This provider's $10.3M in total Medicare payments ranks in the 99th percentile of Pulmonary Disease providers nationally.
Medicare payments to this provider grew 77% from 2014 to 2023.
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 | $172.05 | $90.14 | 1.91x | $81.91 | $740.2K | 7.9K | 1.9K |
| 2015 | $158.40 | $79.96 | 1.98x | $78.44 | $874.6K | 9.6K | 2.3K |
| 2016 | $157.74 | $76.57 | 2.06x | $81.17 | $889.7K | 10.3K | 2.7K |
| 2017 | $130.74 | $67.30 | 1.94x | $63.44 | $796.4K | 8.8K | 2.2K |
| 2018 | $150.53 | $80.28 | 1.88x | $70.25 | $853.6K | 9.0K | 2.4K |
| 2019 | $148.89 | $78.01 | 1.91x | $70.88 | $1.2M | 12.4K | 2.7K |
| 2020 | $153.67 | $82.79 | 1.86x | $70.88 | $1.1M | 11.7K | 2.0K |
| 2021 | $150.34 | $80.26 | 1.87x | $70.08 | $1.2M | 12.5K | 2.2K |
| 2022 | $162.79 | $83.09 | 1.96x | $79.70 | $1.3M | 13.8K | 2.7K |
| 2023 | $173.08 | $84.10 | 2.06x | $88.98 | $1.3M | 13.1K | 2.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 48.7K | $4.4M | $89.36 | 2.26x |
| 99356 | Prolonged inpatient or observation hospital service first hour | 14.8K | $1.2M | $77.92 | 2.57x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 5.8K | $959.8K | $166.05 | 1.71x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 11.3K | $889.5K | $78.98 | 2.58x |
| 99310 | Subsequent nursing facility visit, typically 35 minutes per day | 7.5K | $871.5K | $116.03 | 2.15x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 4.2K | $781.1K | $185.05 | 1.68x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 6.2K | $569.5K | $92.50 | 1.62x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 3.1K | $184.5K | $60.31 | 2.49x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 501 | $72.0K | $143.64 | 1.46x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 384 | $71.7K | $186.80 | 1.34x |
| G0181 | Physician supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of c | 715 | $65.5K | $91.63 | 1.64x |
| 99239 | Hospital discharge day management, more than 30 minutes | 661 | $60.0K | $90.84 | 1.65x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 768 | $52.0K | $67.73 | 1.67x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 270 | $36.6K | $135.56 | 1.72x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 151 | $26.2K | $173.57 | 1.40x |
| G0316 | Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by th | 1.0K | $25.9K | $25.58 | 6.67x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 350 | $21.4K | $61.07 | 3.42x |
| 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 implem | 289 | $13.4K | $46.42 | 2.05x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 359 | $12.2K | $34.05 | 4.40x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 460 | $8.5K | $18.53 | 2.16x |
This provider submits charges 2.17 times higher than what Medicare actually pays.
A markup ratio of 2.17x means for every $100 Medicare pays, this provider initially charges $217. 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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