Other · 0436T

Programming Evaluation Of Implanted Neurostimulator Pulse Generator System For Central Sleep Apnea During Sleep Study

What Medicare pays for 0436T, what providers bill, and how the price varies across 0 states, drawn from CMS 2023 claims data.

0436T · the short answer

For programming evaluation of implanted neurostimulator pulse generator system for central sleep apnea during sleep study, Medicare pays about $40.85 while providers bill $1,107.65 on average, a 27.1× markup, one of the steepest markups in the catalog.

Medicare pays
$40.85
Providers bill
$1,107.65
Markup
27.1×
Markup percentile
100th

Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.

Medicare Payment (avg)
$40.85
What Medicare actually pays
Billed Charge (avg)
$1,107.65
What providers submit
Markup
27.1x
2611% above Medicare rate
17
Total Services
14
Beneficiaries
9
Providers
0
States with Data

What You Might Pay

Est. Commercial Insurance
$114.72
Range: $80.30 – $160.61
Est. Cash / Self-Pay
$343.01
Typical self-pay discount

Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.

How we estimate these prices

These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Other procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.

Where this markup sits nationally

Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate

27 Among the most affordable more affordable than 99% of 8,901 procedures

1–2: 466 procedures (5%). Below this entry. 2–3: 681 procedures (8%). Below this entry. 3–4: 845 procedures (9%). Below this entry. 4–5: 1,308 procedures (15%). Below this entry. 5–6: 1,725 procedures (19%). Below this entry. 6–7: 1,217 procedures (14%). Below this entry. 7–8: 801 procedures (9%). Below this entry. 8–9: 541 procedures (6%). Below this entry. 9–10: 351 procedures (4%). Below this entry. 10–11: 246 procedures (3%). Below this entry. 11–12: 151 procedures (2%). Below this entry. 12–13: 175 procedures (2%). Below this entry. 13–14: 140 procedures (2%). Below this entry. 14–15: 40 procedures (0%). Below this entry. 15–16: 39 procedures (0%). Below this entry. 16–17: 26 procedures (0%). Below this entry. 17–18: 25 procedures (0%). Below this entry. 18–19: 21 procedures (0%). Below this entry. 19–20: 12 procedures (0%). Below this entry. 20–21: 16 procedures (0%). Below this entry. 21–22: 13 procedures (0%). Below this entry. 22–23: 8 procedures (0%). Below this entry. 23–24: 9 procedures (0%). Below this entry. 24–25: 4 procedures (0%). Below this entry. 25–26: 3 procedures (0%). Below this entry. 26–27: 3 procedures (0%). Below this entry. 27–28: 4 procedures (0%). This entry sits in this band. 28–29: 3 procedures (0%). Above this entry. 29–30: 2 procedures (0%). Above this entry. 30–31: 26 procedures (0%). Above this entry. this procedure 1 31 × markup, bucketed by value

Each bar is a band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.

Source CMS Medicare Physician & Other Practitioners · 2023

What the Data Says About Programming Evaluation Of Implanted Neurostimulator Pulse Generator System For Central Sleep Apnea During Sleep Study

Across 0 states with reporting providers, CPT code 0436T (Programming Evaluation Of Implanted Neurostimulator Pulse Generator System For Central Sleep Apnea During Sleep Study) shows a national average Medicare payment of $40.85 against an average billed charge of $1,107.65. That gap, a 27.1x markup, or 2611% above the Medicare allowed amount, sits among the widest billed-to-paid spreads we track, the kind of chargemaster pricing almost no payer, insured or cash, actually honors in full.

Other procedures like this one saw 17 services billed to Medicare in 2023 by 9 distinct providers, serving 14 unique beneficiaries. Regional variation is limited in the underlying CMS file. Where state-level figures exist for programming evaluation of implanted neurostimulator pulse generator system for central sleep apnea during sleep study, Geographic Practice Cost Indices (GPCIs), local malpractice premiums, and practice-expense adjustments are the usual drivers of any difference.

Applying RAND 2024 commercial-to-Medicare ratios specific to the Other category (2.24x), the estimated commercial insurance price lands near $114.72, with self-pay cash discounts commonly bringing the figure closer to $343.01. Within Other, Programming Evaluation Of Implanted Neurostimulator Pulse Generator System For Central Sleep Apnea During Sleep Study ranks #107 of 151 tracked procedures by national average Medicare payment.

What to do with this

If you may have programming evaluation of implanted neurostimulator pulse generator system for central sleep apnea during sleep study done, these steps turn the numbers above into a real-world cost estimate.

  • Request a Good Faith Estimate from your provider at least 3 business days before a scheduled procedure, under the No Surprises Act it is an enforceable written price.
  • Compare programming evaluation of implanted neurostimulator pulse generator system for central sleep apnea during sleep study costs in your state, Medicare rates vary by locality. Browse states
  • Check a hospital’s published cash price, which is often far below the billed charge. Price transparency
  • Understand why billed charges run several times the Medicare rate before you negotiate. Read the guide

Figures here are averages and estimates, not a quote. Confirm coverage and out-of-pocket costs with your insurer and provider.

Frequently Asked Questions

How much does Programming Evaluation Of Implanted Neurostimulator Pulse Generator System For Central Sleep Apnea During Sleep Study cost?

The national average Medicare payment for Programming Evaluation Of Implanted Neurostimulator Pulse Generator System For Central Sleep Apnea During Sleep Study (CPT 0436T) is $40.85, while providers typically bill $1,107.65.

Why do providers charge more than Medicare pays?

Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.

How much does Programming Evaluation Of Implanted Neurostimulator Pulse Generator System For Central Sleep Apnea During Sleep Study cost with insurance?

With commercial insurance, programming evaluation of implanted neurostimulator pulse generator system for central sleep apnea during sleep study costs an estimated $114.72 on average (range: $80.30-$160.61), a moderate premium over Medicare's $40.85. Without insurance, the estimated cash price is $343.01.

How many providers perform Programming Evaluation Of Implanted Neurostimulator Pulse Generator System For Central Sleep Apnea During Sleep Study?

Programming Evaluation Of Implanted Neurostimulator Pulse Generator System For Central Sleep Apnea During Sleep Study is comparatively uncommon: only 9 providers nationally billed Medicare for it in 2023, serving 14 beneficiaries via 17 total services.

What is the billed-to-Medicare markup for Programming Evaluation Of Implanted Neurostimulator Pulse Generator System For Central Sleep Apnea During Sleep Study?

Providers bill 27.1x what Medicare pays for Programming Evaluation Of Implanted Neurostimulator Pulse Generator System For Central Sleep Apnea During Sleep Study - one of the steepest markups in the catalog at 2611% above the Medicare rate.

Related Guides

Negotiating Your Medical Bill

Tips to reduce out-of-pocket costs
Hospital Price Transparency

Your right to upfront pricing
Understanding Medicare Costs

How Medicare payments work
How to Read a Medical Bill

Decode charges and codes
Hospital Markup Explained

Why bills exceed actual costs
Why Costs Vary by State

Geographic pricing factors

Data from CMS Medicare Physician & Other Practitioners (2023).

Read our methodology - how this data is sourced, computed, and verified.

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Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure Editorial

Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error.