Cameron Memorial Community Hospital

All Charges

Charge

Type

Price

PR SIG 7PX MOTION P BTE HA BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261F
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 MOTION P BTE HA MON

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257F
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 MOTION SA BTE HA BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261E
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 MOTION SA BTE HA MON

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257E
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 MOTION SP BTE HA BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261G
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 MOTION SP BTE HA MON

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257G
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 MOTION SX BTE HA BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261D
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 MOTION SX BTE HA MON

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257D
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 PURE BTE HA BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261B
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 PURE BTE HA MON

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257B
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 SILK CIC HA BI

Professional

$5,000.00

Service Code	CPT V5258
Hospital Charge Code	zV5258A
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 SILK CIC HA MON

Professional

$2,500.00

Service Code	CPT V5254
Hospital Charge Code	zV5254A
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 7X PURE CHARGE & GO BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261BZ
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 7X PURE CHARGE & GO MONO

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257DM
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 CELLION CHARGER

Professional

$500.00

Service Code	CPT V5267
Hospital Charge Code	zV5267L
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$500.00
Rate for Payer: Cash Price	$310.00
Rate for Payer: PHCS All Commercial	$375.00
Rate for Payer: Signature Care EPO	$500.00
Rate for Payer: Signature Care PPO	$500.00

PR SIG EASYTEK

Professional

$300.00

Service Code	CPT V5270
Hospital Charge Code	zV5270H
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 SIG ECHARGER

Professional

$500.00

Service Code	CPT V5267
Hospital Charge Code	zV5267H
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$500.00
Rate for Payer: Cash Price	$310.00
Rate for Payer: PHCS All Commercial	$375.00
Rate for Payer: Signature Care EPO	$500.00
Rate for Payer: Signature Care PPO	$500.00

PR SIGMOIDOSCOPY,BIOPSY

Professional

$522.52

Service Code	CPT 45331
Hospital Charge Code	z45331
Min. Negotiated Rate	$66.82
Max. Negotiated Rate	$391.89
Rate for Payer: Aetna Medicare	$66.82
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange	$151.50
Rate for Payer: Anthem Blue Cross of IN Traditional	$151.50
Rate for Payer: CareSource Indiana of IN Just 4 Me	$76.84
Rate for Payer: CareSource Indiana of IN Medicare	$73.50
Rate for Payer: Cash Price	$323.96
Rate for Payer: Cash Price	$323.96
Rate for Payer: Coventry All Commercial	$80.18
Rate for Payer: Frontpath All Commercial	$91.29
Rate for Payer: Humana ChoiceCare	$78.20
Rate for Payer: Humana Medicare	$66.82
Rate for Payer: Lucent All Commercial	$113.59
Rate for Payer: Lutheran Preferred All Commercial	$100.00
Rate for Payer: PHCS All Commercial	$391.89
Rate for Payer: PHP All Commercial	$114.08
Rate for Payer: Plain Church Group Ministry All Commercial	$66.82
Rate for Payer: Signature Care EPO	$235.85
Rate for Payer: Signature Care PPO	$235.85
Rate for Payer: Three Rivers Preferred All Commercial	$94.00
Rate for Payer: United Healthcare Commercial	$85.31
Rate for Payer: United Healthcare Medicare	$66.82

PR SIGMOIDOSCOPY FLX CONTROL BLEEDING

Professional

$900.88

Service Code	CPT 45334
Hospital Charge Code	z45334
Min. Negotiated Rate	$109.15
Max. Negotiated Rate	$675.66
Rate for Payer: Aetna Medicare	$109.15
Rate for Payer: CareSource Indiana of IN Just 4 Me	$125.52
Rate for Payer: CareSource Indiana of IN Medicare	$120.06
Rate for Payer: Cash Price	$558.55
Rate for Payer: Cash Price	$558.55
Rate for Payer: Coventry All Commercial	$130.98
Rate for Payer: Frontpath All Commercial	$151.00
Rate for Payer: Humana ChoiceCare	$174.65
Rate for Payer: Humana Medicare	$109.15
Rate for Payer: Lucent All Commercial	$185.56
Rate for Payer: PHCS All Commercial	$675.66
Rate for Payer: Plain Church Group Ministry All Commercial	$109.15
Rate for Payer: United Healthcare Commercial	$188.90
Rate for Payer: United Healthcare Medicare	$109.15

PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD

Professional

$338.80

Service Code	CPT 45330
Hospital Charge Code	z45330
Min. Negotiated Rate	$52.01
Max. Negotiated Rate	$254.10
Rate for Payer: Aetna Medicare	$52.01
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange	$111.20
Rate for Payer: Anthem Blue Cross of IN Traditional	$111.20
Rate for Payer: CareSource Indiana of IN Just 4 Me	$59.81
Rate for Payer: CareSource Indiana of IN Medicare	$57.21
Rate for Payer: Cash Price	$210.06
Rate for Payer: Cash Price	$210.06
Rate for Payer: Coventry All Commercial	$62.41
Rate for Payer: Frontpath All Commercial	$71.54
Rate for Payer: Humana ChoiceCare	$65.68
Rate for Payer: Humana Medicare	$52.01
Rate for Payer: Lucent All Commercial	$88.42
Rate for Payer: Lutheran Preferred All Commercial	$78.00
Rate for Payer: PHCS All Commercial	$254.10
Rate for Payer: PHP All Commercial	$88.79
Rate for Payer: Plain Church Group Ministry All Commercial	$52.01
Rate for Payer: Signature Care EPO	$172.55
Rate for Payer: Signature Care PPO	$172.55
Rate for Payer: Three Rivers Preferred All Commercial	$73.00
Rate for Payer: United Healthcare Commercial	$70.28
Rate for Payer: United Healthcare Medicare	$52.01

PR SIGMOIDOSCOPY FLX TNDSC BALO DILAT

Professional

$834.64

Service Code	CPT 45340
Hospital Charge Code	z45340
Min. Negotiated Rate	$72.42
Max. Negotiated Rate	$625.98
Rate for Payer: Aetna Medicare	$72.42
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange	$371.38
Rate for Payer: Anthem Blue Cross of IN Traditional	$371.38
Rate for Payer: CareSource Indiana of IN Just 4 Me	$83.28
Rate for Payer: CareSource Indiana of IN Medicare	$79.66
Rate for Payer: Cash Price	$517.48
Rate for Payer: Cash Price	$517.48
Rate for Payer: Coventry All Commercial	$86.90
Rate for Payer: Frontpath All Commercial	$100.41
Rate for Payer: Humana ChoiceCare	$122.81
Rate for Payer: Humana Medicare	$72.42
Rate for Payer: Lucent All Commercial	$123.11
Rate for Payer: Lutheran Preferred All Commercial	$109.00
Rate for Payer: PHCS All Commercial	$625.98
Rate for Payer: PHP All Commercial	$123.65
Rate for Payer: Plain Church Group Ministry All Commercial	$72.42
Rate for Payer: Signature Care EPO	$464.10
Rate for Payer: Signature Care PPO	$464.10
Rate for Payer: Three Rivers Preferred All Commercial	$101.00
Rate for Payer: United Healthcare Commercial	$131.06
Rate for Payer: United Healthcare Medicare	$72.42

PR SIG RCHRGBL BATTERIES

Professional

$50.00

Service Code	CPT V5266
Hospital Charge Code	zV5266B
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$50.00
Rate for Payer: Cash Price	$31.00
Rate for Payer: PHCS All Commercial	$37.50
Rate for Payer: Signature Care EPO	$50.00
Rate for Payer: Signature Care PPO	$50.00

PR SIG STREAMLINE TV

Professional

$300.00

Service Code	CPT V5270
Hospital Charge Code	zV5270K
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 SIG STREAMLINE TV PURE 13 BT

Professional

$300.00

Service Code	CPT V5270
Hospital Charge Code	zV5270J
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 SIG TV TRANS EASYTEK/MINITEK

Professional

$300.00

Service Code	CPT V5270
Hospital Charge Code	zV5270I
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

Price Transparency.

All Charges