This provider's $4.5M in total Medicare payments ranks in the 99th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 145% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 93% in 2015
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 | $105.42 | $46.47 | 2.27x | $58.95 | $190.5K | 3.7K | 2.6K |
| 2015 | $108.29 | $46.59 | 2.32x | $61.70 | $367.0K | 8.1K | 6.4K |
| 2016 | $107.38 | $42.25 | 2.54x | $65.13 | $440.1K | 10.9K | 8.5K |
| 2017 | $108.36 | $44.47 | 2.44x | $63.89 | $423.8K | 10.9K | 8.7K |
| 2018 | $106.57 | $45.75 | 2.33x | $60.82 | $460.3K | 11.9K | 9.6K |
| 2019 | $95.46 | $40.21 | 2.37x | $55.25 | $488.4K | 12.9K | 10.7K |
| 2020 | $94.84 | $41.56 | 2.28x | $53.28 | $516.4K | 13.7K | 11.5K |
| 2021 | $93.34 | $39.34 | 2.37x | $54.00 | $548.9K | 13.8K | 11.5K |
| 2022 | $95.08 | $40.11 | 2.37x | $54.97 | $593.7K | 14.6K | 12.6K |
| 2023 | $93.70 | $39.14 | 2.39x | $54.56 | $467.4K | 12.8K | 11.5K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 20.1K | $1.6M | $78.57 | 3.02x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 7.9K | $984.1K | $124.68 | 2.02x |
| 82306 | Vitamin D-3 level | 5.2K | $169.2K | $32.38 | 2.04x |
| 84443 | Blood test, thyroid stimulating hormone (TSH) | 8.1K | $151.6K | $18.62 | 2.04x |
| 90670 | Pneumococcal vaccine for injection into muscle | 744 | $135.5K | $182.18 | 2.01x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.3K | $135.4K | $105.08 | 3.31x |
| G0444 | Annual depression screening, 15 minutes | 6.6K | $122.4K | $18.47 | 2.04x |
| 90662 | Vaccine for influenza for injection into muscle | 2.3K | $119.2K | $51.65 | 2.01x |
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 8.0K | $111.2K | $13.92 | 2.18x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 549 | $95.7K | $174.23 | 1.96x |
| 80053 | Blood test, comprehensive group of blood chemicals | 8.6K | $94.7K | $11.06 | 2.17x |
| G0402 | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment | 495 | $83.7K | $169.01 | 2.04x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test | 8.3K | $71.9K | $8.62 | 2.04x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 336 | $67.5K | $200.79 | 2.59x |
| G0008 | Administration of influenza virus vaccine | 2.5K | $57.3K | $23.31 | 2.17x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.0K | $52.1K | $50.11 | 3.25x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 1.4K | $45.8K | $32.86 | 2.69x |
| 36415 | Insertion of needle into vein for collection of blood sample | 10.7K | $38.5K | $3.59 | 2.28x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 2.5K | $33.9K | $13.38 | 2.82x |
| 90732 | Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older | 315 | $31.2K | $99.10 | 1.96x |
This provider submits charges 2.49 times higher than what Medicare actually pays.
A markup ratio of 2.49x means for every $100 Medicare pays, this provider initially charges $249. 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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