This provider's $3.2M in total Medicare payments ranks in the 98th 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 | $102.90 | $41.57 | 2.48x | $61.33 | $376.4K | 11.1K | 6.1K |
| 2015 | $93.33 | $35.23 | 2.65x | $58.10 | $416.8K | 12.8K | 6.5K |
| 2016 | $113.05 | $39.56 | 2.86x | $73.49 | $404.5K | 12.4K | 6.1K |
| 2017 | $111.00 | $38.52 | 2.88x | $72.48 | $402.5K | 12.7K | 6.3K |
| 2018 | $110.12 | $37.58 | 2.93x | $72.54 | $346.9K | 10.7K | 5.2K |
| 2019 | $121.81 | $39.95 | 3.05x | $81.86 | $286.5K | 8.5K | 4.5K |
| 2020 | $109.54 | $36.39 | 3.01x | $73.15 | $265.4K | 7.4K | 3.9K |
| 2021 | $93.20 | $35.32 | 2.64x | $57.88 | $223.6K | 7.3K | 3.6K |
| 2022 | $92.92 | $34.62 | 2.68x | $58.30 | $229.8K | 7.3K | 3.8K |
| 2023 | $92.92 | $32.67 | 2.84x | $60.25 | $259.5K | 7.7K | 3.8K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 10.7K | $868.8K | $81.11 | 2.69x |
| 94729 | Measurement of lung diffusing capacity | 8.1K | $346.8K | $43.07 | 2.55x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 8.1K | $342.0K | $42.04 | 3.06x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 2.7K | $296.2K | $108.79 | 2.73x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 7.9K | $250.6K | $31.91 | 2.41x |
| 94640 | Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen | 13.4K | $178.4K | $13.31 | 2.85x |
| 94664 | Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device | 13.1K | $177.0K | $13.50 | 2.65x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 941 | $146.1K | $155.29 | 2.68x |
| 94660 | Initiation and management of continued pressured respiratory assistance by mask or breathing tube | 2.2K | $105.9K | $48.39 | 2.69x |
| 82805 | Blood gases measurement | 1.6K | $82.6K | $51.23 | 1.56x |
| 36600 | Arterial puncture withdrawal of blood for diagnosis | 1.6K | $40.1K | $24.84 | 2.65x |
| 94726 | Determination of lung volumes using plethysmography | 871 | $36.7K | $42.16 | 2.31x |
| 82375 | Carboxyhemoglobin (protein) level | 2.4K | $36.4K | $14.95 | 2.34x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 287 | $35.0K | $122.12 | 2.82x |
| 99354 | Prolonged office or other outpatient service first hour | 506 | $33.9K | $66.91 | 3.03x |
| 94620 | Pulmonary exercise testing | 585 | $25.9K | $44.27 | 2.96x |
| 83050 | Methemoglobin (hemoglobin) analysis | 2.4K | $22.0K | $9.02 | 2.33x |
| 83605 | Lactic acid level | 1.6K | $21.1K | $13.03 | 2.30x |
| G2212 | Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or | 683 | $17.0K | $24.83 | 4.03x |
| 36415 | Insertion of needle into vein for collection of blood sample | 4.2K | $15.9K | $3.75 | 7.99x |
This provider submits charges 2.72 times higher than what Medicare actually pays.
A markup ratio of 2.72x means for every $100 Medicare pays, this provider initially charges $272. 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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