This provider's $7.3M 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 | $188.02 | $71.03 | 2.65x | $116.99 | $685.2K | 8.5K | 5.2K |
| 2015 | $190.14 | $71.61 | 2.66x | $118.53 | $753.1K | 9.4K | 5.9K |
| 2016 | $193.29 | $69.39 | 2.79x | $123.90 | $704.2K | 10.2K | 6.4K |
| 2017 | $236.60 | $71.98 | 3.29x | $164.62 | $646.9K | 9.1K | 6.7K |
| 2018 | $266.53 | $85.76 | 3.11x | $180.77 | $657.5K | 7.7K | 5.5K |
| 2019 | $353.09 | $96.59 | 3.66x | $256.50 | $703.9K | 8.1K | 5.6K |
| 2020 | $342.63 | $86.88 | 3.94x | $255.75 | $748.9K | 10.5K | 7.1K |
| 2021 | $373.79 | $96.26 | 3.88x | $277.53 | $839.3K | 11.4K | 7.4K |
| 2022 | $368.39 | $92.58 | 3.98x | $275.81 | $802.3K | 11.2K | 6.9K |
| 2023 | $373.18 | $92.19 | 4.05x | $280.99 | $711.1K | 9.9K | 6.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 19.2K | $1.6M | $82.65 | 3.14x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 9.4K | $1.0M | $111.06 | 2.93x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 2.4K | $960.1K | $394.95 | 3.31x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 1.6K | $565.4K | $343.90 | 3.22x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 2.7K | $416.2K | $152.02 | 3.23x |
| 94729 | Measurement of lung diffusing capacity | 9.4K | $375.5K | $40.12 | 3.32x |
| 94726 | Determination of lung volumes using plethysmography | 9.3K | $361.3K | $38.95 | 3.36x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 8.8K | $334.8K | $38.13 | 3.74x |
| 94621 | Pulmonary exercise testing | 1.5K | $168.5K | $114.54 | 3.41x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 910 | $152.6K | $167.69 | 3.10x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 988 | $149.5K | $151.31 | 2.55x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 1.7K | $132.9K | $78.62 | 2.56x |
| G0398 | Home sleep study test (hst) with type ii portable monitor, unattended; minimum of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort and oxygen saturation | 1.1K | $113.0K | $105.12 | 3.73x |
| 94660 | Initiation and management of continued pressured respiratory assistance by mask or breathing tube | 2.2K | $100.4K | $44.90 | 4.54x |
| 94010 | Measurement and graphic recording of total and timed exhaled air capacity | 3.4K | $80.7K | $23.50 | 3.88x |
| 99426 | Principal care management services for a single high-risk disease, first 30 minutes of clinical staff time directed by health care professional, per calendar month | 1.7K | $78.6K | $47.12 | 1.61x |
| 96401 | Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle | 1.2K | $66.6K | $56.39 | 3.94x |
| 94618 | Test for exercise-induced lung stress | 2.1K | $53.8K | $25.55 | 4.21x |
| G0399 | Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation | 536 | $52.5K | $97.90 | 3.73x |
| 94620 | Pulmonary exercise testing | 1.1K | $45.3K | $39.53 | 2.84x |
This provider submits charges 3.23 times higher than what Medicare actually pays.
A markup ratio of 3.23x means for every $100 Medicare pays, this provider initially charges $323. 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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