CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Astria Toppenish Hospital

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $1,066
Cash Discount Price: $2,737
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Astria Toppenish Hospital is $1,066. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,737. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 1.22x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$2,737

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,066

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: $2,737 (312%)

Insurance Median: $1,066 (122%)

Cash: $2,737 (312% of Medicare)

Ins. Median: $1,066 (122% 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
Premera_Affordable_Care	$88 - $3,087	10%
Chpw_Cascade_Care	$147 - $5,159	17%
First_Choice	$161 - $5,650	18%
Tpsc	$183 - $6,387	21%
Medicare (plans)	$193 - $6,764	22%
UnitedHealthcare	$193 - $6,764	22%
Aetna	$206 - $7,206	23%
Bcchp	$234 - $4,695	27%
Great_Rivers	$234 - $8,189	27%
Healthcomp	$234 - $8,189	27%
Humana	$234 - $8,189	27%
Washington_State_Hca	$234 - $8,189	27%
Medicaid / KanCare	$509 - $1,866	58%
Ambetter / Centene	$687	78%
Va	$687 - $847	78%
Molina	$700	80%
Molina_Exchange	$892	102%
Li	$977	111%
Cigna	$1,066	122%
Tricare	$1,066	122%
Zenith	$1,077	123%
Regence	$2,776	316%
Premera	$3,087	352%
Kaiser	$3,737	426%

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 $2,737.
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 Astria Toppenish 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.