CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Piedmont Macon North Hospital

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $2,879
Cash Discount Price: $1,972
vs. Medicare Baseline: 3.28x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Piedmont Macon North Hospital is $2,879. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,972. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 3.28x the Medicare baseline. Located in 400 Charter Boulevard, Macon, GA.

Cash / Self-Pay

$1,972

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,879

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: $1,972 (225%)

Insurance Median: $2,879 (328%)

Cash: $1,972 (225% of Medicare)

Ins. Median: $2,879 (328% 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 328% of the Medicare baseline (a markup of 228%). 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	$392 - $1,431	45%
Blue Cross Blue Shield	$1,268 - $2,355	145%
UnitedHealthcare	$1,725 - $2,654	197%
Cigna	$1,733	198%
Phcs [10601]	$2,559 - $5,329	292%
Industry Buying Group [10840]	$2,772 - $5,773	316%
First Health [10303]	$2,986 - $6,217	340%
Aetna	$3,113 - $6,483	355%
Novanet [10819]	$3,199 - $6,661	365%
Beechstreet [10800]	$3,412 - $7,105	389%
Multiplan [10600]	$3,838 - $7,993	437%

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 $1,972.
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 Macon North 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.