This provider's $3.6M in total Medicare payments ranks in the 95th 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 | $403.71 | $115.89 | 3.48x | $287.82 | $411.3K | 6.0K | 4.2K |
| 2015 | $358.09 | $108.68 | 3.29x | $249.41 | $374.1K | 5.7K | 4.4K |
| 2016 | $465.92 | $128.70 | 3.62x | $337.22 | $450.8K | 6.0K | 4.3K |
| 2017 | $375.12 | $106.52 | 3.52x | $268.60 | $385.0K | 5.8K | 4.1K |
| 2018 | $500.32 | $132.20 | 3.78x | $368.12 | $383.7K | 5.4K | 4.0K |
| 2019 | $398.78 | $106.59 | 3.74x | $292.19 | $368.4K | 5.4K | 3.9K |
| 2020 | $373.64 | $99.48 | 3.76x | $274.16 | $294.9K | 4.1K | 3.1K |
| 2021 | $570.10 | $125.23 | 4.55x | $444.87 | $354.9K | 4.6K | 3.2K |
| 2022 | $618.16 | $130.72 | 4.73x | $487.44 | $310.4K | 4.2K | 2.9K |
| 2023 | $596.73 | $120.46 | 4.95x | $476.27 | $307.3K | 4.2K | 2.8K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 10.1K | $670.8K | $66.24 | 1.64x |
| 65855 | Laser repair to improve eye fluid flow, 1 or more sessions | 2.0K | $447.8K | $225.62 | 5.54x |
| 66984 | Removal of cataract with insertion of lens | 698 | $373.5K | $535.13 | 5.45x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 5.5K | $372.7K | $68.37 | 1.73x |
| 92083 | Measurement of field of vision during daylight conditions | 5.0K | $276.8K | $55.54 | 2.34x |
| 92250 | Photography of the retina | 3.7K | $190.5K | $51.73 | 2.32x |
| 66821 | Removal of recurring cataract in lens capsule using laser | 619 | $171.8K | $277.51 | 5.31x |
| 92133 | Diagnostic imaging of optic nerve of eye | 4.7K | $150.5K | $32.29 | 3.72x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 987 | $123.8K | $125.46 | 1.71x |
| 92286 | Microscopic evaluation of deep cells of the eye | 2.9K | $90.0K | $31.15 | 6.42x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 1.1K | $89.7K | $81.29 | 1.60x |
| 92020 | Examination of cornea and iris using lens device and slit lamp | 3.8K | $89.3K | $23.44 | 3.41x |
| 68760 | Repair duct opening | 400 | $84.8K | $211.95 | 1.97x |
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 803 | $79.4K | $98.89 | 1.77x |
| 92025 | Computerized mapping of corneal curvature | 2.2K | $67.5K | $30.45 | 2.79x |
| 92134 | Diagnostic imaging of retina | 1.9K | $67.0K | $35.75 | 3.64x |
| 76512 | Ultrasound of eye disease, growth, or structure | 1.1K | $61.3K | $57.41 | 2.94x |
| 66982 | Removal of cataract with insertion of lens | 89 | $60.2K | $676.93 | 4.42x |
| 92136 | Measurement of corneal curvature and depth of eye | 894 | $53.0K | $59.25 | 3.37x |
| 68761 | Closure of tear duct opening using plug | 137 | $22.4K | $163.39 | 2.86x |
This provider submits charges 3.23 times higher than what Medicare actually pays.
A markup ratio of 3.23x means for every $100 Medicare pays, this provider initially charges $323. This is higher than the national average.
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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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