Sleep study (overnight, in lab)
Facility: Mcpherson Hospital
Billing Code: 95810 (CPT)
- CPT Billing Code: 95810
- Insurance Median: $2,699
- Cash Discount Price: $2,611
- vs. Medicare Baseline: 3.08x 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 308% of the Medicare baseline (a markup of 208%). 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 |
|---|---|---|
| Tricare | $695 | 79% |
| UnitedHealthcare | $790 - $3,528 | 90% |
| Wellcare Mcr Adv - All Plans | $790 | 90% |
| Blue Cross Blue Shield | $790 | 90% |
| Healthy Blue Mcr Adv | $790 | 90% |
| Va Ccn - All Plans | $790 | 90% |
| Humana | $790 | 90% |
| Ambetter / Centene | $908 | 103% |
| Wppa - All Plans | $2,470 | 282% |
| Medical Associates - All Plans | $2,646 | 302% |
| Central Plains - All Plans | $2,646 | 302% |
| Christian Health Aid - All Plans | $2,822 | 322% |
| Aetna | $2,911 - $3,528 | 332% |
| Multiplan - All Plans | $3,175 | 362% |
| Cigna | $3,352 | 382% |
| First Health - All Plans | $3,352 | 382% |
| Health Partners - All Plans | $3,352 | 382% |
| Medicaid / KanCare | $3,528 | 402% |
| Health Blue Mcaid - All Other Plans | $3,599 | 410% |
Consumer Guidance & Cost Commentary
For this sleep study procedure at Mcpherson Hospital in Mcpherson, Kansas, the facility's cash price of $2,611 is notably lower than the median negotiated rate of $2,787 paid by insurance plans. While the hospital's negotiated rates generally align with the state average, the cash price offers a distinct advantage for patients with high-deductible plans or those who have already met their out-of-pocket maximum. In such cases, paying the cash price directly can result in immediate savings compared to the administrative overhead and contract ceilings that commercial insurers apply. Patients should verify their specific plan's deductible status before scheduling, as using insurance for this service may trigger a higher allowed amount that exceeds the cash-pay option.
To maximize potential savings, patients should proactively inquire about "self-pay" or "prompt-pay" discounts before check-in, as these programs often offer reductions of 20% to 50% for upfront payment. This bypasses the costly claims processing cycle and administrative fees that inflate insurance rates, effectively lowering the cost to the patient. Additionally, while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, patients should always request a full itemized bill to ensure no unbundled codes or services not rendered are included. Comparing the facility's rates to the Medicare benchmark of $877.34 reveals a significant markup, highlighting the importance of negotiating directly with the hospital or selecting a plan with a lower allowed amount to avoid unexpected costs.