This provider's $7.5M 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 | $142.14 | $67.62 | 2.10x | $74.52 | $755.3K | 9.8K | 3.2K |
| 2015 | $134.32 | $68.65 | 1.96x | $65.67 | $741.3K | 8.6K | 3.0K |
| 2016 | $135.85 | $66.63 | 2.04x | $69.22 | $687.3K | 7.8K | 2.8K |
| 2017 | $132.86 | $61.47 | 2.16x | $71.39 | $695.1K | 8.3K | 3.1K |
| 2018 | $131.38 | $61.11 | 2.15x | $70.27 | $759.2K | 8.8K | 3.3K |
| 2019 | $142.65 | $64.39 | 2.22x | $78.26 | $877.3K | 9.6K | 3.7K |
| 2020 | $147.54 | $75.41 | 1.96x | $72.13 | $938.5K | 9.6K | 3.2K |
| 2021 | $173.02 | $79.99 | 2.16x | $93.03 | $739.2K | 7.1K | 2.2K |
| 2022 | $174.29 | $74.29 | 2.35x | $100.00 | $667.8K | 6.6K | 2.0K |
| 2023 | $213.88 | $80.76 | 2.65x | $133.12 | $656.5K | 6.3K | 2.1K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 12.8K | $2.3M | $178.82 | 2.20x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 20.4K | $1.8M | $87.58 | 1.55x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 18.6K | $1.6M | $84.71 | 2.23x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 3.3K | $533.6K | $160.92 | 2.23x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 8.8K | $519.3K | $59.31 | 2.46x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 1.1K | $125.2K | $113.44 | 1.55x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 2.1K | $68.5K | $31.93 | 1.84x |
| 94729 | Measurement of lung diffusing capacity | 1.4K | $64.3K | $46.59 | 1.72x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 1.4K | $63.8K | $46.29 | 2.16x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 473 | $58.5K | $123.66 | 1.62x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 337 | $57.6K | $170.86 | 1.84x |
| 94727 | Determination of lung volumes using gas dilution or washout | 1.4K | $49.3K | $35.73 | 2.24x |
| 31625 | Biopsy of lung airways using an endoscope | 374 | $49.1K | $131.23 | 4.19x |
| G0008 | Administration of influenza virus vaccine | 1.7K | $40.4K | $24.11 | 1.28x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 663 | $39.7K | $59.91 | 1.43x |
| 90662 | Vaccine for influenza for injection into muscle | 788 | $30.8K | $39.04 | 1.54x |
| 95831 | Manual muscle testing of arm, leg or trunk | 965 | $24.6K | $25.45 | 1.38x |
| 99292 | Critical care delivery critically ill or injured patient | 211 | $19.1K | $90.65 | 2.10x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 154 | $18.6K | $120.84 | 1.28x |
| 93010 | Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report | 2.5K | $16.4K | $6.60 | 5.45x |
This provider submits charges 2.05 times higher than what Medicare actually pays.
A markup ratio of 2.05x means for every $100 Medicare pays, this provider initially charges $205. 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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