This provider's $15.5M 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 | $623.20 | $182.47 | 3.42x | $440.73 | $1.5M | 3.9K | 3.1K |
| 2015 | $736.78 | $198.44 | 3.71x | $538.34 | $1.5M | 3.6K | 3.0K |
| 2016 | $762.71 | $211.80 | 3.60x | $550.91 | $1.5M | 3.2K | 2.7K |
| 2017 | $798.33 | $203.38 | 3.93x | $594.95 | $1.7M | 3.9K | 3.2K |
| 2018 | $606.93 | $195.25 | 3.11x | $411.68 | $1.7M | 4.4K | 3.7K |
| 2019 | $639.38 | $202.63 | 3.16x | $436.75 | $1.7M | 3.9K | 3.2K |
| 2020 | $696.43 | $222.75 | 3.13x | $473.68 | $1.3M | 2.7K | 2.3K |
| 2021 | $605.73 | $195.76 | 3.09x | $409.97 | $1.4M | 3.9K | 3.4K |
| 2022 | $525.52 | $146.41 | 3.59x | $379.11 | $1.4M | 8.2K | 5.0K |
| 2023 | $540.57 | $157.98 | 3.42x | $382.59 | $1.8M | 19.9K | 6.3K |
| 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 | 16.0K | $8.5M | $533.28 | 3.63x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 10.6K | $5.4M | $506.27 | 3.57x |
| 99454 | Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days | 18.7K | $771.3K | $41.27 | 4.53x |
| 95807 | Sleep study attended by a technician | 749 | $172.1K | $229.82 | 1.35x |
| 95805 | Diagnostic test for sleep disorder | 419 | $148.9K | $355.27 | 3.51x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.0K | $125.8K | $61.44 | 2.13x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 1.1K | $89.4K | $78.28 | 2.80x |
| 99457 | Management using the results of remote vital sign monitoring per calendar month, first 20 minutes | 2.0K | $74.2K | $36.28 | 4.24x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 1.7K | $56.2K | $32.51 | 2.79x |
| 99202 | New patient office or other outpatient visit, typically 20 minutes | 744 | $40.4K | $54.33 | 2.69x |
| G0399 | Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation | 433 | $38.1K | $88.05 | 5.28x |
| 99453 | Remote monitoring of physiologic parameters, initial set-up and patient education on use of equipment | 2.4K | $35.8K | $14.94 | 12.39x |
| 94660 | Initiation and management of continued pressured respiratory assistance by mask or breathing tube | 252 | $11.5K | $45.77 | 2.62x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 83 | $7.2K | $86.65 | 1.64x |
| 95806 | Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort | 87 | $3.3K | $38.45 | 9.15x |
| 99211 | Established patient office or other outpatient visit, typically 5 minutes | 88 | $1.4K | $15.65 | 2.57x |
| 98966 | Telephone assessment and management service, 5-10 minutes of medical discussion | 76 | $847.93 | $11.16 | 4.48x |
This provider submits charges 3.63 times higher than what Medicare actually pays.
A markup ratio of 3.63x means for every $100 Medicare pays, this provider initially charges $363. 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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