CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Franklin General Hospital

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $1,561
Cash Discount Price: $3,326
vs. Medicare Baseline: 1.78x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Franklin General Hospital is $1,561. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,326. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 1.78x the Medicare baseline. Located in 1720 Central Avenue East, Hampton, IA.

Cash / Self-Pay

$3,326

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,561

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: $3,326 (379%)

Insurance Median: $1,561 (178%)

Cash: $3,326 (379% of Medicare)

Ins. Median: $1,561 (178% 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.

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
Wellmark Hmo	$1,115	127%
Wellmark Ppo - All Other Plans	$1,227	140%
Medical Associates Mcare	$1,478	168%
Mount Carmel Hp-All Plans	$1,478	168%
Tricare	$1,478	168%
UnitedHealthcare	$1,478 - $3,071	168%
Amerigroup Mcare	$1,493	170%
Wellmark Mcr Adv	$1,493	170%
Molina Mcare	$1,538	175%
Ambetter / Centene	$1,546 - $2,365	176%
American Hp Iowa - All Plans	$1,552	177%
Amerigroup Mcaid - All Other Plans	$1,561	178%
Molina Mcaid - All Other Plans	$1,569	179%
Centivo - All Plans	$2,218	253%
Medical Ass Hosp Employer Group	$2,218	253%
Oscar - All Plans	$2,218	253%
Midlands Choice-All Plans	$2,587	295%
Medical Associates Hp-All Other Plans	$3,142	358%
Preferred Health Choices-All Plans	$3,142	358%
Splashlight Llc-All Plans	$3,142	358%
Aetna	$3,437 - $3,511	392%
Multiplan-All Plans	$3,511	400%

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 $3,326.
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 Franklin General 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.