Sleep Medicine reimbursement rates by service line
Compare payer-published sleep medicine benchmarks for sleep testing; office visits; pulmonary context; DME context.
Compare national sleep medicine rates by payer
Use the reference codes to compare payer benchmarks, then explore sleep testing; office visits; pulmonary context; DME context. Each rate represents a specific billing code and comparison cohort, rather than a complete episode of care.
Aetna state variation for 95810
National 95810 rate distribution
Each marker shows the national median published rate across billing entities for that payer.
National 95810 rates by payer
| Payer | Rate period | Provider entities | P25 | Median | P75 | P90 | Average |
|---|---|---|---|---|---|---|---|
| Aetna | Jun–Jul 2026 | 5,993 | $786 | $883.45 | |||
| Cigna | Jun–Jul 2026 | 6,402 | $949.90 | $1,094.42 | |||
| United | Jun–Jul 2026 | 6,716 | $947.75 | $1,069.55 | |||
| Anthem | Jun–Jul 2026 | 5,139 | $990.91 | $1,316.70 |
- Source
- Negotiated or fee-schedule amounts published directly by payers in their machine-readable files.
- Rate shown
- Published commercial rate for overnight polysomnography, age 6 or older (95810).
- Method
- Eligible rates are grouped by payer and billing entity so the benchmarks use a consistent service and billing basis.
The state map uses one consistent Aetna reference series; it does not average already-aggregated payer values. The service-line table keeps unlike codes, settings, and billing units in separate comparisons.
How do specific sleep medicine providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
National: Sleep Medicine provider benchmarks (CPT 95810)
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|---|---|---|---|---|
| CAMILO RUIZ DO PANPI 1063664696 · Tax ID 270265223 | FL | 2 | $492.22 | -$293.79 | Below P25 |
| BAPTIST EASLEY HOSPITALNPI 1245431105 · Tax ID 352363050 | MT | 473 | $604.29 | -$181.71 | Below P25 |
| PRIME MEDICAL GROUP PCNPI 1861615452 · Tax ID 320112688 | MI | 19 | $654.57 | -$131.43 | P25 to median |
| PULMONARY AND SLEEP OFFICE OF NEW ENGLAND PCNPI 1225159932 · Tax ID 208448581 | RI | 7 | $763.14 | -$22.86 | P25 to median |
| ROY SLEEP MEDICINE INCNPI 1295077261 · Tax ID 462199325 | AL | 25 | Median to P75 | ||
| UMASS MEMORIAL HEALTH CARE INCNPI 1033735428 · Tax ID 042911067 | MA | 5,674 | Above P75 |
Choose one state to replace the mixed-state examples with payer-specific provider rates across all three preview codes.
No trial or data preparation required.Explore sleep medicine services
Compare codes within the same billing context. A reported billing unit may describe a timed service, supply quantity, daily service or procedure; it does not always mean one visit.
| Service line / billing code | Aetna | Cigna | United | Anthem |
|---|---|---|---|---|
$ per reported billing unit · 7 codes | ||||
99214Established patient office visit, level 4 | $120.81 | $153.90 | $168.34 | $160.07 |
99213Established patient office visit, level 3 | $82.54 | $105.68 | $116.26 | $113.07 |
99204New patient office visit, level 4 | $173.81 | $222.06 | $247.80 | $240.21 |
99215Established patient office visit, level 5 | $169.37 | $218.57 | $229.28 | $225.18 |
99203New patient office visit, level 3 | $112.02 | $143.11 | $165.01 | $156 |
99205New patient office visit, level 5 | $226.09 | $289.27 | $317.67 | $308.55 |
99212Established patient office visit, level 2 | $49.30 | $62.72 | $71.41 | $67.97 |
$ per reported billing unit · 8 codes | ||||
94729Gas Transfer Ability Test | $76.29 | $96.69 | $93.71 | $107.68 |
95810Overnight polysomnography, age 6 or older | $883.45 | $1,094.42 | $1,069.55 | $1,316.70 |
95800Sleep Study | $219.35 | $275.84 | $282.91 | $349.01 |
94060Bronchodilator responsiveness | $65.37 | $82.92 | $91.27 | $99.56 |
95806Unattended sleep study | $174.04 | $220.04 | $218.51 | $313.79 |
95811Polysomnography with CPAP or bilevel ventilation, age 6 or older | $930.40 | $1,151.26 | $1,128 | $1,400.41 |
94726Whole-Body Air Volume Test | $73.95 | $94.81 | $90.77 | $106.18 |
94010Spirometry | $41.69 | $52.78 | $55.76 | $62.05 |
$ per reported rental amount · 1 code | ||||
E0601Continuous positive airway pressure (CPAP) device | $128.02 | $58.87 | $52.85 | $93.15 |
$ per reported supply amount · 3 codes | ||||
A7032Cushion for use on nasal mask interface | $22.20 | $16.62 | $21.54 | $26.80 |
A7033Pillow for use on nasal cannula type interface | $16.46 | $13.37 | $16.06 | $21.07 |
A7031Face mask interface | $37.86 | $30.06 | $36.01 | $48.04 |
$ per reported billing unit · 1 code | ||||
G0399Home sleep test (HST) with type III portable monitor | $171.93 | $99.20 | $279.46 | $259.26 |
Tell us the services, payers, states, and networks you need. We'll confirm available coverage and scope the comparison on a 20-minute call.
Book a 20-min scoping call No trial or data preparation required.How to interpret these benchmarks
Payer-published rates provide market context. They do not establish a practice's contracted rate or the total cost of care.
- Source and periodRates come from the specialty's national report. The displayed period follows the processed data included in the latest published snapshot and updates when that snapshot is refreshed.
- Comparable ratesComparisons use positive professional fee-for-service negotiated and fee-schedule dollar amounts. Percentages, bundled arrangements and per-diem rate types are excluded. Modifier cohorts and code-specific amounts remain separate.
- CalculationRates are reduced to one modal value per NPI and TIN entity, averaging tied modes. Two percent per tail is targeted for trimming while keeping boundary ties. Benchmarks require at least 10 included entities and are not weighted by patient volume.
- CoverageNational report coverage does not guarantee every payer or state is available for every code. Anthem represents the displayed Anthem cohort, rather than all regional Blue plans. Missing benchmarks are not zero rates.
- Billing contextMatch the exact code, billing unit, modifier, setting and network. Equipment rentals and supplies require their own interval and quantity checks. Professional rates exclude facility charges; anesthesia conversion factors are outside these comparisons.
Get the sleep medicine reimbursement data you're looking for
Choose the services, payers, states, networks, and provider entities relevant to your question. We'll confirm the available coverage and prepare the comparison.
- Tell us your marketShare the specialty, geography, payers, networks, and providers.
- We find comparable ratesPayerPrice aligns billing codes, services, settings, and units.
- Get your market viewSee relevant payer and provider rates organized around your question.
We'll tell you what the data can support, where the gaps are, and the clearest way to structure the comparison.
Trusted by teams that need defensible reimbursement data
Explore sleep medicine rates by state
Choose a state to compare payer reference averages for common services.
Questions about sleep medicine benchmarks
How to interpret the selected market and payer-published rates.
What does the national benchmark compare?
The headline uses Overnight polysomnography, age 6 or older (95810). The other reference codes and service lines provide separate comparisons rather than combining unlike services.
Why is a payer or state missing?
A benchmark appears only when the selected code and cohort meet the publication rules, including at least 10 entities after trimming. Report-wide coverage can be broader than an individual comparison.
Will the reporting period change?
Yes. The period displayed with the benchmark follows the processed source data when the publication snapshot is refreshed.