Sleep study (overnight, in lab)
Facility: Phillips County Hospital
Billing Code: 95810 (CPT)
- CPT Billing Code: 95810
- Insurance Median: $1,760
- Cash Discount Price: $1,063
- vs. Medicare Baseline: 2.01x 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 201% of the Medicare baseline (a markup of 101%). 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 |
|---|---|---|
| Midlands Choice Profee Only-All Plans | $235 | 27% |
| Medicaid / KanCare | $476 - $2,200 | 54% |
| UnitedHealthcare | $476 - $2,200 | 54% |
| Blue Cross Blue Shield | $1,272 - $1,782 | 145% |
| Health Partners-All Plans | $2,200 | 251% |
Consumer Guidance & Cost Commentary
For the CPT code 95810, representing an overnight sleep study at Phillips County Hospital in Phillipsburg, KS, the facility's cash median price is $1,063.00, which is lower than the state average of $1,063.00. While the facility is a Critical Access Hospital with government-local ownership, patients should note that commercial insurance rates often exceed cash prices due to administrative overhead and contract structures. For instance, the median negotiated rate across payers is $1,760.00, and the highest allowed amount listed is $2,200.00. If you have a high-deductible plan, paying the cash price upfront might result in lower out-of-pocket costs compared to your insurance's negotiated rate, provided you have not yet met your deductible.
When evaluating costs, it is important to compare rates against the Medicare benchmark rather than the hospital's gross charge list. The Medicare amount for this service is $877.34, which serves as the objective baseline for fair pricing. Commercial rates typically range from 200% to 300% of the Medicare rate, whereas fair pricing is generally defined as 120% to 150% of this benchmark. Additionally, patients should inquire about prompt-pay discounts, which can reduce bills by 20% to 50% when paid in full within a short window, bypassing the administrative costs associated with insurance claims. Always request an itemized bill before paying to ensure no errors or unbundled charges are included, as over 80% of hospital bills contain discrepancies that can be corrected through a formal audit.