This provider's $8.8M 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 | $442.10 | $109.13 | 4.05x | $332.97 | $804.8K | 9.7K | 6.0K |
| 2015 | $413.92 | $102.26 | 4.05x | $311.66 | $1.0M | 12.4K | 7.7K |
| 2016 | $444.23 | $109.61 | 4.05x | $334.62 | $1.1M | 13.1K | 8.5K |
| 2017 | $432.76 | $106.13 | 4.08x | $326.63 | $969.8K | 12.5K | 8.2K |
| 2018 | $406.78 | $90.03 | 4.52x | $316.75 | $821.3K | 11.5K | 7.6K |
| 2019 | $365.88 | $96.80 | 3.78x | $269.08 | $929.5K | 12.8K | 8.2K |
| 2020 | $292.66 | $96.12 | 3.04x | $196.54 | $729.9K | 10.9K | 7.2K |
| 2021 | $247.15 | $96.61 | 2.56x | $150.54 | $936.4K | 13.0K | 8.4K |
| 2022 | $211.44 | $86.42 | 2.45x | $125.02 | $824.3K | 12.0K | 8.5K |
| 2023 | $212.23 | $88.23 | 2.41x | $124.00 | $674.8K | 10.1K | 7.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 32.2K | $2.1M | $65.59 | 1.60x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 21.6K | $1.3M | $58.08 | 2.20x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 10.4K | $966.8K | $92.93 | 1.54x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 1.7K | $777.2K | $463.46 | 4.83x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 6.7K | $587.1K | $87.15 | 2.66x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 5.2K | $564.3K | $109.27 | 2.33x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 1.1K | $545.6K | $499.67 | 5.54x |
| 94729 | Measurement of lung diffusing capacity | 6.9K | $281.1K | $40.69 | 3.63x |
| 94726 | Determination of lung volumes using plethysmography | 6.9K | $267.4K | $38.65 | 3.91x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 6.3K | $240.0K | $38.13 | 4.01x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 1.2K | $211.6K | $176.21 | 2.13x |
| 99238 | Hospital discharge day management, 30 minutes or less | 3.4K | $198.7K | $58.69 | 3.19x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.4K | $185.9K | $132.68 | 2.33x |
| 31645 | Aspiration of lung secretions from lung airways using an endoscope | 1.4K | $165.1K | $122.03 | 4.90x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 622 | $100.7K | $161.86 | 1.85x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 1.0K | $84.4K | $83.64 | 2.41x |
| G0399 | Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation | 870 | $67.5K | $77.64 | 4.77x |
| 31646 | Aspiration of lung secretions from lung airways using an endoscope | 465 | $52.3K | $112.53 | 5.32x |
| 88738 | Hemoglobin measurement | 5.7K | $33.3K | $5.82 | 3.43x |
| 94375 | Diagnostic testing in a pulmonary function lab | 755 | $23.4K | $30.98 | 2.42x |
This provider submits charges 2.74 times higher than what Medicare actually pays.
A markup ratio of 2.74x means for every $100 Medicare pays, this provider initially charges $274. 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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