What does a sleep study cost in Ohio?

The figure on a hospital chargemaster, a cash-pay shopping site, and a Medicare remittance are three different numbers. None of them is Westerville Sleep Center’s fee. Use the public amounts below to ask your plan a precise question, then call the office to confirm what you will owe.

What does Medicare actually pay for a sleep study?

Medicare Part B covers Type I, II, III, and IV sleep tests when you have clinical signs and symptoms of sleep apnea and a doctor or other qualified clinician orders the test. After you meet the Part B deductible, you pay 20 percent of the Medicare-approved amount if the provider accepts assignment. Type I studies are covered only when they are done in a sleep lab facility. Medicare.gov is explicit that what you owe also depends on other insurance, whether the clinician accepts assignment, the type of facility, and where the test is done. Ask the ordering clinician what Medicare will cover for the specific code on the order.

The American Academy of Sleep Medicine publishes a national payment comparison that converts relative value units with CMS conversion factors. For calendar year 2025 the conversion factor in that table is $32.3465. The global (combined technical plus professional) national allowed amounts are:

• CPT 95810, attended polysomnography, age 6 or older, sleep staging plus four or more additional parameters: $608.44.
• CPT 95811, the same study with PAP titration: $637.23.
• CPT 95806, unattended sleep study with respiratory effort: $93.16.
• CPT 95800, a different unattended sleep-study code: $124.53.

Those are national allowed amounts, not billed charges and not this office’s cash price. The professional component (modifier 26) for 95810 is $112.24 in the same table; the technical component (modifier TC) is $496.20. For 95811 the split is $117.09 professional and $520.13 technical. For 95806 it is $41.73 professional and $51.43 technical. Geographic practice-cost indices can move the Ohio payment off the national number. A hospital outpatient department, an independent lab, and a physician office also sit on different fee-schedule lines. Treat $608.44 as a CMS national yardstick, not an invoice.

If a clinician accepted assignment on a 95810 claim whose allowed amount happened to equal that national figure, Part B coinsurance would be 20 percent of $608.44, about $122, plus any unmet deductible. That arithmetic is an illustration of the coinsurance rule. It is not a quote from Pulmonary and Sleep Consultants, LLC, and it is not a promise that your explanation of benefits will print that number.

Why is a hospital chargemaster not an office fee?

A chargemaster is the hospital’s list of gross charges. Insurers negotiate a different rate. Self-pay patients sometimes see a discount off the list, sometimes not. The same CPT code in a health-system sleep lab can carry facility fees, a separate professional interpretation, and overnight staffing that a physician office does not bill the same way. Comparing a Mount Carmel or OhioHealth chargemaster line to a Westerville office visit is comparing two products.

Sidecar Health’s public Ohio table for a generic “sleep study” lists several Columbus-area hospitals in a cash band of $822 to $902, including Riverside Methodist Hospital, Grant Medical Center, and Doctors Hospital. Grady Memorial Hospital in Delaware and Dublin Methodist Hospital sit in that same band. Other Ohio hospitals on the same page run from $342 to $422 at one Bryan location up to $982 to $1,063 at Holzer in Gallipolis. Sidecar’s statewide average cash price on that page is $777, with a displayed range of $342 to $1,063. Those figures mix codes and facilities. Confidence in them as a true Ohio median is low. They are still useful as a reminder that a hospital cash listing is not an independent-practice fee.

MDsave’s Ohio marketplace for “Sleep Study (Polysomnography) with CPAP Therapy” showed $1,541 to $2,003 when this page was researched. The listings on that product page were Knox Community Hospital in Mount Vernon, several Mercy Health sleep centers in the Cincinnati region, and Pomerene Hospital in Millersburg. Westerville Sleep Center is not on that list. MDsave is a bundled cash product for people paying out of pocket. It is not Medicare’s allowed amount, and it is not what a commercially insured patient pays after deductible and coinsurance.

If a friend quotes a four-thousand-dollar “sleep study” from a hospital bill, ask whether that was the chargemaster, the allowed amount, or the patient responsibility after insurance. Those three lines are often an order of magnitude apart. For how this practice handles plan checks, see insurance and costs.

What do cash-pay sites show for Ohio, and how much should I trust them?

Cash aggregators scrape or contract for self-pay rates. They do not audit every lab. They often label a service “sleep study” without separating a Type III home test from a full attended polysomnography, and they rarely separate the interpretation from the recording. The Ohio Sidecar range of about $350 to $1,100 (the page’s $342 to $1,063) should be read as a low-confidence shopping band, not a market survey you can take to a bank. MDsave’s higher $1,541 to $2,003 band is specific to a PSG-with-CPAP product at the hospitals that posted it.

