This provider's $7.4M 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 | $374.59 | $85.04 | 4.40x | $289.55 | $620.4K | 8.3K | 5.2K |
| 2015 | $500.62 | $112.19 | 4.46x | $388.43 | $764.1K | 10.7K | 7.3K |
| 2016 | $493.55 | $105.47 | 4.68x | $388.08 | $866.8K | 12.3K | 8.8K |
| 2017 | $484.30 | $97.20 | 4.98x | $387.10 | $848.8K | 13.4K | 9.8K |
| 2018 | $499.17 | $99.06 | 5.04x | $400.11 | $761.0K | 12.0K | 8.9K |
| 2019 | $499.27 | $101.10 | 4.94x | $398.17 | $856.9K | 12.1K | 9.4K |
| 2020 | $545.41 | $107.44 | 5.08x | $437.97 | $732.5K | 10.7K | 8.3K |
| 2021 | $676.80 | $112.41 | 6.02x | $564.39 | $694.3K | 9.9K | 7.8K |
| 2022 | $598.11 | $62.98 | 9.50x | $535.13 | $632.2K | 10.7K | 8.4K |
| 2023 | $567.50 | $65.99 | 8.60x | $501.51 | $643.9K | 10.6K | 8.5K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 23.5K | $2.0M | $85.19 | 2.09x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 11.8K | $981.4K | $83.09 | 2.18x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 4.5K | $572.1K | $125.86 | 2.42x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 9.0K | $512.9K | $56.82 | 2.14x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 922 | $492.7K | $534.42 | 4.27x |
| 94729 | Measurement of lung diffusing capacity | 10.4K | $443.6K | $42.67 | 3.51x |
| 94726 | Determination of lung volumes using plethysmography | 10.4K | $403.3K | $38.74 | 4.34x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 763 | $384.9K | $504.48 | 4.34x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 9.7K | $377.5K | $38.98 | 3.98x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 2.0K | $356.1K | $176.20 | 2.14x |
| 31653 | Examination of lung airways using an endoscope with imaging guidance and ultrasound | 846 | $155.4K | $183.73 | 8.25x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 854 | $134.5K | $157.50 | 1.97x |
| 94664 | Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device | 7.0K | $97.7K | $14.04 | 3.25x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 1.1K | $83.7K | $75.02 | 2.10x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 958 | $55.0K | $57.46 | 2.19x |
| 94010 | Measurement and graphic recording of total and timed exhaled air capacity | 2.0K | $42.5K | $21.41 | 4.36x |
| 31629 | Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope | 361 | $42.0K | $116.25 | 8.81x |
| 31628 | Biopsy of one lobe of lung using an endoscope | 516 | $38.4K | $74.36 | 13.82x |
| 31627 | Computer-assisted image-guided navigation of lung airways using an endoscope | 462 | $36.0K | $77.82 | 23.66x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 336 | $35.5K | $105.54 | 2.34x |
This provider submits charges 3.28 times higher than what Medicare actually pays.
A markup ratio of 3.28x means for every $100 Medicare pays, this provider initially charges $328. 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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