This provider's $4.5M in total Medicare payments ranks in the 99th percentile of Family Practice 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 | $100.54 | $38.86 | 2.59x | $61.68 | $571.5K | 12.1K | 3.3K |
| 2015 | $108.94 | $41.44 | 2.63x | $67.50 | $509.3K | 11.1K | 3.0K |
| 2016 | $93.81 | $28.89 | 3.25x | $64.92 | $336.8K | 7.3K | 1.5K |
| 2017 | $163.43 | $44.33 | 3.69x | $119.10 | $403.9K | 8.4K | 2.5K |
| 2018 | $144.26 | $48.97 | 2.95x | $95.29 | $476.5K | 9.3K | 2.9K |
| 2019 | $119.04 | $54.56 | 2.18x | $64.48 | $429.2K | 9.7K | 2.4K |
| 2020 | $153.59 | $54.08 | 2.84x | $99.51 | $473.6K | 11.1K | 2.0K |
| 2021 | $151.31 | $52.44 | 2.89x | $98.87 | $447.8K | 9.0K | 1.6K |
| 2022 | $149.90 | $57.05 | 2.63x | $92.85 | $410.5K | 7.4K | 1.3K |
| 2023 | $159.82 | $61.37 | 2.60x | $98.45 | $453.2K | 7.9K | 1.8K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 27.2K | $1.4M | $51.34 | 2.11x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 10.5K | $799.8K | $76.19 | 2.43x |
| 99307 | Subsequent nursing facility visit, typically 10 minutes per day | 22.8K | $746.3K | $32.73 | 2.51x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 6.5K | $374.4K | $57.83 | 2.44x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 1.4K | $150.9K | $108.86 | 2.15x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 1.8K | $126.5K | $70.13 | 2.16x |
| 99495 | Transitional care management services, moderately complexity, requiring face-to-face visits within 14 days of discharge | 771 | $119.1K | $154.48 | 2.03x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 2.1K | $73.3K | $34.11 | 1.99x |
| 20610 | Aspiration and/or injection of large joint or joint capsule | 1.4K | $60.8K | $43.92 | 2.33x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 459 | $57.1K | $124.39 | 2.05x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 883 | $57.0K | $64.60 | 2.38x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 334 | $39.7K | $118.87 | 2.01x |
| 93975 | Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow | 200 | $39.5K | $197.48 | 3.63x |
| G0506 | Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service) | 733 | $33.4K | $45.61 | 2.38x |
| 93925 | Ultrasound study of arteries and arterial grafts of both legs | 201 | $29.6K | $147.17 | 4.28x |
| 93306 | Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function | 199 | $26.7K | $134.30 | 4.30x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 254 | $24.9K | $98.07 | 2.75x |
| 99315 | Nursing facility discharge day management, 30 minutes or less | 426 | $23.4K | $54.88 | 3.41x |
| 93970 | Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers | 202 | $22.8K | $112.63 | 4.36x |
| 93880 | Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck | 195 | $22.6K | $115.72 | 4.28x |
This provider submits charges 2.39 times higher than what Medicare actually pays.
A markup ratio of 2.39x means for every $100 Medicare pays, this provider initially charges $239. 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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