This provider's $6.9M 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 | $210.94 | $77.74 | 2.71x | $133.20 | $727.3K | 8.0K | 3.8K |
| 2015 | $228.11 | $82.69 | 2.76x | $145.42 | $761.9K | 8.5K | 4.5K |
| 2016 | $302.01 | $99.86 | 3.02x | $202.15 | $738.6K | 8.4K | 4.6K |
| 2017 | $262.22 | $120.45 | 2.18x | $141.77 | $1.0M | 8.7K | 4.6K |
| 2018 | $267.87 | $99.28 | 2.70x | $168.59 | $673.6K | 7.3K | 4.1K |
| 2019 | $256.85 | $100.63 | 2.55x | $156.22 | $749.3K | 8.4K | 4.3K |
| 2020 | $332.10 | $109.97 | 3.02x | $222.13 | $572.3K | 6.4K | 3.2K |
| 2021 | $256.93 | $114.80 | 2.24x | $142.13 | $501.0K | 5.4K | 2.9K |
| 2022 | $304.09 | $123.04 | 2.47x | $181.05 | $448.6K | 4.3K | 2.0K |
| 2023 | $336.69 | $108.49 | 3.10x | $228.20 | $658.1K | 5.6K | 2.1K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 9.3K | $1.7M | $183.21 | 2.74x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 13.4K | $1.2M | $87.05 | 2.49x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 9.5K | $835.8K | $87.73 | 2.26x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 6.1K | $751.9K | $122.92 | 2.16x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 2.8K | $465.3K | $163.90 | 2.46x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 491 | $208.7K | $425.06 | 2.44x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 429 | $163.0K | $379.84 | 2.47x |
| 99239 | Hospital discharge day management, more than 30 minutes | 1.7K | $146.7K | $88.09 | 2.37x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 773 | $130.4K | $168.74 | 2.32x |
| 90670 | Pneumococcal vaccine for injection into muscle | 698 | $129.8K | $185.94 | 1.53x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 2.6K | $114.0K | $43.60 | 2.51x |
| 94729 | Measurement of lung diffusing capacity | 2.6K | $112.4K | $43.19 | 2.46x |
| 31645 | Aspiration of lung secretions from lung airways using an endoscope | 776 | $94.9K | $122.26 | 3.02x |
| 94727 | Determination of lung volumes using gas dilution or washout | 2.6K | $87.9K | $33.77 | 2.46x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.4K | $81.6K | $58.60 | 4.76x |
| 90732 | Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older | 736 | $78.5K | $106.72 | 1.91x |
| 96401 | Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle | 1.3K | $73.1K | $58.14 | 1.31x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 499 | $65.9K | $132.12 | 2.43x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 887 | $65.2K | $73.48 | 2.48x |
| 99407 | Smoking and tobacco use intensive counseling, greater than 10 minutes | 1.8K | $47.9K | $27.23 | 1.98x |
This provider submits charges 2.51 times higher than what Medicare actually pays.
A markup ratio of 2.51x means for every $100 Medicare pays, this provider initially charges $251. 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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