This provider's $13.4M 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.
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 | $967.05 | $260.57 | 3.71x | $706.48 | $1.1M | 9.7K | 4.6K |
| 2015 | $756.76 | $193.33 | 3.91x | $563.43 | $1.2M | 10.0K | 4.7K |
| 2016 | $739.14 | $171.08 | 4.32x | $568.06 | $1.2M | 11.8K | 5.4K |
| 2017 | $349.80 | $138.16 | 2.53x | $211.64 | $992.3K | 11.3K | 5.6K |
| 2018 | $400.35 | $150.10 | 2.67x | $250.25 | $1.3M | 10.6K | 5.5K |
| 2019 | $440.77 | $155.72 | 2.83x | $285.05 | $1.8M | 11.2K | 4.8K |
| 2020 | $462.48 | $152.36 | 3.04x | $310.12 | $1.5M | 8.9K | 4.0K |
| 2021 | $500.46 | $149.21 | 3.35x | $351.25 | $1.6M | 9.1K | 3.8K |
| 2022 | $787.74 | $277.87 | 2.83x | $509.87 | $1.5M | 8.4K | 3.5K |
| 2023 | $617.79 | $258.23 | 2.39x | $359.56 | $1.2M | 6.9K | 3.1K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 10.1K | $7.4M | $735.61 | 1.64x |
| 67028 | Injection of drug into eye | 20.4K | $1.5M | $74.71 | 5.74x |
| 92134 | Diagnostic imaging of retina | 27.4K | $806.1K | $29.42 | 4.07x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 6.2K | $487.0K | $78.95 | 2.15x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 1.1K | $449.6K | $401.42 | 3.62x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 4.8K | $262.1K | $54.60 | 2.30x |
| J2778 | Injection, ranibizumab, 0.1 mg | 970 | $257.5K | $265.42 | 1.97x |
| J3490 | Unclassified drugs | 121 | $247.3K | $2.0K | 1.54x |
| J3590 | Unclassified biologics | 4.1K | $219.1K | $52.95 | 4.25x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 2.9K | $213.8K | $74.30 | 2.52x |
| 92235 | Examination of retinal blood vessels by ophthalmoscope | 3.0K | $213.5K | $70.05 | 3.42x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 3.6K | $201.3K | $56.43 | 2.43x |
| J9035 | Injection, bevacizumab, 10 mg | 2.9K | $166.4K | $56.60 | 4.19x |
| 92250 | Photography of the retina | 3.6K | $152.6K | $42.52 | 2.63x |
| 67042 | Removal of membrane from the retina, pars plana approach | 174 | $151.0K | $867.80 | 4.10x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.3K | $146.0K | $114.09 | 2.49x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 371 | $124.6K | $335.86 | 5.80x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 1.1K | $82.5K | $72.91 | 2.61x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 469 | $74.0K | $157.72 | 2.04x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 313 | $44.9K | $143.55 | 2.22x |
This provider submits charges 2.61 times higher than what Medicare actually pays.
A markup ratio of 2.61x means for every $100 Medicare pays, this provider initially charges $261. 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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