CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Stoughton Hospital

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $4,294
Cash Discount Price: $3,948
vs. Medicare Baseline: 4.89x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Stoughton Hospital is $4,294. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,948. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 4.89x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$3,948

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,294

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: $3,948 (450%)

Insurance Median: $4,294 (489%)

Cash: $3,948 (450% of Medicare)

Ins. Median: $4,294 (489% 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 489% of the Medicare baseline (a markup of 389%). 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
Medicaid / KanCare	$905	103%
Quartz Health Solutions - All Other Lans	$1,126	128%
Tricare	$1,662 - $1,755	189%
Healthnet Mcr Adv - All Plans	$1,858 - $1,961	212%
Dean Health Insurance Med Adv	$1,956 - $2,064	223%
Humana	$1,956 - $6,635	223%
Quartz Mcr Adv	$1,956 - $2,064	223%
Security Health/First Health - All Plans	$1,956 - $2,064	223%
Aetna	$2,096 - $6,266	239%
UnitedHealthcare	$3,073 - $5,898	350%
Alliance - All Plans	$4,051 - $4,276	462%
Dean Health Insurance Epo	$4,313 - $4,552	492%
Dean Health Insurance Comm - All Other Plans	$5,234 - $5,524	597%
Geha - All Plans	$5,239 - $5,529	597%
Cigna	$5,588 - $5,898	637%
Wisconsin Ppo Ppa Direct - All Plans	$5,588 - $5,898	637%
Blue Cross Blue Shield	$6,077 - $6,414	693%
Wps - All Plans	$6,286 - $6,635	716%

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 $3,948.
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 Stoughton 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.