This provider's $3.9M in total Medicare payments ranks in the 98th percentile of Pulmonary Disease providers nationally.
Medicare payments to this provider grew 80% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 114% in 2016
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
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 | $176.06 | $81.07 | 2.17x | $94.99 | $197.2K | 2.7K | 1.2K |
| 2015 | $306.73 | $87.04 | 3.52x | $219.69 | $206.6K | 2.7K | 2.0K |
| 2016 | $346.98 | $69.88 | 4.97x | $277.10 | $442.6K | 6.3K | 5.5K |
| 2017 | $344.62 | $65.67 | 5.25x | $278.95 | $521.7K | 7.7K | 6.5K |
| 2018 | $299.41 | $60.12 | 4.98x | $239.29 | $513.5K | 7.8K | 6.3K |
| 2019 | $289.21 | $64.80 | 4.46x | $224.41 | $485.8K | 7.1K | 5.4K |
| 2020 | $260.11 | $63.66 | 4.09x | $196.45 | $408.9K | 6.6K | 5.1K |
| 2021 | $243.10 | $57.68 | 4.21x | $185.42 | $416.1K | 6.1K | 4.5K |
| 2022 | $281.76 | $61.91 | 4.55x | $219.85 | $378.7K | 5.4K | 3.9K |
| 2023 | $279.27 | $57.56 | 4.85x | $221.71 | $355.9K | 5.0K | 3.6K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 8.7K | $707.5K | $81.28 | 1.98x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 1.4K | $619.8K | $459.12 | 4.14x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 1.0K | $445.2K | $436.87 | 3.98x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 2.7K | $303.6K | $113.67 | 2.25x |
| 71250 | CT scan chest | 3.7K | $252.4K | $68.91 | 16.75x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 1.8K | $149.1K | $80.92 | 2.40x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 965 | $144.8K | $150.03 | 2.35x |
| 94729 | Measurement of lung diffusing capacity | 4.0K | $136.8K | $34.34 | 5.64x |
| 94726 | Determination of lung volumes using plethysmography | 3.9K | $130.0K | $33.56 | 4.48x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 741 | $111.5K | $150.48 | 2.66x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.9K | $107.8K | $55.52 | 2.10x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 2.4K | $86.2K | $36.68 | 4.99x |
| 90670 | Pneumococcal vaccine for injection into muscle | 270 | $48.3K | $179.01 | 1.12x |
| 71046 | X-ray of chest, 2 views | 3.0K | $44.5K | $14.98 | 7.74x |
| 90677 | Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use | 161 | $44.1K | $273.98 | 1.25x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 246 | $42.5K | $172.73 | 1.59x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 366 | $41.7K | $113.81 | 2.27x |
| 96401 | Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle | 697 | $39.8K | $57.08 | 3.00x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 734 | $38.9K | $53.04 | 2.07x |
| 94010 | Measurement and graphic recording of total and timed exhaled air capacity | 1.9K | $37.1K | $19.82 | 6.01x |
This provider submits charges 4.26 times higher than what Medicare actually pays.
A markup ratio of 4.26x means for every $100 Medicare pays, this provider initially charges $426. 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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