This provider's $3.5M in total Medicare payments ranks in the 98th percentile of Pulmonary Disease providers nationally.
Medicare payments to this provider grew 70% 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 | $77.88 | $53.88 | 1.45x | $24.00 | $272.2K | 5.5K | 4.2K |
| 2015 | $79.66 | $55.16 | 1.44x | $24.50 | $271.3K | 5.4K | 4.0K |
| 2016 | $72.51 | $49.35 | 1.47x | $23.16 | $246.9K | 5.1K | 3.8K |
| 2017 | $69.49 | $41.01 | 1.69x | $28.48 | $280.6K | 5.9K | 4.4K |
| 2018 | $94.60 | $50.66 | 1.87x | $43.94 | $319.1K | 6.3K | 4.5K |
| 2019 | $82.17 | $52.64 | 1.56x | $29.53 | $360.6K | 7.3K | 5.4K |
| 2020 | $94.46 | $56.53 | 1.67x | $37.93 | $354.7K | 6.5K | 4.9K |
| 2021 | $92.64 | $58.53 | 1.58x | $34.11 | $463.1K | 9.2K | 7.3K |
| 2022 | $103.49 | $55.74 | 1.86x | $47.75 | $479.2K | 9.6K | 7.5K |
| 2023 | $93.59 | $47.51 | 1.97x | $46.08 | $463.0K | 9.9K | 7.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 6.2K | $764.4K | $122.92 | 1.53x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 2.1K | $373.0K | $177.77 | 1.44x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 1.7K | $283.8K | $167.13 | 1.41x |
| 94729 | Measurement of lung diffusing capacity | 4.3K | $209.7K | $49.21 | 1.51x |
| 94726 | Determination of lung volumes using plethysmography | 4.2K | $193.9K | $46.11 | 1.57x |
| 94375 | Diagnostic testing in a pulmonary function lab | 5.8K | $190.6K | $32.99 | 1.40x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 2.2K | $189.3K | $85.81 | 1.38x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 1.8K | $164.2K | $90.53 | 1.50x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 774 | $124.9K | $161.37 | 1.39x |
| 93015 | Exercise or drug-induced heart and blood vessel stress test with EKG monitoring, physician supervision, interpretation, and report | 1.9K | $118.4K | $62.63 | 1.49x |
| 94681 | Collection and analysis of exhaled air and carbon dioxide for evaluation of lung function | 1.8K | $83.9K | $45.38 | 1.70x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 1.9K | $81.1K | $42.89 | 1.88x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 1.6K | $73.3K | $45.32 | 1.62x |
| 94200 | Measurement of largest amount of air breathed in an out of lungs over one minute | 3.9K | $70.6K | $17.94 | 1.87x |
| 99292 | Critical care delivery critically ill or injured patient | 734 | $66.1K | $90.01 | 1.44x |
| 36600 | Arterial puncture withdrawal of blood for diagnosis | 2.3K | $58.7K | $25.36 | 1.45x |
| 82803 | Blood gases measurement | 2.0K | $50.7K | $25.79 | 1.29x |
| 82375 | Carboxyhemoglobin (protein) level | 2.3K | $31.9K | $13.94 | 1.18x |
| 99236 | Hospital observation or inpatient care high severity, 55 minutes per day | 180 | $31.5K | $175.16 | 1.40x |
| 31645 | Aspiration of lung secretions from lung airways using an endoscope | 393 | $30.6K | $77.92 | 2.19x |
This provider submits charges 1.54 times higher than what Medicare actually pays.
A markup ratio of 1.54x means for every $100 Medicare pays, this provider initially charges $154. This is lower 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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