CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Iowa Specialty Hospital - Clarion

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $2,195
Cash Discount Price: $2,407
vs. Medicare Baseline: 2.50x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Iowa Specialty Hospital - Clarion is $2,195. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,407. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 2.50x the Medicare baseline. Located in 1316 South Main Street, Clarion, IA.

Cash / Self-Pay

$2,407

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,195

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: $2,407 (274%)

Insurance Median: $2,195 (250%)

Cash: $2,407 (274% of Medicare)

Ins. Median: $2,195 (250% 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 250% of the Medicare baseline (a markup of 150%). 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
Tricare	$114 - $1,334	13%
Triwest Va - All Plans	$114 - $1,334	13%
Aetna	$120 - $3,658	14%
Healthscope Stellar-All Plans	$189 - $2,273	22%
UnitedHealthcare	$210 - $4,089	24%
Health Partners Ish-All Other Plans	$218 - $3,443	25%
Wellmark Hmo	$220 - $2,774	25%
Wellmark Ppo - All Other Plans	$255 - $3,049	29%
Auxiant Clarion Schools-All Plans	$260 - $2,798	30%
Health Partners Prestage	$300 - $3,228	34%
Cigna	$1,242 - $4,175	142%
Midlands Choice-All Plans	$1,242 - $4,175	142%

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 $2,407.
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 Iowa Specialty Hospital - Clarion 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.