This provider's $6.9M in total Medicare payments ranks in the 99th percentile of Otolaryngology 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 | $594.29 | $139.20 | 4.27x | $455.09 | $623.3K | 9.1K | 6.0K |
| 2015 | $564.67 | $144.62 | 3.90x | $420.05 | $709.4K | 9.8K | 6.5K |
| 2016 | $409.85 | $106.03 | 3.87x | $303.82 | $689.1K | 10.1K | 6.5K |
| 2017 | $1.5K | $305.90 | 4.77x | $1.2K | $807.2K | 10.2K | 6.5K |
| 2018 | $1.8K | $424.28 | 4.25x | $1.4K | $829.5K | 9.6K | 6.3K |
| 2019 | $1.6K | $387.34 | 4.19x | $1.2K | $753.7K | 9.8K | 6.7K |
| 2020 | $983.56 | $434.03 | 2.27x | $549.53 | $646.8K | 7.9K | 5.2K |
| 2021 | $334.93 | $116.59 | 2.87x | $218.34 | $644.2K | 8.7K | 5.3K |
| 2022 | $274.25 | $105.59 | 2.60x | $168.66 | $613.0K | 8.7K | 5.5K |
| 2023 | $287.20 | $108.75 | 2.64x | $178.45 | $605.0K | 8.5K | 5.5K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 30.5K | $1.8M | $58.55 | 2.94x |
| 31231 | Diagnostic examination of nasal passages using an endoscope | 10.8K | $1.7M | $160.28 | 2.57x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 7.3K | $600.1K | $81.79 | 2.78x |
| 69210 | Removal of impact ear wax, one ear | 17.6K | $569.7K | $32.46 | 3.56x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 4.5K | $331.8K | $74.54 | 2.91x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 2.2K | $256.0K | $116.15 | 2.76x |
| 31575 | Diagnostic examination of voice box using flexible endoscope | 2.6K | $249.3K | $97.58 | 2.54x |
| 31298 | Dilation of nasal sinus using an endoscope | 51 | $228.4K | $4.5K | 3.39x |
| 31237 | Biopsy or removal of nasal polyp or tissue using an endoscope | 514 | $149.6K | $291.12 | 3.49x |
| 92557 | Air and bone conduction assessment of hearing loss and speech recognition | 4.7K | $135.7K | $28.73 | 3.90x |
| G0268 | Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing | 3.1K | $116.2K | $37.68 | 3.31x |
| 31295 | Dilation of nasal sinus using an endoscope | 87 | $116.0K | $1.3K | 5.27x |
| 31296 | Dilation of nasal sinus using an endoscope | 37 | $87.1K | $2.4K | 4.22x |
| 69420 | Incision, aspiration, and/or inflation of eardrum | 548 | $86.9K | $158.66 | 2.73x |
| 92550 | Assessment of eardrum and muscle function | 4.8K | $80.0K | $16.64 | 4.89x |
| 70486 | CT scan of face | 553 | $59.9K | $108.26 | 3.00x |
| 69200 | Removal of foreign body from ear canal | 824 | $55.3K | $67.16 | 3.58x |
| 69433 | Incision of eardrum with insertion of eardrum tube under local or topical anesthesia | 240 | $40.9K | $170.22 | 2.56x |
| 31238 | Control of nasal bleeding using an endoscope | 164 | $34.1K | $207.79 | 2.58x |
| 31297 | Dilation of nasal sinus using an endoscope | 25 | $32.5K | $1.3K | 6.93x |
This provider submits charges 3.04 times higher than what Medicare actually pays.
A markup ratio of 3.04x means for every $100 Medicare pays, this provider initially charges $304. 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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