CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Community Medical Center

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $4,281
Cash Discount Price: $1,614
vs. Medicare Baseline: 4.88x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Community Medical Center is $4,281. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,614. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 4.88x the Medicare baseline. Located in 99 Rt 37 West, Toms River, NJ.

Cash / Self-Pay

$1,614

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,281

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: $1,614 (184%)

Insurance Median: $4,281 (488%)

Cash: $1,614 (184% of Medicare)

Ins. Median: $4,281 (488% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 488% of the Medicare baseline (a markup of 388%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
UnitedHealthcare	$966 - $4,663	110%
Fidelis Care	$984 - $1,112	112%
Aetna	$1,057 - $4,281	120%
Blue Cross Blue Shield	$1,112 - $7,121	127%
Clover Health	$1,112	127%
Humana	$1,112	127%
Wellpoint	$1,112 - $4,436	127%
Emblem Health	$1,946	222%
Wellcare	$2,213	252%
Amerihealth	$3,833 - $4,310	437%
Cigna	$4,623 - $6,187	527%
First Health	$4,670	532%
Qualcare Inc	$5,191 - $5,534	592%

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 $1,614.
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 Community Medical Center 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.