This provider's $11.6M in total Medicare payments ranks in the 97th percentile of Ambulatory Surgical Center providers nationally.
Their average markup ratio of 12.21x is significantly above the specialty median of 6.1x.
Medicare payments to this provider grew 179% from 2014 to 2023.
62% of their billing comes from a single procedure code (66984 — Removal of cataract with insertion of lens).
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 77% 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 | $5.3K | $584.48 | 9.12x | $4.7K | $596.6K | 866 | 649 |
| 2015 | $11.3K | $786.47 | 14.33x | $10.5K | $752.7K | 1.0K | 779 |
| 2016 | $13.2K | $811.53 | 16.31x | $12.4K | $843.5K | 1.1K | 848 |
| 2017 | $12.4K | $1.1K | 11.75x | $11.4K | $965.5K | 1.3K | 952 |
| 2018 | $9.8K | $850.99 | 11.48x | $8.9K | $1.1M | 1.4K | 1.0K |
| 2019 | $10.3K | $840.83 | 12.30x | $9.5K | $1.3M | 1.8K | 1.3K |
| 2020 | $11.1K | $925.01 | 12.03x | $10.2K | $930.0K | 1.2K | 900 |
| 2021 | $12.4K | $989.71 | 12.52x | $11.4K | $1.6M | 2.1K | 1.5K |
| 2022 | $14.3K | $1.6K | 8.75x | $12.6K | $1.8M | 2.3K | 1.7K |
| 2023 | $14.0K | $1.5K | 9.31x | $12.5K | $1.7M | 1.9K | 1.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 66984 | Removal of cataract with insertion of lens | 9.1K | $7.1M | $780.37 | 13.25x |
| 67042 | Removal of membrane from the retina, pars plana approach | 515 | $748.8K | $1.5K | 12.79x |
| 66982 | Removal of cataract with insertion of lens | 662 | $529.0K | $799.13 | 13.00x |
| 0191T | Internal insertion of eye fluid drainage device | 242 | $518.4K | $2.1K | 2.32x |
| 67036 | Removal of eye fluid (vitreous) between the lens and retina | 348 | $510.4K | $1.5K | 12.82x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 215 | $317.1K | $1.5K | 12.75x |
| 49505 | Repair of groin hernia patient age 5 years or older | 241 | $268.6K | $1.1K | 13.81x |
| 27447 | Replacement of knee joint, both sides of knee | 32 | $234.7K | $7.3K | 6.53x |
| C9447 | Injection, phenylephrine and ketorolac, 4 ml vial | 533 | $192.3K | $360.85 | 1.32x |
| 67040 | Laser destruction of eye fluid (vitreous) between the lens and retina | 132 | $184.7K | $1.4K | 13.39x |
| 65820 | Incision to improve eye fluid flow | 86 | $130.8K | $1.5K | 7.19x |
| 66821 | Removal of recurring cataract in lens capsule using laser | 546 | $106.4K | $194.85 | 12.92x |
| 64483 | Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance | 378 | $104.1K | $275.42 | 14.24x |
| J1097 | Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml | 1.3K | $93.2K | $74.23 | 1.33x |
| 67041 | Removal of membrane from the retina | 66 | $82.2K | $1.2K | 15.05x |
| 27130 | Replacement of thigh bone and hip joint with prosthesis | 11 | $79.6K | $7.2K | 3.28x |
| 66991 | Extracapsular removal of cataract with insertion of artificial lens and insertion of drainage device in front chamber of eye | 29 | $75.6K | $2.6K | 4.32x |
| 66986 | Exchange of lens prosthesis | 146 | $66.0K | $452.29 | 23.26x |
| 67039 | Laser destruction of eye fluid (vitreous) between the lens and retina | 29 | $42.1K | $1.5K | 12.93x |
| 67113 | Repair of detached retina and drainage of eye fluid between lens and retina | 28 | $40.3K | $1.4K | 13.03x |
This provider submits charges 12.21 times higher than what Medicare actually pays.
A markup ratio of 12.21x means for every $100 Medicare pays, this provider initially charges $1221. 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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