This provider's $4.2M in total Medicare payments ranks in the 99th percentile of Pulmonary Disease providers nationally.
Medicare payments to this provider grew 167% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 51% in 2015
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 | $435.29 | $124.50 | 3.50x | $310.79 | $205.5K | 1.8K | 1.3K |
| 2015 | $417.17 | $100.75 | 4.14x | $316.42 | $309.6K | 2.4K | 1.9K |
| 2016 | $391.88 | $110.09 | 3.56x | $281.79 | $373.9K | 3.0K | 2.1K |
| 2017 | $326.04 | $101.50 | 3.21x | $224.54 | $380.2K | 3.3K | 2.3K |
| 2018 | $404.94 | $123.09 | 3.29x | $281.85 | $537.4K | 3.5K | 2.4K |
| 2019 | $415.84 | $128.03 | 3.25x | $287.81 | $518.7K | 3.2K | 2.3K |
| 2020 | $509.10 | $168.71 | 3.02x | $340.39 | $324.1K | 2.2K | 1.4K |
| 2021 | $462.04 | $159.86 | 2.89x | $302.18 | $426.4K | 2.7K | 1.9K |
| 2022 | $406.60 | $138.91 | 2.93x | $267.69 | $531.5K | 3.2K | 2.2K |
| 2023 | $431.33 | $137.09 | 3.15x | $294.24 | $549.3K | 3.3K | 2.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 1.6K | $932.9K | $580.54 | 3.12x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 7.2K | $699.7K | $96.74 | 3.11x |
| 95819 | Measurement and recording of brain wave (eeg) activity, awake and asleep | 1.4K | $614.1K | $426.17 | 3.03x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 832 | $464.4K | $558.22 | 3.35x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 4.6K | $304.2K | $66.81 | 3.07x |
| 95827 | Measurement and recording of brain wave (EEG) activity, overnight | 384 | $219.7K | $572.15 | 3.92x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.2K | $167.2K | $139.65 | 3.26x |
| 95800 | Study of sleep patterns | 810 | $117.6K | $145.25 | 3.34x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 1.8K | $91.6K | $51.35 | 3.69x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 743 | $91.4K | $123.06 | 3.13x |
| 94729 | Measurement of lung diffusing capacity | 1.8K | $90.9K | $51.02 | 3.84x |
| 94726 | Determination of lung volumes using plethysmography | 1.8K | $87.1K | $49.34 | 3.96x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 391 | $68.5K | $175.21 | 3.14x |
| 95806 | Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort | 500 | $60.7K | $121.38 | 4.09x |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r | 539 | $39.3K | $72.95 | 3.43x |
| 94621 | Pulmonary exercise testing | 139 | $20.0K | $143.95 | 3.32x |
| 92512 | Analysis of nasal resistance during breathing | 246 | $13.4K | $54.35 | 3.97x |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within | 530 | $12.9K | $24.40 | 2.58x |
| 99442 | Physician telephone patient service, 11-20 minutes of medical discussion | 169 | $12.0K | $70.78 | 2.90x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 75 | $7.1K | $95.07 | 3.14x |
This provider submits charges 3.25 times higher than what Medicare actually pays.
A markup ratio of 3.25x means for every $100 Medicare pays, this provider initially charges $325. This is higher than the national average.
Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.
Share this provider's Medicare payment information
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.
Believe this data is inaccurate? Dispute this data