This provider averages 64 services per working day
Based on 160.1K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $30.1M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 64 services per working day raises questions about billing patterns.
63% 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 | $474.70 | $223.67 | 2.12x | $251.03 | $2.6M | 11.7K | 15 |
| 2015 | $497.60 | $242.71 | 2.05x | $254.89 | $2.9M | 12.2K | 14 |
| 2016 | $477.86 | $221.50 | 2.16x | $256.36 | $2.8M | 12.5K | 15 |
| 2017 | $481.94 | $224.04 | 2.15x | $257.90 | $2.9M | 12.9K | 16 |
| 2018 | $456.62 | $217.41 | 2.10x | $239.21 | $2.9M | 13.2K | 19 |
| 2019 | $478.35 | $228.63 | 2.09x | $249.72 | $3.2M | 14.2K | 16 |
| 2020 | $507.17 | $241.60 | 2.10x | $265.57 | $3.0M | 12.3K | 15 |
| 2021 | $516.57 | $248.50 | 2.08x | $268.07 | $3.2M | 12.9K | 15 |
| 2022 | $362.01 | $175.47 | 2.06x | $186.54 | $3.4M | 19.4K | 17 |
| 2023 | $174.61 | $82.70 | 2.11x | $91.91 | $3.2M | 38.8K | 13 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 25.7K | $19.1M | $741.64 | 1.52x |
| J2778 | Injection, ranibizumab, 0.1 mg | 14.3K | $4.0M | $278.07 | 2.02x |
| 92014 | Established patient complete exam of visual system | 26.7K | $2.3M | $85.29 | 1.52x |
| 67028 | Injection of drug into eye | 18.8K | $1.6M | $84.59 | 10.08x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 34.5K | $991.9K | $28.75 | 1.45x |
| 92134 | Imaging of retina | 25.2K | $752.4K | $29.83 | 2.88x |
| J3490 | Unclassified drugs | 184 | $336.7K | $1.8K | 1.42x |
| J9035 | Injection, bevacizumab, 10 mg | 3.8K | $213.3K | $56.89 | 1.59x |
| 67108 | Repair of detached retina with drainage and removal of eye fluid between lens and retina | 168 | $165.3K | $984.03 | 3.05x |
| 92250 | Photography of the retina | 4.6K | $155.6K | $33.89 | 2.31x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.3K | $149.8K | $114.06 | 1.90x |
| J3590 | Unclassified biologics | 2.0K | $105.1K | $53.54 | 1.69x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 797 | $60.6K | $76.04 | 4.34x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 125 | $54.7K | $437.94 | 4.48x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 54 | $48.0K | $888.71 | 2.81x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 346 | $36.9K | $106.61 | 1.41x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 97 | $36.4K | $374.83 | 3.37x |
| 76510 | 1d and 2d ultrasound scan of eye tissue and structures | 290 | $28.7K | $99.02 | 2.10x |
| 92012 | Established patient problem focused exam of visual system | 475 | $28.3K | $59.53 | 1.51x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 47 | $27.3K | $581.22 | 3.44x |
This provider submits charges 2.1 times higher than what Medicare actually pays.
A markup ratio of 2.1x means for every $100 Medicare pays, this provider initially charges $210. 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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