Cost analysis for CPT 95811 — Sleep study in sleep lab with continuous airway pressure (6 years or older)
Average Medicare Payment
$219.00
2023 data
Total Payments (2023)
$46.8M
Services (2023)
191.1K
Price Change (2014–2023)
-5.2%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $230.97 | $96.2M | 389.7K | — |
| 2015 | $231.83 | $98.1M | 394.3K | +0.4% |
| 2016 | $226.78 | $99.7M | 402.7K | -2.2% |
| 2017 | $226.11 | $97.6M | 392.7K | -0.3% |
| 2018 | $226.64 | $94.7M | 378.2K | +0.2% |
| 2019 | $225.76 | $89.3M | 356.3K | -0.4% |
| 2020 | $229.46 | $49.4M | 194.5K | +1.6% |
| 2021 | $230.76 | $53.0M | 203.9K | +0.6% |
| 2022 | $223.94 | $48.6M | 192.6K | -3.0% |
| 2023 | $219.00 | $46.8M | 191.1K | -2.2% |
The most expensive state pays 4.7x more than the cheapest for this procedure. NV averages $430.01 vs SD at $91.22.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| NV | $430.01 | $1.2M | 2.7K | 27 |
| CA | $421.87 | $6.8M | 16.2K | 241 |
| AK | $402.42 | $256.3K | 637 | 18 |
| DC | $386.88 | $171.0K | 442 | 11 |
| PR | $380.17 | $112.2K | 295 | 9 |
| MD | $365.64 | $1.4M | 3.7K | 73 |
| DE | $362.09 | $285.7K | 789 | 17 |
| AZ | $350.69 | $1.8M | 5.2K | 69 |
| WY | $345.84 | $71.9K | 208 | 3 |
| FL | $329.02 | $4.5M | 13.6K | 241 |
| RI | $328.93 | $72.4K | 220 | 7 |
| NY | $304.12 | $1.7M | 5.7K | 139 |
| HI | $302.31 | $170.5K | 564 | 8 |
| VA | $299.38 | $1.7M | 5.8K | 111 |
| OR | $288.49 | $782.1K | 2.7K | 47 |
| NC | $255.64 | $1.5M | 5.8K | 122 |
| GA | $252.90 | $914.5K | 3.6K | 86 |
| MT | $252.64 | $348.6K | 1.4K | 13 |
| TX | $251.35 | $3.9M | 15.4K | 247 |
| NJ | $239.50 | $723.3K | 3.0K | 86 |
| NM | $229.35 | $393.1K | 1.7K | 21 |
| SC | $228.88 | $1.0M | 4.4K | 62 |
| TN | $228.11 | $1.3M | 5.7K | 91 |
| WA | $219.30 | $792.8K | 3.6K | 74 |
| MI | $215.23 | $1.2M | 5.6K | 120 |
| UT | $214.34 | $621.4K | 2.9K | 33 |
| CT | $207.38 | $228.3K | 1.1K | 33 |
| IL | $206.65 | $1.9M | 9.1K | 175 |
| MS | $204.21 | $632.7K | 3.1K | 38 |
| MN | $200.84 | $466.7K | 2.3K | 78 |
| MA | $199.61 | $629.6K | 3.2K | 81 |
| CO | $199.11 | $880.7K | 4.4K | 48 |
| WV | $196.65 | $245.4K | 1.2K | 30 |
| LA | $186.22 | $483.6K | 2.6K | 46 |
| AL | $179.71 | $797.0K | 4.4K | 72 |
| IA | $177.11 | $548.5K | 3.1K | 30 |
| KS | $172.44 | $366.8K | 2.1K | 33 |
| PA | $166.52 | $1.1M | 6.4K | 148 |
| OH | $156.03 | $1.1M | 7.3K | 157 |
| ND | $148.52 | $172.0K | 1.2K | 11 |
| AR | $143.37 | $390.7K | 2.7K | 29 |
| VT | $137.94 | $34.2K | 248 | 5 |
| ID | $137.37 | $157.4K | 1.1K | 22 |
| MO | $136.47 | $639.9K | 4.7K | 87 |
| IN | $130.12 | $586.7K | 4.5K | 87 |
| OK | $129.85 | $563.2K | 4.3K | 41 |
| KY | $126.09 | $321.4K | 2.5K | 54 |
| ME | $121.69 | $74.6K | 613 | 14 |
| WI | $119.68 | $349.6K | 2.9K | 70 |
| NE | $119.23 | $207.1K | 1.7K | 24 |
| NH | $92.76 | $84.7K | 913 | 21 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Mehrdad Razavi | Sleep Medicine | CA | $604.7K | 1.2K | $522.62 |
| Thomas Minor | Pulmonary Disease | CO | $253.0K | 657 | $385.10 |
| Tate Grimes | Sleep Medicine | TX | $251.1K | 925 | $271.51 |
| California Sleep Solutions, Llc | Independent Diagnostic Testing Facility (IDTF) | CA | $229.6K | 845 | $271.71 |
| Fred Mcleod | Otolaryngology | AL | $218.4K | 559 | $390.75 |
| Gonzalo Diaz | Pulmonary Disease | TX | $198.7K | 425 | $467.57 |
| Total Sleep Management Inc | Independent Diagnostic Testing Facility (IDTF) | FL | $192.6K | 513 | $375.40 |
| United Sleep Diagnostics Inc | Independent Diagnostic Testing Facility (IDTF) | NY | $188.1K | 382 | $492.51 |
| Nocturna Sleep Center, Llc | Independent Diagnostic Testing Facility (IDTF) | NV | $172.4K | 350 | $492.60 |
| Alan Steljes | Cardiology | NV | $160.6K | 324 | $495.63 |
| Everett Trevor | Pulmonary Disease | CA | $159.1K | 300 | $530.19 |
| Yash Mehndiratta | Neurology | MD | $157.0K | 268 | $585.64 |
| Syed Sayeeduddin | Sleep Medicine | IL | $155.5K | 301 | $516.51 |
| William Noah | Sleep Medicine | TN | $154.4K | 350 | $441.13 |
| Sleep Associates Llc | Independent Diagnostic Testing Facility (IDTF) | OK | $147.8K | 336 | $439.79 |
| Advocate Health And Hospitals Corporation | Independent Diagnostic Testing Facility (IDTF) | IL | $146.9K | 324 | $453.53 |
| Paul Moore | Neurology | TX | $145.9K | 290 | $503.17 |
| Kaleyathodi Bhat | Allergy/ Immunology | CA | $143.3K | 230 | $622.85 |
| Rachakonda Prabhu | Pulmonary Disease | NV | $143.2K | 306 | $467.86 |
| Melisa Coaker | Sleep Medicine | IA | $133.5K | 647 | $206.33 |
The data suggests significant pricing inconsistencies for CPT 95811. With a 4.7x price gap between the most and least expensive states, geography plays an outsized role in what Medicare pays for this procedure.
While costs have decreased 5.2% since 2014, the wide state-by-state variation suggests the pricing formula may not adequately account for regional differences.
This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.