Cameron Memorial Community Hospital

All Charges

Charge

Type

Price

PROPYLTHIOURACIL 50 MG ORAL TAB

Facility IP

$15.75

Service Code	NDC 68084096495
Hospital Charge Code	6662
Hospital Revenue Code	250
Min. Negotiated Rate	$11.81
Max. Negotiated Rate	$14.65
Rate for Payer: Aetna Commercial	$13.61
Rate for Payer: Cash Price	$9.77
Rate for Payer: Cigna All Commercial	$13.59
Rate for Payer: CORVEL All Commercial	$14.65
Rate for Payer: Coventry All Commercial	$13.86
Rate for Payer: Encore All Commercial	$14.50
Rate for Payer: Frontpath All Commercial	$14.49
Rate for Payer: Humana ChoiceCare	$13.60
Rate for Payer: Lutheran Preferred All Commercial	$14.18
Rate for Payer: PHCS All Commercial	$11.81
Rate for Payer: PHP All Commercial	$11.94
Rate for Payer: Sagamore Health Network All Products	$12.16
Rate for Payer: Signature Care EPO	$13.07
Rate for Payer: Signature Care PPO	$13.86
Rate for Payer: United Healthcare Commercial	$12.41

PROPYLTHIOURACIL 50 MG ORAL TAB

Facility IP

$15.75

Service Code	NDC 68084096425
Hospital Charge Code	6662
Hospital Revenue Code	250
Min. Negotiated Rate	$11.81
Max. Negotiated Rate	$14.65
Rate for Payer: Aetna Commercial	$13.61
Rate for Payer: Cash Price	$9.77
Rate for Payer: Cigna All Commercial	$13.59
Rate for Payer: CORVEL All Commercial	$14.65
Rate for Payer: Coventry All Commercial	$13.86
Rate for Payer: Encore All Commercial	$14.50
Rate for Payer: Frontpath All Commercial	$14.49
Rate for Payer: Humana ChoiceCare	$13.60
Rate for Payer: Lutheran Preferred All Commercial	$14.18
Rate for Payer: PHCS All Commercial	$11.81
Rate for Payer: PHP All Commercial	$11.94
Rate for Payer: Sagamore Health Network All Products	$12.16
Rate for Payer: Signature Care EPO	$13.07
Rate for Payer: Signature Care PPO	$13.86
Rate for Payer: United Healthcare Commercial	$12.41

PR ORAL DEXAMETHASONE

Professional

$0.11

Service Code	CPT J8540
Hospital Charge Code	zJ8540
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Humana ChoiceCare	$0.11
Rate for Payer: United Healthcare Commercial	$0.11

PR OSTEOCHONDRAL KNEE ALLOGRAFT

Professional

$2,476.64

Service Code	CPT 27415
Hospital Charge Code	z27415
Min. Negotiated Rate	$1,269.28
Max. Negotiated Rate	$2,157.78
Rate for Payer: Aetna Medicare	$1,269.28
Rate for Payer: CareSource Indiana of IN Just 4 Me	$1,459.67
Rate for Payer: CareSource Indiana of IN Medicare	$1,396.21
Rate for Payer: Cash Price	$1,535.52
Rate for Payer: Cash Price	$1,535.52
Rate for Payer: Coventry All Commercial	$1,523.14
Rate for Payer: Frontpath All Commercial	$1,781.90
Rate for Payer: Humana ChoiceCare	$1,388.02
Rate for Payer: Humana Medicare	$1,269.28
Rate for Payer: Lucent All Commercial	$2,157.78
Rate for Payer: PHCS All Commercial	$1,857.48
Rate for Payer: PHP All Commercial	$2,154.67
Rate for Payer: Plain Church Group Ministry All Commercial	$1,269.28
Rate for Payer: Signature Care EPO	$1,877.65
Rate for Payer: Signature Care PPO	$1,877.65
Rate for Payer: United Healthcare Commercial	$1,521.06
Rate for Payer: United Healthcare Medicare	$1,269.28

