Sleep study (overnight, in lab)
Facility: Stormont Vail Hospital
Billing Code: 95810 (CPT)
- CPT Billing Code: 95810
- Insurance Median: $916
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.04x 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.
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 |
|---|---|---|
| UnitedHealthcare | $391 - $864 | 45% |
| Ambetter / Centene | $391 - $864 | 45% |
| Blue Cross Blue Shield | $395 - $1,315 | 45% |
| Aetna | $916 - $936 | 104% |
| Humana | $916 - $936 | 104% |
Consumer Guidance & Cost Commentary
For the CPT code 95810, representing an overnight sleep study at Stormont Vail Hospital in Topeka, KS, the facility's negotiated rates range from $391 to $936 depending on the insurance carrier. While the median negotiated payment across payers is $936, the Medicare benchmark rate is $877.34, which serves as the objective baseline for evaluating pricing fairness. It is important to note that commercial negotiated rates often exceed the Medicare benchmark due to administrative overhead and contract dynamics; however, patients should verify if their specific plan falls within the $391 to $936 range to avoid unexpected costs. Since the data does not provide specific county or state average comparisons for this procedure, the focus remains on understanding the facility's own negotiated floor and ceiling against the federal Medicare standard.
Patients should consider that cash-pay options may offer a lower total cost than using insurance, particularly for those with high-deductible plans where the insurance allowed amount might still exceed the cash price. The facility does not list a specific cash median, but it is recommended to inquire directly about "self-pay" or "prompt-pay" discounts, which can range from 20% to 50% off the billed amount when paid in full upfront. Additionally, if you have insurance, ensure you have met your deductible before scheduling, as using an in-network plan without meeting this threshold could result in paying the full negotiated rate. Always request an itemized bill before finalizing payment to ensure all charges are accurate and to identify any potential errors or unbundled codes that could be disputed.