Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or South Carolina for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to South Carolina only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. South Carolina (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Adam Pflugrath (NPI 1134515042)

Field	Value
Entity Type	Individual
Organization	Adam Pflugrath
Address	5 Stevens St Ste 100
City	Greenville
State	SC
ZIP	29605
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	April 8, 2015

Payer Source	Total Paid
Medicare	$3.1M
Medicaid	$0

Key Findings

ADAM PFLUGRATH is operating as a retina specialist with a clear medical-retina focus: the top revenue-driving services are intravitreal injections of anti-VEGF and related agents (J2777, J0178) and standalone intravitreal injection procedures (67028), consistent with treatment of retinal vascular diseases and macular degeneration. High counts for diagnostic imaging codes (92134) and comprehensive ophthalmology visits (92014) further support a practice model centered on frequent injections, image-guided monitoring, and ongoing follow-up care rather than high-volume general ophthalmology or primarily surgical practice.

Revenue is highly concentrated in a small set of Medicare codes: the provider’s top 3 Medicare codes account for 87.4% of total Medicare revenue. Those three codes are J2777 ($1.5M revenue; 48.5% of this provider's total Medicare revenue), J0178 ($1.1M revenue; 34.5% of this provider's total Medicare revenue), and 67028 ($138.5K revenue; 4.4% of this provider's total Medicare revenue), indicating dependence on a narrow set of high-value injection therapies and the associated injection procedure.

This provider’s payer mix is effectively single-payer at the available scope of data: total Medicare revenue is $3.1M while Medicaid revenue is none, indicating no Medicaid billing on file. The absence of Medicaid activity means any Medicaid-focused contracting or access analyses will have no transactional data to evaluate and the provider’s revenue exposure is concentrated in Medicare reimbursements.

ADAM PFLUGRATH shows a national competitive presence for certain retina services: J2777 (faricimab) ranks #97 of 2039 providers nationally (95th percentile; notably above typical national volume), signaling unusually high faricimab usage relative to peers. By contrast, J0178 (aflibercept) ranks #755 of 3204 providers nationally (76th percentile; typical, unremarkable volume), so while aflibercept use is solid it is not exceptional compared with the faricimab activity.

Imaging and follow-up visit volumes are a distinctive feature of this profile: 92134 (retinal imaging) has 2.6K claims, $70.2K revenue and ranks #609 of 26868 providers nationally (98th percentile; extreme outlier), and 92014 (established comprehensive eye exam) has 1.2K claims, $99K revenue and ranks #1074 of 35415 providers nationally (97th percentile; notably above typical national volume). These high percentiles indicate intensive use of diagnostic imaging and follow-up evaluation consistent with an injection-heavy retina practice that relies on imaging to guide frequent treatment decisions.

Surgical retina and other ancillary procedures are present but represent a small share of Medicare revenue: 67042 (vitrectomy with ILM peel) shows 32 claims and $26.4K revenue (0.8% of Medicare revenue), 67036 shows 14 claims and $7.9K (0.3%), and 67145 (laser) shows 29 claims and $5.1K (0.2%), suggesting the practice performs occasional surgical or laser interventions but is primarily focused on office-based medical retina care.

The provider’s lifecycle in the Medicare system is established but not long-tenured by historical standards: NPI enumeration occurred on 2015-04-08 (~11 years ago), indicating roughly a decade of billing history under this NPI. This tenure supports interpretation of the current high injection and imaging volumes as a sustained operating pattern rather than a short-term spike.

Absence of Medicaid claims removes state-level Medicaid benchmarking from analysis and limits visibility into non-Medicare patient mix and access; there are also no in-state Medicaid codes to compare against South Carolina peers. For network planning or Medicaid contracting purposes, this provider should be treated as effectively Medicare-centric until Medicaid billing appears in records.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

22 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J2777	Injection, faricimab‑svoa, 0.1 mg	52,380	$30	$1.5M
J0178	Injection, aflibercept, 1 mg	1,600	$680	$1.1M
67028	The provider injects a medication into the vitreous chamber of the eye as an isolated procedure or a separate procedure unrelated to any other procedure being performed on the eye.	1,610	$90	$138.5K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	1,210	$80	$99K
J2778	Injection, ranibizumab, 0.1 mg	460	$180	$82.9K
92134	The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes.	2,600	$30	$70.2K
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	470	$120	$55.8K
67042	In this procedure, the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina…	30	$820	$26.4K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	190	$80	$15.6K
92250	Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,…	490	$30	$12.3K

Showing 1–10 of 22

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 22 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. South Carolina Distribution

Adam Pflugrath — 2 of 22 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Carolina

Full comparison — all codes billed, vs. state median

22 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	18	50	970	$690	$1.1M
J2777	3	40	15,960	$30	$594.7K
J2778	23	30	1,440	$180	$337.4K
J2781	12	20	720	$120	$128K
67028	19	50	1,140	$90	$110.3K
67036	13	20	20	$1,110	$40.1K
67042	7	30	20	$1,150	$32.3K
J9035	28	40	200	$50	$26.1K
92014	24	540	160	$80	$24.3K
99214	3,517	7,860	160	$80	$23.2K

Showing 1–10 of 22

Related Providers

Other providers that share a Tax Identification Number (TIN) with Adam Pflugrath, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prisma Health University Medical Group	SC	Family Medicine Physician	$0	$171.7M
Prisma Health Medical Group-midlands	SC	Multi-Specialty Clinic/Center	$0	$77.6M
Prisma Health University Medical Group	SC	Developmental - Behavioral Pediatrics Physician	$0	$16M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$8.3M
Prisma Health University Medical Group	SC	Diagnostic Radiology Physician	$0	$7.5M
Stephen Huddleston	TN	Retina Specialist (Ophthalmology) Physician	$5.7M	$0
Clemson Eye, PA	SC	Ophthalmology Physician	$0	$5.5M
Prisma Health University Medical Group	SC	Family Medicine Physician	$0	$4.7M
Columbia Eye Surg Center Inc	SC	Ophthalmologic Surgery Clinic/Center	$3.5M	$1.2K
Philip Ames	FL	Ophthalmology Physician	$3.5M	$350

Nearby Providers

Other providers in the same ZIP code as Adam Pflugrath, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$86.9M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$25M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$22M
Heavenly Care Services Inc.	SC	Nursing Care Agency	$0	$12.1M
Speechworks, Inc.	SC	Speech-Language Pathologist	$0	$10.5M
Plan Home Health Care	SC	Nursing Care Agency	$0	$8.9M
Prisma Health-upstate	SC	Land Ambulance	$4.5M	$3.7M
Prisma Health-upstate	SC	Infusion Therapy Clinic/Center	$0	$7.5M
Carolina Family Services Of Greenville LLC	SC	Community/Behavioral Health Agency	$0	$6M
New Horizon Family Health Services, Inc.	SC	Federally Qualified Health Center (FQHC)	$0	$5.8M

Adam Pflugrath — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References