This provider's $5.7M in total Medicare payments ranks in the 99th percentile of Pulmonary Disease providers nationally.
Medicare payments to this provider grew 80% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 67% in 2017
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
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 | $347.23 | $102.84 | 3.38x | $244.39 | $330.2K | 3.5K | 1.5K |
| 2015 | $519.92 | $103.34 | 5.03x | $416.58 | $378.4K | 3.4K | 1.4K |
| 2016 | $505.38 | $97.42 | 5.19x | $407.96 | $542.1K | 4.8K | 1.9K |
| 2017 | $429.23 | $76.14 | 5.64x | $353.09 | $907.9K | 8.7K | 3.8K |
| 2018 | $493.12 | $85.00 | 5.80x | $408.12 | $718.4K | 7.0K | 3.3K |
| 2019 | $452.24 | $74.24 | 6.09x | $378.00 | $531.7K | 4.9K | 2.2K |
| 2020 | $583.27 | $88.43 | 6.60x | $494.84 | $655.2K | 5.3K | 1.9K |
| 2021 | $340.39 | $86.78 | 3.92x | $253.61 | $580.0K | 4.4K | 1.8K |
| 2022 | $235.42 | $90.65 | 2.60x | $144.77 | $491.5K | 4.1K | 1.6K |
| 2023 | $262.14 | $103.44 | 2.53x | $158.70 | $594.2K | 4.8K | 1.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 13.2K | $2.4M | $178.96 | 3.14x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 17.5K | $1.5M | $85.35 | 4.10x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 3.1K | $491.4K | $160.86 | 3.93x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 3.6K | $339.2K | $95.06 | 2.00x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 2.3K | $296.8K | $130.11 | 2.28x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 2.9K | $167.2K | $58.07 | 4.82x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 789 | $135.6K | $171.90 | 2.60x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 1.7K | $94.0K | $56.23 | 2.31x |
| 99292 | Critical care delivery critically ill or injured patient | 1.0K | $91.7K | $90.66 | 3.37x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 797 | $63.1K | $79.14 | 2.19x |
| 31500 | Emergent insertion of breathing tube into windpipe cartilage using an endoscope | 280 | $32.0K | $114.28 | 8.14x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 236 | $23.9K | $101.12 | 1.35x |
| 99239 | Hospital discharge day management, more than 30 minutes | 242 | $20.7K | $85.34 | 5.27x |
| 94010 | Measurement and graphic recording of total and timed exhaled air capacity | 637 | $18.6K | $29.17 | 4.65x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 139 | $18.0K | $129.70 | 3.63x |
| 31624 | Irrigation and suction of lung airways to obtain cells using an endoscope | 170 | $16.1K | $94.61 | 15.11x |
| 36556 | Insertion of central venous catheter for infusion, patient 5 years or older | 199 | $15.1K | $75.72 | 11.12x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 186 | $13.3K | $71.66 | 2.02x |
| 94726 | Determination of lung volumes using plethysmography | 607 | $7.1K | $11.77 | 20.38x |
| 94729 | Measurement of lung diffusing capacity | 637 | $6.0K | $9.47 | 25.53x |
This provider submits charges 3.52 times higher than what Medicare actually pays.
A markup ratio of 3.52x means for every $100 Medicare pays, this provider initially charges $352. 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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