Dr. Martha Smith , MD
High MarkupHigher Out-of-Pocket Billing Risk
This practice submits charges that average 5.4 times customary allowable rates. If you have not met your annual health insurance deductible, or if this doctor is out-of-network with your health plan, you may face significant balance billing.
- Confirm network status: Call your insurer to confirm this specific physician and office address are in-network.
- Request in-network labs: Before blood draws or biopsies, ask the nurse to send samples exclusively to an in-network commercial laboratory.
- Ask for a written estimate: Under the No Surprises Act, you are legally entitled to a Good Faith Estimate if you are self-pay or out-of-network.
Thorough Listener
Consistently devotes longer face-to-face evaluations. Ideal for complex medical concerns, multiple symptoms, or patients who value comprehensive discussion without feeling rushed.
How is appointment length calculated?
Visit durations reflect official documentation standards for Evaluation and Management (E/M) office billing codes (CPT 99202 through 99215).
Physicians who bill higher-level comprehensive visits (such as 99214 and 99215) consistently spend 30 to 45 minutes reviewing complex records and discussing care plans, whereas routine refill clinics predominantly bill briefer level 2 and 3 codes.
Appointment Length & Visit Style
Clinical appointment coding analysis across standard patient evaluations
Dr. Smith predominantly conducts detailed and comprehensive consultations. This provider schedules longer face-to-face evaluations, spending more time per patient than fast-turnaround clinics.
Pricing Transparency & Fee Comparison
How this provider bills compared to standard insurance benchmarks
⚠️ Price Outlier Warning: Dr. Smith's submitted charges are significantly higher than peer medians (over 5.41x the baseline standard). If you receive treatment out-of-network or without insurance, you could face substantial bills. Confirm in-network participation with your health plan prior to booking.
Verified Clinical Procedures & Surgical Focus
Official annual procedure volumes, customary fee comparisons, and clinical focus areas.
| Clinical Procedure & Code | Annual Services | Doctor Charge | Peer Norm | Standard Baseline | vs. Peer Norm |
|---|---|---|---|---|---|
CPT 99214 | 319 | $200.00 | $245.00 | $108.68 | 0.82x |
CPT 64483 | 119 | $787.76 | $1064.79 | $119.91 | 0.74x |
CPT 64493 | 103 | $970.49 | $985.00 | $121.68 | 0.99x |
CPT 64494 | 99 | $819.64 | $452.00 | $70.58 | 1.81x |
CPT 64635 | 85 | $1260.42 | $1815.43 | $258.78 | 0.69x |
CPT 64636 | 82 | $597.07 | $712.21 | $80.15 | 0.84x |
CPT 27096 | 73 | $834.08 | $730.29 | $89.94 | 1.14x |
CPT 20553 | 61 | $180.00 | $195.00 | $54.23 | 0.92x |
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👨⚕️ Physician & Medical Billing Intelligence (Click to view professional coding data)Expand ↓
This section provides clinical practice analytics for healthcare administrators, billing coders, and peer physicians evaluating practice benchmarks:
Estimated appointment time calculation: 35 minutes. Indicates the proportion of high-complexity (99205/99215) vs. moderate-complexity (99204/99214) documentation relative to national specialty peers.
Gross charge multiplier: 5.41x. Useful for fee schedule alignment, out-of-network charge master analysis, and payer contract negotiations.
Patient Guidance: What to Ask Before Your Appointment
- In-Network Confirmation: Confirm directly with your insurance plan that Dr. Smith participates in your specific network tier.
- Surgical Facility Fees: If having surgery, verify whether it will be in a hospital or an outpatient surgery center. Facility charges are billed separately from physician fees.
- Written Estimates: If you are paying out of pocket or have a high deductible, request a written good-faith estimate before major treatments.