CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Medical City Plano

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $3,839
Cash Discount Price: $13,015
vs. Medicare Baseline: 4.38x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Medical City Plano is $3,839. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $13,015. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 4.38x the Medicare baseline. Located in 3901 W 15Th St, Plano, TX.

Cash / Self-Pay

$13,015

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,839

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: $13,015 (1483%)

Insurance Median: $3,839 (438%)

Cash: $13,015 (1483% of Medicare)

Ins. Median: $3,839 (438% 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 438% of the Medicare baseline (a markup of 338%). 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
Superior Health Plan	$911	104%
Aetna	$1,153 - $7,874	131%
Blue Cross Blue Shield	$1,182 - $5,779	135%
Cigna	$1,757 - $4,855	200%
United	$1,927 - $3,130	220%
Oscar	$2,707	309%
Healthcare Highways	$3,189 - $4,399	363%
Evry Health	$3,358	383%
Humana	$3,448	393%
Lifecare Hospitals	$3,905	445%
Curative Administrators	$5,206	593%
Prominence Health Plan	$5,206	593%
City Of Mckinney	$5,857	668%
Fidelis Securecare	$5,857	668%
National Choicecare	$6,508	742%
Pc Texas Partners	$7,158	816%
Physicians Coop Of Tx	$7,158	816%
Rockport Health Group	$7,158	816%
Averde Health, Inc	$7,549	860%
Texas Healthcare Foundation Wc	$8,460	964%
Coastal Comp Health Networks	$9,111	1038%
Mega Life	$9,111	1038%
Multiplan Phcs	$9,111	1038%
Healthsmart Preferred Care	$9,761	1113%
Lewisville Isd/Dls Consulting	$9,761	1113%
Usa Managed Care	$10,412	1187%
Usc Health Services	$10,412	1187%
Galaxy Health Network	$11,063	1261%
Independent Medical Systems	$13,015	1483%
National Healthcare Solutions	$13,015	1483%
Unicare	$13,015	1483%

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 $13,015.
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 Medical City Plano 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.