This provider's $5.6M 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 | $131.54 | $68.77 | 1.91x | $62.77 | $619.8K | 10.6K | 6.8K |
| 2015 | $124.90 | $66.23 | 1.89x | $58.67 | $735.9K | 12.1K | 7.5K |
| 2016 | $138.90 | $70.45 | 1.97x | $68.45 | $539.5K | 8.7K | 6.0K |
| 2017 | $143.08 | $74.99 | 1.91x | $68.09 | $561.2K | 8.2K | 5.4K |
| 2018 | $158.01 | $79.99 | 1.98x | $78.02 | $522.0K | 6.1K | 4.6K |
| 2019 | $161.54 | $81.44 | 1.98x | $80.10 | $601.0K | 8.0K | 4.9K |
| 2020 | $151.45 | $76.33 | 1.98x | $75.12 | $473.7K | 6.4K | 5.0K |
| 2021 | $134.69 | $74.55 | 1.81x | $60.14 | $588.6K | 7.6K | 5.6K |
| 2022 | $167.90 | $85.92 | 1.95x | $81.98 | $493.0K | 6.2K | 4.8K |
| 2023 | $161.56 | $75.43 | 2.14x | $86.13 | $435.1K | 5.6K | 4.1K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 23.6K | $1.7M | $73.80 | 2.28x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 8.6K | $1.1M | $124.48 | 2.28x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 11.8K | $577.0K | $49.09 | 2.23x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 1.6K | $280.6K | $174.15 | 1.63x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 4.9K | $268.5K | $55.21 | 1.75x |
| 90670 | Pneumococcal vaccine for injection into muscle | 1.2K | $227.7K | $186.96 | 1.33x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 737 | $145.8K | $197.83 | 1.99x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 553 | $86.2K | $155.82 | 1.73x |
| 99335 | Established patient assisted living visit, typically 25 minutes | 1.2K | $85.5K | $70.82 | 1.84x |
| G0402 | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment | 492 | $80.8K | $164.27 | 1.20x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.3K | $76.8K | $57.62 | 2.02x |
| G0008 | Administration of influenza virus vaccine | 3.1K | $73.3K | $23.53 | 1.69x |
| 90694 | Influenza virus vaccine, quadrivalent (aiiv4), inactivated, adjuvanted, preservative free, for injection into muscle, 0.5 ml dosage | 881 | $61.3K | $69.53 | 1.39x |
| 90677 | Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use | 216 | $59.6K | $275.99 | 1.52x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 832 | $59.5K | $71.55 | 1.89x |
| 99495 | Transitional care management services, moderately complexity, requiring face-to-face visits within 14 days of discharge | 405 | $56.9K | $140.56 | 2.26x |
| 90732 | Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older | 497 | $49.1K | $98.89 | 1.20x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 259 | $45.8K | $176.87 | 2.41x |
| 99336 | Established patient assisted living visit, typically 40 minutes | 437 | $45.7K | $104.54 | 1.91x |
| G0180 | Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imple | 1.1K | $45.6K | $43.11 | 2.88x |
This provider submits charges 2.09 times higher than what Medicare actually pays.
A markup ratio of 2.09x means for every $100 Medicare pays, this provider initially charges $209. 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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