CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Merit Health Madison

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $1,667
Cash Discount Price: $987
vs. Medicare Baseline: 1.90x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Merit Health Madison is $1,667. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $987. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 1.90x the Medicare baseline. Located in 161 River Oaks Drive, Canton, MS.

Cash / Self-Pay

$987

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,667

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: $987 (112%)

Insurance Median: $1,667 (190%)

Cash: $987 (112% of Medicare)

Ins. Median: $1,667 (190% 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
United_Exchange	$242	28%
United	$279	32%
Medicare (plans)	$775	88%
Ms-Can-Molina	$799	91%
Wellcare	$799	91%
Humana	$806	92%
Ms-Can-Magnolia	$806	92%
Devoted_Health	$814	93%
Ms-Can-Truecare	$814	93%
Mpcn	$1,513	172%
Firstchoice	$1,551	177%
Molina_Exchange	$1,667	190%
Molina-Chip	$1,706	194%
Magnolia-Chip	$1,744	199%
Truecare-Chip	$1,744	199%
Advhealth	$1,859	212%
Ambetter / Centene	$2,000 - $2,007	228%
Blue Cross Blue Shield	$2,000 - $2,844	228%
Cigna	$2,000 - $2,168	228%

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 $987.
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 Merit Health Madison 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.