This provider's $4.1M in total Medicare payments ranks in the 99th percentile of Infectious Disease 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 | $232.92 | $84.21 | 2.77x | $148.71 | $293.3K | 4.0K | 1.5K |
| 2015 | $224.17 | $83.91 | 2.67x | $140.26 | $274.3K | 3.7K | 1.3K |
| 2016 | $198.68 | $79.60 | 2.50x | $119.08 | $325.0K | 4.7K | 1.6K |
| 2017 | $202.31 | $84.16 | 2.40x | $118.15 | $404.0K | 6.2K | 2.2K |
| 2018 | $188.11 | $84.10 | 2.24x | $104.01 | $541.6K | 7.6K | 3.0K |
| 2019 | $156.58 | $84.25 | 1.86x | $72.33 | $487.3K | 6.5K | 3.0K |
| 2020 | $160.71 | $89.22 | 1.80x | $71.49 | $622.3K | 8.4K | 2.9K |
| 2021 | $160.71 | $90.31 | 1.78x | $70.40 | $504.8K | 7.3K | 2.8K |
| 2022 | $157.22 | $91.97 | 1.71x | $65.25 | $372.9K | 5.3K | 2.3K |
| 2023 | $139.29 | $83.25 | 1.67x | $56.04 | $248.0K | 3.2K | 1.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 31.8K | $1.9M | $59.14 | 2.69x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 7.7K | $862.0K | $111.24 | 1.98x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 2.5K | $399.6K | $163.04 | 1.77x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 3.3K | $284.1K | $85.59 | 2.47x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 2.1K | $218.2K | $104.04 | 2.06x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 5.7K | $186.0K | $32.59 | 2.69x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 1.5K | $84.1K | $54.45 | 2.11x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 464 | $37.0K | $79.75 | 2.38x |
| 99221 | Initial hospital inpatient care, typically 30 minutes per day | 398 | $31.1K | $78.04 | 1.71x |
| 99304 | Initial nursing facility visit, typically 25 minutes per day | 281 | $20.0K | $71.15 | 2.21x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 287 | $17.9K | $62.51 | 1.60x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 114 | $15.4K | $135.40 | 2.21x |
| 99307 | Subsequent nursing facility visit, typically 10 minutes per day | 368 | $13.0K | $35.28 | 2.13x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 117 | $12.8K | $109.27 | 1.87x |
| 99219 | Hospital observation care typically 50 minutes | 63 | $7.0K | $110.61 | 1.73x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 43 | $1.7K | $40.44 | 1.36x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 16 | $1.2K | $74.96 | 2.00x |
| 99238 | Hospital discharge day management, 30 minutes or less | 16 | $935.36 | $58.46 | 3.42x |
This provider submits charges 2.36 times higher than what Medicare actually pays.
A markup ratio of 2.36x means for every $100 Medicare pays, this provider initially charges $236. 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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