Cameron Memorial Community Hospital

All Charges

Charge

Type

Price

PR SIG 5PX MOTION SP BTE HA MON

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257P
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 SX BTE HA BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261M
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 SX BTE HA MON

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257M
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 PURE BTE HA BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261K
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 PURE BTE HA MON

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257K
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 SILK CIC HA BI

Professional

$3,000.00

Service Code	CPT V5258
Hospital Charge Code	zV5258C
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 SILK CIC HA MON

Professional

$1,500.00

Service Code	CPT V5254
Hospital Charge Code	zV5254C
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 5X PURE CHARGE & GO BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261CA
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 5X PURE CHARGE & GO MONO

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257DN
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 7NX MOTION CHARGE & GO BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261AW
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 SIG 7NX MOTION CHARGE & GO MON

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257BV
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 SIG 7NX PURE CHARGE & GO BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261AV
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 SIG 7NX PURE CHARGE & GO MON

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257BT
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 SIG 7NX STYLETTO CONNECT BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261AU
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 SIG 7NX STYLETTO CONNECT MON

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257BR
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 SIG 7PX ACE BTE HA BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261A
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 SIG 7PX ACE BTE HA MON

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257A
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 SIG 7PX CARAT BTE HA BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261C
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 SIG 7PX CARAT BTE HA MON

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257C
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 SIG 7PX CELLION BTE HA BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261H
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 SIG 7PX CELLION BTE HA MON

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257H
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 SIG 7PX INSIO CUST CIC HA MON

Professional

$2,500.00

Service Code	CPT V5254
Hospital Charge Code	zV5254B
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 SIG 7PX INSIO CUST ITE HA MON

Professional

$2,500.00

Service Code	CPT V5256
Hospital Charge Code	zV5256A
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 SIG 7PX INSIO CUSTOM CIC HA BI

Professional

$5,000.00

Service Code	CPT V5258
Hospital Charge Code	zV5258B
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 SIG 7PX INSIO CUSTOM ITE HA BI

Professional

$5,000.00

Service Code	CPT V5260
Hospital Charge Code	zV5260A
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

Price Transparency.

All Charges