This provider's $3.5M 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 | $359.32 | $86.10 | 4.17x | $273.22 | $333.3K | 2.7K | 1.7K |
| 2015 | $357.12 | $89.06 | 4.01x | $268.06 | $330.2K | 2.6K | 1.6K |
| 2016 | $363.93 | $90.48 | 4.02x | $273.45 | $338.1K | 3.1K | 2.2K |
| 2017 | $392.20 | $89.87 | 4.36x | $302.33 | $370.0K | 3.1K | 2.1K |
| 2018 | $404.86 | $89.02 | 4.55x | $315.84 | $358.0K | 3.0K | 1.8K |
| 2019 | $346.84 | $84.96 | 4.08x | $261.88 | $406.8K | 3.4K | 2.2K |
| 2020 | $365.24 | $90.10 | 4.05x | $275.14 | $338.9K | 2.9K | 1.7K |
| 2021 | $346.61 | $89.49 | 3.87x | $257.12 | $341.5K | 3.1K | 1.9K |
| 2022 | $320.43 | $77.82 | 4.12x | $242.61 | $355.5K | 4.0K | 2.2K |
| 2023 | $336.00 | $79.02 | 4.25x | $256.98 | $308.6K | 3.7K | 1.8K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 6.8K | $1.3M | $191.35 | 4.53x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 1.1K | $282.9K | $264.16 | 6.60x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 3.1K | $275.6K | $89.19 | 5.11x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 916 | $232.4K | $253.75 | 6.40x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 2.4K | $220.3K | $91.87 | 3.05x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 3.5K | $213.9K | $61.85 | 3.67x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 678 | $114.4K | $168.72 | 2.83x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 716 | $100.1K | $139.84 | 2.17x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 1.0K | $80.2K | $76.74 | 2.38x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.3K | $80.1K | $62.79 | 2.90x |
| 99310 | Subsequent nursing facility visit, typically 35 minutes per day | 637 | $73.7K | $115.69 | 2.16x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 509 | $63.9K | $125.62 | 2.91x |
| 99292 | Critical care delivery critically ill or injured patient | 529 | $52.2K | $98.74 | 3.43x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 396 | $45.3K | $114.37 | 2.59x |
| 99457 | Management using the results of remote vital sign monitoring per calendar month, first 20 minutes | 927 | $37.7K | $40.68 | 3.69x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 319 | $34.7K | $108.88 | 2.15x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 251 | $32.3K | $128.69 | 2.55x |
| 99454 | Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days | 589 | $25.3K | $42.90 | 3.50x |
| 94729 | Measurement of lung diffusing capacity | 881 | $25.1K | $28.49 | 5.73x |
| 94060 | Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration | 883 | $24.9K | $28.19 | 6.25x |
This provider submits charges 4.33 times higher than what Medicare actually pays.
A markup ratio of 4.33x means for every $100 Medicare pays, this provider initially charges $433. 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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