Are your patients aware of the dispensing fee? Is the dispensing fee fixed for all optometrists in your area or is it a maximum allowable model? Are your exam fees set by the regulating agency or do you have freedom to determine what your exam service is worth?
on a side note of consumers in general. they don't care about the rent, utilities, insurance, payroll, equipment, shipping and other expenses. They see a widget costs a retailer $.50 and sells for $1.50 a 300% mark up
so they feel they should be able to get it for $.55 what they don't realize and what you refuse to take into account it costs the retailer $1.12 per widget to bring it to the consumer, less than a 35% mark up.
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