This provider's $4.2M 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 | $420.39 | $108.71 | 3.87x | $311.68 | $407.6K | 7.1K | 3.4K |
| 2015 | $460.02 | $109.28 | 4.21x | $350.74 | $436.4K | 7.5K | 3.6K |
| 2016 | $497.19 | $111.80 | 4.45x | $385.39 | $435.4K | 7.5K | 3.9K |
| 2017 | $462.21 | $110.05 | 4.20x | $352.16 | $440.3K | 5.9K | 3.4K |
| 2018 | $497.92 | $119.21 | 4.18x | $378.71 | $430.5K | 6.3K | 3.8K |
| 2019 | $496.18 | $119.70 | 4.15x | $376.48 | $468.6K | 6.4K | 3.8K |
| 2020 | $741.82 | $122.73 | 6.04x | $619.09 | $328.7K | 4.6K | 3.1K |
| 2021 | $760.16 | $129.25 | 5.88x | $630.91 | $410.8K | 5.7K | 3.4K |
| 2022 | $755.60 | $119.50 | 6.32x | $636.10 | $412.5K | 6.0K | 3.5K |
| 2023 | $743.57 | $124.25 | 5.98x | $619.32 | $388.2K | 5.4K | 3.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 15.7K | $1.6M | $100.87 | 4.21x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 14.4K | $748.7K | $51.91 | 5.56x |
| 94729 | Measurement of lung diffusing capacity | 6.5K | $346.9K | $53.44 | 5.33x |
| 94726 | Determination of lung volumes using plethysmography | 5.7K | $294.7K | $51.77 | 5.35x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 464 | $274.3K | $591.12 | 5.69x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 412 | $254.8K | $618.42 | 6.21x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 1.2K | $226.3K | $191.12 | 4.14x |
| 90670 | Pneumococcal vaccine for injection into muscle | 398 | $75.9K | $190.68 | 2.20x |
| 95012 | Measurement of inhaled nitric oxide gas | 3.1K | $59.3K | $19.31 | 5.42x |
| 94664 | Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device | 2.4K | $40.5K | $16.56 | 4.66x |
| J0517 | Injection, benralizumab, 1 mg | 257 | $32.6K | $126.72 | 2.97x |
| 94727 | Determination of lung volumes using gas dilution or washout | 729 | $29.1K | $39.96 | 4.00x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 186 | $27.2K | $146.41 | 4.33x |
| 94620 | Pulmonary exercise testing | 489 | $25.0K | $51.14 | 4.98x |
| 94618 | Test for exercise-induced lung stress | 794 | $24.9K | $31.42 | 5.59x |
| 90732 | Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older | 203 | $21.3K | $104.94 | 2.34x |
| 90694 | Influenza virus vaccine, quadrivalent (aiiv4), inactivated, adjuvanted, preservative free, for injection into muscle, 0.5 ml dosage | 248 | $16.6K | $66.92 | 2.16x |
| G0009 | Administration of pneumococcal vaccine | 580 | $14.7K | $25.43 | 3.13x |
| G0008 | Administration of influenza virus vaccine | 482 | $12.6K | $26.22 | 3.18x |
| 36415 | Insertion of needle into vein for collection of blood sample | 2.4K | $8.1K | $3.33 | 5.57x |
This provider submits charges 4.83 times higher than what Medicare actually pays.
A markup ratio of 4.83x means for every $100 Medicare pays, this provider initially charges $483. 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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