This provider's $6.2M in total Medicare payments ranks in the 99th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 365% 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 | $138.92 | $53.83 | 2.58x | $85.09 | $267.9K | 6.1K | 4.1K |
| 2015 | $144.36 | $57.14 | 2.53x | $87.22 | $361.6K | 7.2K | 4.8K |
| 2016 | $149.03 | $60.50 | 2.46x | $88.53 | $376.8K | 7.4K | 5.6K |
| 2017 | $153.91 | $61.30 | 2.51x | $92.61 | $530.1K | 11.5K | 6.8K |
| 2018 | $153.23 | $62.84 | 2.44x | $90.39 | $503.9K | 11.5K | 5.9K |
| 2019 | $135.26 | $55.55 | 2.43x | $79.71 | $546.1K | 12.7K | 6.4K |
| 2020 | $129.58 | $56.59 | 2.29x | $72.99 | $539.4K | 11.6K | 5.8K |
| 2021 | $133.22 | $61.46 | 2.17x | $71.76 | $753.0K | 14.0K | 7.1K |
| 2022 | $143.24 | $65.52 | 2.19x | $77.72 | $1.1M | 17.0K | 8.2K |
| 2023 | $149.26 | $69.17 | 2.16x | $80.09 | $1.2M | 19.1K | 8.6K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 17.7K | $1.6M | $87.99 | 2.55x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 36.6K | $1.4M | $38.07 | 2.31x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 4.7K | $585.8K | $124.72 | 1.94x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 3.6K | $491.2K | $135.06 | 2.24x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 7.7K | $429.1K | $56.07 | 2.73x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 4.2K | $358.9K | $85.14 | 2.07x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 645 | $133.3K | $206.63 | 2.35x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 767 | $131.8K | $171.83 | 2.08x |
| 17000 | Destruction of skin growth | 1.8K | $91.3K | $51.49 | 2.96x |
| 17004 | Destruction of 15 or more skin growths | 702 | $84.6K | $120.52 | 2.66x |
| 90670 | Pneumococcal vaccine for injection into muscle | 473 | $82.7K | $174.79 | 1.85x |
| 99487 | Complex chronic care management services 60 minutes clinical staff time | 841 | $79.4K | $94.39 | 2.04x |
| G0008 | Administration of influenza virus vaccine | 3.2K | $77.6K | $24.13 | 1.99x |
| G0444 | Annual depression screening, 15 minutes | 3.9K | $73.2K | $18.58 | 2.00x |
| G0402 | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment | 360 | $60.7K | $168.61 | 2.05x |
| 90662 | Vaccine for influenza for injection into muscle | 1.1K | $52.8K | $49.07 | 1.69x |
| G0442 | Annual alcohol misuse screening, 15 minutes | 2.6K | $47.7K | $18.65 | 2.04x |
| 36415 | Insertion of needle into vein for collection of blood sample | 11.5K | $43.7K | $3.81 | 2.58x |
| 99358 | Prolonged patient service without direct patient contact first hour | 411 | $34.5K | $83.87 | 2.79x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 270 | $30.9K | $114.55 | 3.04x |
This provider submits charges 2.33 times higher than what Medicare actually pays.
A markup ratio of 2.33x means for every $100 Medicare pays, this provider initially charges $233. 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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