This provider's $12.8M in total Medicare payments ranks in the 99th 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 53% in 2018
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 | $738.62 | $218.17 | 3.39x | $520.45 | $1.0M | 11.6K | 5.4K |
| 2015 | $754.36 | $207.96 | 3.63x | $546.40 | $1.1M | 11.2K | 5.2K |
| 2016 | $754.10 | $183.90 | 4.10x | $570.20 | $1.0M | 11.9K | 5.4K |
| 2017 | $500.62 | $191.70 | 2.61x | $308.92 | $930.2K | 10.4K | 4.6K |
| 2018 | $451.92 | $165.34 | 2.73x | $286.58 | $1.4M | 10.0K | 4.4K |
| 2019 | $555.63 | $190.83 | 2.91x | $364.80 | $1.8M | 10.5K | 4.6K |
| 2020 | $540.97 | $172.13 | 3.14x | $368.84 | $1.5M | 8.3K | 3.7K |
| 2021 | $555.60 | $172.25 | 3.23x | $383.35 | $1.7M | 9.3K | 3.9K |
| 2022 | $640.17 | $241.80 | 2.65x | $398.37 | $1.2M | 6.5K | 2.7K |
| 2023 | $456.84 | $215.98 | 2.12x | $240.86 | $1.0M | 5.9K | 2.5K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 9.6K | $7.0M | $726.01 | 1.66x |
| 67028 | Injection of drug into eye | 19.7K | $1.5M | $73.79 | 6.18x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 12.4K | $979.3K | $78.93 | 2.26x |
| 92134 | Diagnostic imaging of retina | 26.9K | $790.4K | $29.39 | 4.13x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 891 | $331.7K | $372.24 | 4.00x |
| J3590 | Unclassified biologics | 5.5K | $283.8K | $52.05 | 4.32x |
| 67042 | Removal of membrane from the retina, pars plana approach | 282 | $244.9K | $868.49 | 4.05x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 2.9K | $199.6K | $69.87 | 3.67x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.7K | $194.4K | $112.39 | 2.47x |
| J2778 | Injection, ranibizumab, 0.1 mg | 702 | $190.5K | $271.38 | 1.92x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 3.4K | $190.0K | $56.35 | 2.30x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 541 | $176.6K | $326.47 | 5.97x |
| 92250 | Photography of the retina | 3.6K | $152.2K | $42.33 | 2.83x |
| J9035 | Injection, bevacizumab, 10 mg | 2.6K | $145.9K | $56.19 | 4.22x |
| J3490 | Unclassified drugs | 57 | $104.0K | $1.8K | 1.57x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 827 | $71.5K | $86.41 | 2.24x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 606 | $59.6K | $98.35 | 2.63x |
| 92240 | Examination of eye using an endoscope | 317 | $52.1K | $164.46 | 3.82x |
| 92242 | Imaging of blood vessels in back of eye using fluorescein and indocyanine-green dye | 263 | $42.6K | $161.96 | 2.18x |
| 99213 | Established patient outpatient visit, total time 20-29 minutes | 530 | $33.2K | $62.71 | 2.23x |
This provider submits charges 2.73 times higher than what Medicare actually pays.
A markup ratio of 2.73x means for every $100 Medicare pays, this provider initially charges $273. 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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