This provider averages 146 services per working day
Based on 365.1K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $12.4M in total Medicare payments ranks in the 99th percentile of Pulmonary Disease providers nationally.
Averaging 146 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 431% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 61% in 2019
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
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 | $85.34 | $33.13 | 2.58x | $52.21 | $573.9K | 17.3K | 31 |
| 2015 | $83.78 | $33.05 | 2.53x | $50.73 | $567.5K | 17.2K | 27 |
| 2016 | $83.22 | $34.49 | 2.41x | $48.73 | $502.6K | 14.6K | 27 |
| 2017 | $84.57 | $35.63 | 2.37x | $48.94 | $531.5K | 14.9K | 27 |
| 2018 | $80.89 | $35.24 | 2.30x | $45.65 | $696.9K | 19.8K | 28 |
| 2019 | $82.69 | $40.26 | 2.05x | $42.43 | $1.1M | 27.9K | 28 |
| 2020 | $73.87 | $38.37 | 1.93x | $35.50 | $1.4M | 35.8K | 28 |
| 2021 | $66.08 | $35.60 | 1.86x | $30.48 | $1.7M | 48.0K | 28 |
| 2022 | $65.65 | $35.41 | 1.85x | $30.24 | $2.2M | 62.9K | 28 |
| 2023 | $50.11 | $28.55 | 1.76x | $21.56 | $3.0M | 106.7K | 32 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J2357 | Injection, omalizumab, 5 mg | 150.0K | $4.2M | $27.80 | 2.25x |
| J2182 | Injection, mepolizumab, 1 mg | 104.0K | $2.4M | $22.97 | 1.74x |
| J0517 | Injection, benralizumab, 1 mg | 16.7K | $2.2M | $132.72 | 1.30x |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 16.6K | $901.9K | $54.40 | 2.38x |
| J2356 | Injection, tezepelumab-ekko, 1 mg | 31.7K | $455.3K | $14.36 | 1.39x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 8.5K | $439.9K | $51.63 | 1.92x |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | 2.5K | $251.8K | $98.77 | 2.41x |
| 99205 | New patient office or other outpatient visit, 60-74 minutes | 1.2K | $177.6K | $146.99 | 2.15x |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 3.6K | $127.9K | $35.11 | 2.45x |
| 99231 | Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes | 3.9K | $116.0K | $29.56 | 2.88x |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 771 | $114.0K | $147.82 | 2.14x |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | 1.4K | $106.3K | $78.28 | 2.37x |
| 96372 | Injection of drug or substance under skin or into muscle | 7.7K | $100.6K | $13.03 | 3.29x |
| 90670 | Pneumococcal vaccine for injection into muscle | 596 | $95.1K | $159.58 | 1.21x |
| 99291 | Critical care, first 30-74 minutes | 562 | $92.5K | $164.52 | 3.31x |
| 96401 | Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle | 1.3K | $63.9K | $50.95 | 2.62x |
| 94729 | Test to examine how well the lungs exchange gases | 1.8K | $57.8K | $32.90 | 4.07x |
| 99214 | Established patient outpatient visit, total time 30-39 minutes | 668 | $50.4K | $75.47 | 1.89x |
| 94060 | Test to measure expiratory airflow and volume changes before and after medication administration | 1.3K | $49.1K | $37.70 | 3.62x |
| 99442 | Telephone medical discussion with physician, 11-20 minutes | 795 | $42.8K | $53.85 | 2.40x |
This provider submits charges 1.99 times higher than what Medicare actually pays.
A markup ratio of 1.99x means for every $100 Medicare pays, this provider initially charges $199. 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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