This provider's $9.4M 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.
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 | $225.15 | $96.46 | 2.33x | $128.69 | $781.0K | 8.8K | 3.5K |
| 2015 | $307.31 | $105.26 | 2.92x | $202.05 | $958.3K | 11.1K | 4.8K |
| 2016 | $250.94 | $92.48 | 2.71x | $158.46 | $1.1M | 12.1K | 4.5K |
| 2017 | $234.29 | $90.63 | 2.59x | $143.66 | $1.1M | 11.6K | 4.2K |
| 2018 | $251.57 | $95.14 | 2.64x | $156.43 | $1.1M | 11.4K | 3.7K |
| 2019 | $250.67 | $99.26 | 2.53x | $151.41 | $1.1M | 12.2K | 4.0K |
| 2020 | $249.92 | $102.98 | 2.43x | $146.94 | $1.1M | 11.8K | 3.9K |
| 2021 | $261.23 | $114.22 | 2.29x | $147.01 | $844.2K | 8.7K | 2.9K |
| 2022 | $271.63 | $111.27 | 2.44x | $160.36 | $715.8K | 8.8K | 2.8K |
| 2023 | $265.96 | $107.79 | 2.47x | $158.17 | $652.9K | 7.9K | 2.5K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 90960 | Dialysis services (4 or more physician visits per month), patient 20 years of age and older | 10.7K | $2.4M | $223.79 | 2.63x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 30.6K | $1.7M | $55.01 | 2.57x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 9.4K | $1.6M | $167.63 | 2.59x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 11.6K | $815.2K | $70.34 | 2.30x |
| 90935 | Hemodialysis procedure with one physician evaluation | 11.0K | $613.0K | $55.49 | 3.12x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 4.1K | $416.2K | $101.98 | 2.23x |
| 90966 | Home dialysis services per month, patient 20 years of age or older | 1.8K | $335.9K | $188.81 | 2.61x |
| 90961 | Dialysis services (2-3 physician visits per month), patient 20 years of age and older | 1.6K | $304.9K | $187.62 | 2.62x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 3.5K | $273.0K | $79.05 | 2.55x |
| 99239 | Hospital discharge day management, more than 30 minutes | 3.0K | $242.8K | $80.93 | 2.19x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 894 | $166.2K | $185.93 | 1.61x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 646 | $96.2K | $148.91 | 2.60x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 832 | $92.5K | $111.17 | 2.52x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 2.7K | $80.5K | $30.21 | 2.77x |
| 99238 | Hospital discharge day management, 30 minutes or less | 1.3K | $70.6K | $54.89 | 2.39x |
| 90937 | Hemodialysis procedure with repeated evaluations | 444 | $35.1K | $79.16 | 3.98x |
| 90962 | Dialysis services (1 physician visit per month), patient 20 years of age and older | 227 | $31.7K | $139.78 | 3.14x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 376 | $27.8K | $73.92 | 3.20x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 181 | $25.2K | $139.45 | 2.62x |
| 90945 | Dialysis procedure including one evaluation | 375 | $24.3K | $64.88 | 3.83x |
This provider submits charges 2.57 times higher than what Medicare actually pays.
A markup ratio of 2.57x means for every $100 Medicare pays, this provider initially charges $257. 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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