This provider's $3.6M in total Medicare payments ranks in the 99th percentile of Sleep Medicine 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 | $199.24 | $72.20 | 2.76x | $127.04 | $397.5K | 5.2K | 2.7K |
| 2015 | $226.64 | $87.46 | 2.59x | $139.18 | $440.9K | 5.7K | 3.1K |
| 2016 | $207.59 | $76.29 | 2.72x | $131.30 | $423.8K | 5.4K | 2.9K |
| 2017 | $222.62 | $80.99 | 2.75x | $141.63 | $349.3K | 4.2K | 2.2K |
| 2018 | $195.60 | $80.43 | 2.43x | $115.17 | $353.6K | 4.3K | 2.3K |
| 2019 | $226.75 | $93.82 | 2.42x | $132.93 | $356.8K | 3.9K | 2.0K |
| 2020 | $212.36 | $94.87 | 2.24x | $117.49 | $277.8K | 2.6K | 1.5K |
| 2021 | $203.00 | $91.47 | 2.22x | $111.53 | $358.6K | 3.3K | 1.7K |
| 2022 | $186.69 | $77.41 | 2.41x | $109.28 | $349.3K | 3.4K | 1.9K |
| 2023 | $231.58 | $89.16 | 2.60x | $142.42 | $340.6K | 3.3K | 1.8K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 12.6K | $1.1M | $90.79 | 1.88x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 4.4K | $812.1K | $184.07 | 2.36x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 5.0K | $450.1K | $89.27 | 1.80x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 7.4K | $446.0K | $60.45 | 1.85x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 1.3K | $147.3K | $111.23 | 1.91x |
| 94375 | Diagnostic testing in a pulmonary function lab | 4.4K | $143.7K | $32.82 | 2.04x |
| 95806 | Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort | 921 | $109.0K | $118.36 | 2.70x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 509 | $83.6K | $164.28 | 1.90x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 943 | $80.3K | $85.12 | 2.02x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 466 | $60.3K | $129.42 | 2.02x |
| 99238 | Hospital discharge day management, 30 minutes or less | 644 | $39.6K | $61.52 | 1.84x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 581 | $34.8K | $59.88 | 1.94x |
| 36556 | Insertion of central venous catheter for infusion, patient 5 years or older | 248 | $21.5K | $86.77 | 4.60x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 172 | $17.9K | $104.08 | 4.04x |
| 31500 | Emergent insertion of breathing tube into windpipe cartilage using an endoscope | 140 | $15.3K | $109.46 | 1.57x |
| 71010 | X-ray of chest, 1 view, front | 686 | $13.3K | $19.44 | 2.11x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 111 | $11.8K | $106.40 | 4.23x |
| 31624 | Irrigation and suction of lung airways to obtain cells using an endoscope | 113 | $11.8K | $104.12 | 5.22x |
| 76937 | Ultrasound guidance for accessing into blood vessel | 248 | $3.0K | $12.09 | 4.92x |
| 94640 | Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen | 69 | $1.2K | $16.81 | 1.73x |
This provider submits charges 2.06 times higher than what Medicare actually pays.
A markup ratio of 2.06x means for every $100 Medicare pays, this provider initially charges $206. 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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