This provider's $8.4M in total Medicare payments ranks in the 99th percentile of Pulmonary Disease providers nationally.
Their average markup ratio of 10.84x is significantly above the specialty median of 3.0x.
Medicare payments to this provider grew 82% 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 | $143.29 | $96.89 | 1.48x | $46.40 | $548.9K | 5.9K | 2.8K |
| 2015 | $459.16 | $86.07 | 5.33x | $373.09 | $622.4K | 7.3K | 3.5K |
| 2016 | $533.62 | $84.62 | 6.31x | $449.00 | $646.5K | 7.8K | 3.6K |
| 2017 | $558.42 | $83.40 | 6.70x | $475.02 | $619.7K | 7.1K | 3.1K |
| 2018 | $637.50 | $90.75 | 7.02x | $546.75 | $861.8K | 8.0K | 2.7K |
| 2019 | $602.30 | $93.73 | 6.43x | $508.57 | $926.7K | 8.6K | 2.8K |
| 2020 | $644.85 | $97.78 | 6.59x | $547.07 | $1.2M | 10.8K | 2.7K |
| 2021 | $1.1K | $102.37 | 10.87x | $1.0K | $999.2K | 11.6K | 3.0K |
| 2022 | $1.1K | $111.50 | 10.15x | $1.0K | $978.9K | 12.3K | 3.3K |
| 2023 | $1.1K | $104.93 | 10.42x | $988.15 | $1.0M | 12.0K | 3.5K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 28.5K | $2.7M | $95.48 | 10.13x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 35.4K | $2.4M | $66.92 | 15.47x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 7.7K | $1.4M | $183.25 | 7.98x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 4.5K | $559.6K | $124.25 | 17.42x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 2.4K | $367.5K | $150.31 | 3.09x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 5.4K | $344.3K | $64.19 | 5.00x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 3.6K | $302.7K | $84.21 | 4.57x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 418 | $82.8K | $198.19 | 2.38x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 656 | $76.7K | $116.86 | 3.23x |
| 99239 | Hospital discharge day management, more than 30 minutes | 246 | $23.5K | $95.54 | 3.18x |
| 99307 | Subsequent nursing facility visit, typically 10 minutes per day | 514 | $20.2K | $39.31 | 6.85x |
| 99407 | Smoking and tobacco use intensive counseling, greater than 10 minutes | 737 | $18.7K | $25.43 | 6.70x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 493 | $17.2K | $34.86 | 14.20x |
| 99335 | Established patient assisted living visit, typically 25 minutes | 186 | $15.0K | $80.88 | 3.09x |
| 31623 | Examination of lung airways using an endoscope | 95 | $11.6K | $122.32 | 1.52x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 93 | $6.7K | $71.70 | 1.39x |
| 99292 | Critical care delivery critically ill or injured patient | 51 | $5.0K | $97.90 | 1.47x |
| 99406 | Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes | 222 | $2.8K | $12.41 | 16.19x |
| 99336 | Established patient assisted living visit, typically 40 minutes | 15 | $1.8K | $119.75 | 2.51x |
| 99221 | Initial hospital inpatient care, typically 30 minutes per day | 15 | $1.4K | $92.52 | 6.60x |
This provider submits charges 10.84 times higher than what Medicare actually pays.
A markup ratio of 10.84x means for every $100 Medicare pays, this provider initially charges $1084. 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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