CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: UPMC Mercy

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $3,272
Cash Discount Price: $5,774
vs. Medicare Baseline: 3.73x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at UPMC Mercy is $3,272. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,774. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 3.73x the Medicare baseline. Located in 1400 Locust Street, Pittsburgh, PA.

Cash / Self-Pay

$5,774

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,272

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: $5,774 (658%)

Insurance Median: $3,272 (373%)

Cash: $5,774 (658% of Medicare)

Ins. Median: $3,272 (373% 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 373% of the Medicare baseline (a markup of 273%). 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
Upmc Health Plan	$381 - $995	43%
UnitedHealthcare	$399	45%
Blue Cross Blue Shield	$505 - $2,861	58%
Highmark Wholecare (Prev Gateway)	$514 - $1,048	59%
Amerihealth Caritas	$548 - $1,048	62%
Pa Health & Wellness	$591 - $1,048	67%
Upmc Work Partners	$1,001	114%
Aetna	$1,018 - $3,849	116%
Cigna	$3,272 - $5,774	373%
Bravo	$3,368	384%
Coventry/First Health	$4,234	483%
Intergroup	$4,812 - $7,698	548%
Private Health Care Systems	$7,217	823%
American Healthcare Group	$7,698	877%
National Provider Network	$7,891	899%
Health Payors Organization	$8,661	987%
Multiplan	$8,661	987%

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 $5,774.
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 UPMC Mercy 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.