This provider's $4.0M in total Medicare payments ranks in the 99th percentile of Otolaryngology 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 | $177.70 | $78.38 | 2.27x | $99.32 | $492.5K | 6.5K | 4.0K |
| 2015 | $177.85 | $71.33 | 2.49x | $106.52 | $433.3K | 5.7K | 3.5K |
| 2016 | $164.54 | $69.65 | 2.36x | $94.89 | $442.5K | 5.8K | 3.6K |
| 2017 | $134.06 | $63.18 | 2.12x | $70.88 | $372.9K | 5.2K | 3.3K |
| 2018 | $131.33 | $61.85 | 2.12x | $69.48 | $308.1K | 4.7K | 3.3K |
| 2019 | $130.72 | $62.98 | 2.08x | $67.74 | $413.1K | 5.8K | 3.8K |
| 2020 | $129.27 | $68.11 | 1.90x | $61.16 | $317.9K | 4.0K | 2.7K |
| 2021 | $119.45 | $66.53 | 1.80x | $52.92 | $405.5K | 4.7K | 3.1K |
| 2022 | $115.69 | $65.92 | 1.76x | $49.77 | $420.0K | 4.9K | 3.3K |
| 2023 | $126.73 | $70.47 | 1.80x | $56.26 | $443.0K | 5.2K | 3.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 31231 | Diagnostic examination of nasal passages using an endoscope | 10.3K | $1.9M | $183.35 | 1.92x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 10.5K | $424.2K | $40.39 | 1.86x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 4.0K | $399.1K | $99.30 | 1.52x |
| 31575 | Diagnostic examination of voice box using flexible endoscope | 1.7K | $176.7K | $102.15 | 1.72x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.2K | $167.1K | $135.96 | 1.67x |
| 69210 | Removal of impact ear wax, one ear | 5.7K | $155.3K | $27.41 | 2.87x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.7K | $154.8K | $58.12 | 1.73x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 1.5K | $139.7K | $90.16 | 2.03x |
| G0268 | Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing | 3.2K | $122.2K | $37.60 | 2.00x |
| 92567 | Eardrum testing using ear probe | 5.4K | $71.8K | $13.35 | 3.00x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 870 | $63.7K | $73.24 | 1.98x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 709 | $62.2K | $87.74 | 2.11x |
| 92557 | Air and bone conduction assessment of hearing loss and speech recognition | 1.3K | $44.1K | $33.28 | 2.55x |
| 99335 | Established patient assisted living visit, typically 25 minutes | 481 | $38.0K | $79.01 | 1.38x |
| 92550 | Assessment of eardrum and muscle function | 1.3K | $25.3K | $19.35 | 2.54x |
| 92511 | Examination of the nose and throat using an endoscope | 179 | $21.8K | $121.98 | 2.05x |
| 92625 | Evaluation of hearing ringing in ear | 315 | $19.1K | $60.76 | 1.56x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 156 | $18.2K | $116.57 | 1.72x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 109 | $11.9K | $108.79 | 1.70x |
| 99354 | Prolonged office or other outpatient service first hour | 108 | $9.4K | $86.95 | 1.84x |
This provider submits charges 1.92 times higher than what Medicare actually pays.
A markup ratio of 1.92x means for every $100 Medicare pays, this provider initially charges $192. 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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