CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: St Nicholas Hospital

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 95810
  • Insurance Median: $3,907
  • Cash Discount Price: $3,926
  • vs. Medicare Baseline: 4.45x Medicare
The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at St Nicholas Hospital is $3,907. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,926. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 4.45x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$3,926

Average discount available for prompt cash payment at this facility.

Insurance Median
$3,907

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: $3,926 (447%)
Insurance Median: $3,907 (445%)
Cash: $3,926 (447% of Medicare)
Ins. Median: $3,907 (445% 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 445% of the Medicare baseline (a markup of 345%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 $339 - $3,793 39%
Community Care Family Care $339 39%
Managed Health Services $339 39%
Medicaid / KanCare $339 39%
Meridian Health Plan $339 39%
Molina Healthcare $359 - $983 41%
Triology $359 - $4,836 41%
P360 Small Group $421 48%
Prevea Health Network $421 48%
Aetna $983 - $6,121 112%
Humana $983 - $5,203 112%
Medica $983 112%
Medicare (plans) $983 112%
UnitedHealthcare $983 - $3,739 112%
Security Health Plan $993 - $3,907 113%
Naphcare $2,213 252%
Molina Healthcare Of Wi $2,888 - $3,060 329%
Hshs Employees $3,131 - $3,318 357%
Arise Health Plan $3,466 - $3,673 395%
Wea Provider Network $3,581 - $4,407 408%
Cigna $4,043 - $4,285 461%
Interplan $4,043 - $4,285 461%
Network Health Plan $4,043 - $4,285 461%
Health Care Alliance $4,216 - $4,468 481%
Health Eos $4,332 - $4,591 494%
Healthsmart $4,332 - $4,591 494%
Wisconsin Physician Service $4,621 - $4,897 527%
Multiplan/Phcs $4,852 - $5,142 553%
Choicecare $4,910 - $5,203 560%
North Central Healthcare Alliance $5,314 - $5,631 606%
First Health $5,487 - $5,815 625%
Caterpillar, Inc. $5,776 - $6,121 658%
Cofinity $5,776 - $6,121 658%
Live360 $5,776 - $6,121 658%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3100 Superior Ave, Sheboygan, WI 53081
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals