This provider's $4.6M in total Medicare payments ranks in the 96th percentile of Ophthalmology providers nationally.
This provider's billing patterns fall within normal ranges for their specialty.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 58% in 2021
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 | $684.83 | $207.00 | 3.31x | $477.83 | $555.9K | 4.7K | 1.6K |
| 2015 | $692.15 | $190.86 | 3.63x | $501.29 | $497.7K | 4.1K | 1.4K |
| 2016 | $733.05 | $148.44 | 4.94x | $584.61 | $360.0K | 4.5K | 1.8K |
| 2017 | $531.46 | $85.52 | 6.21x | $445.94 | $251.8K | 4.7K | 1.7K |
| 2018 | $606.21 | $94.85 | 6.39x | $511.36 | $237.7K | 4.5K | 1.7K |
| 2019 | $732.01 | $149.54 | 4.90x | $582.47 | $372.5K | 4.8K | 1.7K |
| 2020 | $660.64 | $143.79 | 4.59x | $516.85 | $369.9K | 3.5K | 1.6K |
| 2021 | $648.35 | $134.83 | 4.81x | $513.52 | $585.0K | 4.2K | 1.7K |
| 2022 | $728.58 | $147.31 | 4.95x | $581.27 | $673.1K | 5.0K | 1.8K |
| 2023 | $730.95 | $145.27 | 5.03x | $585.68 | $698.2K | 5.6K | 1.8K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2.5K | $1.8M | $724.97 | 1.66x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 10.5K | $565.5K | $53.67 | 1.71x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 1.1K | $406.8K | $369.80 | 5.49x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 1.1K | $406.0K | $357.09 | 6.67x |
| 67028 | Injection of drug into eye | 3.6K | $270.8K | $76.04 | 9.92x |
| 99214 | Established patient outpatient visit, total time 30-39 minutes | 2.7K | $232.6K | $84.78 | 1.95x |
| 92134 | Diagnostic imaging of retina | 7.4K | $206.2K | $28.04 | 6.72x |
| 92250 | Photography of the retina | 5.7K | $186.1K | $32.88 | 4.41x |
| 92020 | Examination of cornea and iris using lens device and slit lamp | 4.6K | $85.2K | $18.38 | 3.10x |
| 92083 | Measurement of field of vision during daylight conditions | 2.2K | $80.1K | $37.24 | 3.76x |
| 66761 | Creation of eye fluid drainage tracts in iris using laser, per session | 370 | $77.5K | $209.45 | 6.87x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.1K | $69.2K | $60.90 | 1.90x |
| J2778 | Injection, ranibizumab, 0.1 mg | 183 | $56.9K | $311.11 | 1.61x |
| 76512 | Ultrasound of eye disease, growth, or structure | 738 | $31.5K | $42.72 | 8.60x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 310 | $29.2K | $94.15 | 1.89x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 358 | $27.9K | $77.95 | 1.97x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 226 | $24.2K | $107.13 | 1.88x |
| J3590 | Unclassified biologics | 404 | $22.5K | $55.62 | 3.59x |
| J9035 | Injection, bevacizumab, 10 mg | 251 | $15.4K | $61.48 | 3.67x |
| 65855 | Laser repair to improve eye fluid flow, 1 or more sessions | 91 | $15.1K | $166.43 | 10.07x |
This provider submits charges 3.54 times higher than what Medicare actually pays.
A markup ratio of 3.54x means for every $100 Medicare pays, this provider initially charges $354. 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 WV for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Gary Miller, MD | Morgantown, WV | $39.6M | ✓ 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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