This provider's $4.7M 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 | $255.66 | $63.21 | 4.04x | $192.45 | $455.2K | 8.1K | 5.5K |
| 2015 | $271.67 | $61.70 | 4.40x | $209.97 | $543.7K | 10.9K | 7.2K |
| 2016 | $229.34 | $60.01 | 3.82x | $169.33 | $511.4K | 9.8K | 7.0K |
| 2017 | $289.34 | $64.31 | 4.50x | $225.03 | $537.7K | 10.5K | 7.5K |
| 2018 | $272.33 | $60.25 | 4.52x | $212.08 | $521.8K | 9.8K | 6.9K |
| 2019 | $230.67 | $63.94 | 3.61x | $166.73 | $417.6K | 7.6K | 5.7K |
| 2020 | $228.70 | $59.71 | 3.83x | $168.99 | $405.8K | 7.3K | 5.2K |
| 2021 | $246.67 | $63.72 | 3.87x | $182.95 | $473.6K | 7.6K | 5.3K |
| 2022 | $232.22 | $55.17 | 4.21x | $177.05 | $483.2K | 8.4K | 5.6K |
| 2023 | $371.19 | $59.55 | 6.23x | $311.64 | $371.1K | 6.8K | 4.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 12.9K | $1.1M | $82.09 | 2.57x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 13.5K | $745.7K | $55.44 | 2.71x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 7.3K | $399.8K | $54.82 | 2.51x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 2.2K | $262.5K | $118.96 | 2.70x |
| 94729 | Measurement of lung diffusing capacity | 6.6K | $253.6K | $38.57 | 3.08x |
| 94726 | Determination of lung volumes using plethysmography | 6.3K | $235.0K | $37.26 | 3.11x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 5.7K | $212.0K | $37.46 | 3.58x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 1.6K | $161.6K | $102.85 | 2.57x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 1.7K | $136.0K | $79.10 | 2.57x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 699 | $117.7K | $168.39 | 3.20x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 1.4K | $115.3K | $79.51 | 2.65x |
| 96401 | Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle | 2.0K | $113.0K | $56.31 | 3.11x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 724 | $109.7K | $151.56 | 2.64x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 1.1K | $108.6K | $96.65 | 3.30x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 1.1K | $100.5K | $93.85 | 2.72x |
| 94618 | Test for exercise-induced lung stress | 3.0K | $72.9K | $24.69 | 3.72x |
| 94200 | Measurement of largest amount of air breathed in an out of lungs over one minute | 3.3K | $58.9K | $17.92 | 2.78x |
| 94620 | Pulmonary exercise testing | 1.4K | $57.5K | $40.51 | 2.75x |
| 94664 | Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device | 4.2K | $49.8K | $11.87 | 3.75x |
| 31628 | Biopsy of one lobe of lung using an endoscope | 499 | $44.8K | $89.84 | 7.92x |
This provider submits charges 3.01 times higher than what Medicare actually pays.
A markup ratio of 3.01x means for every $100 Medicare pays, this provider initially charges $301. 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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