This provider's $6.0M in total Medicare payments ranks in the 99th percentile of Otolaryngology providers nationally.
Medicare payments to this provider grew 115% 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 | $563.54 | $155.68 | 3.62x | $407.86 | $444.6K | 4.1K | 3.1K |
| 2015 | $392.47 | $105.68 | 3.71x | $286.79 | $443.4K | 4.4K | 3.5K |
| 2016 | $693.23 | $187.63 | 3.69x | $505.60 | $467.6K | 4.2K | 3.2K |
| 2017 | $393.81 | $109.56 | 3.59x | $284.25 | $509.3K | 4.9K | 3.9K |
| 2018 | $478.82 | $115.48 | 4.15x | $363.34 | $511.2K | 5.5K | 4.3K |
| 2019 | $408.72 | $117.60 | 3.48x | $291.12 | $617.2K | 6.7K | 5.0K |
| 2020 | $462.88 | $114.37 | 4.05x | $348.51 | $473.8K | 5.6K | 3.9K |
| 2021 | $504.40 | $124.12 | 4.06x | $380.28 | $684.8K | 7.6K | 5.2K |
| 2022 | $576.73 | $130.10 | 4.43x | $446.63 | $845.1K | 8.5K | 5.8K |
| 2023 | $572.89 | $125.40 | 4.57x | $447.49 | $957.0K | 9.5K | 6.5K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 31231 | Diagnostic examination of nasal passages using an endoscope | 9.7K | $1.6M | $164.02 | 3.94x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 12.2K | $732.3K | $60.25 | 4.23x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 8.0K | $681.2K | $85.61 | 3.59x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 3.5K | $435.2K | $124.19 | 4.01x |
| 31233 | Examination of nasal passage and sinus using an endoscope | 1.4K | $410.6K | $285.32 | 4.34x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 427 | $194.5K | $455.54 | 3.78x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 1.1K | $175.0K | $154.14 | 2.99x |
| 69210 | Removal of impact ear wax, one ear | 4.8K | $169.1K | $35.20 | 4.38x |
| 92511 | Examination of the nose and throat using an endoscope | 1.7K | $161.0K | $94.82 | 4.03x |
| 31579 | Examination to assess movement of vocal cord flaps using an endoscope | 998 | $156.5K | $156.82 | 3.82x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 306 | $139.1K | $454.60 | 3.81x |
| 31238 | Control of nasal bleeding using an endoscope | 436 | $101.8K | $233.40 | 4.23x |
| 31235 | Examination of nasal passages and sinus using an endoscope via sinus puncture | 273 | $97.5K | $357.13 | 4.33x |
| 91038 | Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours) | 252 | $94.0K | $372.84 | 3.26x |
| 31237 | Biopsy or removal of nasal polyp or tissue using an endoscope | 283 | $85.4K | $301.84 | 4.78x |
| 76536 | Ultrasound of head and neck | 1.3K | $83.3K | $62.90 | 5.19x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 989 | $77.1K | $77.94 | 3.70x |
| 91010 | Measurement of esophageal swallowing movement | 445 | $71.3K | $160.22 | 3.19x |
| 31295 | Dilation of nasal sinus using an endoscope | 23 | $51.4K | $2.2K | 3.70x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 1.6K | $50.1K | $32.31 | 3.64x |
This provider submits charges 3.96 times higher than what Medicare actually pays.
A markup ratio of 3.96x means for every $100 Medicare pays, this provider initially charges $396. 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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