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 | $323.89 | $80.56 | 4.02x | $243.33 | $455.7K | 6.4K | 2.4K |
| 2015 | $288.11 | $69.99 | 4.12x | $218.12 | $423.7K | 6.0K | 2.5K |
| 2016 | $288.08 | $78.15 | 3.69x | $209.93 | $357.3K | 5.0K | 2.3K |
| 2017 | $291.57 | $72.72 | 4.01x | $218.85 | $368.8K | 4.9K | 2.1K |
| 2018 | $244.19 | $64.54 | 3.78x | $179.65 | $339.8K | 4.5K | 2.1K |
| 2019 | $251.06 | $67.34 | 3.73x | $183.72 | $413.5K | 5.1K | 2.1K |
| 2020 | $305.68 | $74.64 | 4.10x | $231.04 | $473.8K | 4.4K | 1.5K |
| 2021 | $270.73 | $72.81 | 3.72x | $197.92 | $323.6K | 2.5K | 934 |
| 2022 | $289.91 | $72.24 | 4.01x | $217.67 | $457.6K | 3.8K | 1.3K |
| 2023 | $299.92 | $77.12 | 3.89x | $222.80 | $434.4K | 3.8K | 1.1K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 7.3K | $1.4M | $194.01 | 3.96x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 11.4K | $706.1K | $61.96 | 3.30x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 7.7K | $694.1K | $89.80 | 3.23x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 4.9K | $270.9K | $55.35 | 3.07x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 3.1K | $263.8K | $84.94 | 3.43x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 1.7K | $192.8K | $110.86 | 3.58x |
| 99307 | Subsequent nursing facility visit, typically 10 minutes per day | 3.6K | $130.3K | $36.34 | 2.90x |
| 99304 | Initial nursing facility visit, typically 25 minutes per day | 773 | $58.3K | $75.48 | 4.96x |
| 94729 | Measurement of lung diffusing capacity | 1.1K | $48.9K | $45.96 | 5.43x |
| 71250 | CT scan chest | 367 | $47.3K | $128.88 | 4.74x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 628 | $41.9K | $66.68 | 3.40x |
| 94727 | Determination of lung volumes using gas dilution or washout | 1.1K | $37.4K | $35.22 | 4.69x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 1.1K | $36.7K | $34.83 | 4.43x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 270 | $30.3K | $112.09 | 3.57x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 181 | $23.2K | $128.05 | 3.71x |
| 99292 | Critical care delivery critically ill or injured patient | 175 | $17.3K | $98.88 | 3.69x |
| 94620 | Pulmonary exercise testing | 253 | $11.1K | $43.78 | 9.14x |
| 94010 | Measurement and graphic recording of total and timed exhaled air capacity | 316 | $8.2K | $26.06 | 4.30x |
| 94618 | Test for exercise-induced lung stress | 124 | $3.5K | $28.49 | 4.09x |
| G0297 | Low dose ct scan (ldct) for lung cancer screening | 11 | $2.8K | $258.94 | 1.16x |
This provider submits charges 3.63 times higher than what Medicare actually pays.
A markup ratio of 3.63x means for every $100 Medicare pays, this provider initially charges $363. 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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