This provider's $3.9M in total Medicare payments ranks in the 99th percentile of Pediatric Medicine providers nationally.
Medicare payments to this provider grew 601% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 116% in 2017
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 | $419.42 | $86.30 | 4.86x | $333.12 | $89.4K | 1.3K | 768 |
| 2015 | $437.04 | $84.45 | 5.18x | $352.59 | $104.7K | 1.4K | 903 |
| 2016 | $161.54 | $50.23 | 3.22x | $111.31 | $209.4K | 4.8K | 4.2K |
| 2017 | $81.19 | $39.11 | 2.08x | $42.08 | $453.0K | 14.1K | 10.0K |
| 2018 | $73.32 | $31.89 | 2.30x | $41.43 | $453.2K | 15.5K | 11.2K |
| 2019 | $76.30 | $32.89 | 2.32x | $43.41 | $436.0K | 16.1K | 11.1K |
| 2020 | $76.32 | $33.12 | 2.30x | $43.20 | $417.8K | 15.5K | 11.1K |
| 2021 | $82.05 | $36.29 | 2.26x | $45.76 | $559.5K | 18.1K | 12.5K |
| 2022 | $88.44 | $42.12 | 2.10x | $46.32 | $539.7K | 17.6K | 12.6K |
| 2023 | $88.49 | $38.34 | 2.31x | $50.15 | $627.5K | 18.9K | 13.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 13.6K | $1.0M | $75.74 | 1.65x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 4.9K | $561.7K | $114.26 | 1.40x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 7.2K | $315.8K | $43.64 | 2.02x |
| 90662 | Vaccine for influenza for injection into muscle | 2.4K | $142.1K | $60.42 | 1.09x |
| 84443 | Blood test, thyroid stimulating hormone (TSH) | 6.9K | $124.1K | $18.02 | 4.05x |
| 90670 | Pneumococcal vaccine for injection into muscle | 614 | $120.9K | $196.96 | 1.15x |
| 90677 | Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use | 402 | $111.0K | $276.23 | 1.03x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.9K | $102.6K | $53.43 | 4.57x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 629 | $97.7K | $155.29 | 1.05x |
| 80053 | Blood test, comprehensive group of blood chemicals | 7.2K | $81.6K | $11.32 | 5.03x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 489 | $71.3K | $145.89 | 4.28x |
| 90732 | Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older | 717 | $71.2K | $99.26 | 1.14x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test | 8.1K | $67.0K | $8.32 | 5.29x |
| 83036 | Hemoglobin A1C level | 6.2K | $64.9K | $10.42 | 4.22x |
| 84439 | Thyroxine (thyroid chemical) measurement | 6.7K | $64.4K | $9.68 | 4.26x |
| 36415 | Insertion of needle into vein for collection of blood sample | 15.2K | $57.2K | $3.75 | 4.53x |
| G0008 | Administration of influenza virus vaccine | 2.8K | $54.6K | $19.21 | 1.20x |
| 77080 | Bone density measurement using dedicated X-ray machine | 1.5K | $53.4K | $35.16 | 5.69x |
| 82306 | Vitamin D-3 level | 1.6K | $49.7K | $30.51 | 6.62x |
| 83718 | HDL cholesterol level | 4.6K | $42.2K | $9.24 | 3.03x |
This provider submits charges 2.48 times higher than what Medicare actually pays.
A markup ratio of 2.48x means for every $100 Medicare pays, this provider initially charges $248. 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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