CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Lexington Memorial Hospital Inc

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $1,736
Cash Discount Price: $1,967
vs. Medicare Baseline: 1.98x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Lexington Memorial Hospital Inc is $1,736. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,967. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 1.98x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$1,967

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,736

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: $1,967 (224%)

Insurance Median: $1,736 (198%)

Cash: $1,967 (224% of Medicare)

Ins. Median: $1,736 (198% 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
Amerihealth	$741 - $1,081	84%
Carolina Complete	$741	84%
Healthy Blue	$741	84%
Partners	$741	84%
UnitedHealthcare	$748 - $1,762	85%
Vaya	$748	85%
Wellcare	$748	85%
Alliance	$756	86%
Trillium	$763	87%
Medcost	$861 - $2,631	98%
Blue Cross Blue Shield	$1,078 - $1,730	123%
Aetna	$1,117 - $3,634	127%
Ambetter / Centene	$1,129	129%
Oscar	$1,259 - $1,731	144%
Cigna	$1,711 - $1,742	195%
Directnet	$2,324	265%
Healthgram Lexington Home Brands	$2,832	323%
Healthgram	$3,146	359%
Private Healthcare Systems	$3,225	368%
Beechstreet	$3,461	394%
Humana	$3,461	394%
Multiplan	$3,540	403%
National Provider Network	$3,540	403%

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 $1,967.
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 Lexington Memorial Hospital Inc 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.