CMS Price Transparency Data

Sleep study (overnight, in lab)

Facility: Pinckneyville Community Hospital

Billing Code: 95810 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 95810
Insurance Median: $2,152
Cash Discount Price: $3,115
vs. Medicare Baseline: 2.45x Medicare

The contracted insurance negotiated median rate for a Sleep study (overnight, in lab) at Pinckneyville Community Hospital is $2,152. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,115. Compared to the federal Medicare reimbursement reference rate of $877.34, this hospital’s rate is 2.45x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$3,115

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,152

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: $3,115 (355%)

Insurance Median: $2,152 (245%)

Cash: $3,115 (355% of Medicare)

Ins. Median: $2,152 (245% 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 245% of the Medicare baseline (a markup of 145%). 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	$90 - $5,235	10%
Ambetter / Centene	$90 - $4,314	10%
Blue Cross Blue Shield	$90 - $4,314	10%
Medicaid / KanCare	$90 - $4,314	10%
Humana	$116 - $2,152	13%
Umwa Mcr Adv - All Plans	$119 - $2,152	14%
UnitedHealthcare	$119 - $4,770	14%
Wellcare Mcr Adv - All Plans	$119 - $2,152	14%
Cigna	$142 - $4,799	16%
Healthlink Hmo	$255 - $4,566	29%
Healthlink Ppo - All Other Plans	$255 - $4,799	29%
Phcs Savility	$350 - $4,944	40%
Multiplan - All Plans	$371 - $5,235	42%
Phcs - All Other Plans	$371 - $4,770	42%
Healthlink Work Comp	$4,799	547%

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 $3,115.
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 Pinckneyville Community 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.