This provider averages 86 services per working day
Based on 215.2K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $43.5M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 86 services per working day raises questions about billing patterns.
78% 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 | $480.78 | $278.10 | 1.73x | $202.68 | $3.5M | 12.5K | 18 |
| 2015 | $499.18 | $292.26 | 1.71x | $206.92 | $3.8M | 13.0K | 14 |
| 2016 | $483.36 | $286.47 | 1.69x | $196.89 | $4.1M | 14.2K | 13 |
| 2017 | $483.18 | $284.00 | 1.70x | $199.18 | $4.1M | 14.5K | 13 |
| 2018 | $482.95 | $281.30 | 1.72x | $201.65 | $4.6M | 16.2K | 16 |
| 2019 | $486.67 | $282.67 | 1.72x | $204.00 | $4.9M | 17.3K | 17 |
| 2020 | $477.52 | $272.16 | 1.75x | $205.36 | $4.4M | 16.3K | 14 |
| 2021 | $461.29 | $261.22 | 1.77x | $200.07 | $4.6M | 17.5K | 13 |
| 2022 | $326.02 | $179.40 | 1.82x | $146.62 | $4.6M | 25.6K | 14 |
| 2023 | $128.32 | $72.99 | 1.76x | $55.33 | $5.0M | 68.0K | 12 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 45.7K | $33.9M | $740.87 | 1.49x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 27.5K | $2.2M | $79.78 | 2.73x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 64.9K | $1.9M | $29.13 | 1.46x |
| 67028 | Injection of drug into eye | 20.2K | $1.8M | $87.76 | 4.02x |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 4.5K | $1.1M | $247.16 | 1.80x |
| 92134 | Imaging of retina | 35.6K | $1.1M | $30.46 | 2.68x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 6.4K | $395.6K | $61.97 | 2.61x |
| J3490 | Unclassified drugs | 114 | $305.8K | $2.7K | 2.43x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 3.1K | $237.3K | $76.07 | 3.11x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.0K | $111.6K | $111.08 | 2.89x |
| 67228 | Destruction of leaking blood vessels of retina using laser | 293 | $106.0K | $361.66 | 5.24x |
| J2778 | Injection, ranibizumab, 0.1 mg | 223 | $67.9K | $304.46 | 1.51x |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 615 | $67.3K | $109.44 | 2.65x |
| 67041 | Removal of membrane from the retina | 74 | $64.8K | $875.40 | 2.57x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 143 | $55.9K | $391.13 | 2.59x |
| 67040 | Laser destruction of eye fluid (vitreous) between the lens and retina | 29 | $26.2K | $902.40 | 2.98x |
| 67108 | Repair of detached retina with drainage and removal of eye fluid between lens and retina | 23 | $23.0K | $998.22 | 3.00x |
| 67042 | Removal of membrane from the retina, pars plana approach | 25 | $21.8K | $873.04 | 3.19x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 119 | $18.3K | $153.58 | 1.65x |
| 76512 | 2d ultrasound scan of eye tissue and structures | 324 | $16.5K | $50.89 | 5.29x |
This provider submits charges 1.74 times higher than what Medicare actually pays.
A markup ratio of 1.74x means for every $100 Medicare pays, this provider initially charges $174. 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 |
| Nitin Gupta, M.D., M.P.H. | Raleigh, NC | $42.0M | ✓ Clear |
| Igor Westra, MD | Wilmington, NC | $40.5M | ✓ Clear |
| William Bridges, M.D. | Asheville, NC | $38.4M | ✓ 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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