This provider's $7.2M in total Medicare payments ranks in the 99th percentile of Pulmonary Disease providers nationally.
Medicare payments to this provider grew 55% 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 | $295.04 | $81.65 | 3.61x | $213.39 | $605.9K | 7.3K | 2.0K |
| 2015 | $336.74 | $83.27 | 4.04x | $253.47 | $889.0K | 10.3K | 3.4K |
| 2016 | $366.89 | $81.37 | 4.51x | $285.52 | $782.3K | 9.9K | 3.2K |
| 2017 | $318.78 | $79.99 | 3.99x | $238.79 | $714.8K | 9.5K | 3.6K |
| 2018 | $310.91 | $77.96 | 3.99x | $232.95 | $734.8K | 9.5K | 3.5K |
| 2019 | $310.66 | $72.80 | 4.27x | $237.86 | $696.7K | 9.0K | 3.3K |
| 2020 | $333.83 | $83.04 | 4.02x | $250.79 | $524.1K | 6.2K | 2.4K |
| 2021 | $336.28 | $83.74 | 4.02x | $252.54 | $696.0K | 8.6K | 4.0K |
| 2022 | $302.35 | $81.44 | 3.71x | $220.91 | $632.8K | 9.2K | 5.3K |
| 2023 | $314.42 | $72.07 | 4.36x | $242.35 | $939.1K | 14.5K | 8.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 18.7K | $1.8M | $95.42 | 2.38x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 28.6K | $1.6M | $56.11 | 2.23x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 10.0K | $840.4K | $83.86 | 4.47x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 4.7K | $834.0K | $176.73 | 3.39x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 2.9K | $510.3K | $173.62 | 2.91x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 1.9K | $308.8K | $160.68 | 4.05x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 3.2K | $220.4K | $68.35 | 2.19x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 1.1K | $133.7K | $122.25 | 2.67x |
| 94660 | Initiation and management of continued pressured respiratory assistance by mask or breathing tube | 2.4K | $128.8K | $53.46 | 4.76x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 986 | $117.5K | $119.14 | 1.28x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.6K | $92.7K | $57.63 | 4.95x |
| 94618 | Test for exercise-induced lung stress | 2.6K | $71.9K | $27.98 | 13.24x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 1.6K | $70.3K | $43.36 | 5.19x |
| 94010 | Measurement and graphic recording of total and timed exhaled air capacity | 2.1K | $57.0K | $26.53 | 5.65x |
| 99239 | Hospital discharge day management, more than 30 minutes | 487 | $41.8K | $85.89 | 5.24x |
| 94664 | Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device | 2.5K | $38.0K | $15.00 | 4.00x |
| 94729 | Measurement of lung diffusing capacity | 734 | $37.3K | $50.85 | 4.92x |
| 99457 | Management using the results of remote vital sign monitoring per calendar month, first 20 minutes | 902 | $36.5K | $40.44 | 4.23x |
| 94726 | Determination of lung volumes using plethysmography | 736 | $34.7K | $47.20 | 5.09x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 293 | $29.7K | $101.25 | 9.38x |
This provider submits charges 3.23 times higher than what Medicare actually pays.
A markup ratio of 3.23x means for every $100 Medicare pays, this provider initially charges $323. 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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