This provider's $5.2M 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 | $733.18 | $164.24 | 4.46x | $568.94 | $557.9K | 6.2K | 1.5K |
| 2015 | $592.50 | $130.50 | 4.54x | $462.00 | $751.5K | 10.0K | 2.5K |
| 2016 | $644.12 | $138.24 | 4.66x | $505.88 | $521.7K | 7.3K | 1.8K |
| 2017 | $637.67 | $134.67 | 4.74x | $503.00 | $397.6K | 5.7K | 1.6K |
| 2018 | $535.75 | $117.85 | 4.55x | $417.90 | $461.0K | 6.8K | 1.8K |
| 2019 | $465.40 | $97.59 | 4.77x | $367.81 | $684.2K | 10.4K | 2.6K |
| 2020 | $460.40 | $94.82 | 4.86x | $365.58 | $444.9K | 7.8K | 2.4K |
| 2021 | $503.18 | $110.39 | 4.56x | $392.79 | $443.8K | 7.2K | 2.4K |
| 2022 | $511.36 | $109.24 | 4.68x | $402.12 | $447.9K | 7.1K | 2.9K |
| 2023 | $505.18 | $106.59 | 4.74x | $398.59 | $464.2K | 7.4K | 3.1K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 7.2K | $476.7K | $66.66 | 3.00x |
| 99354 | Prolonged office or other outpatient service first hour | 5.2K | $464.3K | $89.12 | 2.81x |
| 95923 | Testing of autonomic (sympathetic) nervous system function | 3.6K | $443.6K | $122.89 | 4.07x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 8.0K | $425.6K | $53.16 | 4.57x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 611 | $368.8K | $603.56 | 4.64x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 3.5K | $353.8K | $99.70 | 3.01x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 611 | $350.7K | $573.95 | 4.88x |
| 95922 | Testing of autonomic (sympathetic) nervous system function at least 5 minutes of tilt | 3.6K | $325.2K | $89.81 | 5.57x |
| 94729 | Measurement of lung diffusing capacity | 6.1K | $320.6K | $52.22 | 5.74x |
| 93922 | Ultrasound study of arteries of both arms and legs | 3.7K | $299.1K | $81.40 | 6.14x |
| 94690 | Collection and analysis of exhaled air for evaluation of lung function at rest | 5.3K | $240.7K | $45.82 | 4.36x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 1.7K | $210.9K | $125.81 | 3.18x |
| 94727 | Determination of lung volumes using gas dilution or washout | 5.1K | $204.5K | $39.89 | 7.52x |
| 95012 | Measurement of inhaled nitric oxide gas | 10.1K | $187.1K | $18.56 | 13.47x |
| 94726 | Determination of lung volumes using plethysmography | 2.6K | $127.7K | $49.97 | 6.00x |
| 94070 | Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration | 2.3K | $125.9K | $54.59 | 3.66x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 365 | $57.4K | $157.30 | 3.81x |
| 94762 | Overnight measurement of oxygen saturation in blood using ear or finger device | 2.0K | $48.1K | $24.29 | 8.23x |
| 94375 | Diagnostic testing in a pulmonary function lab | 1.1K | $38.1K | $35.49 | 5.64x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 152 | $19.8K | $130.01 | 3.85x |
This provider submits charges 4.78 times higher than what Medicare actually pays.
A markup ratio of 4.78x means for every $100 Medicare pays, this provider initially charges $478. 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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