CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: West Penn Hospital

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $624
Cash Discount Price: $3,714
vs. Medicare Baseline: 0.71x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at West Penn Hospital is $624. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,714. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 0.71x the Medicare baseline. Located in 4800 Friendship Avenue, Pittsburgh, PA.

Cash / Self-Pay

$3,714

Average discount available for prompt cash payment at this facility.

Insurance Median

$624

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: $3,714 (423%)

Insurance Median: $624 (71%)

Cash: $3,714 (423% of Medicare)

Ins. Median: $624 (71% 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	$80 - $1,028	9%
Pennsylvania Health And Wellness	$101 - $520	12%
Geisinger	$111 - $554	13%
UnitedHealthcare	$111 - $3,434	13%
Highmark	$134 - $2,484	15%
Cigna	$187 - $3,248	21%
University Of Pittsburgh Medical Center	$297 - $381	34%
Aetna	$324 - $3,240	37%
Highmark Wholecare	$373 - $1,037	43%
American Health Plans	$979	112%
Life Pittsburgh	$979	112%
Martin'S Point	$979	112%
Medicare (plans)	$1,008	115%
Humana	$1,037	118%
Molina	$1,067	122%
Medical Mutual	$3,248	370%

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 $3,714.
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 West Penn Hospital 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.