CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Memorial Hospital

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $4,142
Cash Discount Price: $3,885
vs. Medicare Baseline: 4.72x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Memorial Hospital is $4,142. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,885. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 4.72x the Medicare baseline. Located in 1454 N County Road 2050 E, Carthage, IL.

Cash / Self-Pay

$3,885

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,142

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: $3,885 (443%)

Insurance Median: $4,142 (472%)

Cash: $3,885 (443% of Medicare)

Ins. Median: $4,142 (472% 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 472% of the Medicare baseline (a markup of 372%). 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	$558 - $4,157	64%
Consociate	$558 - $4,128	64%
Cigna	$1,000 - $3,326	114%
Humana	$1,094 - $4,856	125%
Blue Cross Blue Shield	$1,358 - $4,157	155%
Health Alliance	$1,360 - $4,856	155%
Meridian	$1,360 - $4,856	155%
Molina	$1,360 - $4,856	155%
UnitedHealthcare	$1,360 - $4,856	155%
First Health Network	$1,374 - $4,322	157%
Healthlink	$3,300 - $4,128	376%
Private Healthcare Systems	$4,128	471%
Integrated Health Plan	$4,273	487%
Health Dynamics	$4,370	498%
Health Payors Org	$4,370	498%
Iowa Health Solutions	$4,370	498%
Multiplan	$4,370	498%
Preferred Plan Inc	$4,370	498%
Three Rivers Provider Network	$4,370	498%
Health First Network	$4,419	504%
Pponext	$4,419	504%
Corvel	$4,613	526%

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 $3,885.
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 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.