This provider's $4.2M in total Medicare payments ranks in the 99th percentile of Infectious Disease 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 | $131.96 | $65.42 | 2.02x | $66.54 | $281.2K | 4.3K | 2.4K |
| 2015 | $119.68 | $60.25 | 1.99x | $59.43 | $311.0K | 5.1K | 2.5K |
| 2016 | $152.87 | $65.62 | 2.33x | $87.25 | $427.7K | 7.4K | 2.4K |
| 2017 | $144.88 | $60.88 | 2.38x | $84.00 | $481.9K | 9.2K | 2.4K |
| 2018 | $144.03 | $59.82 | 2.41x | $84.21 | $477.5K | 8.2K | 2.4K |
| 2019 | $146.66 | $59.84 | 2.45x | $86.82 | $432.4K | 7.7K | 2.1K |
| 2020 | $146.04 | $62.25 | 2.35x | $83.79 | $435.9K | 7.1K | 1.9K |
| 2021 | $154.91 | $71.22 | 2.18x | $83.69 | $507.3K | 7.9K | 2.2K |
| 2022 | $139.70 | $65.94 | 2.12x | $73.76 | $450.8K | 7.8K | 2.1K |
| 2023 | $138.81 | $65.04 | 2.13x | $73.77 | $406.8K | 7.6K | 2.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour | 15.6K | $955.7K | $61.27 | 4.44x |
| 96521 | Refilling and maintenance of portable pump | 5.9K | $748.1K | $125.75 | 4.43x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 9.2K | $554.5K | $60.28 | 1.59x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 3.3K | $536.3K | $164.30 | 1.94x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 3.9K | $353.0K | $91.35 | 1.58x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 3.6K | $213.6K | $58.60 | 1.67x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 1.4K | $157.7K | $111.24 | 2.44x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 1.4K | $123.0K | $88.17 | 1.56x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 657 | $114.5K | $174.29 | 1.56x |
| J1335 | Injection, ertapenem sodium, 500 mg | 3.5K | $106.4K | $30.03 | 3.45x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 481 | $41.5K | $86.28 | 2.02x |
| 96367 | Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour | 1.4K | $36.4K | $26.84 | 4.92x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 584 | $33.0K | $56.49 | 1.54x |
| 99221 | Initial hospital inpatient care, typically 30 minutes per day | 392 | $32.6K | $83.10 | 2.75x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 1.2K | $32.5K | $26.33 | 2.47x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 262 | $27.2K | $103.89 | 1.55x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 207 | $26.6K | $128.62 | 1.73x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 191 | $24.7K | $129.24 | 1.53x |
| 11042 | Removal of skin and tissue first 20 sq cm or less | 443 | $22.8K | $51.40 | 2.99x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 485 | $15.8K | $32.58 | 2.57x |
This provider submits charges 3.06 times higher than what Medicare actually pays.
A markup ratio of 3.06x means for every $100 Medicare pays, this provider initially charges $306. 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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