Sleep study (overnight, in lab)
Facility: Cloud County Health Center
Billing Code: 95810 (CPT)
- CPT Billing Code: 95810
- Insurance Median: $4,911
- Cash Discount Price: $3,618
- vs. Medicare Baseline: 5.60x 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 560% of the Medicare baseline (a markup of 460%). 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 |
|---|---|---|
| Mpi-All Plans | $160 - $5,386 | 18% |
| Pponext-All Plans | $656 - $5,386 | 75% |
| Aetna | $4,652 - $5,273 | 530% |
| Health Partners - All Plans | $4,911 - $5,386 | 560% |
Consumer Guidance & Cost Commentary
For the CPT code 95810, representing an overnight sleep study at Cloud County Health Center in Concordia, KS, the facility's cash median price is $3,618.00, which is lower than the state average of $4,911.00. While the facility's negotiated rates with major payers like Aetna and Health Partners range between $4,652 and $5,386, these amounts remain significantly higher than the cash price. This pricing structure highlights a common scenario where paying out-of-pocket can be more cost-effective for patients with high-deductible plans, as the commercial negotiated rates often include administrative overhead that inflates the baseline price by 20% to 40% compared to direct cash payments.
To maximize savings, patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% when paid upfront, bypassing the costly insurance claims processing cycle. It is important to note that the facility's gross charge of $5,169.00 is substantially higher than the Medicare benchmark of $877.34, indicating a significant markup typical of commercial billing. Consumers are advised to request an itemized bill before scheduling to ensure no unbundled codes or services not rendered are included, and to check their specific deductible status to avoid unexpected out-of-pocket costs if they choose to use insurance coverage.