This provider's $5.1M in total Medicare payments ranks in the 99th percentile of Sleep Medicine providers nationally.
Their average markup ratio of 5.28x is significantly above the specialty median of 3.7x.
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 | $522.00 | $125.33 | 4.17x | $396.67 | $412.4K | 3.5K | 1.8K |
| 2015 | $679.30 | $141.28 | 4.81x | $538.02 | $543.9K | 4.2K | 2.1K |
| 2016 | $912.85 | $121.18 | 7.53x | $791.67 | $543.3K | 4.7K | 2.3K |
| 2017 | $958.61 | $132.39 | 7.24x | $826.22 | $544.1K | 4.5K | 2.5K |
| 2018 | $912.21 | $121.85 | 7.49x | $790.36 | $568.8K | 4.6K | 2.5K |
| 2019 | $1.1K | $102.84 | 11.18x | $1.0K | $554.9K | 5.2K | 2.9K |
| 2020 | $1.1K | $85.93 | 12.38x | $978.21 | $440.4K | 4.5K | 2.7K |
| 2021 | $1.2K | $134.62 | 8.83x | $1.1K | $595.4K | 4.2K | 2.5K |
| 2022 | $1.0K | $127.52 | 8.15x | $911.86 | $448.0K | 3.9K | 2.5K |
| 2023 | $1.0K | $124.62 | 8.21x | $898.35 | $484.5K | 4.2K | 2.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 9.8K | $1.0M | $102.98 | 3.79x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 3.7K | $697.5K | $190.46 | 5.69x |
| 95811 | Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube | 1.3K | $683.0K | $531.94 | 6.46x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 9.4K | $673.4K | $71.72 | 3.73x |
| 95810 | Sleep monitoring of patient (6 years or older) in sleep lab | 1.1K | $622.4K | $543.62 | 5.88x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 6.3K | $396.3K | $63.39 | 3.65x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 3.2K | $302.9K | $93.43 | 3.81x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 1.0K | $175.1K | $172.63 | 3.79x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 1.2K | $119.8K | $98.49 | 4.12x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 701 | $106.8K | $152.36 | 3.96x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 826 | $95.5K | $115.56 | 4.12x |
| 32555 | Removal of fluid from chest cavity with imaging guidance | 420 | $40.4K | $96.18 | 26.54x |
| 31652 | Examination of lung airways using an endoscope with imaging guidance and ultrasound | 198 | $39.1K | $197.57 | 19.79x |
| 31645 | Aspiration of lung secretions from lung airways using an endoscope | 469 | $38.1K | $81.17 | 17.09x |
| 36556 | Insertion of central venous catheter for infusion, patient 5 years or older | 186 | $15.7K | $84.60 | 13.17x |
| 31628 | Biopsy of one lobe of lung using an endoscope | 91 | $12.8K | $140.35 | 12.70x |
| 99239 | Hospital discharge day management, more than 30 minutes | 132 | $12.7K | $96.10 | 3.82x |
| 99442 | Physician telephone patient service, 11-20 minutes of medical discussion | 161 | $12.5K | $77.91 | 1.82x |
| 99238 | Hospital discharge day management, 30 minutes or less | 175 | $11.4K | $65.02 | 3.97x |
| 94726 | Determination of lung volumes using plethysmography | 613 | $8.7K | $14.23 | 17.06x |
This provider submits charges 5.28 times higher than what Medicare actually pays.
A markup ratio of 5.28x means for every $100 Medicare pays, this provider initially charges $528. 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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