This provider's $4.0M in total Medicare payments ranks in the 97th percentile of Medical Oncology 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 | $189.28 | $74.17 | 2.55x | $115.11 | $286.5K | 6.7K | 3.1K |
| 2015 | $209.57 | $81.57 | 2.57x | $128.00 | $320.6K | 6.8K | 3.3K |
| 2016 | $232.56 | $91.03 | 2.55x | $141.53 | $399.5K | 7.5K | 3.6K |
| 2017 | $225.34 | $85.24 | 2.64x | $140.10 | $462.1K | 7.9K | 3.6K |
| 2018 | $245.38 | $92.79 | 2.64x | $152.59 | $518.4K | 8.1K | 3.6K |
| 2019 | $238.48 | $83.83 | 2.84x | $154.65 | $608.6K | 9.6K | 3.9K |
| 2020 | $250.92 | $77.83 | 3.22x | $173.09 | $545.6K | 9.5K | 3.6K |
| 2021 | $131.64 | $38.83 | 3.39x | $92.81 | $276.1K | 7.6K | 3.2K |
| 2022 | $116.83 | $33.96 | 3.44x | $82.87 | $313.0K | 8.4K | 3.6K |
| 2023 | $101.49 | $32.00 | 3.17x | $69.49 | $291.1K | 8.7K | 3.5K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J2505 | Injection, pegfilgrastim, 6 mg | 272 | $867.7K | $3.2K | 2.43x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 7.4K | $599.3K | $81.39 | 3.05x |
| G9678 | Oncology Care Model service | 3.1K | $487.4K | $157.42 | 1.02x |
| 96413 | Infusion of chemotherapy into a vein up to 1 hour | 4.1K | $403.5K | $99.13 | 3.01x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 4.4K | $242.5K | $55.40 | 3.16x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 1.1K | $124.0K | $117.57 | 2.76x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 645 | $97.3K | $150.82 | 3.03x |
| J9217 | Leuprolide acetate (for depot suspension), 7.5 mg | 590 | $94.6K | $160.42 | 5.38x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.6K | $86.2K | $54.51 | 2.89x |
| J3315 | Injection, triptorelin pamoate, 3.75 mg | 349 | $81.2K | $232.71 | 5.14x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 543 | $80.8K | $148.84 | 2.84x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test | 9.7K | $71.6K | $7.35 | 2.72x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 2.0K | $58.8K | $29.42 | 3.58x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour | 1.2K | $57.9K | $49.05 | 3.03x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 3.1K | $46.3K | $14.87 | 4.04x |
| 80053 | Blood test, comprehensive group of blood chemicals | 4.0K | $42.4K | $10.62 | 3.76x |
| 84153 | PSA (prostate specific antigen) measurement | 1.9K | $39.4K | $20.28 | 2.63x |
| 96367 | Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour | 1.6K | $35.7K | $22.28 | 3.13x |
| 96417 | Infusion of different chemotherapy drug or substance into a vein up to 1 hour | 739 | $35.5K | $48.05 | 2.98x |
| 96375 | Injection of different drug or substance into a vein for therapy, diagnosis, or prevention | 2.4K | $31.9K | $13.49 | 3.92x |
This provider submits charges 2.79 times higher than what Medicare actually pays.
A markup ratio of 2.79x means for every $100 Medicare pays, this provider initially charges $279. 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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