Sleep study (overnight, in lab)
Facility: Clay County Medical Center
Billing Code: 95810 (CPT)
- CPT Billing Code: 95810
- Insurance Median: $238
- Cash Discount Price: $256
- vs. Medicare Baseline: 0.27x 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 |
|---|---|---|
| Health Partners - All Plans | $75 - $243 | 9% |
| Multiplan- All Plans | $114 - $243 | 13% |
| UnitedHealthcare | $210 - $243 | 24% |
| Aetna | $238 | 27% |
| Wppa/Providrs Care- All Plans | $238 | 27% |
Consumer Guidance & Cost Commentary
For this sleep study procedure at Clay County Medical Center in Clay Center, KS, the cash price is $256.00, which matches the facility's median negotiated rate of $238.00. This negotiated rate is lower than the facility's gross charge of $256.00, reflecting the contractual agreements between the hospital and commercial payers like Health Partners and UnitedHealthcare. While the facility is a Critical Access Hospital with government-local ownership, patients should note that cash payments can sometimes be more cost-effective than using insurance, particularly if the patient's plan has a high deductible or if the negotiated rate exceeds the cash price. It is advisable to ask the billing department directly about "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed.
The facility's pricing is significantly lower than the Medicare benchmark for this service, which is set at $877.34. This substantial difference highlights that commercial negotiated rates often represent a more efficient baseline for patients than the federal government's reimbursement rate. Although the facility is located in Clay County (ZIP 67432), the provided data does not include specific county or state average comparisons for this procedure, so the $877.34 Medicare rate serves as the primary objective benchmark for evaluating the facility's pricing markup. Patients are encouraged to request an itemized bill to ensure all charges are accurate and to verify that no unexpected balance billing occurs, as federal protections generally prevent surprise charges for services at in-network facilities.