95810

Sleep study in sleep lab (6 years or older)

Medicare pricing data for 6,338 providers across 52 states

🤖AI Overview

Prices vary significantly by location — from $117 in New Hampshire to $565 in Alaska. 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 in sleep lab (6 years or older) (HCPCS code 95810) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $302.29, but hospitals typically charge $1,174 — a 3.9x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$60.46

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $302.29, your out-of-pocket cost would be approximately $60.46. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$302.29
Average Hospital Charge
$1,174
Markup Ratio
3.9x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,173.55
Medicare Allowed$302.29
Medicare Payment$234.72

Hospitals charge 3.9x more than what Medicare allows for this procedure. Medicare actually pays $234.72 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$565$3,70422723+86.8%
Nevada$517$1,681582,251+71.0%
District of Columbia$512$1,11517636+69.5%
California$499$1,89337816,306+65.2%
Wyoming$446$1,2714142+47.7%
Hawaii$441$1,40114298+45.9%
Puerto Rico$427$44513112+41.4%
Arizona$423$1,6881034,213+39.8%
Delaware$419$2,249311,140+38.7%
Maryland$412$1,3401174,702+36.2%
Florida$390$1,21245614,908+28.9%
Virginia$369$1,1121776,719+22.0%
Rhode Island$345$1,16915269+14.0%
Oregon$340$1,067742,257+12.4%
Montana$339$948281,071+12.1%
New York$335$1,6103147,491+10.7%
Minnesota$327$1,3011322,426+8.1%
Utah$315$909501,864+4.3%
Texas$313$1,22746714,013+3.6%
Georgia$313$1,1841904,405+3.4%
North Carolina$306$1,1262556,985+1.1%
Washington$293$9491404,224-3.2%
New Mexico$292$1,303281,138-3.5%
South Carolina$284$1,0941184,564-6.2%
New Jersey$283$1,7092023,607-6.4%
Tennessee$267$1,1441575,843-11.5%
Massachusetts$263$9201584,076-13.0%
Illinois$262$1,3163228,384-13.4%
Connecticut$259$1,238761,924-14.2%
Iowa$245$973441,805-18.8%
Michigan$244$7072405,066-19.3%
West Virginia$239$972611,180-21.0%
Mississippi$238$1,425562,896-21.4%
Colorado$226$648922,273-25.3%
Louisiana$223$960692,266-26.3%
Vermont$220$2,06610295-27.2%
Kansas$215$939491,413-28.9%
Alabama$199$6141063,859-34.1%
Idaho$194$524481,020-35.7%
Pennsylvania$186$6473056,687-38.4%
Missouri$184$7881713,829-39.1%
North Dakota$182$58818926-39.7%
Arkansas$179$678462,678-40.7%
Ohio$170$8503167,586-43.9%
Indiana$167$7351584,803-44.6%
Maine$167$51925696-44.7%
Oklahoma$160$415593,018-47.0%
Kentucky$159$6611112,330-47.5%
Nebraska$152$43036852-49.6%
Wisconsin$149$1,5341442,584-50.9%
South Dakota$123$44821845-59.3%
New Hampshire$117$709321,043-61.4%

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

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