Cameron Memorial Community Hospital

All Charges

Charge

Type

Price

PR SIG 3PX SILK CIC HA BI

Professional

$2,000.00

Service Code	CPT V5258
Hospital Charge Code	zV5258E
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 SIG 3PX SILK CIC HA MON

Professional

$1,000.00

Service Code	CPT V5254
Hospital Charge Code	zV5254E
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 SIG 3X PURE CHARGE & GO BI

Professional

$2,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261CB
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 SIG 3X PURE CHARGE & GO MONO

Professional

$1,000.00

Service Code	CPT V5257
Hospital Charge Code	zV5257DO
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 SIG 5NX MOTION CHARGE & GO BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261AY
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 SIG 5NX MOTION CHARGE & GO MON

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257BZ
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 SIG 5NX PURE CHARGE & GO BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261AX
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 SIG 5NX PURE CHARGE & GO MON

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257BX
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 SIG 5NX STYLETTO CONNECT BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261BB
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 SIG 5NX STYLETTOCONNECTMONO

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257CF
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 SIG 5PX ACE BTE HA BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261J
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 SIG 5PX ACE BTE HA MON

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257J
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 SIG 5PX CARAT BTE HA BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261L
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 SIG 5PX CARAT BTE HA MON

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257L
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 SIG 5PX CELLION BTE HA BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261Q
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 SIG 5PX CELLION BTE HA MON

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257Q
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 SIG 5PX INSIO CUST CIC HA MON

Professional

$1,500.00

Service Code	CPT V5254
Hospital Charge Code	zV5254D
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 SIG 5PX INSIO CUST ITE HA MON

Professional

$1,500.00

Service Code	CPT V5256
Hospital Charge Code	zV5256B
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 SIG 5PX INSIO CUSTOM CIC HA BI

Professional

$3,000.00

Service Code	CPT V5258
Hospital Charge Code	zV5258D
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 SIG 5PX INSIO CUSTOM ITE HA BI

Professional

$3,000.00

Service Code	CPT V5260
Hospital Charge Code	zV5260B
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 SIG 5PX MOTION P BTE HA BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261O
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 SIG 5PX MOTION P BTE HA MON

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257O
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 SIG 5PX MOTION SA BTE HA BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261N
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 SIG 5PX MOTION SA BTE HA MON

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257N
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 SIG 5PX MOTION SP BTE HA BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261P
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

Price Transparency.

All Charges