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 Washington for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Washington 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. Washington (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 Institute, PLLC (NPI 1528303849)

Retina Institute, PLLC is a retina specialist (ophthalmology) physician provider located in Renton, Washington. This profile covers 0 Medicare and 19 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Retina Institute, PLLC
Address	4300 Talbot Rd S Ste 300
City	Renton
State	WA
ZIP	98055
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	November 28, 2012

Payer Source	Total Paid
Medicaid	$5.5M
Medicare	$0

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

19 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	3,730	$1,080	$4M
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.	11,740	$30	$364K
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…	6,320	$40	$240.1K
J9035	Injection, bevacizumab, 10 mg	4,860	$50	$228.2K
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.	14,260	$10	$171.2K
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…	6,110	$30	$152.8K
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,…	7,300	$10	$102.2K
92235	The provider uses a special dye, fluorescein that causes the blood vessels in the one or both eyes to stand out in photographic images taken with the use of multiframe timing, or serial images, taken…	3,160	$30	$91.6K
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…	1,120	$50	$58.4K
92004	The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.	550	$60	$31.2K

Showing 1–10 of 19

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Washington Distribution

Retina Institute, PLLC — 9 of 19 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Washington

Full comparison — all codes billed, vs. Washington median

19 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	Injection, aflibercept, 1 mg	2	30	550	$930	$892.3K
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…	788	1,820	480	$60	$379.6K
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…	1,508	1,860	610	$40	$295.5K
J9035	Injection, bevacizumab, 10 mg	1	30	420	$190	$160.8K
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…	74	530	80	$90	$87.4K
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.	3	60	710	$40	$81.7K
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…	19	480	290	$60	$65.2K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	546	700	180	$50	$59.3K
92004	The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.	206	580	240	$70	$57.3K
92235	The provider uses a special dye, fluorescein that causes the blood vessels in the one or both eyes to stand out in photographic images taken with the use of multiframe timing, or serial images, taken…	1	20	300	$40	$23.1K

Showing 1–10 of 19

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Benjamin Reiss	WA	Retina Specialist (Ophthalmology) Physician	$1.9M	$0
George Ko	WA	Retina Specialist (Ophthalmology) Physician	$1.7M	$0
Kenneth Fung	WA	Ophthalmology Physician	$1.6M	$0
Christopher Chapman	MI	Ophthalmology Physician	$297.2K	$0
Samaneh Davoudimoghaddam	WA	Ophthalmology Physician	$233K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Public Hospital District 1 Of King County	WA	General Acute Care Hospital	$0	$120.6M
Valley Medical Group-renton	WA	General Acute Care Hospital	$0	$28.3M
Associated Emergency Room Physicians, Inc P.s.	WA	Emergency Medicine Physician	$0	$12M
Valley Children's Clinic	WA	Pediatric Adolescent Medicine Physician	$0	$5.2M
Proliance Surgery Center At Valley, LLC	WA	Ambulatory Surgical Clinic/Center	$3.3M	$0
Vantage Radiology & Diagnostic Services, A Professional Services Corp	WA	Diagnostic Radiology Physician	$0	$2.6M
Renton Regional Fire Authority	WA	Land Ambulance	$229.9K	$186.7K
Craig Fujisaki	WA	Dermatology Physician	$376.9K	$0
Timothy Alton	WA	Orthopaedic Surgery Physician	$313.4K	$0
William Barrett	WA	Orthopaedic Surgery Physician	$272.7K	$0

Retina Institute, PLLC — Billing Profile & Reimbursement Data

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Retina Institute, PLLC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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