This provider's $4.6M 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 | $389.75 | $107.61 | 3.62x | $282.14 | $565.6K | 4.2K | 3.8K |
| 2015 | $404.89 | $119.45 | 3.39x | $285.44 | $577.9K | 3.7K | 3.4K |
| 2016 | $404.57 | $118.91 | 3.40x | $285.66 | $534.4K | 3.6K | 3.4K |
| 2017 | $483.57 | $132.31 | 3.65x | $351.26 | $460.1K | 3.0K | 2.8K |
| 2018 | $426.79 | $107.64 | 3.96x | $319.15 | $437.5K | 2.5K | 2.4K |
| 2019 | $432.68 | $106.73 | 4.05x | $325.95 | $496.5K | 2.5K | 2.4K |
| 2020 | $461.00 | $111.79 | 4.12x | $349.21 | $364.9K | 1.9K | 1.8K |
| 2021 | $463.87 | $122.58 | 3.78x | $341.29 | $431.0K | 2.1K | 2.0K |
| 2022 | $468.37 | $119.52 | 3.92x | $348.85 | $375.1K | 1.8K | 1.7K |
| 2023 | $570.04 | $146.34 | 3.90x | $423.70 | $368.9K | 1.7K | 1.6K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 3.6K | $1.9M | $542.13 | 5.25x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 2.5K | $1.3M | $515.72 | 4.84x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 5.6K | $471.3K | $84.39 | 1.72x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 1.8K | $283.0K | $156.94 | 1.96x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 4.5K | $247.6K | $54.91 | 2.28x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.8K | $204.0K | $113.72 | 2.31x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 592 | $67.8K | $114.51 | 1.55x |
| 95807 | Sleep study attended by a technician | 67 | $26.6K | $397.30 | 2.52x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 1.4K | $16.1K | $11.24 | 4.53x |
| 90670 | Pneumococcal vaccine for injection into muscle | 93 | $15.1K | $161.95 | 1.07x |
| 94726 | Determination of lung volumes using plethysmography | 1.5K | $14.3K | $9.34 | 5.35x |
| 94729 | Measurement of lung diffusing capacity | 1.5K | $10.8K | $6.96 | 3.59x |
| 90662 | Vaccine for influenza for injection into muscle | 137 | $8.1K | $58.76 | 1.14x |
| G0008 | Administration of influenza virus vaccine | 275 | $6.8K | $24.55 | 1.38x |
| 99406 | Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes | 411 | $6.2K | $15.12 | 1.65x |
| 94620 | Pulmonary exercise testing | 131 | $5.8K | $44.49 | 3.93x |
| 94010 | Measurement and graphic recording of total and timed exhaled air capacity | 604 | $3.9K | $6.46 | 3.88x |
| 99211 | Established patient office or other outpatient visit, typically 5 minutes | 199 | $3.7K | $18.35 | 4.39x |
| 94618 | Test for exercise-induced lung stress | 112 | $2.9K | $26.21 | 6.68x |
| G0009 | Administration of pneumococcal vaccine | 91 | $2.4K | $26.19 | 1.12x |
This provider submits charges 4.17 times higher than what Medicare actually pays.
A markup ratio of 4.17x means for every $100 Medicare pays, this provider initially charges $417. 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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