This provider's $5.1M 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 | $232.47 | $130.53 | 1.78x | $101.94 | $454.2K | 6.3K | 4.6K |
| 2015 | $222.45 | $128.43 | 1.73x | $94.02 | $417.3K | 6.4K | 4.8K |
| 2016 | $246.05 | $131.64 | 1.87x | $114.41 | $441.0K | 7.1K | 5.3K |
| 2017 | $160.42 | $92.34 | 1.74x | $68.08 | $436.6K | 7.3K | 5.3K |
| 2018 | $144.60 | $93.78 | 1.54x | $50.82 | $498.4K | 7.8K | 5.7K |
| 2019 | $139.57 | $94.52 | 1.48x | $45.05 | $599.2K | 8.2K | 6.1K |
| 2020 | $141.70 | $102.08 | 1.39x | $39.62 | $524.7K | 6.7K | 4.9K |
| 2021 | $161.24 | $104.61 | 1.54x | $56.63 | $549.2K | 7.0K | 4.9K |
| 2022 | $156.45 | $97.84 | 1.60x | $58.61 | $548.5K | 7.2K | 5.0K |
| 2023 | $216.54 | $134.48 | 1.61x | $82.06 | $615.9K | 7.6K | 5.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 18.8K | $1.6M | $86.33 | 1.52x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 7.5K | $906.6K | $120.70 | 1.49x |
| 69210 | Removal of impact ear wax, one ear | 19.1K | $639.9K | $33.42 | 1.63x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 11.9K | $626.8K | $52.57 | 1.50x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 6.6K | $502.8K | $76.22 | 1.61x |
| 31575 | Diagnostic examination of voice box using flexible endoscope | 4.2K | $355.5K | $84.92 | 1.47x |
| 30903 | Complex control of nose bleed | 523 | $83.1K | $158.96 | 1.42x |
| 31231 | Diagnostic examination of nasal passages using an endoscope | 529 | $76.4K | $144.52 | 1.48x |
| 30901 | Simple control of nose bleed | 660 | $58.7K | $88.96 | 1.57x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 310 | $48.9K | $157.88 | 1.49x |
| 69433 | Incision of eardrum with insertion of eardrum tube under local or topical anesthesia | 250 | $38.6K | $154.41 | 1.53x |
| 13132 | Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet | 53 | $18.4K | $347.48 | 1.89x |
| 31600 | Opening of windpipe through neck for insertion of breathing tube | 47 | $15.5K | $330.52 | 1.80x |
| 69200 | Removal of foreign body from ear canal | 256 | $15.0K | $58.73 | 2.25x |
| 69220 | Removal of skin debris and drainage of mastoid cavity | 228 | $14.1K | $61.68 | 2.08x |
| 69420 | Incision, aspiration, and/or inflation of eardrum | 77 | $11.3K | $146.37 | 1.60x |
| 41100 | Biopsy of tongue | 87 | $10.9K | $125.08 | 1.44x |
| 13152 | Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips | 31 | $10.8K | $348.67 | 1.84x |
| 17000 | Destruction of skin growth | 158 | $7.3K | $45.91 | 1.73x |
| 12051 | Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth | 50 | $6.7K | $134.17 | 2.45x |
This provider submits charges 1.54 times higher than what Medicare actually pays.
A markup ratio of 1.54x means for every $100 Medicare pays, this provider initially charges $154. 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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