CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Doctors Hospital

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $2,472
Cash Discount Price: $4,228
vs. Medicare Baseline: 2.82x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Doctors Hospital is $2,472. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,228. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 2.82x the Medicare baseline. Located in 5000 University Dr, Coral Gables, FL.

Cash / Self-Pay

$4,228

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,472

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: $4,228 (482%)

Insurance Median: $2,472 (282%)

Cash: $4,228 (482% of Medicare)

Ins. Median: $2,472 (282% 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 282% of the Medicare baseline (a markup of 182%). 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
Amerigroup	$471	54%
Medicaid / KanCare	$471 - $519	54%
UnitedHealthcare	$495 - $6,505	56%
Wellcare	$495	56%
Sunshine State	$500	57%
Aetna	$509 - $5,204	58%
Vista	$509	58%
Medicare (plans)	$897 - $1,211	102%
Blue Cross Blue Shield	$928 - $4,215	106%
Medica Health Plan	$960	109%
Humana	$977	111%
Avmed	$986 - $3,220	112%
Leon Medical	$1,004	114%
Cigna	$1,022 - $5,204	116%
Non Contracted	$2,387	272%
Amerihealth	$2,927	334%
International	$4,228	482%
Dimension Health Plan	$4,879 - $5,854	556%
Affordable	$5,529	630%
Phcs	$5,854	667%
Quality Health	$5,854	667%

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 $4,228.
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 Doctors Hospital 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.