CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Piedmont Newton Hospital

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $4,047
Cash Discount Price: $2,097
vs. Medicare Baseline: 4.61x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Piedmont Newton Hospital is $4,047. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,097. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 4.61x the Medicare baseline. Located in 5126 Hospital Drive Ne, Covington, GA.

Cash / Self-Pay

$2,097

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,047

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: $2,097 (239%)

Insurance Median: $4,047 (461%)

Cash: $2,097 (239% of Medicare)

Ins. Median: $4,047 (461% 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 461% of the Medicare baseline (a markup of 361%). 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
Medicaid / KanCare	$542 - $866	62%
Cigna	$1,192 - $1,733	136%
UnitedHealthcare	$1,725 - $2,654	197%
Blue Cross Blue Shield	$2,189 - $2,355	250%
First Health [10303]	$3,881 - $5,906	442%
Aetna	$4,047 - $6,159	461%
Kaiser [10500]	$4,158 - $6,328	474%
Novanet [10819]	$4,158 - $6,328	474%
Phcs [10601]	$4,546 - $6,918	518%
Beechstreet [10800]	$4,713 - $7,171	537%
Multiplan [10600]	$4,713 - $7,171	537%

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 $2,097.
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 Piedmont Newton 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.