PR OSTEOCHONDRAL KNEE AUTOGRAFT

Professional

$1,773.62

Service Code	CPT 27416
Hospital Charge Code	z27416
Min. Negotiated Rate	$909.30
Max. Negotiated Rate	$1,545.81
Rate for Payer: Aetna Medicare	$909.30
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange	$1,322.50
Rate for Payer: Anthem Blue Cross of IN Traditional	$1,322.50
Rate for Payer: CareSource Indiana of IN Just 4 Me	$1,045.70
Rate for Payer: CareSource Indiana of IN Medicare	$1,000.23
Rate for Payer: Cash Price	$1,099.64
Rate for Payer: Cash Price	$1,099.64
Rate for Payer: Coventry All Commercial	$1,091.16
Rate for Payer: Frontpath All Commercial	$1,275.35
Rate for Payer: Humana ChoiceCare	$929.04
Rate for Payer: Humana Medicare	$909.30
Rate for Payer: Lucent All Commercial	$1,545.81
Rate for Payer: Lutheran Preferred All Commercial	$1,455.00
Rate for Payer: PHCS All Commercial	$1,330.22
Rate for Payer: PHP All Commercial	$1,543.05
Rate for Payer: Plain Church Group Ministry All Commercial	$909.30
Rate for Payer: Signature Care EPO	$1,261.31
Rate for Payer: Signature Care PPO	$1,261.31
Rate for Payer: Three Rivers Preferred All Commercial	$1,364.00
Rate for Payer: United Healthcare Commercial	$1,052.64
Rate for Payer: United Healthcare Medicare	$909.30

PR OSTEOPATHIC MANIP,1-2 BODY REGN

Professional

$57.58

Service Code	CPT 98925
Hospital Charge Code	z98925
Min. Negotiated Rate	$21.56
Max. Negotiated Rate	$43.18
Rate for Payer: Aetna Medicare	$22.10
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange	$27.13
Rate for Payer: Anthem Blue Cross of IN Traditional	$27.13
Rate for Payer: CareSource Indiana of IN Just 4 Me	$25.42
Rate for Payer: CareSource Indiana of IN Medicare	$24.31
Rate for Payer: Cash Price	$35.70
Rate for Payer: Cash Price	$35.70
Rate for Payer: Coventry All Commercial	$26.52
Rate for Payer: Frontpath All Commercial	$24.38
Rate for Payer: Humana ChoiceCare	$22.97
Rate for Payer: Humana Medicare	$22.10
Rate for Payer: Lucent All Commercial	$37.57
Rate for Payer: Lutheran Preferred All Commercial	$29.00
Rate for Payer: PHCS All Commercial	$43.18
Rate for Payer: PHP All Commercial	$21.56
Rate for Payer: Plain Church Group Ministry All Commercial	$22.10
Rate for Payer: Signature Care EPO	$26.35
Rate for Payer: Signature Care PPO	$26.35
Rate for Payer: Three Rivers Preferred All Commercial	$27.00
Rate for Payer: United Healthcare Commercial	$26.21
Rate for Payer: United Healthcare Medicare	$22.10

PR OSTEOPATHIC MANIP,3-4 BODY REGN

Professional

$83.14

Service Code	CPT 98926
Hospital Charge Code	z98926
Min. Negotiated Rate	$33.35
Max. Negotiated Rate	$62.36
Rate for Payer: Aetna Medicare	$33.35
Rate for Payer: CareSource Indiana of IN Just 4 Me	$38.35
Rate for Payer: CareSource Indiana of IN Medicare	$36.68
Rate for Payer: Cash Price	$51.55
Rate for Payer: Cash Price	$51.55
Rate for Payer: Coventry All Commercial	$40.02
Rate for Payer: Frontpath All Commercial	$36.33
Rate for Payer: Humana ChoiceCare	$34.89
Rate for Payer: Humana Medicare	$33.35
Rate for Payer: Lucent All Commercial	$56.70
Rate for Payer: PHCS All Commercial	$62.36
Rate for Payer: Plain Church Group Ministry All Commercial	$33.35
Rate for Payer: United Healthcare Commercial	$38.39
Rate for Payer: United Healthcare Medicare	$33.35

