This provider's $3.9M in total Medicare payments ranks in the 99th percentile of Internal Medicine 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 | $84.88 | $35.29 | 2.41x | $49.59 | $383.9K | 12.6K | 7.4K |
| 2015 | $94.60 | $40.06 | 2.36x | $54.54 | $370.5K | 11.3K | 6.9K |
| 2016 | $103.88 | $41.61 | 2.50x | $62.27 | $408.6K | 11.2K | 6.5K |
| 2017 | $168.53 | $49.89 | 3.38x | $118.64 | $414.2K | 10.8K | 6.3K |
| 2018 | $192.18 | $55.99 | 3.43x | $136.19 | $432.4K | 9.3K | 5.7K |
| 2019 | $182.59 | $54.92 | 3.32x | $127.67 | $395.1K | 8.3K | 5.3K |
| 2020 | $166.26 | $56.34 | 2.95x | $109.92 | $374.7K | 8.0K | 4.8K |
| 2021 | $177.22 | $58.40 | 3.03x | $118.82 | $404.2K | 7.9K | 4.7K |
| 2022 | $166.69 | $52.64 | 3.17x | $114.05 | $388.0K | 8.2K | 4.8K |
| 2023 | $152.94 | $55.90 | 2.74x | $97.04 | $347.4K | 7.7K | 4.5K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 13.0K | $722.2K | $55.69 | 3.23x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 7.0K | $474.9K | $68.30 | 2.08x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 8.1K | $388.1K | $47.71 | 1.79x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 7.9K | $361.1K | $45.57 | 1.99x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 2.9K | $283.7K | $97.71 | 2.51x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 1.5K | $225.2K | $149.45 | 3.28x |
| 99495 | Transitional care management services, moderately complexity, requiring face-to-face visits within 14 days of discharge | 1.2K | $173.0K | $144.68 | 2.17x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 1.3K | $159.5K | $120.44 | 1.83x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 1.9K | $149.7K | $80.38 | 5.40x |
| 99239 | Hospital discharge day management, more than 30 minutes | 1.4K | $112.0K | $81.45 | 3.58x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 528 | $86.3K | $163.53 | 1.83x |
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 5.4K | $64.5K | $12.00 | 5.25x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 298 | $52.9K | $177.42 | 2.49x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 441 | $51.1K | $115.85 | 1.38x |
| 84443 | Blood test, thyroid stimulating hormone (TSH) | 2.6K | $50.0K | $19.50 | 2.72x |
| 99238 | Hospital discharge day management, 30 minutes or less | 885 | $49.0K | $55.36 | 3.21x |
| 83036 | Hemoglobin A1C level | 4.0K | $46.1K | $11.47 | 4.71x |
| 99220 | Hospital observation care typically 70 minutes per day | 330 | $45.5K | $138.00 | 3.39x |
| 80048 | Blood test, basic group of blood chemicals | 4.3K | $41.0K | $9.49 | 6.32x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test | 4.0K | $37.1K | $9.26 | 3.35x |
This provider submits charges 2.83 times higher than what Medicare actually pays.
A markup ratio of 2.83x means for every $100 Medicare pays, this provider initially charges $283. 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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