CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Adena Pike Medical Center

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $3,873
Cash Discount Price: $2,569
vs. Medicare Baseline: 4.41x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Adena Pike Medical Center is $3,873. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,569. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 4.41x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$2,569

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,873

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: $2,569 (293%)

Insurance Median: $3,873 (441%)

Cash: $2,569 (293% of Medicare)

Ins. Median: $3,873 (441% 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 441% of the Medicare baseline (a markup of 341%). 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
Aetna	$1,233 - $4,183	141%
Blue Cross Blue Shield	$1,233 - $4,435	141%
Buckeye Community Health Plan	$1,233	141%
Humana	$1,233 - $4,882	141%
Medical Mutual Of Ohio	$1,233 - $3,266	141%
Medigold	$1,233	141%
Molina	$1,233	141%
Care Source	$1,258	143%
Gateway Health	$1,696	193%
Molina Marketplace	$2,023	231%
Care Source Just4Me	$2,220	253%
Sidecar Health	$3,392	387%
Ohio Ppo Connect	$3,597	410%
The Health Plan	$3,597	410%
Cigna	$3,721	424%
Medical Mutual Of Ohio Supermed	$3,873	441%
First Health	$4,029	459%
Ohio Health Choice	$4,090	466%
UnitedHealthcare	$4,419	504%
Integrated Health Plan	$4,830	551%
Healthsmart	$4,882	556%
Multiplan/Private Healthcare Systems	$4,882	556%
Three Rivers Network	$4,882	556%

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 $2,569.
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 Adena Pike 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.