This provider's $4.7M in total Medicare payments ranks in the 99th percentile of Pulmonary Disease providers nationally.
Their average markup ratio of 5.4x is significantly above the specialty median of 3.0x.
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 | $223.28 | $39.38 | 5.67x | $183.90 | $421.7K | 9.4K | 4.9K |
| 2015 | $238.62 | $41.77 | 5.71x | $196.85 | $470.9K | 10.1K | 5.6K |
| 2016 | $226.71 | $42.32 | 5.36x | $184.39 | $453.5K | 10.3K | 5.3K |
| 2017 | $222.54 | $41.96 | 5.30x | $180.58 | $455.1K | 10.1K | 5.1K |
| 2018 | $226.03 | $43.86 | 5.15x | $182.17 | $421.2K | 9.3K | 5.0K |
| 2019 | $232.22 | $46.63 | 4.98x | $185.59 | $448.7K | 9.6K | 5.1K |
| 2020 | $234.59 | $52.44 | 4.47x | $182.15 | $425.1K | 8.0K | 5.0K |
| 2021 | $276.06 | $64.53 | 4.28x | $211.53 | $488.4K | 8.6K | 4.7K |
| 2022 | $289.85 | $62.69 | 4.62x | $227.16 | $522.1K | 9.0K | 5.0K |
| 2023 | $313.52 | $59.86 | 5.24x | $253.66 | $575.3K | 11.0K | 6.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 10.0K | $1.1M | $109.99 | 5.07x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 13.4K | $841.9K | $62.95 | 5.54x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 12.1K | $647.1K | $53.36 | 5.98x |
| 94729 | Measurement of lung diffusing capacity | 8.1K | $430.3K | $53.06 | 5.42x |
| 94727 | Determination of lung volumes using gas dilution or washout | 7.4K | $302.4K | $40.79 | 5.52x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 895 | $172.7K | $192.92 | 5.11x |
| 94010 | Measurement and graphic recording of total and timed exhaled air capacity | 5.3K | $151.7K | $28.65 | 6.53x |
| 71046 | X-ray of chest, 2 views | 3.8K | $113.4K | $30.16 | 5.60x |
| 90662 | Vaccine for influenza for injection into muscle | 1.9K | $107.0K | $55.87 | 2.89x |
| 90670 | Pneumococcal vaccine for injection into muscle | 418 | $75.6K | $180.84 | 1.79x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 396 | $66.0K | $166.78 | 5.54x |
| 95012 | Measurement of inhaled nitric oxide gas | 3.5K | $64.7K | $18.54 | 6.95x |
| G0008 | Administration of influenza virus vaccine | 2.4K | $63.4K | $26.89 | 3.20x |
| 71020 | X-ray of chest, 2 views, front and side | 2.0K | $50.5K | $25.47 | 7.69x |
| 94750 | Measurement of lung stretching capacity | 583 | $45.8K | $78.55 | 5.73x |
| 90677 | Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use | 145 | $40.2K | $277.14 | 2.98x |
| 94640 | Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen | 2.1K | $36.9K | $17.34 | 5.56x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 354 | $32.9K | $92.84 | 6.89x |
| G0009 | Administration of pneumococcal vaccine | 771 | $22.2K | $28.76 | 3.72x |
| 90732 | Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older | 211 | $22.2K | $105.09 | 2.67x |
This provider submits charges 5.4 times higher than what Medicare actually pays.
A markup ratio of 5.4x means for every $100 Medicare pays, this provider initially charges $540. 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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