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 82% from 2014 to 2023.
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 | $294.48 | $75.98 | 3.88x | $218.50 | $270.7K | 3.6K | 2.6K |
| 2015 | $298.12 | $79.62 | 3.74x | $218.50 | $294.1K | 4.1K | 2.9K |
| 2016 | $354.47 | $81.93 | 4.33x | $272.54 | $307.2K | 4.6K | 3.6K |
| 2017 | $366.58 | $84.63 | 4.33x | $281.95 | $345.3K | 5.2K | 4.1K |
| 2018 | $284.67 | $86.85 | 3.28x | $197.82 | $393.4K | 5.5K | 4.4K |
| 2019 | $235.51 | $87.46 | 2.69x | $148.05 | $439.2K | 5.5K | 4.4K |
| 2020 | $242.78 | $92.61 | 2.62x | $150.17 | $368.5K | 5.1K | 4.1K |
| 2021 | $250.53 | $91.33 | 2.74x | $159.20 | $479.4K | 6.3K | 5.0K |
| 2022 | $263.09 | $89.04 | 2.95x | $174.05 | $513.3K | 7.1K | 5.8K |
| 2023 | $282.29 | $91.10 | 3.10x | $191.19 | $492.2K | 7.1K | 5.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 12.0K | $1.3M | $105.63 | 3.10x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 2.0K | $395.2K | $202.44 | 3.73x |
| 94729 | Measurement of lung diffusing capacity | 5.9K | $313.0K | $52.68 | 3.61x |
| 94726 | Determination of lung volumes using plethysmography | 5.8K | $294.9K | $51.02 | 3.64x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.5K | $224.0K | $151.13 | 3.13x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.6K | $183.5K | $70.59 | 3.33x |
| 94375 | Diagnostic testing in a pulmonary function lab | 4.9K | $176.6K | $36.16 | 3.83x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 3.1K | $169.3K | $54.91 | 3.83x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 1.6K | $146.5K | $93.82 | 3.08x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 818 | $120.5K | $147.30 | 3.10x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.7K | $108.0K | $64.12 | 3.27x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 508 | $99.1K | $195.03 | 3.16x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 446 | $80.5K | $180.44 | 3.21x |
| 94200 | Measurement of largest amount of air breathed in an out of lungs over one minute | 3.3K | $58.7K | $17.77 | 5.98x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 361 | $41.6K | $115.28 | 3.57x |
| 99442 | Physician telephone patient service, 11-20 minutes of medical discussion | 395 | $32.6K | $82.49 | 3.02x |
| 87635 | Sars-cov-2 covid-19 amp prb | 635 | $31.9K | $50.22 | 2.59x |
| 99211 | Established patient office or other outpatient visit, typically 5 minutes | 1.1K | $30.3K | $27.77 | 2.31x |
| 94620 | Pulmonary exercise testing | 408 | $20.4K | $49.98 | 4.03x |
| 99443 | Physician telephone patient service, 21-30 minutes of medical discussion | 169 | $18.3K | $108.43 | 2.88x |
This provider submits charges 3.41 times higher than what Medicare actually pays.
A markup ratio of 3.41x means for every $100 Medicare pays, this provider initially charges $341. 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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