This provider's $7.7M in total Medicare payments ranks in the 97th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 73% from 2014 to 2023.
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 | $487.08 | $209.04 | 2.33x | $278.04 | $589.0K | 4.6K | 1.6K |
| 2015 | $448.48 | $191.49 | 2.34x | $256.99 | $768.7K | 4.7K | 1.7K |
| 2016 | $464.62 | $156.44 | 2.97x | $308.18 | $739.3K | 4.5K | 1.7K |
| 2017 | $453.08 | $149.84 | 3.02x | $303.24 | $685.5K | 4.4K | 1.8K |
| 2018 | $405.33 | $142.59 | 2.84x | $262.74 | $718.0K | 4.7K | 1.9K |
| 2019 | $388.75 | $127.77 | 3.04x | $260.98 | $717.3K | 4.9K | 2.1K |
| 2020 | $323.29 | $132.73 | 2.44x | $190.56 | $829.7K | 5.2K | 2.0K |
| 2021 | $437.36 | $143.20 | 3.05x | $294.16 | $794.8K | 4.8K | 1.9K |
| 2022 | $336.86 | $128.36 | 2.62x | $208.50 | $799.7K | 4.9K | 1.9K |
| 2023 | $1.5K | $413.97 | 3.62x | $1.1K | $1.0M | 4.5K | 1.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 5.0K | $3.7M | $738.96 | 1.69x |
| J2778 | Injection, ranibizumab, 0.1 mg | 4.5K | $1.3M | $282.25 | 1.77x |
| 67028 | Injection of drug into eye | 11.4K | $947.9K | $83.28 | 8.13x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 3.8K | $319.9K | $83.92 | 2.38x |
| 92134 | Diagnostic imaging of retina | 10.1K | $313.1K | $31.08 | 3.22x |
| J3590 | Unclassified biologics | 544 | $272.0K | $499.93 | 4.03x |
| 92250 | Photography of the retina | 6.1K | $236.3K | $38.56 | 3.89x |
| J3490 | Unclassified drugs | 74 | $145.1K | $2.0K | 3.59x |
| 99213 | Established patient outpatient visit, total time 20-29 minutes | 1.5K | $95.1K | $61.56 | 2.60x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 858 | $94.9K | $110.60 | 2.02x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 1.2K | $93.7K | $75.56 | 3.31x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 178 | $73.8K | $414.71 | 4.82x |
| J9035 | Injection, bevacizumab, 10 mg | 767 | $44.0K | $57.30 | 1.75x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 282 | $26.2K | $93.04 | 2.29x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 287 | $18.6K | $64.93 | 2.64x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 160 | $12.1K | $75.89 | 2.69x |
| 99212 | Established patient outpatient visit, total time 10-19 minutes | 154 | $6.3K | $40.97 | 2.81x |
| 76512 | Ultrasound of eye disease, growth, or structure | 65 | $3.4K | $51.54 | 4.17x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 44 | $3.0K | $69.01 | 2.17x |
| 67515 | Injection of medication or substance into membrane covering eyeball | 48 | $3.0K | $63.19 | 2.37x |
This provider submits charges 2.85 times higher than what Medicare actually pays.
A markup ratio of 2.85x means for every $100 Medicare pays, this provider initially charges $285. 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 |
|---|---|---|---|
| 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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