CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $2,454
Cash Discount Price: $1,532
vs. Medicare Baseline: 2.80x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Carilion Stonewall Jackson Hospital is $2,454. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,532. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 2.80x the Medicare baseline. Located in 1 Health Circle, Lexington, VA.

Cash / Self-Pay

$1,532

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,454

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: $1,532 (175%)

Insurance Median: $2,454 (280%)

Cash: $1,532 (175% of Medicare)

Ins. Median: $2,454 (280% 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 280% of the Medicare baseline (a markup of 180%). 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
Blue Cross Blue Shield	$560 - $4,008	64%
Sentara Health Plan	$571 - $2,713	65%
Abh of VA (Formerly Coventry)	$587	67%
Abh of Wva (Formerly Coventry)	$587	67%
Humana	$587 - $906	67%
UnitedHealthcare	$587 - $3,577	67%
Aetna	$754 - $2,906	86%
Gateway - Tier 3	$2,407	274%
Vhn - Ultra	$2,713	309%
Connecticare	$3,063	349%
Gateway - Tier 2	$3,501	399%
Vhn - Plus	$3,501	399%
Cigna	$3,505	400%
Integrated Health Plan	$3,720	424%
Vhn	$3,720	424%
Vhn - Link	$3,938	449%
Beech Street	$4,026	459%
Gateway - Tier 1	$4,157	474%
Vhn - Secondary Payors	$4,157	474%

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 $1,532.
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 Carilion Stonewall Jackson 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.