This provider's $5.6M 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 | $453.21 | $124.16 | 3.65x | $329.05 | $552.6K | 3.6K | 2.5K |
| 2015 | $402.71 | $112.16 | 3.59x | $290.55 | $562.0K | 4.3K | 3.1K |
| 2016 | $418.20 | $112.86 | 3.71x | $305.34 | $488.5K | 5.5K | 2.9K |
| 2017 | $388.15 | $104.29 | 3.72x | $283.86 | $568.5K | 5.2K | 3.2K |
| 2018 | $323.91 | $92.08 | 3.52x | $231.83 | $639.0K | 5.2K | 3.5K |
| 2019 | $372.99 | $100.80 | 3.70x | $272.19 | $909.0K | 6.6K | 4.5K |
| 2020 | $590.43 | $155.07 | 3.81x | $435.36 | $487.4K | 3.8K | 2.7K |
| 2021 | $407.05 | $110.72 | 3.68x | $296.33 | $508.1K | 3.8K | 2.5K |
| 2022 | $542.69 | $138.94 | 3.91x | $403.75 | $392.2K | 3.0K | 2.1K |
| 2023 | $422.17 | $115.78 | 3.65x | $306.39 | $497.8K | 3.7K | 2.9K |
| 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 | 4.8K | $2.3M | $474.78 | 3.78x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 3.4K | $1.5M | $452.03 | 3.98x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 18.0K | $910.3K | $50.68 | 2.32x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 4.2K | $299.4K | $70.77 | 3.19x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 3.6K | $283.9K | $77.88 | 2.16x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 6.5K | $187.4K | $28.70 | 2.57x |
| 71250 | CT scan chest | 164 | $19.3K | $117.70 | 3.62x |
| 99442 | Telephone medical discussion with physician, 11-20 minutes | 409 | $18.4K | $44.97 | 3.34x |
| 95165 | Preparation and provision of single or multiple antigens for allergen immunotherapy | 1.9K | $16.8K | $8.98 | 2.23x |
| G0399 | Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation | 167 | $14.7K | $88.03 | 6.54x |
| 94729 | Measurement of lung diffusing capacity | 268 | $10.8K | $40.30 | 3.25x |
| 94726 | Determination of lung volumes using plethysmography | 258 | $10.1K | $39.28 | 3.23x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 194 | $7.9K | $40.69 | 3.33x |
| 99443 | Telephone medical discussion with physician, 21-30 minutes | 62 | $4.2K | $68.01 | 5.22x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 31 | $3.9K | $126.97 | 2.06x |
| 71020 | X-ray of chest, 2 views, front and side | 121 | $2.4K | $19.97 | 3.57x |
| 71046 | X-ray of chest, 2 views | 78 | $1.8K | $23.32 | 3.25x |
| 94375 | Diagnostic testing in a pulmonary function lab | 58 | $1.7K | $29.21 | 3.21x |
| 95012 | Measurement of inhaled nitric oxide gas | 99 | $1.4K | $14.31 | 3.21x |
| 95977 | Electronic analysis of implanted neurostimulator generator with complex cranial nerve stimulator programming | 34 | $1.3K | $39.17 | 2.55x |
This provider submits charges 3.44 times higher than what Medicare actually pays.
A markup ratio of 3.44x means for every $100 Medicare pays, this provider initially charges $344. 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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