CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Mc Donough District Hospital

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $992
Cash Discount Price: $3,616
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Mc Donough District Hospital is $992. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,616. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 1.13x the Medicare baseline. Located in 525 East Grant Street, Macomb, IL.

Cash / Self-Pay

$3,616

Average discount available for prompt cash payment at this facility.

Insurance Median

$992

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: $3,616 (412%)

Insurance Median: $992 (113%)

Cash: $3,616 (412% of Medicare)

Ins. Median: $992 (113% 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
Hfn	$104 - $5,423	12%
UnitedHealthcare	$104 - $5,423	12%
Aetna	$111 - $6,026	13%
Health Alliance	$111 - $5,363	13%
Humana	$111 - $5,423	13%
Medicaid / KanCare	$111 - $6,026	13%
Medicare (plans)	$111 - $1,136	13%
Meridian	$111 - $1,136	13%
Molina	$111 - $6,026	13%
Mutual Medical	$111 - $6,026	13%
Veteran Affairs	$111 - $1,136	13%
Blue Cross Blue Shield	$992 - $6,026	113%
Tricare	$1,061	121%
Springfield Health	$4,941	563%
Consociate	$5,122	584%
Trilogy	$5,122	584%
Blue Choice	$5,423	618%
Current Health	$5,423	618%
Healthlink	$5,423 - $5,664	618%
Preferred Plan	$5,725	653%

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 $3,616.
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 Mc Donough District 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.