This provider's $4.3M in total Medicare payments ranks in the 99th percentile of Pulmonary Disease 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 | $184.84 | $85.19 | 2.17x | $99.65 | $304.6K | 2.8K | 1.1K |
| 2015 | $210.00 | $102.25 | 2.05x | $107.75 | $410.5K | 3.8K | 1.2K |
| 2016 | $198.75 | $93.04 | 2.14x | $105.71 | $436.8K | 4.1K | 1.3K |
| 2017 | $225.50 | $111.91 | 2.02x | $113.59 | $496.4K | 4.4K | 1.4K |
| 2018 | $219.50 | $104.93 | 2.09x | $114.57 | $465.6K | 3.9K | 1.4K |
| 2019 | $226.37 | $108.52 | 2.09x | $117.85 | $410.1K | 3.5K | 1.2K |
| 2020 | $210.56 | $101.17 | 2.08x | $109.39 | $541.9K | 4.4K | 1.7K |
| 2021 | $208.64 | $94.67 | 2.20x | $113.97 | $406.6K | 3.3K | 980 |
| 2022 | $218.75 | $113.03 | 1.94x | $105.72 | $430.8K | 3.4K | 1.1K |
| 2023 | $261.99 | $100.40 | 2.61x | $161.59 | $434.8K | 3.5K | 1.1K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 13.2K | $2.5M | $186.57 | 2.40x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 13.3K | $819.5K | $61.68 | 1.92x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 6.5K | $584.5K | $90.33 | 1.95x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 1.5K | $247.4K | $163.92 | 2.01x |
| 99292 | Critical care delivery critically ill or injured patient | 967 | $91.2K | $94.32 | 2.09x |
| 31500 | Emergent insertion of breathing tube into windpipe cartilage using an endoscope | 315 | $36.6K | $116.19 | 1.68x |
| 36556 | Insertion of central venous catheter for infusion, patient 5 years or older | 283 | $24.5K | $86.67 | 2.24x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 286 | $24.5K | $85.70 | 2.39x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 289 | $22.1K | $76.42 | 2.01x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 177 | $10.2K | $57.51 | 2.25x |
| 31624 | Irrigation and suction of lung airways to obtain cells using an endoscope | 60 | $5.4K | $90.35 | 2.71x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 49 | $4.7K | $96.67 | 2.44x |
| 92950 | Attempt to restart heart and lungs | 17 | $2.7K | $160.84 | 1.87x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 27 | $2.5K | $91.87 | 2.23x |
| 99238 | Hospital discharge day management, 30 minutes or less | 36 | $2.2K | $61.82 | 1.94x |
| 36620 | Insertion of arterial catheter for blood sampling or infusion, accessed through the skin | 36 | $1.3K | $37.41 | 2.29x |
| 31622 | Diagnostic examination of lung airways using an endoscope | 11 | $1.2K | $112.87 | 2.13x |
| 99202 | New patient office or other outpatient visit, typically 20 minutes | 13 | $713.90 | $54.92 | 2.64x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 19 | $623.82 | $32.83 | 1.98x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 12 | $597.46 | $49.79 | 2.28x |
This provider submits charges 2.21 times higher than what Medicare actually pays.
A markup ratio of 2.21x means for every $100 Medicare pays, this provider initially charges $221. 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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