This practice does not publish a cash menu on the website. A number you see on Sidecar, MDsave, or a hospital price-transparency file is not Westerville Sleep Center’s price. If you are uninsured, on a high-deductible plan, or paying cash on purpose, call (614) 898-9340 and ask the office for the fee that applies to the test the physician actually orders. Bring the CPT code if you have one. Do not assume the home-test code and the in-lab code cost the same.

How much will I pay if I have insurance?

For Original Medicare, the patient share on a covered sleep study is the Part B deductible (if unmet) plus 20 percent of the approved amount when the clinician accepts assignment. Medigap or other secondary coverage may pick up some or all of that coinsurance. Medicare Advantage plans must cover at least what Original Medicare covers, but they often add prior authorization, network rules, and a copay that is not 20 percent. Commercial PPO, HMO, and employer plans vary by group. Many require prior authorization for attended codes 95810 and 95811, and many prefer a home test first in uncomplicated suspected obstructive apnea.

Prior authorization is not the same as a referral, and it is not a quote. Approval means the plan agrees the test meets its medical-necessity rule if the claim is billed as described. You can still owe deductible, copay, or coinsurance. Logos on a clinic website are not proof of a live contract for your employer group. Confirm the plan with the office before you treat a logo as a guarantee.

Ohio Medicaid managed-care products and commercial HMOs often want the test approved before the night of recording. If the plan denies an attended study because it wanted a home test first, that is a coverage rule, not a clinical insult. The American Academy of Sleep Medicine’s 2017 diagnostic guideline still treats attended polysomnography as the standard test and allows a technically adequate home sleep apnea test in uncomplicated adults who already look like they have a high chance of moderate to severe obstructive apnea. A negative, inconclusive, or technically inadequate home test is supposed to be followed by in-lab polysomnography. Your plan’s algorithm and the guideline are not always identical. Ask which rule the authorization desk is using.

Does a home test cost less than a night in the lab?

On the Medicare physician fee schedule, yes, by a wide margin: the 2025 national global allowed amount for unattended 95806 is $93.16, versus $608.44 for attended 95810. That gap is why plans push home testing. It is not a reason to force a home test on someone who needs a lab night. Significant heart or lung disease, neuromuscular weakness, suspected hypoventilation, chronic opioid use, prior stroke, severe insomnia, and other sleep disorders that a Type III device cannot score are reasons the 2017 guideline recommends polysomnography rather than a home test.

Medicare often wants home tests billed with HCPCS G0398, G0399, or G0400 rather than CPT 95806. Commercial payers more often accept 95806 or 95800. The code on the claim changes the allowed amount. A patient who compares a G-code remittance to a 95810 hospital bill is comparing different services. For what the night itself involves, and who should not use a home device, start with home and in-lab sleep testing.

A split-night study (diagnosis plus PAP titration in one admission) bills under 95811 when PAP is used. The national allowed amount is only about $29 above diagnostic 95810. The patient still spends a night in the lab. The cheaper path, when it is clinically appropriate, is a home test plus a later titration if obstructive apnea is confirmed. The more expensive path is not a scam. It is the test that can score sleep stages, limb movements, and hypoventilation that a belt-and-cannula device misses.

How should I check my own cost before I schedule?

Call the number on your insurance card. Ask whether the specific CPT or G-code needs prior authorization, whether a home test is required first, what your remaining deductible is, and whether the sleep physician and the lab are in network as two separate questions. Then call the office at (614) 898-9340 with the same codes so staff can tell you whether this practice can bill them and what, if anything, they can estimate. Hours and the Suite 230 address are on the contact page. An estimate is not a final bill. Facility, interpretation, and DME (if a machine is dispensed later) can arrive on separate statements.

Bring the order, if another clinician already wrote one, to your appointment. Testing is ordered after a sleep-medicine evaluation when it is indicated; a website cannot quote a study you have not been prescribed. If you already had a study elsewhere, bring the report so you are not paying twice for the same night of data.

Do not use a dollar figure from this article as “what Westerville Sleep Center charges.” The CMS 2025 national amounts, the Sidecar Ohio cash band, and the MDsave PSG-with-CPAP range are public reference points. Your responsibility is the number on your plan’s authorization and this office’s itemized statement. Verify both before you treat a blog post as a price list.