⚠️ This provider averages 475 services per working day — physically unusual for an individual practitioner
Based on 1.2M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $45.7M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 475 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 306% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 63% in 2023
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 |
|---|---|---|---|---|---|---|---|
| 2014 | $429.55 | $171.08 | 2.51x | $258.47 | $2.2M | 12.8K | 18 |
| 2015 | $398.63 | $155.49 | 2.56x | $243.14 | $2.4M | 15.1K | 19 |
| 2016 | $435.61 | $173.51 | 2.51x | $262.10 | $3.4M | 19.8K | 22 |
| 2017 | $444.29 | $182.55 | 2.43x | $261.74 | $3.9M | 21.5K | 20 |
| 2018 | $427.02 | $171.23 | 2.49x | $255.79 | $4.0M | 23.4K | 21 |
| 2019 | $456.98 | $171.83 | 2.66x | $285.15 | $4.5M | 26.2K | 22 |
| 2020 | $518.61 | $186.89 | 2.77x | $331.72 | $5.2M | 27.8K | 22 |
| 2021 | $521.76 | $184.26 | 2.83x | $337.50 | $5.8M | 31.3K | 20 |
| 2022 | $396.69 | $126.50 | 3.14x | $270.19 | $5.5M | 43.1K | 22 |
| 2023 | $21.94 | $9.19 | 2.39x | $12.75 | $8.9M | 966.9K | 26 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J2778 | Injection, ranibizumab, 0.1 mg | 63.6K | $16.8M | $265.07 | 2.84x |
| J0178 | Injection, aflibercept, 1 mg | 15.8K | $11.7M | $738.90 | 1.69x |
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | 17.1K | $2.9M | $170.02 | 2.06x |
| 67028 | Injection of drug into eye | 30.2K | $2.5M | $82.51 | 6.84x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 69.0K | $2.0M | $28.50 | 2.11x |
| J3490 | Unclassified drugs | 786 | $1.4M | $1.8K | 2.40x |
| 92134 | Imaging of retina | 45.3K | $1.4M | $31.19 | 3.21x |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 10.1K | $1.2M | $120.34 | 2.08x |
| 92014 | Established patient complete exam of visual system | 8.4K | $742.9K | $88.21 | 1.70x |
| J2403 | Chloroprocaine hcl ophthalmic, 3% gel, 1 mg | 860.0K | $472.1K | $0.55 | 1.31x |
| 67042 | Removal of membrane of retina with removal of internal limiting membrane of retina | 430 | $408.8K | $950.61 | 4.95x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 4.4K | $386.7K | $88.47 | 1.85x |
| 92235 | Exam of retinal blood vessels using a special camera after injection of a dye | 4.6K | $385.7K | $83.36 | 2.40x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 5.0K | $348.7K | $70.07 | 1.66x |
| 92012 | Established patient problem focused exam of visual system | 5.1K | $328.2K | $64.07 | 1.72x |
| 92242 | Exam of retinal blood vessels and blood vessels between the white part of eye and retina using a special camera after injection of a dye | 1.6K | $316.2K | $192.95 | 1.61x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 2.6K | $310.0K | $120.44 | 1.69x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 15.5K | $289.8K | $18.64 | 5.39x |
| J9035 | Injection, bevacizumab, 10 mg | 3.6K | $208.2K | $57.51 | 1.74x |
| J3590 | Unclassified biologics | 80 | $196.8K | $2.5K | 2.54x |
This provider submits charges 2.64 times higher than what Medicare actually pays.
A markup ratio of 2.64x means for every $100 Medicare pays, this provider initially charges $264. 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 MD for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Michael Elman, M.D. | Baltimore, MD | $68.5M | ✓ Clear |
| David Warrow, M.D. | Hagerstown, MD | $65.5M | ✓ Clear |
| Raymond Sjaarda, M.D. | Baltimore, MD | $47.2M | ✓ Clear |
| James Rial, M.D. | Salisbury, MD | $45.2M | ✓ Clear |
| Joseph Schwartz, M.D. | Salisbury, MD | $44.0M | ✓ 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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