This provider's $5.1M 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.
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 | $434.71 | $220.04 | 1.98x | $214.67 | $663.6K | 7.8K | 5.4K |
| 2015 | $447.18 | $211.64 | 2.11x | $235.54 | $693.9K | 7.7K | 5.3K |
| 2016 | $479.52 | $213.59 | 2.25x | $265.93 | $581.4K | 6.9K | 4.9K |
| 2017 | $457.45 | $187.01 | 2.45x | $270.44 | $533.0K | 7.1K | 5.0K |
| 2018 | $466.40 | $190.76 | 2.44x | $275.64 | $507.8K | 7.3K | 5.1K |
| 2019 | $519.22 | $191.04 | 2.72x | $328.18 | $513.0K | 7.0K | 4.8K |
| 2020 | $532.06 | $197.90 | 2.69x | $334.16 | $333.3K | 5.3K | 3.8K |
| 2021 | $507.76 | $176.54 | 2.88x | $331.22 | $468.7K | 6.5K | 4.7K |
| 2022 | $474.78 | $180.45 | 2.63x | $294.33 | $405.6K | 6.2K | 4.3K |
| 2023 | $419.13 | $171.73 | 2.44x | $247.40 | $404.4K | 5.8K | 4.0K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 66984 | Removal of cataract with insertion of lens | 1.8K | $922.3K | $517.00 | 2.90x |
| 66821 | Removal of recurring cataract in lens capsule using laser | 3.3K | $915.8K | $274.94 | 1.82x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 25.2K | $897.6K | $35.55 | 1.77x |
| 66982 | Removal of cataract with insertion of lens | 648 | $430.4K | $664.16 | 2.55x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 4.5K | $233.6K | $51.40 | 1.75x |
| 67210 | Laser destruction of retinal growth, 1 or more sessions | 528 | $231.0K | $437.47 | 1.71x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 2.7K | $206.5K | $77.27 | 1.87x |
| 67031 | Laser release of scar tissue between the lens and retina | 554 | $179.1K | $323.28 | 1.55x |
| 92134 | Diagnostic imaging of retina | 4.4K | $141.3K | $32.12 | 3.11x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 7.2K | $136.9K | $18.94 | 3.23x |
| 65855 | Laser repair to improve eye fluid flow, 1 or more sessions | 534 | $118.1K | $221.19 | 2.26x |
| 67966 | Removal of over one-fourth of the eyelid involving lid margin | 163 | $92.1K | $565.01 | 1.58x |
| 76519 | Ultrasound of eye for determination of lens power | 2.9K | $87.1K | $30.01 | 2.08x |
| 92133 | Diagnostic imaging of optic nerve of eye | 2.6K | $75.3K | $29.11 | 3.43x |
| 0191T | Internal insertion of eye fluid drainage device | 142 | $72.4K | $510.05 | 2.92x |
| 92250 | Photography of the retina | 2.6K | $59.2K | $22.97 | 2.18x |
| 92202 | Extended examination of eye with drawing of optic nerve and surrounding area (macula) | 3.9K | $44.6K | $11.45 | 6.55x |
| 67228 | Laser destruction of leaking retinal blood vessels, 1 or more sessions | 54 | $40.0K | $741.19 | 1.28x |
| 92083 | Measurement of field of vision during daylight conditions | 1.5K | $38.3K | $25.20 | 1.79x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 466 | $34.6K | $74.18 | 1.76x |
This provider submits charges 2.27 times higher than what Medicare actually pays.
A markup ratio of 2.27x means for every $100 Medicare pays, this provider initially charges $227. 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 NJ for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Howard Fine, MD MHSC | New Brunswick, NJ | $44.5M | ✓ Clear |
| Robert Barone, MD | Newton, NJ | $43.3M | ✓ Clear |
| Jonathan Prenner, MD | New Brunswick, NJ | $43.1M | ✓ Clear |
| Sumit Shah, M.D. | New Brunswick, NJ | $37.0M | ✓ Clear |
| David Kim, M.D. | Union, NJ | $36.1M | ✓ 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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