This provider's $4.8M in total Medicare payments ranks in the 99th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 121% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 291% in 2019
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 | $57.57 | $31.31 | 1.84x | $26.26 | $437.0K | 28.0K | 19.5K |
| 2015 | $60.53 | $33.17 | 1.82x | $27.36 | $433.7K | 27.7K | 19.5K |
| 2016 | $72.10 | $44.08 | 1.64x | $28.02 | $173.3K | 3.7K | 2.4K |
| 2017 | $73.21 | $50.74 | 1.44x | $22.47 | $166.8K | 3.6K | 2.4K |
| 2018 | $79.47 | $52.52 | 1.51x | $26.95 | $143.7K | 3.0K | 2.0K |
| 2019 | $66.46 | $48.24 | 1.38x | $18.22 | $562.2K | 9.8K | 7.6K |
| 2020 | $77.29 | $56.63 | 1.36x | $20.66 | $592.0K | 10.2K | 7.8K |
| 2021 | $82.84 | $58.34 | 1.42x | $24.50 | $651.2K | 10.1K | 7.2K |
| 2022 | $96.72 | $67.28 | 1.44x | $29.44 | $683.6K | 9.4K | 6.9K |
| 2023 | $95.26 | $64.53 | 1.48x | $30.73 | $966.7K | 12.6K | 9.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 19.2K | $1.5M | $79.98 | 1.66x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 21.7K | $1.1M | $50.09 | 1.83x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 3.9K | $497.9K | $127.74 | 1.06x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 3.4K | $287.5K | $83.80 | 1.20x |
| 90662 | Vaccine for influenza for injection into muscle | 3.2K | $172.1K | $53.64 | 1.13x |
| 90677 | Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use | 302 | $84.6K | $280.01 | 1.04x |
| G0008 | Administration of influenza virus vaccine | 3.3K | $79.3K | $23.89 | 1.28x |
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 5.1K | $77.5K | $15.25 | 4.52x |
| 80053 | Blood test, comprehensive group of blood chemicals | 6.8K | $77.0K | $11.29 | 3.99x |
| 90670 | Pneumococcal vaccine for injection into muscle | 354 | $68.4K | $193.13 | 1.05x |
| 83721 | LDL cholesterol level | 5.1K | $64.5K | $12.72 | 5.11x |
| 84443 | Blood test, thyroid stimulating hormone (TSH) | 2.8K | $61.7K | $22.42 | 3.26x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test | 5.4K | $55.9K | $10.37 | 2.89x |
| G0444 | Annual depression screening, 15 minutes | 2.9K | $55.2K | $19.28 | 1.52x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 305 | $53.2K | $174.49 | 1.06x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 262 | $52.6K | $200.69 | 1.33x |
| 83036 | Hemoglobin A1C level | 3.2K | $41.6K | $12.94 | 4.25x |
| G0402 | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment | 246 | $40.6K | $165.21 | 1.07x |
| 36415 | Insertion of needle into vein for collection of blood sample | 12.3K | $36.0K | $2.93 | 3.41x |
| 99495 | Transitional care management services, moderately complexity, requiring face-to-face visits within 14 days of discharge | 216 | $34.6K | $160.39 | 1.29x |
This provider submits charges 1.8 times higher than what Medicare actually pays.
A markup ratio of 1.8x means for every $100 Medicare pays, this provider initially charges $180. This is lower 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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