This provider's $3.7M in total Medicare payments ranks in the 98th percentile of Pulmonary Disease providers nationally.
Medicare payments to this provider grew 1198% from 2014 to 2023.
67% of their billing comes from a single procedure code (99233 — Subsequent hospital inpatient care, typically 35 minutes per day).
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 104% in 2016
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 | $438.95 | $97.39 | 4.51x | $341.56 | $49.0K | 418 | 235 |
| 2015 | $508.93 | $127.00 | 4.01x | $381.93 | $99.0K | 876 | 402 |
| 2016 | $384.12 | $101.62 | 3.78x | $282.50 | $202.3K | 2.0K | 637 |
| 2017 | $295.90 | $108.29 | 2.73x | $187.61 | $260.5K | 2.7K | 762 |
| 2018 | $298.12 | $123.13 | 2.42x | $174.99 | $354.2K | 3.5K | 917 |
| 2019 | $299.69 | $128.44 | 2.33x | $171.25 | $443.1K | 4.2K | 1.2K |
| 2020 | $332.50 | $129.90 | 2.56x | $202.60 | $573.9K | 5.5K | 1.2K |
| 2021 | $459.61 | $199.22 | 2.31x | $260.39 | $555.3K | 5.2K | 1.3K |
| 2022 | $353.88 | $139.00 | 2.55x | $214.88 | $488.8K | 4.9K | 1.3K |
| 2023 | $253.22 | $99.48 | 2.55x | $153.74 | $635.4K | 5.9K | 1.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 27.2K | $2.5M | $90.36 | 2.30x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 3.6K | $600.0K | $166.81 | 2.59x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 2.1K | $403.2K | $191.81 | 3.17x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 701 | $62.8K | $89.58 | 2.30x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 910 | $54.4K | $59.80 | 3.99x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 142 | $20.0K | $140.62 | 2.31x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 49 | $16.5K | $337.51 | 2.79x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 111 | $15.6K | $140.17 | 2.32x |
| 99310 | Subsequent nursing facility visit, typically 35 minutes per day | 105 | $11.8K | $112.79 | 2.13x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 111 | $9.2K | $82.62 | 2.00x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 39 | $4.5K | $114.77 | 3.68x |
| 94729 | Test to examine how well the lungs exchange gases | 41 | $1.9K | $47.07 | 2.76x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 19 | $1.6K | $86.31 | 3.48x |
| 95806 | Sleep study including heart rate, breathing, airflow, and effort | 24 | $1.6K | $67.47 | 3.61x |
| 94727 | Test to determine lung volumes using gas dilution or washout | 41 | $1.4K | $34.59 | 2.89x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 17 | $1.4K | $81.55 | 6.32x |
| 94060 | Test to measure expiratory airflow and volume changes before and after medication administration | 40 | $1.2K | $30.78 | 4.87x |
| 94010 | Measurement and graphic recording of total and timed exhaled air capacity | 30 | $877.44 | $29.25 | 3.01x |
This provider submits charges 2.48 times higher than what Medicare actually pays.
A markup ratio of 2.48x means for every $100 Medicare pays, this provider initially charges $248. 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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