This provider's $4.3M 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 | $135.46 | $38.66 | 3.50x | $96.80 | $458.4K | 10.5K | 6.9K |
| 2015 | $132.03 | $36.86 | 3.58x | $95.17 | $424.9K | 9.9K | 6.2K |
| 2016 | $146.87 | $38.11 | 3.85x | $108.76 | $442.6K | 10.5K | 6.5K |
| 2017 | $142.41 | $36.62 | 3.89x | $105.79 | $347.9K | 8.6K | 5.5K |
| 2018 | $125.61 | $38.37 | 3.27x | $87.24 | $429.5K | 10.5K | 5.4K |
| 2019 | $135.87 | $40.37 | 3.37x | $95.50 | $496.3K | 11.4K | 5.7K |
| 2020 | $125.92 | $35.32 | 3.57x | $90.60 | $460.8K | 10.2K | 5.5K |
| 2021 | $109.15 | $38.65 | 2.82x | $70.50 | $495.9K | 10.4K | 5.3K |
| 2022 | $113.99 | $45.00 | 2.53x | $68.99 | $414.9K | 8.7K | 4.6K |
| 2023 | $124.07 | $46.01 | 2.70x | $78.06 | $378.5K | 7.6K | 4.1K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 30.4K | $1.7M | $54.51 | 1.92x |
| 94729 | Measurement of lung diffusing capacity | 16.6K | $691.4K | $41.75 | 2.40x |
| 94726 | Determination of lung volumes using plethysmography | 12.8K | $509.4K | $39.64 | 6.31x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 4.4K | $389.0K | $88.04 | 1.66x |
| 94010 | Measurement and graphic recording of total and timed exhaled air capacity | 15.3K | $374.5K | $24.48 | 3.06x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.8K | $210.1K | $117.85 | 1.73x |
| 94620 | Pulmonary exercise testing | 2.6K | $105.0K | $40.22 | 3.98x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 1.5K | $61.6K | $41.93 | 2.39x |
| 94727 | Determination of lung volumes using gas dilution or washout | 1.7K | $55.3K | $32.09 | 6.23x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 878 | $48.3K | $54.99 | 2.36x |
| 94644 | Respiratory inhaled aerosol treatment to relieve airway obstruction, first hour | 918 | $34.5K | $37.63 | 2.13x |
| 94618 | Test for exercise-induced lung stress | 1.3K | $32.8K | $25.20 | 6.34x |
| 94070 | Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration | 693 | $31.7K | $45.68 | 4.82x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 205 | $31.1K | $151.77 | 2.67x |
| 31624 | Irrigation and suction of lung airways to obtain cells using an endoscope | 324 | $27.4K | $84.46 | 5.90x |
| 95070 | Inhalation of medications with allergic reaction analysis | 703 | $17.2K | $24.40 | 5.74x |
| 76604 | Ultrasound of chest | 241 | $14.7K | $60.93 | 1.87x |
| 94728 | Measurement of airway resistance by impulse oscillometry | 353 | $11.2K | $31.70 | 2.37x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 832 | $11.0K | $13.21 | 3.03x |
| 99205 | New patient office or other outpatient visit, 60-74 minutes | 58 | $9.4K | $162.84 | 1.53x |
This provider submits charges 2.83 times higher than what Medicare actually pays.
A markup ratio of 2.83x means for every $100 Medicare pays, this provider initially charges $283. 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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