This provider's $4.3M in total Medicare payments ranks in the 99th percentile of Pulmonary Disease providers nationally.
Their average markup ratio of 5.39x is significantly above the specialty median of 3.0x.
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 | $226.91 | $43.49 | 5.22x | $183.42 | $437.6K | 10.1K | 6.7K |
| 2015 | $239.09 | $42.49 | 5.63x | $196.60 | $479.4K | 10.2K | 7.2K |
| 2016 | $227.24 | $40.73 | 5.58x | $186.51 | $459.2K | 10.1K | 7.0K |
| 2017 | $254.96 | $47.14 | 5.41x | $207.82 | $433.7K | 9.4K | 6.5K |
| 2018 | $279.71 | $53.21 | 5.26x | $226.50 | $411.5K | 8.9K | 6.3K |
| 2019 | $247.24 | $50.16 | 4.93x | $197.08 | $412.5K | 8.5K | 6.1K |
| 2020 | $267.71 | $57.89 | 4.62x | $209.82 | $323.8K | 6.0K | 4.8K |
| 2021 | $279.21 | $65.49 | 4.26x | $213.72 | $406.2K | 6.6K | 5.1K |
| 2022 | $322.89 | $65.55 | 4.93x | $257.34 | $454.2K | 7.7K | 5.8K |
| 2023 | $316.89 | $59.58 | 5.32x | $257.31 | $433.3K | 7.7K | 5.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 16.1K | $1.1M | $67.18 | 5.48x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 5.8K | $620.1K | $107.41 | 5.16x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 7.9K | $431.3K | $54.27 | 5.87x |
| 94729 | Measurement of lung diffusing capacity | 7.4K | $393.5K | $53.06 | 5.42x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 1.3K | $248.9K | $193.54 | 5.11x |
| 94727 | Determination of lung volumes using gas dilution or washout | 5.9K | $240.6K | $40.70 | 5.53x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 1.1K | $149.1K | $132.96 | 6.18x |
| 94010 | Measurement and graphic recording of total and timed exhaled air capacity | 3.7K | $104.7K | $28.58 | 6.54x |
| 90662 | Vaccine for influenza for injection into muscle | 1.9K | $102.6K | $54.07 | 2.90x |
| 90670 | Pneumococcal vaccine for injection into muscle | 550 | $97.5K | $177.30 | 1.81x |
| 94750 | Measurement of lung stretching capacity | 1.2K | $94.4K | $77.35 | 5.92x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 622 | $94.2K | $151.47 | 5.15x |
| 71046 | X-ray of chest, 2 views | 2.8K | $83.5K | $30.29 | 5.59x |
| G0008 | Administration of influenza virus vaccine | 2.3K | $62.4K | $27.04 | 3.03x |
| 71020 | X-ray of chest, 2 views, front and side | 2.0K | $51.8K | $25.52 | 7.67x |
| 94070 | Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration | 716 | $39.3K | $54.88 | 5.90x |
| 94726 | Determination of lung volumes using plethysmography | 746 | $39.3K | $52.65 | 5.47x |
| 94640 | Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen | 1.6K | $27.7K | $17.46 | 5.54x |
| 90732 | Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older | 256 | $27.3K | $106.76 | 2.73x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 399 | $25.7K | $64.53 | 7.39x |
This provider submits charges 5.39 times higher than what Medicare actually pays.
A markup ratio of 5.39x means for every $100 Medicare pays, this provider initially charges $539. 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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