This provider's $5.3M in total Medicare payments ranks in the 99th percentile of Pediatric Medicine providers nationally.
Medicare payments to this provider grew 85039% from 2017 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 2627% in 2018
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 |
|---|---|---|---|---|---|---|---|
| 2017 | $294.29 | $51.76 | 5.69x | $242.53 | $5.0K | 97 | 3 |
| 2018 | $281.43 | $46.40 | 6.07x | $235.03 | $136.9K | 3.0K | 12 |
| 2019 | $296.22 | $45.40 | 6.52x | $250.82 | $131.9K | 2.9K | 13 |
| 2020 | $320.15 | $44.59 | 7.18x | $275.56 | $220.2K | 4.9K | 14 |
| 2021 | $315.38 | $43.24 | 7.29x | $272.14 | $215.9K | 5.0K | 14 |
| 2022 | $346.67 | $46.56 | 7.45x | $300.11 | $331.0K | 7.1K | 16 |
| 2023 | $736.54 | $182.00 | 4.05x | $554.54 | $4.3M | 23.5K | 29 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| Q4205 | Membrane graft or membrane wrap, per square centimeter | 1.3K | $1.5M | $1.2K | 1.38x |
| Q4197 | Puraply xt, per square centimeter | 8.2K | $1.1M | $127.68 | 7.08x |
| Q4158 | Kerecis omega3, per square centimeter | 4.6K | $694.9K | $150.50 | 4.07x |
| Q4159 | Affinity, per square centimeter | 1.7K | $490.9K | $294.65 | 2.71x |
| 11042 | Removal of skin and tissue, 20.0 sq cm or less | 10.1K | $451.8K | $44.54 | 8.29x |
| Q4186 | Epifix, per square centimeter | 1.7K | $198.9K | $117.39 | 9.37x |
| 11045 | Removal of skin and tissue, each additional 20.0 sq cm or less | 6.8K | $134.6K | $19.73 | 8.48x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 2.9K | $126.7K | $43.00 | 4.29x |
| 15271 | Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less | 1.5K | $124.0K | $83.41 | 5.79x |
| 15275 | Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less | 965 | $92.3K | $95.70 | 5.35x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 1.2K | $81.6K | $66.84 | 4.11x |
| 11044 | Removal of bone, 20.0 sq cm or less | 488 | $80.9K | $165.86 | 6.91x |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | 768 | $77.5K | $100.96 | 4.06x |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 776 | $42.6K | $54.95 | 4.18x |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 612 | $34.1K | $55.79 | 5.32x |
| 11043 | Removal of muscle and/or tissue, 20.0 sq cm or less | 293 | $31.6K | $107.69 | 7.46x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 255 | $23.9K | $93.75 | 4.51x |
| 11047 | Removal of bone, each additional 20.0 sq cm or less | 342 | $22.1K | $64.68 | 6.76x |
| 97597 | Removal of tissue from wound, 20.0 sq cm or less | 544 | $13.6K | $24.96 | 8.28x |
| 99223 | Initial hospital inpatient care per day, typically 70 minutes | 90 | $13.4K | $149.12 | 4.46x |
This provider submits charges 4.64 times higher than what Medicare actually pays.
A markup ratio of 4.64x means for every $100 Medicare pays, this provider initially charges $464. 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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