This provider's $4.5M in total Medicare payments ranks in the 99th percentile of Sleep Medicine providers nationally.
Medicare payments to this provider grew 192% from 2014 to 2023.
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 | $706.12 | $191.45 | 3.69x | $514.67 | $172.6K | 1.0K | 711 |
| 2015 | $762.14 | $202.71 | 3.76x | $559.43 | $249.3K | 1.3K | 951 |
| 2016 | $673.03 | $173.71 | 3.87x | $499.32 | $315.9K | 1.9K | 1.2K |
| 2017 | $754.90 | $206.54 | 3.65x | $548.36 | $432.3K | 2.6K | 1.7K |
| 2018 | $600.85 | $166.84 | 3.60x | $434.01 | $533.1K | 3.5K | 2.2K |
| 2019 | $764.23 | $209.66 | 3.65x | $554.57 | $497.9K | 3.4K | 2.1K |
| 2020 | $515.01 | $141.10 | 3.65x | $373.91 | $647.9K | 9.8K | 3.5K |
| 2021 | $422.29 | $115.81 | 3.65x | $306.48 | $600.7K | 7.6K | 3.5K |
| 2022 | $484.24 | $132.82 | 3.65x | $351.42 | $578.8K | 6.6K | 3.4K |
| 2023 | $428.79 | $99.16 | 4.32x | $329.63 | $503.9K | 7.1K | 3.6K |
| 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 | 2.5K | $1.2M | $493.81 | 4.04x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 13.5K | $1.1M | $82.63 | 3.75x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 1.2K | $586.8K | $469.79 | 4.05x |
| 99454 | Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days | 9.1K | $386.9K | $42.73 | 2.22x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 2.3K | $300.3K | $128.57 | 3.33x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 2.2K | $259.0K | $115.35 | 4.06x |
| 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 | 6.4K | $237.6K | $36.93 | 1.37x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 468 | $72.0K | $153.93 | 3.89x |
| 94660 | Initiation and management of continued pressured respiratory assistance by mask or breathing tube | 1.3K | $58.8K | $47.00 | 4.07x |
| 90868 | Treatment using magnetic field to stimulate nerve cells in brain, subsequent delivery and management | 565 | $50.2K | $88.88 | 8.40x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 734 | $43.0K | $58.58 | 3.51x |
| 95819 | Measurement and recording of brain wave (eeg) activity, awake and asleep | 98 | $33.9K | $345.96 | 1.88x |
| 95800 | Sleep study including heart rate, breathing, and sleep time | 373 | $31.0K | $83.17 | 6.53x |
| 95827 | Measurement and recording of brain wave (EEG) activity, overnight | 58 | $28.5K | $491.48 | 2.50x |
| 99354 | Prolonged office or other outpatient service first hour | 263 | $26.8K | $101.85 | 2.45x |
| G2212 | Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or | 667 | $16.4K | $24.61 | 3.47x |
| 99443 | Physician telephone patient service, 21-30 minutes of medical discussion | 187 | $13.0K | $69.39 | 1.56x |
| 95972 | Electronic analysis of implanted neurostimulator generator with complex spinal cord or peripheral nerve stimulator programming | 309 | $12.9K | $41.66 | 2.16x |
| 95971 | Electronic analysis of implanted neurostimulator generator with simple spinal cord or peripheral nerve stimulator programming | 334 | $12.0K | $36.03 | 2.22x |
| 99451 | Telephone or internet assessment and management service provided by consultative physician with written report, 5 minutes or more of medical consultative discussion and review | 302 | $8.1K | $26.82 | 1.86x |
This provider submits charges 3.66 times higher than what Medicare actually pays.
A markup ratio of 3.66x means for every $100 Medicare pays, this provider initially charges $366. 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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