CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Elmhurst Hospital Center

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $1,032
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.18x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Elmhurst Hospital Center is $1,032. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 1.18x the Medicare baseline. Located in 79-01 Broadway, Elmhurst, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,032

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%)

Insurance Median: $1,032 (118%)

Ins. Median: $1,032 (118% 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
Healthfirst	$99 - $2,321	11%
Aetna	$104 - $1,373	12%
Amidacare	$124 - $1,032	14%
Emblem	$124 - $1,806	14%
Wellcare	$134 - $776	15%
Metroplus	$159 - $2,321	18%
Fidelis	$179 - $2,321	20%
Oscar	$186 - $892	21%
Magnacare	$320	36%
Oxford	$362 - $410	41%
United	$434 - $1,289	49%
Blue Cross Blue Shield	$1,032 - $2,557	118%
Carelon	$1,032 - $2,077	118%
Senior Whole Health	$1,032	118%
United Behavioral Health	$1,032 - $1,135	118%
Affinity	$1,052 - $2,321	120%
Carelon (Amida Care)	$1,052	120%
Vnsny	$1,052 - $1,204	120%
Elderplan	$1,204	137%
Vaccn	$1,204	137%
Centers Plan For Healthy Living	$1,252	143%
Centerlight	$1,598	182%
Multiplan	$2,557	291%
Local 1199	$2,716	310%
Villagecare Max	$2,716	310%

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 $X.
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 Elmhurst Hospital 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.