CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Decatur Memorial Hospital

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $3,304
Cash Discount Price: $7,508
vs. Medicare Baseline: 3.77x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Decatur Memorial Hospital is $3,304. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,508. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 3.77x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$7,508

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,304

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: $7,508 (856%)

Insurance Median: $3,304 (377%)

Cash: $7,508 (856% of Medicare)

Ins. Median: $3,304 (377% 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 377% of the Medicare baseline (a markup of 277%). 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
Aetna	$618 - $5,038	70%
Blue Cross Blue Shield	$618 - $7,508	70%
Coventry	$618 - $4,505	70%
Health Alliance	$618 - $4,993	70%
Humana	$618 - $3,121	70%
Medicare (plans)	$618 - $906	70%
UnitedHealthcare	$618 - $7,508	70%
Veterans Administration	$618 - $906	70%
Tricare	$628 - $920	72%
Wellcare	$906	103%
Medicaid / KanCare	$992 - $1,012	113%
Illinois Workers Compensation	$1,579 - $3,994	180%
Caterpillar	$2,071	236%
Mennonite Churches	$3,228	368%
Plain Church Medical Group	$3,379	385%
Health Alliance Mh Employee Plan	$3,454	394%
Cigna	$3,499	399%
Hfn	$3,755 - $5,631	428%
Commercial Workers Compensation	$3,795	433%
6 Degrees Health	$4,505	513%
Hopetrust	$4,505	513%
Hst	$4,505	513%
Phcs Savility	$4,880	556%
Phcs Multiplan Ppo	$5,105	582%
Healthlink	$5,150	587%
Corvel	$5,406	616%
Consociate	$5,556	633%
Liability	$7,508	856%

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 $7,508.
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 Decatur Memorial 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.