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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
Disclaimer: This site is an independent journalism project. Data analysis and editorial content are not affiliated with or endorsed by CMS or any government agency. All spending figures are based on publicly available Medicare payment records.
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Methodology•Download Data
  1. Home
  2. Providers
  3. Paul Carnes
⚕️
MDIndividual

Paul Carnes, M.D.

NPI: 1417940990
Raleigh, NC
10 years of data
Pain Management
$3.4M
Total Payments
25.7K
Beneficiaries
46.0K
Services
5.41x
Markup Ratio

Peer Comparison

98th
percentile in specialty
This provider$3.4M
Specialty median$156.5K

📋 Key Findings

1Billed $3.4M over 10 years
25.41x markup ratio (above median)
398th percentile in Pain Management by payments
4Payments surged 159% in 2015
515 procedures with >3x markup
✓ No flags detected

🔎 Data Analysis

This provider's $3.4M in total Medicare payments ranks in the 98th percentile of Pain Management providers nationally.

Their average markup ratio of 5.41x is significantly above the specialty median of 5.1x.

Medicare payments to this provider grew 328% from 2014 to 2023.

AI-generated analysis based on Medicare payment data.

Annual Medicare Payments

Annual Services Provided

Avg Payment per Service

Markup Ratio Over Time

📈

Notable: Payments increased 159% in 2015

Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.

Submitted Charges vs. Medicare Payments

Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.

YearAvg SubmittedAvg PaidMarkup RatioGap per ServiceTotal PaymentsServicesBeneficiaries
2014$426.10$83.085.13x$343.02$99.6K1.5K973
2015$450.43$88.665.08x$361.77$258.1K4.4K2.6K
2016$628.70$101.246.21x$527.46$267.9K4.2K2.4K
2017$838.46$113.717.37x$724.75$342.9K5.6K3.2K
2018$799.53$115.216.94x$684.32$380.5K5.5K3.2K
2019$817.46$126.536.46x$690.93$401.7K5.9K3.1K
2020$753.75$106.457.08x$647.30$329.2K4.9K2.6K
2021$691.74$106.196.51x$585.55$368.2K5.6K2.9K
2022$854.01$220.323.88x$633.69$539.4K4.6K2.5K
2023$812.40$220.453.69x$591.95$426.3K3.8K2.2K

Top Procedures (20)

J7999Compounded drug, not otherwise classified
$397.0K
98 services$4.1K/svc1.92x markup
64483Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance⚠ 5.5x markup
$367.9K
1.9K services$190.92/svc5.50x markup
64635Destruction of lower or sacral spinal facet joint nerves using imaging guidance⚠ 5.9x markup
$201.8K
631 services$319.83/svc5.86x markup
27096Injection procedure into sacroiliac joint for anesthetic or steroid⚠ 3.3x markup
$184.3K
1.3K services$146.37/svc3.34x markup
64493Injections of lower or sacral spine facet joint using imaging guidance⚠ 4.9x markup
$178.3K
1.1K services$167.13/svc4.92x markup
64490Injections of upper or middle spine facet joint using imaging guidance⚠ 4.8x markup
$162.4K
884 services$183.67/svc4.76x markup
76942Ultrasonic guidance imaging supervision and interpretation for insertion of needle⚠ 13.6x markup
$148.9K
3.4K services$43.41/svc13.60x markup
64633Destruction of upper or middle spinal facet joint nerves using imaging guidance⚠ 6.2x markup
$126.8K
386 services$328.54/svc6.23x markup
99204New patient office or other outpatient visit, typically 45 minutes
$125.5K
1.0K services$120.43/svc2.99x markup
99213Established patient office or other outpatient visit, typically 15 minutes
$113.2K
2.1K services$53.21/svc2.64x markup
20611Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance⚠ 4.8x markup
$100.5K
1.4K services$71.77/svc4.75x markup
64494Injections of lower or sacral spine facet joint using imaging guidance⚠ 5.7x markup
$91.2K
1.0K services$89.27/svc5.68x markup
62321Injection of substance into spinal canal of upper or middle back using imaging guidance⚠ 8.6x markup
$87.0K
473 services$183.89/svc8.58x markup
99205New patient office or other outpatient visit, typically 60 minutes
$79.9K
540 services$148.05/svc2.90x markup
64636Destruction of lower or sacral spinal facet joint nerves with imaging guidance⚠ 5.3x markup
$79.2K
575 services$137.71/svc5.34x markup
64491Injections of upper or middle spine facet joint using imaging guidance⚠ 7.1x markup
$77.2K
816 services$94.64/svc7.08x markup
99214Established patient office or other outpatient, visit typically 25 minutes
$71.9K
917 services$78.37/svc2.68x markup
64484Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance⚠ 7.7x markup
$66.5K
994 services$66.92/svc7.68x markup
64405Injection of anesthetic agent, greater occipital nerve⚠ 5.5x markup
$64.5K
775 services$83.29/svc5.52x markup
64450Injection of anesthetic agent, other peripheral nerve or branch⚠ 9.4x markup
$64.2K
1.3K services$49.31/svc9.37x markup
Show detailed table ▾
CodeDescriptionServicesPaymentsAvg/ServiceMarkup
J7999Compounded drug, not otherwise classified98$397.0K$4.1K1.92x
64483Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance1.9K$367.9K$190.925.50x
64635Destruction of lower or sacral spinal facet joint nerves using imaging guidance631$201.8K$319.835.86x
27096Injection procedure into sacroiliac joint for anesthetic or steroid1.3K$184.3K$146.373.34x
64493Injections of lower or sacral spine facet joint using imaging guidance1.1K$178.3K$167.134.92x
64490Injections of upper or middle spine facet joint using imaging guidance884$162.4K$183.674.76x
76942Ultrasonic guidance imaging supervision and interpretation for insertion of needle3.4K$148.9K$43.4113.60x
64633Destruction of upper or middle spinal facet joint nerves using imaging guidance386$126.8K$328.546.23x
99204New patient office or other outpatient visit, typically 45 minutes1.0K$125.5K$120.432.99x
99213Established patient office or other outpatient visit, typically 15 minutes2.1K$113.2K$53.212.64x
20611Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance1.4K$100.5K$71.774.75x
64494Injections of lower or sacral spine facet joint using imaging guidance1.0K$91.2K$89.275.68x
62321Injection of substance into spinal canal of upper or middle back using imaging guidance473$87.0K$183.898.58x
99205New patient office or other outpatient visit, typically 60 minutes540$79.9K$148.052.90x
64636Destruction of lower or sacral spinal facet joint nerves with imaging guidance575$79.2K$137.715.34x
64491Injections of upper or middle spine facet joint using imaging guidance816$77.2K$94.647.08x
99214Established patient office or other outpatient, visit typically 25 minutes917$71.9K$78.372.68x
64484Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance994$66.5K$66.927.68x
64405Injection of anesthetic agent, greater occipital nerve775$64.5K$83.295.52x
64450Injection of anesthetic agent, other peripheral nerve or branch1.3K$64.2K$49.319.37x

Markup Analysis

Charge-to-Payment Ratio

5.41x

This provider submits charges 5.41 times higher than what Medicare actually pays.

What This Means

A markup ratio of 5.41x means for every $100 Medicare pays, this provider initially charges $541. This is higher than the national average.

Location

Raleigh, NC

Provider Verification

Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.

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Data Sources

  • • Centers for Medicare & Medicaid Services (CMS)
  • • Medicare Provider Utilization and Payment Data (2014-2023)
  • • National Plan and Provider Enumeration System (NPPES)

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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