This provider averages 58 services per working day
Based on 146.2K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $27.5M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 58 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 69% from 2014 to 2023.
68% 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 | $223.64 | $159.62 | 1.40x | $64.02 | $1.9M | 12.0K | 18 |
| 2015 | $265.34 | $186.18 | 1.43x | $79.16 | $2.4M | 12.6K | 21 |
| 2016 | $281.90 | $198.28 | 1.42x | $83.62 | $2.5M | 12.8K | 17 |
| 2017 | $313.93 | $217.39 | 1.44x | $96.54 | $2.9M | 13.4K | 15 |
| 2018 | $335.76 | $228.56 | 1.47x | $107.20 | $3.2M | 14.0K | 19 |
| 2019 | $338.70 | $226.24 | 1.50x | $112.46 | $3.1M | 13.6K | 16 |
| 2020 | $368.13 | $241.17 | 1.53x | $126.96 | $2.8M | 11.5K | 17 |
| 2021 | $362.84 | $234.67 | 1.55x | $128.17 | $2.7M | 11.6K | 20 |
| 2022 | $306.15 | $203.34 | 1.51x | $102.81 | $2.8M | 13.7K | 19 |
| 2023 | $161.97 | $104.51 | 1.55x | $57.46 | $3.2M | 30.9K | 22 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 25.0K | $18.6M | $743.52 | 1.45x |
| 67028 | Injection of drug into eye | 25.4K | $2.1M | $81.81 | 1.69x |
| J2778 | Injection, ranibizumab, 0.1 mg | 5.6K | $1.5M | $269.10 | 1.59x |
| 92134 | Imaging of retina | 31.8K | $951.6K | $29.93 | 1.55x |
| J7999 | Compounded drug, not otherwise classified | 12.3K | $770.5K | $62.68 | 1.42x |
| 92014 | Established patient complete exam of visual system | 7.4K | $668.7K | $90.21 | 1.52x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 20.4K | $593.8K | $29.11 | 1.58x |
| J3590 | Unclassified biologics | 3.1K | $319.5K | $103.02 | 1.36x |
| 92012 | Established patient problem focused exam of visual system | 4.5K | $281.6K | $63.23 | 1.45x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 2.2K | $264.9K | $118.05 | 1.48x |
| 67108 | Repair of detached retina with drainage and removal of eye fluid between lens and retina | 233 | $224.9K | $965.21 | 1.44x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 215 | $199.3K | $926.80 | 1.41x |
| 67041 | Removal of membrane of retina | 215 | $194.8K | $906.04 | 1.44x |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 1.3K | $160.7K | $120.36 | 1.53x |
| 67040 | Destruction of eye fluid (vitreous) between lens and retina and all of retina using a laser | 179 | $149.2K | $833.80 | 1.58x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 1.9K | $114.5K | $60.80 | 1.49x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 199 | $80.2K | $402.80 | 1.50x |
| 92250 | Photography of the retina | 1.5K | $65.9K | $44.14 | 1.63x |
| 67036 | Removal of eye fluid (vitreous) between lens and retina | 89 | $59.5K | $668.69 | 1.50x |
| J3490 | Unclassified drugs | 35 | $58.4K | $1.7K | 1.47x |
This provider submits charges 1.48 times higher than what Medicare actually pays.
A markup ratio of 1.48x means for every $100 Medicare pays, this provider initially charges $148. 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 SD for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Prema Abraham, MD | Rapid City, SD | $39.1M | ✓ 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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