Cameron Memorial Community Hospital

All Charges

Charge

Type

Price

PR OTI MORE 2 MINIRITE-R BTE BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261BO
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Cash Price	$1,860.00
Rate for Payer: Cash Price	$1,860.00
Rate for Payer: PHCS All Commercial	$2,250.00
Rate for Payer: Signature Care EPO	$3,000.00
Rate for Payer: Signature Care PPO	$3,000.00
Rate for Payer: United Healthcare Commercial	$5,000.00

PR OTI MORE 2 MINIRITE-R BTE MONO

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257DB
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Cash Price	$930.00
Rate for Payer: Cash Price	$930.00
Rate for Payer: PHCS All Commercial	$1,125.00
Rate for Payer: Signature Care EPO	$1,500.00
Rate for Payer: Signature Care PPO	$1,500.00
Rate for Payer: United Healthcare Commercial	$2,500.00

PR OTI MORE 3 MINIRITE-R BTE BI

Professional

$2,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261BP
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Cash Price	$1,240.00
Rate for Payer: Cash Price	$1,240.00
Rate for Payer: PHCS All Commercial	$1,500.00
Rate for Payer: Signature Care EPO	$2,000.00
Rate for Payer: Signature Care PPO	$2,000.00
Rate for Payer: United Healthcare Commercial	$5,000.00

PR OTI MORE 3 MINIRITE-R BTE MONO

Professional

$1,000.00

Service Code	CPT V5257
Hospital Charge Code	zV5257DC
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Cash Price	$620.00
Rate for Payer: Cash Price	$620.00
Rate for Payer: PHCS All Commercial	$750.00
Rate for Payer: Signature Care EPO	$1,000.00
Rate for Payer: Signature Care PPO	$1,000.00
Rate for Payer: United Healthcare Commercial	$2,500.00

PR OTI OPN 1 BTE13 PP BTE HA BI

Professional

$6,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261AC
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Cash Price	$3,720.00
Rate for Payer: Cash Price	$3,720.00
Rate for Payer: PHCS All Commercial	$4,500.00
Rate for Payer: Signature Care EPO	$6,000.00
Rate for Payer: Signature Care PPO	$6,000.00
Rate for Payer: United Healthcare Commercial	$5,000.00

PR OTI OPN 1 BTE13 PP BTE HA MON

Professional

$3,000.00

Service Code	CPT V5257
Hospital Charge Code	zV5257AC
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Cash Price	$1,860.00
Rate for Payer: Cash Price	$1,860.00
Rate for Payer: PHCS All Commercial	$2,250.00
Rate for Payer: Signature Care EPO	$3,000.00
Rate for Payer: Signature Care PPO	$3,000.00
Rate for Payer: United Healthcare Commercial	$2,500.00

PR OTI OPN 1 MINIR BTE HA BI

Professional

$6,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261AA
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Cash Price	$3,720.00
Rate for Payer: Cash Price	$3,720.00
Rate for Payer: PHCS All Commercial	$4,500.00
Rate for Payer: Signature Care EPO	$6,000.00
Rate for Payer: Signature Care PPO	$6,000.00
Rate for Payer: United Healthcare Commercial	$5,000.00

PR OTI OPN 1 MINIR BTE HA MON

Professional

$3,000.00

Service Code	CPT V5257
Hospital Charge Code	zV5257AA
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Cash Price	$1,860.00
Rate for Payer: Cash Price	$1,860.00
Rate for Payer: PHCS All Commercial	$2,250.00
Rate for Payer: Signature Care EPO	$3,000.00
Rate for Payer: Signature Care PPO	$3,000.00
Rate for Payer: United Healthcare Commercial	$2,500.00

PR OTI OPN 1 MINIR T BTE HA BI

Professional

$6,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261AB
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Cash Price	$3,720.00
Rate for Payer: Cash Price	$3,720.00
Rate for Payer: PHCS All Commercial	$4,500.00
Rate for Payer: Signature Care EPO	$6,000.00
Rate for Payer: Signature Care PPO	$6,000.00
Rate for Payer: United Healthcare Commercial	$5,000.00

