Sleep study (overnight, in lab)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 95810 (CPT)
- CPT Billing Code: 95810
- Insurance Median: $1,979
- Cash Discount Price: $3,836
- vs. Medicare Baseline: 2.26x 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 226% of the Medicare baseline (a markup of 126%). 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 | $1,056 | 120% |
| Aetna | $1,765 - $3,069 | 201% |
| UnitedHealthcare | $2,194 | 250% |
Consumer Guidance & Cost Commentary
For the CPT code 95810, representing an overnight sleep study at Community Memorial Healthcare in Marysville, Kansas, the cash median price is $3,836.00, which matches the facility's gross charge. This cash rate is significantly higher than the state average, as indicated by a 2.3x multiplier relative to the Medicare benchmark of $877.34. While commercial insurance plans like Aetna and UnitedHealthcare negotiate rates ranging from $1,765 to $3,069, these negotiated amounts often exceed the cash price for patients with high deductibles. In such cases, paying out-of-pocket directly can sometimes result in lower total costs, provided the patient secures a prompt-pay discount before the claim is submitted to the insurer.
Patients should be aware that commercial insurance contracts often include administrative overheads that inflate the baseline price by 20% to 40%, making the negotiated rate higher than the direct cash price. To minimize costs, it is essential to verify your deductible status before scheduling and to explicitly request a "self-pay" or "prompt-pay" discount at registration, which can reduce the bill by 20% to 50% if paid in full upfront. If you receive a bill after using insurance, you should demand a full itemized CPT-coded statement rather than accepting a summary bill, as over 80% of hospital invoices contain errors such as unbundled codes or services not rendered. Disputing these errors in writing with the billing supervisor is the most effective way to ensure you are only charged for accurate, necessary care.