This provider's $4.7M 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 | $193.05 | $73.15 | 2.64x | $119.90 | $465.0K | 7.6K | 3.4K |
| 2015 | $198.87 | $68.44 | 2.91x | $130.43 | $532.8K | 8.6K | 3.8K |
| 2016 | $191.87 | $68.36 | 2.81x | $123.51 | $518.6K | 8.6K | 4.0K |
| 2017 | $194.78 | $69.40 | 2.81x | $125.38 | $535.0K | 8.8K | 4.1K |
| 2018 | $180.74 | $70.12 | 2.58x | $110.62 | $501.7K | 8.3K | 4.0K |
| 2019 | $210.58 | $86.02 | 2.45x | $124.56 | $483.5K | 7.5K | 3.8K |
| 2020 | $196.37 | $76.02 | 2.58x | $120.35 | $368.3K | 5.2K | 3.0K |
| 2021 | $234.95 | $85.38 | 2.75x | $149.57 | $414.9K | 5.5K | 3.2K |
| 2022 | $228.25 | $69.93 | 3.26x | $158.32 | $431.3K | 5.7K | 3.5K |
| 2023 | $210.87 | $68.60 | 3.07x | $142.27 | $420.9K | 6.0K | 3.6K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 11.5K | $1.1M | $97.96 | 1.80x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 12.7K | $849.5K | $67.11 | 1.92x |
| 94726 | Determination of lung volumes using plethysmography | 17.1K | $835.3K | $48.74 | 4.18x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 15.3K | $781.3K | $50.94 | 4.27x |
| 94729 | Measurement of lung diffusing capacity | 7.0K | $358.3K | $51.44 | 3.98x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 1.5K | $286.7K | $188.12 | 2.26x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 1.4K | $194.8K | $137.97 | 2.26x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 481 | $67.3K | $139.99 | 2.17x |
| 94010 | Measurement and graphic recording of total and timed exhaled air capacity | 1.8K | $56.9K | $30.85 | 4.58x |
| 94618 | Test for exercise-induced lung stress | 847 | $26.0K | $30.72 | 9.40x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 121 | $21.4K | $176.93 | 1.71x |
| 94620 | Pulmonary exercise testing | 409 | $20.0K | $48.98 | 7.74x |
| 99443 | Physician telephone patient service, 21-30 minutes of medical discussion | 143 | $14.1K | $98.58 | 1.98x |
| 94664 | Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device | 552 | $8.8K | $16.00 | 6.26x |
| G0008 | Administration of influenza virus vaccine | 268 | $7.6K | $28.19 | 1.62x |
| Q2038 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) | 267 | $4.2K | $15.58 | 2.02x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 46 | $4.1K | $90.13 | 2.50x |
| 99457 | Management using the results of remote vital sign monitoring per calendar month, first 20 minutes | 53 | $2.4K | $45.03 | 1.67x |
| 99454 | Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days | 30 | $1.4K | $47.82 | 2.09x |
| 99458 | Management using the results of remote vital sign monitoring per calendar month, each additional 20 minutes | 35 | $1.3K | $36.34 | 1.43x |
This provider submits charges 2.99 times higher than what Medicare actually pays.
A markup ratio of 2.99x means for every $100 Medicare pays, this provider initially charges $299. 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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