This provider averages 55 services per working day
Based on 137.8K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $7.8M in total Medicare payments ranks in the 99th percentile of Pulmonary Disease providers nationally.
Averaging 55 services per working day raises questions about billing patterns.
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 | $182.40 | $63.89 | 2.85x | $118.51 | $658.9K | 11.7K | 5.7K |
| 2015 | $177.35 | $65.38 | 2.71x | $111.97 | $671.3K | 11.0K | 6.0K |
| 2016 | $176.85 | $64.17 | 2.76x | $112.68 | $761.2K | 13.2K | 6.7K |
| 2017 | $184.32 | $64.63 | 2.85x | $119.69 | $783.1K | 15.5K | 7.0K |
| 2018 | $194.04 | $68.38 | 2.84x | $125.66 | $781.0K | 14.3K | 6.7K |
| 2019 | $177.18 | $65.19 | 2.72x | $111.99 | $797.6K | 15.1K | 7.4K |
| 2020 | $204.43 | $76.55 | 2.67x | $127.88 | $737.9K | 12.4K | 6.4K |
| 2021 | $184.30 | $71.84 | 2.57x | $112.46 | $870.1K | 14.0K | 7.0K |
| 2022 | $192.78 | $72.31 | 2.67x | $120.47 | $825.0K | 14.4K | 6.9K |
| 2023 | $195.06 | $72.77 | 2.68x | $122.29 | $941.1K | 16.3K | 7.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 25.7K | $2.2M | $85.43 | 2.61x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 9.4K | $782.2K | $83.11 | 2.51x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 12.2K | $689.1K | $56.59 | 2.70x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 2.7K | $474.4K | $176.74 | 2.91x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour | 9.0K | $468.7K | $51.97 | 2.64x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 10.9K | $427.0K | $39.09 | 2.53x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 2.5K | $386.9K | $155.12 | 2.66x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 659 | $305.9K | $464.13 | 2.74x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 603 | $293.4K | $486.59 | 2.79x |
| 94729 | Measurement of lung diffusing capacity | 6.8K | $289.2K | $42.24 | 2.55x |
| 94726 | Determination of lung volumes using plethysmography | 6.8K | $276.7K | $40.48 | 2.60x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 2.0K | $244.2K | $121.72 | 2.63x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 1.6K | $168.4K | $104.78 | 2.65x |
| 96375 | Injection of different drug or substance into a vein for therapy, diagnosis, or prevention | 8.6K | $119.4K | $13.92 | 2.74x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 808 | $93.4K | $115.61 | 2.59x |
| J1335 | Injection, ertapenem sodium, 500 mg | 2.4K | $70.1K | $28.94 | 3.32x |
| 90670 | Pneumococcal vaccine for injection into muscle | 322 | $57.5K | $178.52 | 1.54x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 280 | $43.6K | $155.77 | 2.62x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 2.7K | $36.8K | $13.56 | 2.66x |
| G0008 | Administration of influenza virus vaccine | 1.5K | $35.1K | $22.74 | 1.58x |
This provider submits charges 2.64 times higher than what Medicare actually pays.
A markup ratio of 2.64x means for every $100 Medicare pays, this provider initially charges $264. 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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