This provider's $4.9M in total Medicare payments ranks in the 99th percentile of Pulmonary Disease providers nationally.
Medicare payments to this provider grew 53% 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 | $154.32 | $59.51 | 2.59x | $94.81 | $508.0K | 10.5K | 7.9K |
| 2015 | $158.62 | $55.87 | 2.84x | $102.75 | $382.1K | 7.0K | 5.1K |
| 2016 | $172.03 | $51.04 | 3.37x | $120.99 | $348.7K | 6.4K | 4.8K |
| 2017 | $201.58 | $67.21 | 3.00x | $134.37 | $504.8K | 8.0K | 6.1K |
| 2018 | $195.80 | $63.35 | 3.09x | $132.45 | $392.0K | 6.9K | 5.5K |
| 2019 | $170.70 | $57.06 | 2.99x | $113.64 | $420.2K | 7.5K | 5.9K |
| 2020 | $159.02 | $50.68 | 3.14x | $108.34 | $449.0K | 8.3K | 6.7K |
| 2021 | $169.21 | $58.61 | 2.89x | $110.60 | $499.3K | 8.5K | 7.1K |
| 2022 | $197.27 | $67.39 | 2.93x | $129.88 | $664.3K | 10.7K | 8.8K |
| 2023 | $187.71 | $55.10 | 3.41x | $132.61 | $779.6K | 13.3K | 10.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 27.3K | $2.4M | $86.34 | 2.43x |
| 94729 | Measurement of lung diffusing capacity | 9.0K | $385.7K | $42.87 | 2.80x |
| 94726 | Determination of lung volumes using plethysmography | 8.9K | $373.8K | $41.80 | 1.91x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 9.0K | $371.8K | $41.26 | 3.64x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 1.4K | $174.7K | $121.25 | 2.37x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.3K | $161.3K | $122.53 | 2.59x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.6K | $157.2K | $59.46 | 2.42x |
| 95800 | Study of sleep patterns | 931 | $120.4K | $129.35 | 4.17x |
| 94664 | Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device | 9.1K | $116.9K | $12.91 | 4.26x |
| 94620 | Pulmonary exercise testing | 2.1K | $86.6K | $41.69 | 4.80x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 833 | $79.8K | $95.82 | 4.17x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 643 | $64.4K | $100.09 | 3.50x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 664 | $54.8K | $82.60 | 2.60x |
| 94660 | Initiation and management of continued pressured respiratory assistance by mask or breathing tube | 1.1K | $49.9K | $47.44 | 1.69x |
| 94640 | Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen | 3.8K | $49.5K | $12.93 | 4.25x |
| 94618 | Test for exercise-induced lung stress | 1.7K | $45.0K | $25.93 | 3.09x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 225 | $40.8K | $181.12 | 3.03x |
| 99442 | Physician telephone patient service, 11-20 minutes of medical discussion | 664 | $39.7K | $59.81 | 2.46x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 160 | $25.0K | $156.47 | 2.65x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 142 | $23.7K | $167.10 | 2.41x |
This provider submits charges 2.73 times higher than what Medicare actually pays.
A markup ratio of 2.73x means for every $100 Medicare pays, this provider initially charges $273. 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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