This provider's $4.0M 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 | $102.03 | $55.85 | 1.83x | $46.18 | $343.4K | 5.6K | 2.4K |
| 2015 | $113.76 | $66.94 | 1.70x | $46.82 | $347.4K | 5.5K | 2.4K |
| 2016 | $103.35 | $68.33 | 1.51x | $35.02 | $346.2K | 5.7K | 2.8K |
| 2017 | $212.43 | $72.46 | 2.93x | $139.97 | $414.3K | 6.3K | 3.3K |
| 2018 | $112.24 | $63.07 | 1.78x | $49.17 | $374.7K | 5.8K | 2.9K |
| 2019 | $118.36 | $70.93 | 1.67x | $47.43 | $447.8K | 6.3K | 2.9K |
| 2020 | $113.87 | $67.75 | 1.68x | $46.12 | $373.3K | 5.4K | 2.7K |
| 2021 | $108.46 | $70.59 | 1.54x | $37.87 | $433.4K | 5.5K | 2.6K |
| 2022 | $225.73 | $77.04 | 2.93x | $148.69 | $446.9K | 5.4K | 2.4K |
| 2023 | $119.35 | $74.80 | 1.60x | $44.55 | $446.5K | 5.3K | 2.5K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 15.3K | $948.7K | $62.03 | 3.22x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 6.7K | $666.3K | $99.01 | 1.35x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 7.0K | $500.2K | $71.01 | 2.53x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 6.3K | $406.0K | $64.04 | 1.40x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 2.1K | $316.5K | $148.19 | 2.02x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 3.8K | $311.4K | $81.34 | 2.67x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 709 | $125.3K | $176.79 | 1.32x |
| 99316 | Nursing facility discharge management, more than 30 minutes | 1.2K | $117.9K | $96.29 | 2.08x |
| 99350 | Established patient home visit, typically 60 minutes | 596 | $93.5K | $156.85 | 1.31x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 554 | $83.1K | $149.97 | 1.01x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 891 | $83.0K | $93.20 | 1.28x |
| 99239 | Hospital discharge day management, more than 30 minutes | 653 | $62.7K | $96.06 | 1.28x |
| 99496 | Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge | 121 | $26.3K | $217.44 | 1.28x |
| G0008 | Administration of influenza virus vaccine | 1.0K | $23.5K | $22.76 | 1.10x |
| 90674 | Vaccine for influenza for administration into muscle, 0.5 ml dosage | 634 | $17.0K | $26.75 | 1.31x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 424 | $16.6K | $39.13 | 1.43x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 720 | $12.9K | $17.95 | 1.43x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 66 | $12.5K | $190.14 | 1.06x |
| 99491 | Chronic care management services by qualified health care professional, 30 minutes or more per calendar month | 161 | $12.3K | $76.17 | 1.29x |
| G0447 | Face-to-face behavioral counseling for obesity, 15 minutes | 388 | $11.6K | $29.86 | 1.02x |
This provider submits charges 2.17 times higher than what Medicare actually pays.
A markup ratio of 2.17x means for every $100 Medicare pays, this provider initially charges $217. 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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