This provider's $3.7M in total Medicare payments ranks in the 98th percentile of Pulmonary Disease providers nationally.
75% of their billing comes from a single procedure code (99291 — Critical care delivery critically ill or injured patient, first 30-74 minutes).
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 | $226.21 | $86.72 | 2.61x | $139.49 | $314.5K | 2.3K | 788 |
| 2015 | $244.82 | $99.46 | 2.46x | $145.36 | $425.2K | 2.8K | 966 |
| 2016 | $227.26 | $89.72 | 2.53x | $137.54 | $483.6K | 3.3K | 1.0K |
| 2017 | $208.10 | $88.10 | 2.36x | $120.00 | $503.3K | 3.4K | 921 |
| 2018 | $170.80 | $82.68 | 2.07x | $88.12 | $484.8K | 3.2K | 958 |
| 2019 | $160.96 | $79.47 | 2.03x | $81.49 | $468.7K | 3.1K | 960 |
| 2020 | $156.33 | $83.41 | 1.87x | $72.92 | $327.1K | 2.1K | 683 |
| 2021 | $178.95 | $112.10 | 1.60x | $66.85 | $213.6K | 1.4K | 517 |
| 2022 | $189.97 | $99.53 | 1.91x | $90.44 | $243.6K | 1.4K | 488 |
| 2023 | $235.48 | $105.74 | 2.23x | $129.74 | $274.4K | 1.6K | 544 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 14.1K | $2.8M | $200.14 | 1.92x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 5.3K | $491.9K | $92.04 | 1.77x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 608 | $107.5K | $176.85 | 1.45x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 923 | $87.8K | $95.11 | 1.87x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.1K | $72.6K | $64.56 | 3.57x |
| 36556 | Insertion of central venous catheter for infusion, patient 5 years or older | 547 | $51.9K | $94.88 | 2.79x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 158 | $23.0K | $145.56 | 1.64x |
| 99292 | Critical care delivery critically ill or injured patient | 179 | $17.8K | $99.70 | 2.79x |
| 32555 | Removal of fluid from chest cavity with imaging guidance | 115 | $11.6K | $101.20 | 3.54x |
| 31500 | Emergent insertion of breathing tube into windpipe cartilage using an endoscope | 83 | $8.7K | $104.46 | 2.35x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 156 | $8.4K | $54.10 | 2.76x |
| 94729 | Measurement of lung diffusing capacity | 154 | $7.8K | $50.40 | 1.98x |
| 76937 | Ultrasound guidance for accessing into blood vessel | 560 | $7.3K | $13.03 | 4.05x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 52 | $5.9K | $114.23 | 1.75x |
| 94727 | Determination of lung volumes using gas dilution or washout | 148 | $5.8K | $38.92 | 2.57x |
| 31624 | Irrigation and suction of lung airways to obtain cells using an endoscope | 39 | $5.2K | $132.62 | 2.69x |
| 32551 | Removal of fluid from between lung and chest cavity, open procedure | 24 | $3.8K | $158.28 | 2.81x |
| 99211 | Established patient office or other outpatient visit, typically 5 minutes | 116 | $2.1K | $17.87 | 2.87x |
| 99407 | Smoking and tobacco use intensive counseling, greater than 10 minutes | 63 | $2.0K | $31.13 | 1.61x |
| 36620 | Insertion of arterial catheter for blood sampling or infusion, accessed through the skin | 46 | $1.9K | $40.76 | 1.59x |
This provider submits charges 1.95 times higher than what Medicare actually pays.
A markup ratio of 1.95x means for every $100 Medicare pays, this provider initially charges $195. This is lower 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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