This provider's $3.3M in total Medicare payments ranks in the 99th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 108% from 2014 to 2023.
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 | $114.60 | $39.57 | 2.90x | $75.03 | $251.9K | 8.5K | 4.8K |
| 2015 | $119.54 | $37.67 | 3.17x | $81.87 | $288.5K | 8.7K | 5.3K |
| 2016 | $104.57 | $38.09 | 2.75x | $66.48 | $272.7K | 9.0K | 5.4K |
| 2017 | $123.56 | $46.01 | 2.69x | $77.55 | $302.1K | 9.2K | 5.7K |
| 2018 | $140.14 | $47.98 | 2.92x | $92.16 | $332.8K | 10.1K | 6.3K |
| 2019 | $134.06 | $43.30 | 3.10x | $90.76 | $364.4K | 11.0K | 6.6K |
| 2020 | $146.37 | $53.31 | 2.75x | $93.06 | $289.3K | 8.4K | 5.7K |
| 2021 | $126.84 | $44.22 | 2.87x | $82.62 | $332.6K | 9.1K | 5.9K |
| 2022 | $152.36 | $50.79 | 3.00x | $101.57 | $362.1K | 9.7K | 6.4K |
| 2023 | $161.75 | $49.13 | 3.29x | $112.62 | $524.9K | 11.1K | 6.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 13.3K | $967.4K | $72.50 | 3.53x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 3.1K | $348.8K | $113.83 | 1.45x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 5.9K | $285.6K | $48.21 | 3.65x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 4.8K | $259.0K | $54.22 | 3.18x |
| 90677 | Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use | 449 | $125.5K | $279.57 | 2.44x |
| 90670 | Pneumococcal vaccine for injection into muscle | 707 | $121.9K | $172.46 | 1.68x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 713 | $104.4K | $146.48 | 3.30x |
| 77067 | Mammography of both breasts | 1.0K | $88.5K | $88.15 | 2.26x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test | 10.3K | $76.3K | $7.39 | 4.47x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 473 | $73.4K | $155.16 | 2.04x |
| 36415 | Insertion of needle into vein for collection of blood sample | 16.9K | $58.7K | $3.47 | 5.03x |
| 99490 | Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month | 1.4K | $58.6K | $42.62 | 2.53x |
| 99495 | Transitional care management services, moderately complexity, requiring face-to-face visits within 14 days of discharge | 378 | $49.6K | $131.30 | 3.17x |
| G0202 | Screening mammography, producing direct digital image, bilateral, all views | 543 | $48.0K | $88.35 | 1.85x |
| 90694 | Influenza virus vaccine, quadrivalent (aiiv4), inactivated, adjuvanted, preservative free, for injection into muscle, 0.5 ml dosage | 714 | $46.9K | $65.64 | 1.06x |
| 83036 | Hemoglobin A1C level | 4.0K | $44.0K | $10.95 | 7.10x |
| 90732 | Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older | 395 | $42.4K | $107.31 | 2.20x |
| 99238 | Hospital discharge day management, 30 minutes or less | 774 | $41.9K | $54.09 | 3.20x |
| G0008 | Administration of influenza virus vaccine | 1.9K | $38.0K | $19.75 | 1.16x |
| G0402 | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment | 232 | $36.4K | $156.96 | 1.41x |
This provider submits charges 3.07 times higher than what Medicare actually pays.
A markup ratio of 3.07x means for every $100 Medicare pays, this provider initially charges $307. 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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