This provider's $6.0M 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 | $222.21 | $70.71 | 3.14x | $151.50 | $681.7K | 8.7K | 4.2K |
| 2015 | $210.35 | $64.17 | 3.28x | $146.18 | $680.2K | 8.9K | 4.9K |
| 2016 | $222.64 | $69.92 | 3.18x | $152.72 | $657.0K | 8.2K | 4.7K |
| 2017 | $211.70 | $70.55 | 3.00x | $141.15 | $681.0K | 9.0K | 6.0K |
| 2018 | $207.32 | $68.14 | 3.04x | $139.18 | $742.8K | 9.9K | 6.2K |
| 2019 | $206.94 | $70.60 | 2.93x | $136.34 | $843.0K | 10.7K | 6.4K |
| 2020 | $218.24 | $78.13 | 2.79x | $140.11 | $569.0K | 7.0K | 4.5K |
| 2021 | $230.28 | $74.55 | 3.09x | $155.73 | $517.1K | 5.4K | 3.6K |
| 2022 | $285.87 | $80.65 | 3.54x | $205.22 | $326.3K | 2.1K | 1.6K |
| 2023 | $791.84 | $188.67 | 4.20x | $603.17 | $351.2K | 1.6K | 1.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 21.6K | $1.7M | $78.05 | 2.09x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 2.7K | $1.3M | $496.55 | 4.83x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 2.1K | $1.0M | $477.23 | 4.39x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 2.0K | $233.0K | $118.39 | 2.27x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 2.4K | $195.0K | $79.80 | 1.94x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 1.1K | $132.4K | $116.56 | 1.90x |
| 94729 | Measurement of lung diffusing capacity | 2.6K | $94.8K | $36.85 | 2.67x |
| 93306 | Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function | 776 | $92.9K | $119.67 | 3.44x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 2.8K | $91.3K | $32.83 | 2.59x |
| 93880 | Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck | 624 | $82.2K | $131.80 | 3.31x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 2.2K | $80.3K | $37.22 | 2.58x |
| 94727 | Determination of lung volumes using gas dilution or washout | 2.4K | $73.9K | $30.73 | 2.72x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 480 | $73.2K | $152.55 | 2.00x |
| 95800 | Study of sleep patterns | 506 | $62.1K | $122.70 | 3.48x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 919 | $53.9K | $58.70 | 1.76x |
| 99443 | Physician telephone patient service, 21-30 minutes of medical discussion | 605 | $52.5K | $86.82 | 1.57x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 283 | $47.3K | $167.20 | 3.00x |
| 76700 | Ultrasound of abdomen | 460 | $43.8K | $95.12 | 2.53x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 787 | $43.5K | $55.32 | 1.95x |
| 90670 | Pneumococcal vaccine for injection into muscle | 233 | $40.9K | $175.32 | 1.11x |
This provider submits charges 3.21 times higher than what Medicare actually pays.
A markup ratio of 3.21x means for every $100 Medicare pays, this provider initially charges $321. 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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