This provider averages 113 services per working day
Based on 281.4K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $63.1M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 113 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 412% 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.
Notable: Payments increased 162% in 2016
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 |
|---|---|---|---|---|---|---|---|
| 2014 | $293.71 | $166.92 | 1.76x | $126.79 | $1.2M | 7.1K | 17 |
| 2015 | $425.95 | $194.26 | 2.19x | $231.69 | $1.7M | 8.7K | 18 |
| 2016 | $471.66 | $180.05 | 2.62x | $291.61 | $4.4M | 24.7K | 22 |
| 2017 | $598.64 | $225.84 | 2.65x | $372.80 | $6.4M | 28.5K | 22 |
| 2018 | $597.02 | $224.66 | 2.66x | $372.36 | $6.8M | 30.3K | 25 |
| 2019 | $626.85 | $243.77 | 2.57x | $383.08 | $8.8M | 36.3K | 25 |
| 2020 | $686.03 | $271.60 | 2.53x | $414.43 | $10.4M | 38.3K | 24 |
| 2021 | $708.07 | $278.25 | 2.54x | $429.82 | $10.0M | 35.9K | 24 |
| 2022 | $689.18 | $261.68 | 2.63x | $427.50 | $7.2M | 27.6K | 25 |
| 2023 | $375.71 | $137.86 | 2.73x | $237.85 | $6.1M | 44.0K | 19 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 59.6K | $44.1M | $740.13 | 2.13x |
| J2778 | Injection, ranibizumab, 0.1 mg | 28.1K | $7.3M | $261.20 | 1.99x |
| 67028 | Injection of drug into eye | 42.5K | $3.7M | $87.71 | 7.77x |
| 92134 | Imaging of retina | 51.8K | $1.6M | $31.47 | 5.61x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 10.3K | $1.6M | $157.53 | 2.39x |
| 92014 | Established patient complete exam of visual system | 9.7K | $865.0K | $89.49 | 1.95x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 27.4K | $796.1K | $29.10 | 2.41x |
| J9035 | Injection, bevacizumab, 10 mg | 9.2K | $537.3K | $58.12 | 4.18x |
| 92012 | Established patient problem focused exam of visual system | 8.0K | $496.1K | $62.04 | 2.16x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 380 | $338.8K | $891.48 | 2.86x |
| J3590 | Unclassified biologics | 5.4K | $296.5K | $54.71 | 1.35x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 3.2K | $255.4K | $79.37 | 2.99x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 2.1K | $244.3K | $117.68 | 1.86x |
| 92250 | Photography of the retina | 4.0K | $152.7K | $37.95 | 2.22x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 3.0K | $63.3K | $20.97 | 3.39x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 537 | $57.8K | $107.55 | 1.95x |
| 67039 | Destruction of eye fluid (vitreous) between lens and retina using a laser | 71 | $52.4K | $738.43 | 4.06x |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 180 | $44.7K | $248.08 | 2.22x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 626 | $44.1K | $70.52 | 2.12x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 47 | $43.9K | $933.23 | 4.32x |
This provider submits charges 2.58 times higher than what Medicare actually pays.
A markup ratio of 2.58x means for every $100 Medicare pays, this provider initially charges $258. 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 NC for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| 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 |
| 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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