This provider's $3.2M 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 | $569.00 | $136.72 | 4.16x | $432.28 | $291.2K | 2.2K | 1.8K |
| 2015 | $557.93 | $137.30 | 4.06x | $420.63 | $318.8K | 2.2K | 1.9K |
| 2016 | $477.58 | $108.41 | 4.41x | $369.17 | $356.3K | 3.0K | 2.4K |
| 2017 | $700.77 | $132.89 | 5.27x | $567.88 | $421.9K | 3.3K | 2.7K |
| 2018 | $616.90 | $120.71 | 5.11x | $496.19 | $386.9K | 3.2K | 2.6K |
| 2019 | $475.40 | $112.30 | 4.23x | $363.10 | $353.9K | 2.6K | 1.9K |
| 2020 | $485.39 | $116.13 | 4.18x | $369.26 | $227.7K | 2.0K | 1.5K |
| 2021 | $507.68 | $121.19 | 4.19x | $386.49 | $293.5K | 2.4K | 1.4K |
| 2022 | $513.13 | $122.16 | 4.20x | $390.97 | $295.9K | 2.5K | 1.5K |
| 2023 | $487.31 | $111.24 | 4.38x | $376.07 | $280.6K | 2.7K | 1.6K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 2.0K | $1.0M | $500.62 | 4.72x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 1.8K | $843.4K | $478.12 | 4.61x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 7.7K | $424.5K | $54.92 | 3.87x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 3.4K | $259.7K | $77.31 | 4.35x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.8K | $201.3K | $113.81 | 4.42x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 1.4K | $55.3K | $39.52 | 2.81x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 1.6K | $51.4K | $31.74 | 4.63x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 279 | $48.3K | $173.24 | 4.61x |
| 94660 | Initiation and management of continued pressured respiratory assistance by mask or breathing tube | 985 | $47.3K | $48.02 | 4.33x |
| 95800 | Study of sleep patterns | 402 | $47.2K | $117.43 | 5.02x |
| 95806 | Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort | 340 | $34.7K | $102.03 | 5.63x |
| J2357 | Injection, omalizumab, 5 mg | 992 | $27.9K | $28.15 | 2.97x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 342 | $26.7K | $78.20 | 4.21x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 157 | $23.6K | $150.54 | 4.05x |
| 99454 | Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days | 517 | $22.5K | $43.52 | 3.38x |
| 99457 | Remote physiologic monitoring treatment management services, health care professional time in a calendar month requiring interactive communication with the patient/caregiver; first 20 minutes | 555 | $20.9K | $37.66 | 2.89x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 153 | $16.0K | $104.30 | 4.40x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 991 | $13.1K | $13.21 | 5.58x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 212 | $11.5K | $54.13 | 4.23x |
| 96401 | Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle | 125 | $6.5K | $52.30 | 7.88x |
This provider submits charges 4.46 times higher than what Medicare actually pays.
A markup ratio of 4.46x means for every $100 Medicare pays, this provider initially charges $446. 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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