95800

Sleep study including heart rate, breathing, and sleep time

Medicare pricing data for 3,601 providers across 49 states

🤖AI Overview

Prices vary significantly by location — from $39 in Vermont to $176 in Florida. Where you get this procedure matters more than almost any other factor. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Sleep study including heart rate, breathing, and sleep time (HCPCS code 95800) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $133.93, but hospitals typically charge $432.46 — a 3.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$26.79

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $133.93, your out-of-pocket cost would be approximately $26.79. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$133.93
Average Hospital Charge
$432.46
Markup Ratio
3.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$432.46
Medicare Allowed$133.93
Medicare Payment$100.64

Hospitals charge 3.2x more than what Medicare allows for this procedure. Medicare actually pays $100.64 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Florida$176$42219720,692+31.1%
Maryland$169$36914428,527+26.5%
Connecticut$155$54428479+15.9%
California$149$73624013,661+10.9%
Alaska$146$1,01625393+9.3%
Nevada$144$604551,597+7.9%
Delaware$136$355211,119+1.5%
District of Columbia$133$44417278-0.9%
New York$130$6152636,530-2.6%
Alabama$130$428522-2.8%
Virginia$130$467972,980-3.1%
Illinois$128$24021012,402-4.2%
Arizona$127$3721223,364-5.1%
Rhode Island$127$2764668-5.3%
Oklahoma$126$23619973-5.9%
Montana$124$351786-7.2%
New Mexico$121$4838327-9.8%
South Carolina$119$44446901-11.3%
Missouri$118$348371,951-12.0%
Texas$117$44249215,056-12.5%
Mississippi$111$75531827-17.1%
West Virginia$108$440447-19.3%
Colorado$104$338822,484-22.0%
North Carolina$104$373521,008-22.3%
Pennsylvania$103$3852276,383-23.0%
New Jersey$100$4801805,478-25.1%
Iowa$99$447361,409-25.7%
Massachusetts$99$453746,447-25.8%
Nebraska$99$22117693-26.0%
Minnesota$98$51389699-27.2%
Tennessee$97$30133800-27.5%
Oregon$96$399511,127-28.5%
Louisiana$94$558981,773-30.0%
Ohio$92$59531591-31.7%
Georgia$91$3472055,155-32.0%
Michigan$90$248721,171-32.9%
Kentucky$88$24917146-34.2%
Kansas$87$34722981-34.8%
Utah$85$43413147-36.7%
North Dakota$71$2146255-47.2%
Wisconsin$69$622501,460-48.3%
Idaho$66$28712183-50.6%
Washington$65$22741730-51.8%
Indiana$53$194641,100-60.4%
Arkansas$49$15917261-63.4%
New Hampshire$45$300874-66.8%
Maine$42$2419330-68.7%
Hawaii$40$1123141-70.2%
Vermont$39$259128-70.6%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber