M	$0
Ronald Albert	CT	General Practice Dentistry	$0	$1.3M
Jeffrey Ranaudo	CT	Vascular Surgery Physician	$319.3K	$0
Hazar Dahhan	CT	Cardiovascular Disease Physician	$318.1K	$0
Walgreen Co	CT	Pharmacy	$140.3K	$43.3K
John Pietropaoli	CT	Vascular Surgery Physician	$137.2K	$0

Retina Consultants PC — Billing Profile & Reimbursement Data

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Retina Consultants PC — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References