CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Children's Hospital of Philadelphia

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $4,332
Cash Discount Price: $10,307
vs. Medicare Baseline: 4.94x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Children's Hospital of Philadelphia is $4,332. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,307. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 4.94x the Medicare baseline. Located in 3401 Civic Center Blvd, Philadelphia, PA.

Cash / Self-Pay

$10,307

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,332

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: $10,307 (1175%)

Insurance Median: $4,332 (494%)

Cash: $10,307 (1175% of Medicare)

Ins. Median: $4,332 (494% 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 494% of the Medicare baseline (a markup of 394%). 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
Geisinger Medical Assistance	$365	42%
Highmark Wholecare	$405	46%
Medicaid / KanCare	$1,701	194%
UnitedHealthcare	$1,711 - $5,669	195%
Health Partners	$1,943	221%
Horizon Nj Health	$2,461	281%
Aetna	$2,713 - $5,154	309%
Upmc Medical Assistance	$2,814	321%
Keystone First Chip	$3,195	364%
Keystone Health Plan East	$3,259	371%
Blue Cross Blue Shield	$3,638 - $4,129	415%
Geisinger Health Plan Commercial	$4,535	517%
Jefferson Health Plans	$4,875	556%
Cigna	$5,154	587%
Highmark	$5,154	587%
Qualcare	$5,669	646%
First Health Network	$6,700	764%
Devon Health, Intergroup, Multiplan, Valley Preferred/Populytics	$8,246	940%
Private Health Care Systems	$8,246	940%
Choice Care Network	$9,276	1057%

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 $10,307.
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 Children's Hospital of Philadelphia 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.