CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Adventist Health Clearlake

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $7,076
Cash Discount Price: $3,317
vs. Medicare Baseline: 8.07x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Adventist Health Clearlake is $7,076. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,317. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 8.07x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$3,317

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,076

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: $3,317 (378%)

Insurance Median: $7,076 (807%)

Cash: $3,317 (378% of Medicare)

Ins. Median: $7,076 (807% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 807% of the Medicare baseline (a markup of 707%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Bc Managed Mcal	$499	57%
Medi-Cal	$499	57%
Blue Cross Blue Shield	$1,620 - $2,161	185%
Blue Shield Mcr Adv	$1,935	221%
Kaiser Mcr Adv	$1,935	221%
Tricare	$1,935	221%
UnitedHealthcare	$2,128 - $7,684	243%
Ah Employee Health Plan - All Plans	$3,870	441%
Aetna	$6,885	785%
Western Growers- All Plans	$6,910	788%
Blue Shield Epn - All Other Plans	$7,076	807%
Blue Shield Non-Epn	$7,076	807%
First Health- All Plans	$7,371	840%
Healthnet- All Plans	$7,555	861%
Foundation- All Plans	$7,832	893%
Health Mgmt Network- All Plans	$7,832	893%
Humana	$7,832	893%
Phcs- All Plans	$7,832	893%
Cigna	$8,293	945%
Interplan- All Plans	$8,293	945%
Kaiser- All Other Plans	$8,293	945%
Three Rivers Provider Network- All Plans	$8,293	945%
Partnership Mcal - All Plans	$15,203	1733%

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 $3,317.
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 Clearlake 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.