Sleep study (overnight, in lab)
Facility: Rooks County Health Center
Billing Code: 95810 (CPT)
- CPT Billing Code: 95810
- Insurance Median: $2,261
- Cash Discount Price: $1,884
- vs. Medicare Baseline: 2.58x 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 258% of the Medicare baseline (a markup of 158%). 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 |
|---|---|---|
| Veterans Admin - All Plans | $1,181 | 135% |
| Tricare | $1,181 | 135% |
| Celtic Mcr Adv | $1,181 | 135% |
| Blue Cross Blue Shield | $1,272 | 145% |
| Celtic Comm - All Other Plans | $1,299 | 148% |
| UnitedHealthcare | $2,261 | 258% |
| Preferred Benefits Admin | $2,261 | 258% |
| Aetna | $2,261 | 258% |
| Health Partners - All Plans | $2,386 | 272% |
| Preferred Hlthcare - All Other Plans | $2,386 | 272% |
| Healthy Blue Mcaid - All Plans | $2,512 | 286% |
Consumer Guidance & Cost Commentary
For CPT code 95810, a sleep study (overnight, in lab), the facility in Plainville, KS, has a cash median price of $1,884.00, which is lower than the negotiated rates paid by most insurance plans, including UnitedHealthcare and Aetna at $2,261.00. While the data does not provide specific county or state average figures for comparison, the cash rate represents a significant discount compared to the standard negotiated amounts. Patients with high-deductible plans may find this cash price advantageous if their insurance negotiated rate exceeds $1,884.00, as paying out-of-pocket could result in immediate savings. It is important to verify if the facility offers "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed.
The Medicare benchmark for this service is $877.34, serving as a baseline to evaluate the facility's pricing structure. The cash median of $1,884.00 is approximately 2.6 times the Medicare amount, reflecting the typical markup found in commercial healthcare pricing. If you receive a bill from an out-of-network provider or encounter unexpected charges, you may be subject to balance billing, where the provider bills you for the difference between their full chargemaster rate and what your insurance allowed. To avoid these surprises, always request an itemized bill before paying, ensuring you can identify any unbundled codes or services not rendered. If you receive a balance bill, you can dispute it with your insurer or request a No Surprises Act audit, as federal protections often ban these charges for emergency and non-emergency services at in-network