CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Baylor Scott & White Medical Center - Marble Falls

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $2,616
Cash Discount Price: $4,314
vs. Medicare Baseline: 2.98x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Baylor Scott & White Medical Center - Marble Falls is $2,616. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,314. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 2.98x the Medicare baseline. Located in 810 W Highway 71, Marble Falls, TX.

Cash / Self-Pay

$4,314

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,616

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: $4,314 (492%)

Insurance Median: $2,616 (298%)

Cash: $4,314 (492% of Medicare)

Ins. Median: $2,616 (298% 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 298% of the Medicare baseline (a markup of 198%). 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
Baylor Scott & White Health Plan	$876 - $3,077	100%
Humana	$922 - $5,033	105%
Superior Health Plan	$922 - $1,294	105%
Triwest	$922	105%
Corvel	$966	110%
Prime Health Services	$966	110%
American Health Plan	$968	110%
Blue Cross Blue Shield	$968 - $1,733	110%
Healthspring	$968	110%
Procare Advantage	$968	110%
UnitedHealthcare	$1,060 - $3,976	121%
Sedgwick	$1,378	157%
Aetna	$2,007	229%
Cigna	$3,695 - $4,335	421%
Midcoast	$3,954	451%
Quiktrip	$3,954	451%
University Of Mary Hardin-Baylor	$4,170	475%
Independent Medical System	$4,314	492%
Curative	$4,673	533%
First Health	$5,033	574%
Healthsmart	$5,033 - $5,392	574%
Bluebell Creameries	$5,392	615%
Private Health Care System	$5,392	615%
Three Rivers	$6,471	738%

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 $4,314.
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 Baylor Scott & White Medical Center - Marble Falls 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.