Sleep study (overnight, in lab)
Facility: Pratt Regional Medical Center
Billing Code: 95810 (CPT)
- CPT Billing Code: 95810
- Insurance Median: $2,910
- Cash Discount Price: $2,448
- vs. Medicare Baseline: 3.32x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 332% of the Medicare baseline (a markup of 232%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Celtic Insurance Company | $969 | 110% |
| Healthy Blue | $998 | 114% |
| UnitedHealthcare | $1,066 - $3,567 | 122% |
| Christian Health Aid | $2,623 | 299% |
| Health Partners Of Kansas | $2,972 | 339% |
| Aetna | $3,147 | 359% |
| Choicecare | $3,497 | 399% |
Consumer Guidance & Cost Commentary
For the sleep study procedure (CPT 95810) at Pratt Regional Medical Center in Pratt, Kansas, the cash price is $2,448, which is lower than the facility's gross charge of $3,497. While the facility's negotiated rates with major payers like UnitedHealthcare and Aetna range from $1,066 to $3,147, these amounts are generally higher than the cash price. This pricing structure highlights a common billing dynamic where paying out-of-pocket can be more cost-effective for patients with high-deductible plans, as the insurance negotiated rates often exceed the cash price. To maximize savings, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the final cost.
When evaluating the cost of this service, it is important to compare rates against the Medicare benchmark rather than the hospital's full list price. The Medicare amount for this code is $877.34, and the facility's cash rate of $2,448 represents a 3.3x markup relative to this federal baseline. Although the data does not provide specific state or county average comparisons for this exact procedure, the significant difference between the Medicare rate and the commercial cash price underscores the importance of understanding the true cost of care. Patients should be aware that while balance billing is largely prohibited for emergency services at in-network facilities under the No Surprises Act, reviewing itemized bills is still a critical step to ensure no unbundled charges or services not rendered are included in the final invoice.