This provider's $3.4M in total Medicare payments ranks in the 99th percentile of Optometry 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 | $115.33 | $51.34 | 2.25x | $63.99 | $323.0K | 6.0K | 4.9K |
| 2015 | $121.72 | $58.97 | 2.06x | $62.75 | $346.4K | 6.4K | 5.4K |
| 2016 | $119.09 | $56.04 | 2.13x | $63.05 | $384.0K | 7.0K | 5.6K |
| 2017 | $121.59 | $54.76 | 2.22x | $66.83 | $336.8K | 6.5K | 5.4K |
| 2018 | $142.16 | $63.28 | 2.25x | $78.88 | $252.1K | 4.7K | 4.0K |
| 2019 | $165.15 | $73.92 | 2.23x | $91.23 | $323.9K | 4.7K | 3.8K |
| 2020 | $190.94 | $79.44 | 2.40x | $111.50 | $326.3K | 5.3K | 4.3K |
| 2021 | $178.34 | $81.82 | 2.18x | $96.52 | $331.0K | 5.2K | 4.3K |
| 2022 | $198.72 | $83.09 | 2.39x | $115.63 | $361.5K | 6.0K | 5.1K |
| 2023 | $185.97 | $80.09 | 2.32x | $105.88 | $393.6K | 6.3K | 5.5K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 92014 | Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits | 9.5K | $833.3K | $87.81 | 2.03x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 6.4K | $735.0K | $115.65 | 2.14x |
| 92012 | Eye and medical examination for diagnosis and treatment, established patient | 8.7K | $520.7K | $59.58 | 1.79x |
| 92250 | Photography of the retina | 12.2K | $442.6K | $36.40 | 3.14x |
| 92134 | Diagnostic imaging of retina | 14.1K | $437.3K | $31.08 | 3.35x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.1K | $97.4K | $46.50 | 1.94x |
| 92004 | Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits | 760 | $78.8K | $103.64 | 2.01x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 1.1K | $78.5K | $70.17 | 1.99x |
| 76512 | Ultrasound of eye disease, growth, or structure | 664 | $35.8K | $53.96 | 3.29x |
| 92242 | Imaging of blood vessels in back of eye using fluorescein and indocyanine-green dye | 185 | $34.4K | $186.16 | 1.69x |
| 92225 | Examination of eye by ophthalmoscope with retinal drawing | 1.4K | $28.8K | $21.00 | 4.19x |
| 92235 | Imaging of blood vessels in back of eye using fluorescein dye | 281 | $22.5K | $79.94 | 2.50x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 100 | $15.7K | $157.00 | 2.21x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 293 | $5.5K | $18.64 | 2.68x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 53 | $3.8K | $70.80 | 2.05x |
| 92020 | Examination of cornea and iris using lens device and slit lamp | 161 | $3.4K | $20.87 | 2.70x |
| 92002 | Eye and medical examination for diagnosis and treatment, new patient | 26 | $1.3K | $51.74 | 2.03x |
| 92133 | Diagnostic imaging of optic nerve of eye | 34 | $1.1K | $31.16 | 3.21x |
| 83861 | Microfluid analysis of tears | 41 | $903.23 | $22.03 | 1.82x |
| 99442 | Physician telephone patient service, 11-20 minutes of medical discussion | 18 | $851.72 | $47.32 | 3.38x |
This provider submits charges 2.37 times higher than what Medicare actually pays.
A markup ratio of 2.37x means for every $100 Medicare pays, this provider initially charges $237. 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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