Sleep study (overnight, in lab)
Facility: Nemaha Valley Community Hospital
Billing Code: 95810 (CPT)
- CPT Billing Code: 95810
- Insurance Median: $1,928
- Cash Discount Price: $3,456
- vs. Medicare Baseline: 2.20x 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 220% of the Medicare baseline (a markup of 120%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $1,272 | 145% |
| Humana | $1,690 | 193% |
| Va Ccn - All Plans | $1,690 | 193% |
| Aetna | $1,706 - $3,264 | 194% |
| Celtic Comm Exch - All Plans | $1,859 | 212% |
| Partners Direct Health - All Plans | $1,997 | 228% |
| Multiplan - All Plans | $3,456 | 394% |
| Health Partners - All Plans | $3,648 | 416% |
| Midlands Choice - All Plans | $3,648 | 416% |
Consumer Guidance & Cost Commentary
For the sleep study (overnight, in lab) procedure at Nemaha Valley Community Hospital in Seneca, KS, the cash median price is $3,456, which aligns with the highest negotiated rate among the nine payers listed. While the facility's cash price is lower than the gross charge of $3,840, it is important to note that commercial negotiated rates for this service range from $1,272 to $3,648 depending on the insurance plan. Patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds $3,456, as paying out-of-pocket could result in lower total costs compared to the insurance allowed amount. Additionally, patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing administrative processing fees associated with insurance claims.
This facility, a Critical Access Hospital owned by a voluntary non-profit, operates with a Medicare benchmark of $877.34, which serves as the objective baseline for evaluating pricing markups. The facility's cash median of $3,456 represents a significant markup over the Medicare rate, reflecting the administrative costs and contract dynamics inherent in commercial billing. To ensure accuracy and avoid unexpected charges, patients should request an itemized billing audit rather than accepting a summary bill, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. By comparing the facility's rates directly to the Medicare benchmark and demanding a detailed line-by-line statement, consumers can identify potential overcharges and negotiate a fair settlement before finalizing payment.