This provider's $3.6M in total Medicare payments ranks in the 98th percentile of Pulmonary Disease providers nationally.
Medicare payments to this provider grew 402% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 365% in 2018
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
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 | $196.75 | $82.15 | 2.40x | $114.60 | $103.4K | 1.3K | 1.1K |
| 2015 | $198.35 | $78.32 | 2.53x | $120.03 | $60.9K | 809 | 658 |
| 2016 | $177.47 | $82.41 | 2.15x | $95.06 | $94.2K | 1.2K | 878 |
| 2017 | $170.52 | $72.32 | 2.36x | $98.20 | $88.3K | 1.1K | 842 |
| 2018 | $316.70 | $114.10 | 2.78x | $202.60 | $410.5K | 1.9K | 1.5K |
| 2019 | $378.64 | $132.40 | 2.86x | $246.24 | $757.4K | 2.8K | 2.3K |
| 2020 | $343.64 | $125.07 | 2.75x | $218.57 | $625.1K | 2.6K | 2.1K |
| 2021 | $334.41 | $125.30 | 2.67x | $209.11 | $482.0K | 2.6K | 2.1K |
| 2022 | $339.45 | $119.76 | 2.83x | $219.69 | $436.0K | 2.6K | 2.1K |
| 2023 | $350.68 | $117.24 | 2.99x | $233.44 | $519.5K | 3.0K | 2.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 4.4K | $1.7M | $390.62 | 3.11x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 2.0K | $777.6K | $379.86 | 3.06x |
| 95800 | Study of sleep patterns | 2.0K | $241.7K | $122.62 | 3.78x |
| 95806 | Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort | 2.8K | $210.5K | $74.42 | 7.36x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 2.1K | $174.9K | $83.42 | 2.00x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 671 | $80.2K | $119.57 | 2.19x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 942 | $78.1K | $82.93 | 2.03x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 353 | $55.8K | $157.96 | 1.99x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 258 | $45.2K | $175.20 | 2.52x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 752 | $42.3K | $56.27 | 2.08x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 710 | $28.9K | $40.65 | 2.49x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 439 | $25.2K | $57.42 | 2.04x |
| 94729 | Measurement of lung diffusing capacity | 498 | $20.3K | $40.71 | 2.19x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 160 | $18.3K | $114.53 | 2.05x |
| 94762 | Overnight measurement of oxygen saturation in blood using ear or finger device | 944 | $18.1K | $19.22 | 6.78x |
| 94727 | Determination of lung volumes using gas dilution or washout | 410 | $13.9K | $33.92 | 2.51x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 122 | $13.2K | $108.03 | 1.92x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 33 | $4.9K | $149.49 | 2.43x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 37 | $3.1K | $85.02 | 2.91x |
| 31645 | Aspiration of lung secretions from lung airways using an endoscope | 16 | $2.1K | $131.61 | 1.99x |
This provider submits charges 3.25 times higher than what Medicare actually pays.
A markup ratio of 3.25x means for every $100 Medicare pays, this provider initially charges $325. 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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