G0398

Home sleep study test (hst) with type ii portable monitor, unattended; minimum of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort and oxygen saturation

Medicare pricing data for 298 providers across 29 states

🤖AI Overview

Prices vary significantly by location — from $35 in Nebraska to $379 in Massachusetts. Where you get this procedure matters more than almost any other factor. This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. 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

Home sleep study test (hst) with type ii portable monitor, unattended; minimum of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort and oxygen saturation (HCPCS code G0398) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $132.74, but hospitals typically charge $459.26 — a 3.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$26.55

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $132.74, your out-of-pocket cost would be approximately $26.55. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$132.74
Average Hospital Charge
$459.26
Markup Ratio
3.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$459.26
Medicare Allowed$132.74
Medicare Payment$101.68

Hospitals charge 3.5x more than what Medicare allows for this procedure. Medicare actually pays $101.68 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Massachusetts$379$700122+185.4%
New Hampshire$298$5942596+124.7%
Ohio$256$5219339+92.5%
Illinois$207$3413197+56.3%
Wisconsin$201$1,195238+51.1%
Wyoming$167$233126+26.1%
Georgia$161$693749+21.4%
Arizona$155$43318233+16.8%
Michigan$155$360614+16.7%
California$151$1,07021618+13.7%
Maryland$149$384436+12.5%
Virginia$149$492187+12.2%
Pennsylvania$149$65725254+11.9%
Florida$146$52714868+9.8%
Alabama$144$321222+8.2%
Texas$144$40717494+8.1%
South Carolina$137$3117114+3.5%
Louisiana$135$539312+1.5%
Iowa$118$396261-11.2%
Utah$116$4342100-12.9%
New Jersey$114$2529444-14.3%
West Virginia$113$597753-14.8%
New York$102$20535450-23.3%
New Mexico$71$140166-46.1%
North Carolina$55$25434806-58.9%
Indiana$46$1728265-65.7%
Arkansas$42$221852-68.2%
Idaho$39$163216-70.5%
Nebraska$35$406124-73.5%

⚠️ 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