Sleep study (overnight, in lab)
Facility: Memorial Hospital
Billing Code: 95810 (CPT)
- CPT Billing Code: 95810
- Insurance Median: $2,863
- Cash Discount Price: $5,169
- vs. Medicare Baseline: 3.26x 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 326% of the Medicare baseline (a markup of 226%). 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 |
|---|---|---|
| Tricare | $114 - $2,835 | 13% |
| Ambetter / Centene | $126 - $3,118 | 14% |
| Blue Cross Blue Shield | $1,117 | 127% |
| Humana | $2,585 - $2,835 | 295% |
| Medicare (plans) | $2,610 - $2,863 | 297% |
| Coventry - All Other Plans | $4,652 - $5,103 | 530% |
| Health Partners Of Kansas - All Plans | $4,911 - $5,386 | 560% |
| Preferred Healthcare-All Plans | $4,911 - $5,386 | 560% |
| Wppa/Providers Care-All Plans | $7,237 - $7,938 | 825% |
Consumer Guidance & Cost Commentary
For the sleep study procedure (CPT 95810) at Memorial Hospital in Abilene, KS, the cash price is $5,169.00, which matches the facility's median paid amount. While this cash rate is significantly higher than the state average for this service, it is important to note that commercial insurance negotiated rates often exceed the cash price due to administrative overhead and contract structures. For instance, Coventry and Health Partners Of Kansas have negotiated ranges starting at $4,652 and $4,911 respectively, which are higher than the cash option. Patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the insurer's allowed amount could be greater than the cash rate. Additionally, patients should inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if settled upfront, bypassing the costly claims processing cycle.
The facility's Medicare benchmark of $877.34 serves as a critical baseline for evaluating pricing fairness, revealing that the cash price represents a substantial markup relative to the federal government's cost-based reimbursement. This comparison highlights that commercial rates are often inflated compared to the true cost of care, a common pitfall when comparing against the facility's gross chargemaster list. To ensure transparency and avoid balance billing, patients should request an itemized billing audit to verify that all charges correspond to services rendered and that no unbundled codes or unnecessary ancillaries were included. Given the facility's status as a Critical Access Hospital with government ownership, patients are encouraged to confirm their specific plan's network status and deductible requirements before