This provider's $3.5M in total Medicare payments ranks in the 98th percentile of Pulmonary Disease providers nationally.
Medicare payments to this provider grew 102% 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 | $366.84 | $78.28 | 4.69x | $288.56 | $227.2K | 2.7K | 1.7K |
| 2015 | $361.37 | $84.39 | 4.28x | $276.98 | $257.9K | 3.3K | 2.2K |
| 2016 | $362.01 | $79.30 | 4.57x | $282.71 | $305.2K | 4.0K | 2.8K |
| 2017 | $392.45 | $86.41 | 4.54x | $306.04 | $334.7K | 4.6K | 3.5K |
| 2018 | $492.14 | $80.72 | 6.10x | $411.42 | $359.6K | 5.0K | 3.8K |
| 2019 | $407.78 | $87.22 | 4.68x | $320.56 | $376.4K | 4.9K | 3.7K |
| 2020 | $420.68 | $94.38 | 4.46x | $326.30 | $332.2K | 4.6K | 3.6K |
| 2021 | $478.78 | $106.03 | 4.52x | $372.75 | $439.4K | 5.9K | 4.4K |
| 2022 | $432.38 | $99.43 | 4.35x | $332.95 | $449.7K | 6.6K | 5.0K |
| 2023 | $425.18 | $89.03 | 4.78x | $336.15 | $458.2K | 6.9K | 5.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 8.1K | $860.5K | $106.88 | 3.07x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 2.0K | $400.2K | $202.42 | 3.87x |
| 94729 | Measurement of lung diffusing capacity | 4.8K | $257.5K | $54.02 | 3.54x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 3.5K | $257.2K | $74.37 | 3.08x |
| 94726 | Determination of lung volumes using plethysmography | 4.6K | $238.3K | $51.69 | 3.60x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 3.5K | $226.0K | $64.75 | 3.38x |
| 94375 | Diagnostic testing in a pulmonary function lab | 5.9K | $215.9K | $36.32 | 3.80x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.4K | $210.5K | $152.00 | 3.15x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 1.5K | $141.6K | $93.07 | 3.35x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 764 | $136.7K | $178.89 | 3.51x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 1.9K | $104.9K | $55.41 | 3.78x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 612 | $90.3K | $147.61 | 3.01x |
| 31652 | Examination of lung airways using an endoscope with imaging guidance and ultrasound | 277 | $56.2K | $202.89 | 9.02x |
| 94200 | Measurement of largest amount of air breathed in an out of lungs over one minute | 3.1K | $55.0K | $17.65 | 6.05x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 238 | $48.0K | $201.70 | 2.78x |
| 31628 | Biopsy of one lobe of lung using an endoscope | 287 | $27.4K | $95.37 | 10.77x |
| 99211 | Established patient office or other outpatient visit, typically 5 minutes | 968 | $26.9K | $27.81 | 2.29x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 185 | $22.1K | $119.70 | 3.68x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 189 | $22.1K | $116.70 | 3.60x |
| 94620 | Pulmonary exercise testing | 308 | $15.4K | $50.05 | 4.00x |
This provider submits charges 3.73 times higher than what Medicare actually pays.
A markup ratio of 3.73x means for every $100 Medicare pays, this provider initially charges $373. 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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