PR OSTEOPATHIC MANIP,5-6 BODY REGN

Professional

$108.10

Service Code	CPT 98927
Hospital Charge Code	z98927
Min. Negotiated Rate	$43.98
Max. Negotiated Rate	$81.08
Rate for Payer: Aetna Medicare	$43.98
Rate for Payer: CareSource Indiana of IN Just 4 Me	$50.58
Rate for Payer: CareSource Indiana of IN Medicare	$48.38
Rate for Payer: Cash Price	$67.02
Rate for Payer: Cash Price	$67.02
Rate for Payer: Coventry All Commercial	$52.78
Rate for Payer: Frontpath All Commercial	$48.02
Rate for Payer: Humana ChoiceCare	$44.94
Rate for Payer: Humana Medicare	$43.98
Rate for Payer: Lucent All Commercial	$74.77
Rate for Payer: PHCS All Commercial	$81.08
Rate for Payer: Plain Church Group Ministry All Commercial	$43.98
Rate for Payer: United Healthcare Commercial	$50.38
Rate for Payer: United Healthcare Medicare	$43.98

PR OSTEOTOMY HUMERUS

Professional

$1,534.46

Service Code	CPT 24400
Hospital Charge Code	z24400
Min. Negotiated Rate	$770.56
Max. Negotiated Rate	$1,309.95
Rate for Payer: Aetna Medicare	$770.56
Rate for Payer: CareSource Indiana of IN Just 4 Me	$886.14
Rate for Payer: CareSource Indiana of IN Medicare	$847.62
Rate for Payer: Cash Price	$951.37
Rate for Payer: Cash Price	$951.37
Rate for Payer: Coventry All Commercial	$924.67
Rate for Payer: Frontpath All Commercial	$1,071.69
Rate for Payer: Humana ChoiceCare	$869.77
Rate for Payer: Humana Medicare	$770.56
Rate for Payer: Lucent All Commercial	$1,309.95
Rate for Payer: PHCS All Commercial	$1,150.84
Rate for Payer: Plain Church Group Ministry All Commercial	$770.56
Rate for Payer: United Healthcare Commercial	$891.00
Rate for Payer: United Healthcare Medicare	$770.56

PR OSTEOTOMY TIBIA

Professional

$1,371.76

Service Code	CPT 27705
Hospital Charge Code	z27705
Min. Negotiated Rate	$703.19
Max. Negotiated Rate	$1,195.42
Rate for Payer: Aetna Medicare	$703.19
Rate for Payer: CareSource Indiana of IN Just 4 Me	$808.67
Rate for Payer: CareSource Indiana of IN Medicare	$773.51
Rate for Payer: Cash Price	$850.49
Rate for Payer: Cash Price	$850.49
Rate for Payer: Coventry All Commercial	$843.83
Rate for Payer: Frontpath All Commercial	$985.50
Rate for Payer: Humana ChoiceCare	$810.50
Rate for Payer: Humana Medicare	$703.19
Rate for Payer: Lucent All Commercial	$1,195.42
Rate for Payer: PHCS All Commercial	$1,028.82
Rate for Payer: PHP All Commercial	$1,193.43
Rate for Payer: Plain Church Group Ministry All Commercial	$703.19
Rate for Payer: Signature Care EPO	$1,088.85
Rate for Payer: Signature Care PPO	$1,088.85
Rate for Payer: United Healthcare Commercial	$838.09
Rate for Payer: United Healthcare Medicare	$703.19

