This provider's $5.9M in total Medicare payments ranks in the 99th percentile of Family Practice providers nationally.
64% of their billing comes from a single procedure code (99214 — Established patient office or other outpatient, visit typically 25 minutes).
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 | $117.25 | $45.63 | 2.57x | $71.62 | $519.0K | 12.4K | 4.4K |
| 2015 | $125.60 | $47.10 | 2.67x | $78.50 | $531.1K | 12.2K | 3.9K |
| 2016 | $119.69 | $43.82 | 2.73x | $75.87 | $698.6K | 16.0K | 4.3K |
| 2017 | $105.05 | $42.92 | 2.45x | $62.13 | $616.5K | 14.1K | 4.5K |
| 2018 | $93.74 | $46.16 | 2.03x | $47.58 | $611.3K | 13.6K | 3.8K |
| 2019 | $96.53 | $47.40 | 2.04x | $49.13 | $593.4K | 12.6K | 4.1K |
| 2020 | $96.25 | $49.92 | 1.93x | $46.33 | $551.4K | 7.9K | 2.4K |
| 2021 | $210.90 | $123.73 | 1.70x | $87.17 | $615.8K | 6.1K | 764 |
| 2022 | $123.71 | $67.66 | 1.83x | $56.05 | $611.7K | 7.5K | 2.7K |
| 2023 | $112.26 | $47.81 | 2.35x | $64.45 | $591.1K | 8.1K | 2.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 43.7K | $3.7M | $84.62 | 2.07x |
| 99443 | Physician telephone patient service, 21-30 minutes of medical discussion | 6.4K | $620.0K | $96.68 | 1.81x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 2.1K | $278.7K | $129.71 | 1.68x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 1.6K | $192.9K | $122.79 | 1.57x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 10.6K | $189.9K | $17.90 | 3.58x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 872 | $171.0K | $196.11 | 1.47x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 1.1K | $90.8K | $83.48 | 1.55x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 1.6K | $81.8K | $50.14 | 1.50x |
| 93000 | Routine EKG using at least 12 leads including interpretation and report | 4.5K | $57.8K | $12.87 | 8.31x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 297 | $52.1K | $175.45 | 1.20x |
| 93922 | Ultrasound study of arteries of both arms and legs | 673 | $50.0K | $74.32 | 3.29x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 490 | $47.3K | $96.47 | 2.22x |
| G0008 | Administration of influenza virus vaccine | 1.8K | $43.7K | $24.91 | 2.25x |
| 82962 | Blood glucose (sugar) test performed by hand-held instrument | 11.6K | $36.5K | $3.16 | 3.17x |
| G0446 | Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes | 1.3K | $35.8K | $26.56 | 1.64x |
| G0442 | Annual alcohol misuse screening, 15 minutes | 1.5K | $29.5K | $19.07 | 2.40x |
| 99354 | Prolonged office or other outpatient service first hour | 349 | $27.7K | $79.33 | 2.21x |
| 99495 | Transitional care management services, moderately complexity, requiring face-to-face visits within 14 days of discharge | 176 | $24.6K | $139.98 | 1.70x |
| 90674 | Vaccine for influenza for administration into muscle, 0.5 ml dosage | 923 | $24.0K | $26.01 | 1.36x |
| G0444 | Annual depression screening, 15 minutes | 1.2K | $22.7K | $18.95 | 2.55x |
This provider submits charges 2.25 times higher than what Medicare actually pays.
A markup ratio of 2.25x means for every $100 Medicare pays, this provider initially charges $225. 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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