Sleep study (overnight, in lab)
Facility: William Newton Hospital
Billing Code: 95810 (CPT)
- CPT Billing Code: 95810
- Insurance Median: $1,658
- Cash Discount Price: $4,605
- vs. Medicare Baseline: 1.89x 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 |
|---|---|---|
| Blue Cross Blue Shield | $1,208 - $1,658 | 138% |
| Triwest- All Plans | $1,608 | 183% |
| UnitedHealthcare | $1,658 - $4,145 | 189% |
| Ambetter / Centene | $1,658 - $4,605 | 189% |
| Providrs Care Nexus | $2,818 | 321% |
| Providrs Care - All Other Plans | $3,224 | 367% |
Consumer Guidance & Cost Commentary
For the CPT code 95810, representing an overnight sleep study at William Newton Hospital in Winfield, KS, the cash price is $4,605.00, which matches the facility's gross chargemaster rate. This cash price is significantly higher than the state average for this procedure, as indicated by the Medicare benchmark of $877.34 and the commercial median negotiated rate of $1,658.00. While commercial insurance plans like UnitedHealthcare and Ambetter / Centene may negotiate rates up to $4,605.00, patients with high-deductible plans should consider paying cash directly, as the cash price is lower than the maximum negotiated amounts some insurers might apply. It is advisable to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can further reduce the final cost before any insurance claim is processed.
The facility, a Critical Access Hospital owned by the local government, reports a facility rating of 4 and serves six different payers, with negotiated rates ranging from $1,208 to $4,605.00 depending on the specific insurance plan. Patients should be aware that balance billing can occur if a patient receives care from an out-of-network provider, where the hospital bills the difference between the full charge and the insurance allowed amount. However, under the No Surprises Act, balance billing is generally prohibited for emergency care and non-emergency services from out-of-network providers at in-network facilities. To ensure accuracy and avoid unexpected charges, consumers should request a full itemized bill rather than accepting a summary invoice, and they should dispute any errors in writing to the billing supervisor rather than settling