PROTAMINE 10 MG/ML IV SOLN

Facility IP

$301.20

Service Code	HCPCS J2720
Hospital Charge Code	6677
Hospital Revenue Code	250
Min. Negotiated Rate	$225.90
Max. Negotiated Rate	$280.12
Rate for Payer: Aetna Commercial	$260.24
Rate for Payer: Cash Price	$186.74
Rate for Payer: Cigna All Commercial	$259.94
Rate for Payer: CORVEL All Commercial	$280.12
Rate for Payer: Coventry All Commercial	$265.06
Rate for Payer: Encore All Commercial	$277.25
Rate for Payer: Frontpath All Commercial	$277.10
Rate for Payer: Humana ChoiceCare	$260.15
Rate for Payer: Lutheran Preferred All Commercial	$271.08
Rate for Payer: PHCS All Commercial	$225.90
Rate for Payer: PHP All Commercial	$228.43
Rate for Payer: Sagamore Health Network All Products	$232.53
Rate for Payer: Signature Care EPO	$250.00
Rate for Payer: Signature Care PPO	$265.06
Rate for Payer: United Healthcare Commercial	$237.35

PROTAMINE 10 MG/ML IV SOLN

Facility OP

$301.20

Service Code	HCPCS J2720
Hospital Charge Code	6677
Hospital Revenue Code	636
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$280.12
Rate for Payer: Aetna Commercial	$254.21
Rate for Payer: Aetna Medicare	$99.40
Rate for Payer: Anthem Blue Cross of IN Medicare	$99.40
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange	$172.98
Rate for Payer: Anthem Blue Cross of IN Traditional	$188.28
Rate for Payer: CareSource Indiana of IN Just 4 Me	$114.31
Rate for Payer: CareSource Indiana of IN Medicare	$109.34
Rate for Payer: Cash Price	$186.74
Rate for Payer: Centivo All Commercial	$153.61
Rate for Payer: Cigna All Commercial	$259.94
Rate for Payer: CORVEL All Commercial	$280.12
Rate for Payer: Coventry All Commercial	$265.06
Rate for Payer: Encore All Commercial	$277.25
Rate for Payer: Frontpath All Commercial	$277.10
Rate for Payer: Humana ChoiceCare	$260.15
Rate for Payer: Humana Medicare	$153.61
Rate for Payer: Lucent All Commercial	$153.61
Rate for Payer: Lutheran Preferred All Commercial	$271.08
Rate for Payer: PHCS All Commercial	$225.90
Rate for Payer: PHP All Commercial	$228.43
Rate for Payer: Plain Church Group Ministry All Commercial	$117.47
Rate for Payer: Sagamore Health Network All Products	$232.53
Rate for Payer: Signature Care EPO	$250.00
Rate for Payer: Signature Care PPO	$265.06
Rate for Payer: Three Rivers Preferred All Commercial	$256.02
Rate for Payer: United Healthcare Commercial	$237.35
Rate for Payer: United Healthcare Medicare	$99.40

PR OTI AMIGO ARC REC - MONO

Professional

$800.00

Service Code	CPT V5281
Hospital Charge Code	zV5281E
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$800.00
Rate for Payer: Cash Price	$496.00
Rate for Payer: PHCS All Commercial	$600.00
Rate for Payer: Signature Care EPO	$800.00
Rate for Payer: Signature Care PPO	$800.00

PR OTI AMIGO STAR REC – BI

Professional

$1,600.00

Service Code	CPT V5282
Hospital Charge Code	zV5282A
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: Cash Price	$992.00
Rate for Payer: PHCS All Commercial	$1,200.00
Rate for Payer: Signature Care EPO	$1,600.00
Rate for Payer: Signature Care PPO	$1,600.00

PR OTI AMIGO STAR REC – MONO

Professional

$800.00

Service Code	CPT V5281
Hospital Charge Code	zV5281D
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$800.00
Rate for Payer: Cash Price	$496.00
Rate for Payer: PHCS All Commercial	$600.00
Rate for Payer: Signature Care EPO	$800.00
Rate for Payer: Signature Care PPO	$800.00

