This provider's $5.4M in total Medicare payments ranks in the 99th percentile of Pulmonary Disease providers nationally.
Medicare payments to this provider grew 74% 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 | $341.68 | $81.95 | 4.17x | $259.73 | $452.4K | 5.2K | 3.2K |
| 2015 | $346.90 | $82.28 | 4.22x | $264.62 | $438.2K | 5.4K | 3.5K |
| 2016 | $333.96 | $77.96 | 4.28x | $256.00 | $456.0K | 5.9K | 4.0K |
| 2017 | $348.45 | $81.74 | 4.26x | $266.71 | $466.1K | 6.3K | 3.8K |
| 2018 | $204.58 | $75.89 | 2.70x | $128.69 | $490.2K | 6.8K | 3.5K |
| 2019 | $177.81 | $68.34 | 2.60x | $109.47 | $445.8K | 6.3K | 3.6K |
| 2020 | $281.40 | $66.93 | 4.20x | $214.47 | $476.1K | 6.5K | 3.1K |
| 2021 | $361.08 | $77.11 | 4.68x | $283.97 | $599.1K | 7.3K | 3.5K |
| 2022 | $240.71 | $72.99 | 3.30x | $167.72 | $779.4K | 11.5K | 5.1K |
| 2023 | $160.85 | $66.71 | 2.41x | $94.14 | $789.1K | 13.1K | 5.5K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 16.4K | $1.4M | $84.72 | 2.17x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 15.8K | $891.6K | $56.47 | 2.34x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 4.4K | $755.6K | $172.82 | 2.82x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 4.1K | $431.9K | $105.37 | 2.34x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 2.5K | $303.9K | $120.97 | 2.36x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 1.7K | $257.6K | $151.45 | 2.39x |
| 99308 | Follow-up nursing facility visit per day, typically 15 minutes | 2.8K | $153.6K | $55.28 | 2.15x |
| 99490 | Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month | 3.1K | $152.4K | $48.58 | 1.78x |
| 94729 | Measurement of lung diffusing capacity | 3.0K | $124.7K | $41.77 | 2.56x |
| 94726 | Determination of lung volumes using plethysmography | 3.0K | $118.0K | $39.89 | 2.93x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 2.9K | $114.9K | $39.50 | 3.09x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 1.1K | $92.9K | $84.05 | 2.24x |
| 99457 | Management using the results of remote vital sign monitoring per calendar month, first 20 minutes | 2.3K | $87.0K | $37.56 | 2.45x |
| 95806 | Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort | 620 | $54.9K | $88.54 | 4.11x |
| G0398 | Home sleep study test (hst) with type ii portable monitor, unattended; minimum of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort and oxygen saturation | 399 | $48.2K | $120.85 | 2.80x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 873 | $47.9K | $54.85 | 2.24x |
| 99454 | Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days | 1.0K | $39.0K | $38.36 | 1.98x |
| 94620 | Pulmonary exercise testing | 854 | $35.1K | $41.09 | 2.90x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 320 | $33.2K | $103.78 | 14.33x |
| 94618 | Test for exercise-induced lung stress | 1.3K | $33.1K | $25.03 | 3.20x |
This provider submits charges 2.53 times higher than what Medicare actually pays.
A markup ratio of 2.53x means for every $100 Medicare pays, this provider initially charges $253. 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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