This provider's $8.1M in total Medicare payments ranks in the 98th percentile of Ophthalmology providers nationally.
Medicare payments to this provider grew 394% from 2015 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 309% 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 |
|---|---|---|---|---|---|---|---|
| 2015 | $316.66 | $193.90 | 1.63x | $122.76 | $186.4K | 1.5K | 1.1K |
| 2016 | $416.46 | $192.84 | 2.16x | $223.62 | $762.2K | 6.2K | 3.2K |
| 2017 | $580.12 | $242.28 | 2.39x | $337.84 | $815.9K | 6.7K | 3.5K |
| 2018 | $676.17 | $277.21 | 2.44x | $398.96 | $997.8K | 9.2K | 4.2K |
| 2019 | $540.96 | $226.94 | 2.38x | $314.02 | $976.6K | 9.2K | 4.2K |
| 2020 | $547.29 | $237.41 | 2.31x | $309.88 | $1.1M | 8.9K | 4.2K |
| 2021 | $535.16 | $227.69 | 2.35x | $307.47 | $1.2M | 9.6K | 3.9K |
| 2022 | $647.29 | $326.77 | 1.98x | $320.52 | $1.1M | 8.4K | 2.9K |
| 2023 | $514.47 | $205.13 | 2.51x | $309.34 | $921.0K | 8.0K | 2.8K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 3.4K | $2.5M | $728.07 | 1.39x |
| J2778 | Injection, ranibizumab, 0.1 mg | 6.7K | $1.8M | $266.50 | 1.71x |
| 67028 | Injection of drug into eye | 12.5K | $1.0M | $82.71 | 3.27x |
| 92134 | Diagnostic imaging of retina | 19.9K | $596.9K | $30.07 | 2.37x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 9.3K | $517.1K | $55.37 | 1.61x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 683 | $186.5K | $272.99 | 4.82x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 2.3K | $172.5K | $73.60 | 2.48x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 1.7K | $149.7K | $89.00 | 1.48x |
| J3490 | Unclassified drugs | 65 | $134.9K | $2.1K | 1.52x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 2.0K | $123.3K | $60.61 | 1.77x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.1K | $122.0K | $112.35 | 1.86x |
| 92250 | Photography of the retina | 3.0K | $121.7K | $39.94 | 2.43x |
| 67042 | Removal of membrane from the retina, pars plana approach | 127 | $111.7K | $879.39 | 2.35x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 269 | $102.1K | $379.38 | 2.40x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 1.1K | $98.8K | $86.74 | 1.75x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 497 | $78.5K | $157.93 | 1.43x |
| J9035 | Injection, bevacizumab, 10 mg | 1.2K | $67.1K | $57.64 | 1.53x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 68 | $61.1K | $898.63 | 3.17x |
| 67113 | Repair of detached retina and drainage of eye fluid between lens and retina | 46 | $46.7K | $1.0K | 2.52x |
| 67145 | Preventive retinal detachment treatment by heat or laser, 1 or more sessions | 106 | $38.7K | $364.97 | 2.26x |
This provider submits charges 1.99 times higher than what Medicare actually pays.
A markup ratio of 1.99x means for every $100 Medicare pays, this provider initially charges $199. 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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