This provider's $4.0M in total Medicare payments ranks in the 98th 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 | $238.29 | $106.69 | 2.23x | $131.60 | $352.1K | 4.3K | 3.0K |
| 2015 | $231.86 | $101.08 | 2.29x | $130.78 | $389.4K | 4.9K | 3.5K |
| 2016 | $439.59 | $104.69 | 4.20x | $334.90 | $402.1K | 4.8K | 3.4K |
| 2017 | $614.96 | $108.39 | 5.67x | $506.57 | $437.3K | 4.8K | 3.5K |
| 2018 | $640.91 | $105.67 | 6.07x | $535.24 | $405.9K | 5.1K | 3.4K |
| 2019 | $758.72 | $101.30 | 7.49x | $657.42 | $458.3K | 5.6K | 3.8K |
| 2020 | $508.63 | $94.31 | 5.39x | $414.32 | $321.4K | 4.8K | 3.2K |
| 2021 | $523.63 | $106.78 | 4.90x | $416.85 | $419.4K | 6.0K | 3.8K |
| 2022 | $566.45 | $98.37 | 5.76x | $468.08 | $420.8K | 6.0K | 3.8K |
| 2023 | $457.18 | $106.93 | 4.28x | $350.25 | $399.1K | 6.1K | 3.5K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 13.4K | $826.8K | $61.85 | 1.94x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 1.5K | $793.9K | $521.27 | 6.48x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 1.1K | $537.0K | $490.43 | 7.05x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 4.9K | $445.5K | $90.70 | 1.86x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 1.1K | $185.6K | $166.58 | 1.50x |
| 94729 | Measurement of lung diffusing capacity | 3.5K | $158.6K | $45.61 | 1.93x |
| 94010 | Measurement and graphic recording of total and timed exhaled air capacity | 5.6K | $145.0K | $26.06 | 2.87x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.0K | $136.4K | $130.40 | 1.93x |
| 94727 | Determination of lung volumes using gas dilution or washout | 3.5K | $120.1K | $34.43 | 1.83x |
| 31622 | Diagnostic examination of lung airways using an endoscope | 833 | $97.4K | $116.88 | 4.11x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.5K | $91.8K | $59.60 | 1.70x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 2.1K | $67.9K | $32.54 | 2.38x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 3.9K | $56.5K | $14.68 | 3.09x |
| 96401 | Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle | 768 | $50.7K | $65.96 | 2.20x |
| 90662 | Vaccine for influenza for injection into muscle | 592 | $32.4K | $54.73 | 1.41x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 293 | $25.1K | $85.81 | 1.63x |
| J1040 | Injection, methylprednisolone acetate, 80 mg | 2.6K | $20.5K | $7.79 | 2.58x |
| J2182 | Injection, mepolizumab, 1 mg | 770 | $17.6K | $22.88 | 2.07x |
| 94620 | Pulmonary exercise testing | 381 | $17.4K | $45.74 | 4.37x |
| 90670 | Pneumococcal vaccine for injection into muscle | 96 | $15.9K | $165.72 | 1.19x |
This provider submits charges 3.7 times higher than what Medicare actually pays.
A markup ratio of 3.7x means for every $100 Medicare pays, this provider initially charges $370. 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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