This provider's $4.5M in total Medicare payments ranks in the 99th percentile of Otolaryngology 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 | $149.47 | $87.59 | 1.71x | $61.88 | $436.1K | 7.0K | 5.5K |
| 2015 | $100.43 | $65.89 | 1.52x | $34.54 | $392.6K | 5.8K | 4.5K |
| 2016 | $125.06 | $80.67 | 1.55x | $44.39 | $434.9K | 6.1K | 4.5K |
| 2017 | $141.74 | $88.28 | 1.61x | $53.46 | $508.5K | 6.8K | 4.8K |
| 2018 | $147.07 | $91.77 | 1.60x | $55.30 | $542.7K | 6.8K | 4.8K |
| 2019 | $138.26 | $86.50 | 1.60x | $51.76 | $537.8K | 6.1K | 4.3K |
| 2020 | $140.73 | $86.33 | 1.63x | $54.40 | $356.6K | 4.1K | 2.9K |
| 2021 | $138.98 | $89.56 | 1.55x | $49.42 | $497.5K | 5.2K | 3.6K |
| 2022 | $144.12 | $90.23 | 1.60x | $53.89 | $408.0K | 4.3K | 3.1K |
| 2023 | $130.40 | $79.56 | 1.64x | $50.84 | $355.5K | 4.0K | 2.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 16.1K | $1.1M | $66.37 | 1.35x |
| 31575 | Diagnostic examination of voice box using flexible endoscope | 9.2K | $939.5K | $102.35 | 1.47x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 5.1K | $524.2K | $103.64 | 1.32x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 4.9K | $454.4K | $92.65 | 1.46x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 2.7K | $381.5K | $142.88 | 1.32x |
| 31231 | Diagnostic examination of nasal passages using an endoscope | 2.1K | $374.1K | $182.15 | 1.54x |
| 69210 | Removal of impact ear wax, one ear | 7.6K | $278.2K | $36.73 | 1.64x |
| 92511 | Examination of the nose and throat using an endoscope | 1.0K | $115.0K | $110.44 | 1.90x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 2.4K | $93.0K | $39.53 | 1.67x |
| 69220 | Removal of skin debris and drainage of mastoid cavity | 667 | $52.9K | $79.34 | 2.14x |
| 31238 | Control of nasal bleeding using an endoscope | 194 | $43.7K | $225.28 | 1.52x |
| 69200 | Removal of foreign body from ear canal | 656 | $43.7K | $66.59 | 2.33x |
| 92557 | Air and bone conduction assessment of hearing loss and speech recognition | 845 | $27.1K | $32.02 | 1.96x |
| 92504 | Diagnostic examination of ear and nose | 737 | $19.8K | $26.88 | 1.49x |
| 99442 | Physician telephone patient service, 11-20 minutes of medical discussion | 183 | $14.5K | $79.16 | 1.38x |
| 17250 | Application of chemical agent to excessive wound tissue | 191 | $13.3K | $69.51 | 1.44x |
| 92567 | Eardrum testing using ear probe | 839 | $10.6K | $12.58 | 2.17x |
| 30115 | Removal of polyps in nose | 13 | $4.9K | $378.13 | 2.10x |
| 95004 | Injection of allergenic extracts into skin, accessed through the skin | 903 | $4.5K | $4.94 | 1.56x |
| 42809 | Removal of foreign body from throat | 26 | $4.4K | $169.33 | 1.30x |
This provider submits charges 1.46 times higher than what Medicare actually pays.
A markup ratio of 1.46x means for every $100 Medicare pays, this provider initially charges $146. 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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