This provider's $4.2M in total Medicare payments ranks in the 99th percentile of Internal Medicine providers nationally.
This provider's billing patterns fall within normal ranges for their specialty.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 51% in 2021
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 | $175.17 | $45.74 | 3.83x | $129.43 | $449.2K | 7.6K | 3.8K |
| 2015 | $198.19 | $53.36 | 3.71x | $144.83 | $442.2K | 7.6K | 4.2K |
| 2016 | $199.05 | $54.42 | 3.66x | $144.63 | $410.9K | 6.9K | 3.8K |
| 2017 | $207.50 | $66.64 | 3.11x | $140.86 | $397.3K | 6.0K | 3.3K |
| 2018 | $219.00 | $72.27 | 3.03x | $146.73 | $382.7K | 5.5K | 3.0K |
| 2019 | $224.89 | $72.87 | 3.09x | $152.02 | $387.4K | 5.4K | 3.2K |
| 2020 | $232.48 | $77.55 | 3.00x | $154.93 | $342.0K | 5.0K | 3.0K |
| 2021 | $245.97 | $81.61 | 3.01x | $164.36 | $517.9K | 6.2K | 4.3K |
| 2022 | $268.28 | $78.25 | 3.43x | $190.03 | $433.6K | 5.8K | 4.1K |
| 2023 | $262.47 | $76.71 | 3.42x | $185.76 | $398.0K | 5.4K | 4.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 23.5K | $1.8M | $75.86 | 3.98x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 7.7K | $436.4K | $56.36 | 4.51x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 1.5K | $194.3K | $133.67 | 2.62x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 1.2K | $183.7K | $158.61 | 2.52x |
| G0181 | Physician supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of c | 1.9K | $159.5K | $84.56 | 3.46x |
| 95923 | Testing of autonomic (sympathetic) nervous system function | 1.3K | $134.7K | $102.02 | 2.80x |
| 93923 | Ultrasound study of arteries of both arms and legs | 1.2K | $125.3K | $102.99 | 2.62x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 1.4K | $103.1K | $74.25 | 2.70x |
| 99238 | Hospital discharge day management, 30 minutes or less | 1.5K | $90.1K | $58.35 | 4.02x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 485 | $86.4K | $178.08 | 1.88x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 2.7K | $86.2K | $31.66 | 6.40x |
| 95921 | Testing of autonomic (sympathetic) nervous system function | 1.2K | $79.3K | $64.69 | 3.64x |
| 90670 | Pneumococcal vaccine for injection into muscle | 417 | $78.4K | $188.00 | 1.42x |
| 99220 | Hospital observation care typically 70 minutes per day | 523 | $76.6K | $146.46 | 2.45x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.3K | $74.0K | $57.82 | 4.26x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 569 | $62.3K | $109.56 | 3.30x |
| 78452 | Nuclear medicine study of vessels of heart using drugs or exercise multiple studies | 847 | $51.9K | $61.29 | 8.08x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 234 | $45.7K | $195.38 | 1.76x |
| 99217 | Hospital observation care discharge | 560 | $32.5K | $58.05 | 3.13x |
| 93922 | Ultrasound study of arm and leg arteries | 506 | $30.2K | $59.59 | 3.65x |
This provider submits charges 3.72 times higher than what Medicare actually pays.
A markup ratio of 3.72x means for every $100 Medicare pays, this provider initially charges $372. 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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