CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Virginia Gay Hospital

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $2,008
Cash Discount Price: $3,325
vs. Medicare Baseline: 2.29x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Virginia Gay Hospital is $2,008. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,325. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 2.29x the Medicare baseline. Located in 502 North 9Th Avenue, Vinton, IA.

Cash / Self-Pay

$3,325

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,008

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: $3,325 (379%)

Insurance Median: $2,008 (229%)

Cash: $3,325 (379% of Medicare)

Ins. Median: $2,008 (229% 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 229% of the Medicare baseline (a markup of 129%). 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
Aetna	$355	40%
Medicaid / KanCare	$877 - $1,807	100%
Wellmark Hmo	$1,115	127%
Wellmark Ppo-All Other Plans	$1,227	140%
UnitedHealthcare	$1,392 - $2,008	159%
Va Ccn-All Plans	$1,515 - $1,561	173%
Health Alliance Mcr Adv	$1,597 - $1,645	182%
Medical Associates-All Plans	$3,071 - $3,164	350%
Cedar Valley Community Healthcare-All Plans	$3,224 - $3,321	367%
Humana	$3,276 - $3,374	373%
Health Partners-All Plans	$3,481 - $3,585	397%
Healthsmart-All Plans	$3,481 - $3,585	397%
Corvel-All Plans	$3,808 - $3,923	434%
Health Alliance-All Other Plans	$3,890 - $4,007	443%

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 $3,325.
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 Virginia Gay 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.