CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Adventist Health Tulare

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $784
Cash Discount Price: $988
vs. Medicare Baseline: 0.89x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Adventist Health Tulare is $784. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $988. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 0.89x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$988

Average discount available for prompt cash payment at this facility.

Insurance Median

$784

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$877.34

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $877.34 (100%)

Cash / Self-Pay: $988 (113%)

Insurance Median: $784 (89%)

Cash: $988 (113% of Medicare)

Ins. Median: $784 (89% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $877.34 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Shield Mcare	$123 - $1,104	14%
Fhcn Pace Mcr Adv - All Plans	$123 - $1,104	14%
Medicare (plans)	$123 - $1,104	14%
Tricare	$123 - $1,104	14%
UnitedHealthcare	$123 - $1,104	14%
Upn-United Physcn Ntwrk Mcr Adv Profee Only-All Ot	$123	14%
Ah Employee Health Plan - All Plans	$135 - $1,988	15%
Incentive Hlth - All Plans	$135 - $1,988	15%
Blue Shield Epn	$146 - $2,486	17%
Cigna	$150 - $3,209	17%
Hs Interplan-All Plans	$153 - $4,643	17%
Blue Shield-All Other Plans	$154 - $3,450	18%
Cal Forensic Med Grp - All Plans	$159 - $1,436	18%
Healthnet Hmo/Ppo - All Other Plans	$179 - $2,943	20%
Blue Cross Blue Shield	$264 - $1,885	30%
Ccipa Medi-Cal - All Plans	$287 - $649	33%
Healthnet Medi-Cal	$287 - $654	33%
Medi-Cal	$287 - $499	33%
Upn-United Physcn Ntwrk Mcal Profee Only	$287	33%
Dignity Mcal Op Only	$549	63%
Independence Op Only - All Plans	$549	63%
Aetna	$629 - $2,984	72%
Dignity Mcr Op Only - All Other Plans	$1,104	126%
Prime Health - All Plans	$1,104	126%
Prison Hlthcre - All Plans	$1,414	161%
Bright Health - All Plans	$1,602	183%
Network By Design-All Plans	$2,300	262%
Western Growers - All Plans	$2,443 - $3,257	278%
Multiplan - All Plans	$4,418 - $5,890	504%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $988.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 95810.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health Tulare is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 95810.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.