This provider's $6.9M 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 | $282.91 | $83.57 | 3.39x | $199.34 | $922.3K | 9.1K | 2.8K |
| 2015 | $297.10 | $84.91 | 3.50x | $212.19 | $832.0K | 8.2K | 2.6K |
| 2016 | $269.95 | $80.57 | 3.35x | $189.38 | $660.7K | 7.4K | 2.6K |
| 2017 | $324.20 | $84.51 | 3.84x | $239.69 | $698.9K | 8.0K | 2.8K |
| 2018 | $286.57 | $75.83 | 3.78x | $210.74 | $622.2K | 7.4K | 2.7K |
| 2019 | $286.77 | $83.20 | 3.45x | $203.57 | $714.0K | 7.4K | 2.7K |
| 2020 | $266.83 | $87.49 | 3.05x | $179.34 | $780.0K | 7.3K | 2.3K |
| 2021 | $285.30 | $86.62 | 3.29x | $198.68 | $678.4K | 6.8K | 2.1K |
| 2022 | $288.44 | $88.17 | 3.27x | $200.27 | $627.8K | 6.3K | 2.0K |
| 2023 | $361.35 | $87.58 | 4.13x | $273.77 | $397.1K | 4.0K | 2.1K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 13.6K | $2.7M | $200.37 | 2.62x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 27.6K | $1.8M | $64.51 | 3.11x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 8.4K | $790.8K | $93.71 | 2.97x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 3.3K | $376.7K | $115.90 | 3.20x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 5.9K | $363.3K | $61.61 | 1.81x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 2.0K | $180.4K | $92.05 | 2.02x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 681 | $117.0K | $171.82 | 2.74x |
| 99238 | Hospital discharge day management, 30 minutes or less | 1.6K | $108.7K | $66.35 | 3.19x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 590 | $85.2K | $144.34 | 2.45x |
| 94729 | Measurement of lung diffusing capacity | 1.3K | $67.0K | $52.69 | 7.59x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 1.8K | $64.7K | $35.52 | 2.67x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 1.3K | $63.8K | $50.12 | 5.99x |
| 94727 | Determination of lung volumes using gas dilution or washout | 1.3K | $50.7K | $39.91 | 9.98x |
| 99292 | Critical care delivery critically ill or injured patient | 361 | $36.5K | $100.97 | 3.58x |
| 31622 | Diagnostic examination of lung airways using an endoscope | 284 | $36.3K | $127.80 | 5.40x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 234 | $21.6K | $92.33 | 3.05x |
| G0008 | Administration of influenza virus vaccine | 582 | $15.4K | $26.49 | 1.89x |
| 31628 | Biopsy of one lobe of lung using an endoscope | 89 | $15.2K | $170.56 | 5.81x |
| G0180 | Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imple | 171 | $8.2K | $47.82 | 5.21x |
| 32555 | Removal of fluid from chest cavity with imaging guidance | 65 | $6.5K | $100.09 | 4.97x |
This provider submits charges 2.93 times higher than what Medicare actually pays.
A markup ratio of 2.93x means for every $100 Medicare pays, this provider initially charges $293. 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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