PR OTI OPN 1 MINIR T BTE HA MON

Professional

$3,000.00

Service Code	CPT V5257
Hospital Charge Code	zV5257AB
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Cash Price	$1,860.00
Rate for Payer: Cash Price	$1,860.00
Rate for Payer: PHCS All Commercial	$2,250.00
Rate for Payer: Signature Care EPO	$3,000.00
Rate for Payer: Signature Care PPO	$3,000.00
Rate for Payer: United Healthcare Commercial	$2,500.00

PR OTI OPN 2 BTE PP HA BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261AS
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 OPN 2 BTE PP HA MON

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257BL
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

PR OTI OPN 2 MINIR BTE HA BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261AQ
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 OPN 2 MINIR BTE HA MON

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257BJ
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

PR OTI OPN 2 MINIR R BTE HA BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261AT
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 OPN 2 MINIR R BTE HA MON

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257BP
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

PR OTI OPN 2 MINIR T BTE HA BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261AR
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 OPN 2 MINIR T BTE HA MON

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257BK
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

PR OTI OPN3 BTE13 PP BTE HA BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261AF
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Cash Price	$1,860.00
Rate for Payer: Cash Price	$1,860.00
Rate for Payer: PHCS All Commercial	$2,250.00
Rate for Payer: Signature Care EPO	$3,000.00
Rate for Payer: Signature Care PPO	$3,000.00
Rate for Payer: United Healthcare Commercial	$5,000.00

PR OTI OPN3 BTE13 PP BTE HA MON

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257AF
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Cash Price	$930.00
Rate for Payer: Cash Price	$930.00
Rate for Payer: PHCS All Commercial	$1,125.00
Rate for Payer: Signature Care EPO	$1,500.00
Rate for Payer: Signature Care PPO	$1,500.00
Rate for Payer: United Healthcare Commercial	$2,500.00

PR OTI OPN3 MINIR BTE HA BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261AD
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Cash Price	$1,860.00
Rate for Payer: Cash Price	$1,860.00
Rate for Payer: PHCS All Commercial	$2,250.00
Rate for Payer: Signature Care EPO	$3,000.00
Rate for Payer: Signature Care PPO	$3,000.00
Rate for Payer: United Healthcare Commercial	$5,000.00

PR OTI OPN3 MINIR BTE HA MON

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257AD
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Cash Price	$930.00
Rate for Payer: Cash Price	$930.00
Rate for Payer: PHCS All Commercial	$1,125.00
Rate for Payer: Signature Care EPO	$1,500.00
Rate for Payer: Signature Care PPO	$1,500.00
Rate for Payer: United Healthcare Commercial	$2,500.00

PR OTI OPN3 MINIR T BTE HA BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261AE
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Cash Price	$1,860.00
Rate for Payer: Cash Price	$1,860.00
Rate for Payer: PHCS All Commercial	$2,250.00
Rate for Payer: Signature Care EPO	$3,000.00
Rate for Payer: Signature Care PPO	$3,000.00
Rate for Payer: United Healthcare Commercial	$5,000.00

PR OTI OPN3 MINIR T BTE HA MON

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257AE
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Cash Price	$930.00
Rate for Payer: Cash Price	$930.00
Rate for Payer: PHCS All Commercial	$1,125.00
Rate for Payer: Signature Care EPO	$1,500.00
Rate for Payer: Signature Care PPO	$1,500.00
Rate for Payer: United Healthcare Commercial	$2,500.00

PR OTI OPN CONNECTCLIP

Professional

$400.00

Service Code	CPT V5267
Hospital Charge Code	zV5267J
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$400.00
Rate for Payer: Cash Price	$248.00
Rate for Payer: PHCS All Commercial	$300.00
Rate for Payer: Signature Care EPO	$400.00
Rate for Payer: Signature Care PPO	$400.00

Price Transparency.

All Charges