This provider's $6.1M in total Medicare payments ranks in the 99th percentile of Family Practice 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 | $97.04 | $41.35 | 2.35x | $55.69 | $480.6K | 9.6K | 3.7K |
| 2015 | $108.33 | $45.58 | 2.38x | $62.75 | $619.6K | 11.4K | 4.5K |
| 2016 | $111.74 | $44.26 | 2.52x | $67.48 | $615.3K | 12.4K | 4.2K |
| 2017 | $92.55 | $38.39 | 2.41x | $54.16 | $647.7K | 11.7K | 3.4K |
| 2018 | $88.20 | $36.43 | 2.42x | $51.77 | $643.4K | 11.9K | 3.5K |
| 2019 | $99.97 | $48.35 | 2.07x | $51.62 | $572.5K | 10.4K | 3.5K |
| 2020 | $100.27 | $48.07 | 2.09x | $52.20 | $630.7K | 11.0K | 3.1K |
| 2021 | $107.79 | $47.17 | 2.29x | $60.62 | $579.0K | 10.7K | 3.2K |
| 2022 | $117.45 | $51.96 | 2.26x | $65.49 | $686.1K | 12.3K | 3.5K |
| 2023 | $122.90 | $53.44 | 2.30x | $69.46 | $662.9K | 12.2K | 3.5K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 47.8K | $2.6M | $53.70 | 1.98x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 5.0K | $733.1K | $145.55 | 2.04x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 12.7K | $614.0K | $48.40 | 2.10x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 7.6K | $600.8K | $79.06 | 1.94x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 5.0K | $336.9K | $67.21 | 2.42x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 9.0K | $287.5K | $32.10 | 1.82x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 1.5K | $177.1K | $121.39 | 2.02x |
| 99238 | Hospital discharge day management, 30 minutes or less | 3.0K | $160.9K | $53.84 | 2.16x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 2.1K | $133.5K | $64.38 | 2.08x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.2K | $56.4K | $47.29 | 2.57x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 508 | $48.7K | $95.85 | 2.15x |
| 99315 | Nursing facility discharge day management, 30 minutes or less | 914 | $48.6K | $53.14 | 2.02x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 206 | $31.3K | $152.11 | 2.30x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 248 | $28.8K | $116.17 | 2.14x |
| 99307 | Subsequent nursing facility visit, typically 10 minutes per day | 861 | $25.8K | $30.00 | 2.19x |
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 1.6K | $24.0K | $15.23 | 2.18x |
| 99239 | Hospital discharge day management, more than 30 minutes | 295 | $23.2K | $78.72 | 2.02x |
| 99220 | Hospital observation care, typically 70 minutes | 155 | $21.2K | $136.89 | 1.99x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test | 2.2K | $19.7K | $9.17 | 2.18x |
| 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 | 434 | $15.9K | $36.73 | 3.38x |
This provider submits charges 2.05 times higher than what Medicare actually pays.
A markup ratio of 2.05x means for every $100 Medicare pays, this provider initially charges $205. 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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