CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Berkeley Medical Center

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $355
Cash Discount Price: $2,544
vs. Medicare Baseline: 0.40x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Berkeley Medical Center is $355. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,544. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 0.40x the Medicare baseline. Located in 2500 Hospital Drive, Martinsburg, WV.

Cash / Self-Pay

$2,544

Average discount available for prompt cash payment at this facility.

Insurance Median

$355

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: $2,544 (290%)

Insurance Median: $355 (40%)

Cash: $2,544 (290% of Medicare)

Ins. Median: $355 (40% 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
Highmark Health Options West Va	$87	10%
Wellpoint West Virginia	$87	10%
The Health Plan Wv	$88	10%
Aetna	$89 - $868	10%
Medicare (plans)	$165 - $876	19%
Humana	$174 - $868	20%
UnitedHealthcare	$180 - $901	21%
Caresource Exchange Plan	$248 - $1,240	28%

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 $2,544.
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 Berkeley Medical Center 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.