PR OTI AMIGO TRANS T30

Professional

$1,100.00

Service Code	CPT V5281
Hospital Charge Code	zV5281A
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Cash Price	$682.00
Rate for Payer: PHCS All Commercial	$825.00
Rate for Payer: Signature Care EPO	$1,100.00
Rate for Payer: Signature Care PPO	$1,100.00

PR OTI AMIGO TRANS T30

Professional

$1,100.00

Service Code	CPT V5281
Hospital Charge Code	zV5281F
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Cash Price	$682.00
Rate for Payer: PHCS All Commercial	$825.00
Rate for Payer: Signature Care EPO	$1,100.00
Rate for Payer: Signature Care PPO	$1,100.00

PR OTI AMIGO TRANS T31

Professional

$1,100.00

Service Code	CPT V5281
Hospital Charge Code	zV5281B
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Cash Price	$682.00
Rate for Payer: PHCS All Commercial	$825.00
Rate for Payer: Signature Care EPO	$1,100.00
Rate for Payer: Signature Care PPO	$1,100.00

PR OTI AMIGO TRANS T5

Professional

$1,100.00

Service Code	CPT V5281
Hospital Charge Code	zV5281C
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Cash Price	$682.00
Rate for Payer: PHCS All Commercial	$825.00
Rate for Payer: Signature Care EPO	$1,100.00
Rate for Payer: Signature Care PPO	$1,100.00

PR OTI CONNECTLINE MICROPHONE

Professional

$300.00

Service Code	CPT V5270
Hospital Charge Code	zV5270G
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$300.00
Rate for Payer: Cash Price	$186.00
Rate for Payer: PHCS All Commercial	$225.00
Rate for Payer: Signature Care EPO	$300.00
Rate for Payer: Signature Care PPO	$300.00

PR OTI CONNECTLINE PH ADPT 2.0

Professional

$300.00

Service Code	CPT V5270
Hospital Charge Code	zV5270F
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$300.00
Rate for Payer: Cash Price	$186.00
Rate for Payer: PHCS All Commercial	$225.00
Rate for Payer: Signature Care EPO	$300.00
Rate for Payer: Signature Care PPO	$300.00

PR OTI CONNECTLINE STREAMERPRO

Professional

$300.00

Service Code	CPT V5270
Hospital Charge Code	zV5270E
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$300.00
Rate for Payer: Cash Price	$186.00
Rate for Payer: PHCS All Commercial	$225.00
Rate for Payer: Signature Care EPO	$300.00
Rate for Payer: Signature Care PPO	$300.00

PR OTI CONNECTLINE TV ADPTR2.0

Professional

$300.00

Service Code	CPT V5270
Hospital Charge Code	zV5270A
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$300.00
Rate for Payer: Cash Price	$186.00
Rate for Payer: PHCS All Commercial	$225.00
Rate for Payer: Signature Care EPO	$300.00
Rate for Payer: Signature Care PPO	$300.00

PR OTI MORE 1 MINIRITE-R BTE BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261BN
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Cash Price	$3,100.00
Rate for Payer: Cash Price	$3,100.00
Rate for Payer: PHCS All Commercial	$3,750.00
Rate for Payer: Signature Care EPO	$5,000.00
Rate for Payer: Signature Care PPO	$5,000.00
Rate for Payer: United Healthcare Commercial	$5,000.00

PR OTI MORE 1 MINIRITE-R BTE MONO

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257DA
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Cash Price	$1,550.00
Rate for Payer: Cash Price	$1,550.00
Rate for Payer: PHCS All Commercial	$1,875.00
Rate for Payer: Signature Care EPO	$2,500.00
Rate for Payer: Signature Care PPO	$2,500.00
Rate for Payer: United Healthcare Commercial	$2,500.00

Price Transparency.

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