Sleep study (overnight, in lab)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 95810 (CPT)
- CPT Billing Code: 95810
- Insurance Median: $1,676
- Cash Discount Price: $1,764
- vs. Medicare Baseline: 1.91x 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 |
|---|---|---|
| Tricare | $1,413 | 161% |
| Humana | $1,605 | 183% |
| Aetna | $1,632 - $1,764 | 186% |
| UnitedHealthcare | $1,676 | 191% |
| Hpk-All Plans | $1,676 | 191% |
| Medicaid / KanCare | $1,764 | 201% |
Consumer Guidance & Cost Commentary
For the CPT code 95810, representing an overnight sleep study at Medicine Lodge Memorial Hospital in Medicine Lodge, Kansas, the facility's cash price is $1,764.00, which matches the maximum negotiated rate across all payers. This cash price is significantly higher than the Medicare benchmark of $877.34, reflecting a markup of 199% above the federal baseline. While commercial insurance plans like Aetna and UnitedHealthcare negotiate rates ranging from $1,605 to $1,764, these amounts remain well above the Medicare rate, illustrating that in-network coverage does not guarantee the lowest possible cost. Patients with high-deductible plans should be aware that paying the cash price of $1,764.00 upfront might result in lower out-of-pocket expenses if their insurance deductible has not yet been met or if their negotiated allowed amount exceeds the cash rate.
The facility, a Critical Access Hospital owned by a Government Hospital District, lists a median negotiated payment of $1,676.00, which is identical to the median negotiated rate across all six payers for this service. Although specific county or state average data is not provided in the current dataset, the consistent gap between the cash price and the Medicare benchmark highlights the importance of verifying self-pay or prompt-pay discounts before scheduling. Patients are encouraged to contact the hospital directly to inquire about potential fee reductions for upfront payment, as bypassing the insurance billing cycle can eliminate administrative overhead and reduce the final bill. Additionally, because the No Surprises Act prohibits balance billing for out-of-network providers at in-network facilities, patients should ensure they receive an itemized bill to confirm all