CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Valley West Community Hospital

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $4,124
Cash Discount Price: $4,582
vs. Medicare Baseline: 4.70x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Valley West Community Hospital is $4,124. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,582. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 4.70x the Medicare baseline. Located in 11 East Pleasant Avenue, Sandwich, IL.

Cash / Self-Pay

$4,582

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,124

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: $4,582 (522%)

Insurance Median: $4,124 (470%)

Cash: $4,582 (522% of Medicare)

Ins. Median: $4,124 (470% 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 470% of the Medicare baseline (a markup of 370%). 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
Blue Cross Blue Shield	$1,244 - $5,348	142%
Global Excel [1712]	$1,244	142%
Humana	$1,244	142%
Aetna	$1,663 - $4,536	190%
Health'S Finest Network [126]	$2,946 - $5,564	336%
Cigna	$2,965 - $3,162	338%
UnitedHealthcare	$3,286 - $6,546	375%
The Alliance [1703]	$3,558	406%
Choicecare [177]	$4,412	503%
Healthlink [125]	$4,910	560%
Multiplan/Phcs [142]	$5,237 - $6,546	597%
First Health Plan [6034]	$6,546	746%

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 $4,582.
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 Valley West Community 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.