CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: McLaren Macomb

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $565
Cash Discount Price: $1,491
vs. Medicare Baseline: 0.64x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at McLaren Macomb is $565. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,491. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 0.64x the Medicare baseline. Located in 1000 Harrington St, Mount Clemens, MI.

Cash / Self-Pay

$1,491

Average discount available for prompt cash payment at this facility.

Insurance Median

$565

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$877.34

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $877.34 (100%)

Cash / Self-Pay: $1,491 (170%)

Insurance Median: $565 (64%)

Cash: $1,491 (170% of Medicare)

Ins. Median: $565 (64% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Medicaid / KanCare	$74 - $584	8%
Humana	$117 - $992	13%
Medicare (plans)	$117 - $1,588	13%
Aetna	$133 - $3,013	15%
U Of M Health Plan	$135	15%
UnitedHealthcare	$142 - $3,294	16%
Blue Cross Blue Shield	$146 - $851	17%
Priority Health	$157 - $2,736	18%
Mclaren Commercial Ins	$197 - $1,400	22%
Tricare	$897	102%
Mi Amish Medical Board	$992	113%
Workers Compensation	$1,596	182%
Cofinity Group 15892 & 15893	$2,537	289%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,491.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 95810.

Insurance In-Network Protection Plan

Contact your insurance company to confirm McLaren Macomb is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 95810.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.