This provider's $3.9M in total Medicare payments ranks in the 99th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 150% from 2014 to 2023.
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 | $56.75 | $28.10 | 2.02x | $28.65 | $219.2K | 5.0K | 2.7K |
| 2015 | $58.47 | $32.21 | 1.82x | $26.26 | $251.8K | 5.6K | 3.3K |
| 2016 | $57.06 | $31.17 | 1.83x | $25.89 | $324.2K | 7.3K | 4.1K |
| 2017 | $58.77 | $33.11 | 1.77x | $25.66 | $332.9K | 6.8K | 4.0K |
| 2018 | $73.75 | $43.35 | 1.70x | $30.40 | $403.8K | 7.5K | 4.5K |
| 2019 | $70.45 | $43.53 | 1.62x | $26.92 | $479.9K | 8.9K | 6.1K |
| 2020 | $81.60 | $52.99 | 1.54x | $28.61 | $386.8K | 6.7K | 4.9K |
| 2021 | $99.58 | $58.28 | 1.71x | $41.30 | $434.7K | 6.2K | 4.2K |
| 2022 | $101.46 | $60.12 | 1.69x | $41.34 | $503.1K | 7.0K | 4.7K |
| 2023 | $109.19 | $58.59 | 1.86x | $50.60 | $548.7K | 7.3K | 5.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 19.4K | $1.6M | $80.24 | 1.84x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 16.3K | $888.3K | $54.58 | 2.03x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 4.2K | $530.4K | $126.94 | 1.31x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 2.7K | $226.7K | $83.24 | 1.30x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.4K | $139.1K | $99.03 | 2.07x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 4.3K | $61.6K | $14.43 | 2.16x |
| G0402 | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment | 335 | $57.6K | $171.85 | 1.25x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 222 | $46.7K | $210.52 | 1.63x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 258 | $44.2K | $171.40 | 1.33x |
| G0442 | Annual alcohol misuse screening, 15 minutes | 1.9K | $35.4K | $18.92 | 1.14x |
| G0444 | Annual depression screening, 15 minutes | 1.7K | $32.2K | $18.91 | 1.14x |
| G0008 | Administration of influenza virus vaccine | 1.4K | $29.7K | $21.75 | 1.34x |
| 90732 | Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older | 319 | $29.5K | $92.52 | 1.19x |
| 69210 | Removal of impact ear wax, one ear | 781 | $26.9K | $34.41 | 2.15x |
| 99495 | Transitional care management services, moderately complexity, requiring face-to-face visits within 14 days of discharge | 165 | $24.3K | $147.16 | 1.58x |
| 93000 | Routine EKG using at least 12 leads including interpretation and report | 2.0K | $23.3K | $11.73 | 2.43x |
| G0179 | Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial im | 475 | $14.4K | $30.27 | 1.96x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 217 | $13.5K | $62.33 | 2.24x |
| 87426 | Elisa detection of severe acute respiratory syndrome coronavirus 2 (covid-19) antigen | 372 | $12.8K | $34.54 | 2.89x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 83 | $9.8K | $117.82 | 1.71x |
This provider submits charges 1.79 times higher than what Medicare actually pays.
A markup ratio of 1.79x means for every $100 Medicare pays, this provider initially charges $179. 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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