This provider averages 70 services per working day
Based on 122.4K total services over 7 years (250 working days/year). Learn about impossible service volumes →
This provider's $14.5M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 70 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 3036% from 2017 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.
Notable: Payments increased 878% in 2018
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
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 |
|---|---|---|---|---|---|---|---|
| 2017 | $305.18 | $135.11 | 2.26x | $170.07 | $124.8K | 924 | 13 |
| 2018 | $386.51 | $198.12 | 1.95x | $188.39 | $1.2M | 6.2K | 16 |
| 2019 | $426.02 | $219.75 | 1.94x | $206.27 | $1.9M | 8.4K | 17 |
| 2020 | $473.04 | $241.82 | 1.96x | $231.22 | $1.9M | 7.8K | 13 |
| 2021 | $504.64 | $262.42 | 1.92x | $242.22 | $2.5M | 9.4K | 13 |
| 2022 | $520.68 | $265.40 | 1.96x | $255.28 | $3.0M | 11.3K | 13 |
| 2023 | $99.14 | $49.98 | 1.98x | $49.16 | $3.9M | 78.3K | 15 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 13.9K | $10.1M | $726.57 | 1.66x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 67.9K | $2.0M | $28.94 | 1.73x |
| 67028 | Injection of drug into eye | 9.1K | $708.9K | $77.93 | 4.90x |
| 92134 | Imaging of retina | 16.0K | $476.4K | $29.77 | 3.36x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 4.2K | $235.9K | $56.71 | 2.07x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 2.9K | $175.9K | $60.35 | 1.71x |
| J2778 | Injection, ranibizumab, 0.1 mg | 594 | $155.0K | $260.95 | 1.90x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 791 | $124.4K | $157.33 | 1.81x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 134 | $117.6K | $877.52 | 4.86x |
| 67145 | Photocoagulation treatment to prevent detachment of retina | 323 | $107.5K | $332.86 | 4.09x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 608 | $66.7K | $109.69 | 2.32x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 701 | $59.8K | $85.29 | 2.01x |
| 67108 | Repair of detached retina with drainage and removal of eye fluid between lens and retina | 52 | $47.3K | $909.39 | 3.44x |
| 92201 | Extended exam of the back part of the eye with retinal drawing | 2.2K | $37.0K | $17.13 | 4.20x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 1.7K | $32.9K | $19.76 | 3.65x |
| J9035 | Injection, bevacizumab, 10 mg | 366 | $20.3K | $55.48 | 1.49x |
| 92002 | Eye and medical examination for diagnosis and treatment, new patient | 340 | $18.5K | $54.47 | 1.92x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 101 | $10.5K | $103.94 | 1.63x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 121 | $8.2K | $67.36 | 2.27x |
| 76512 | Ultrasound of eye disease, growth, or structure | 84 | $3.7K | $43.65 | 6.10x |
This provider submits charges 1.96 times higher than what Medicare actually pays.
A markup ratio of 1.96x means for every $100 Medicare pays, this provider initially charges $196. This is lower 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 NC for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Shil Patel, M.D. | New Bern, NC | $63.1M | ✓ Clear |
| James Pate, M.D. | Raleigh, NC | $44.5M | ✓ Clear |
| Justin Brown, M.D. | Charlotte, NC | $43.5M | ✓ Clear |
| Nitin Gupta, M.D., M.P.H. | Raleigh, NC | $42.0M | ✓ Clear |
| Igor Westra, MD | Wilmington, NC | $40.5M | ✓ 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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