Cameron Memorial Community Hospital

All Charges

Charge

Type

Price

PR ASPIRAT/INJECTION GANGLION CYST(S)

Professional

$116.90

Service Code	CPT 20612
Hospital Charge Code	z20612
Min. Negotiated Rate	$38.30
Max. Negotiated Rate	$87.68
Rate for Payer: Aetna Medicare	$38.30
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange	$64.90
Rate for Payer: Anthem Blue Cross of IN Traditional	$64.90
Rate for Payer: CareSource Indiana of IN Just 4 Me	$44.04
Rate for Payer: CareSource Indiana of IN Medicare	$42.13
Rate for Payer: Cash Price	$72.48
Rate for Payer: Cash Price	$72.48
Rate for Payer: Coventry All Commercial	$45.96
Rate for Payer: Frontpath All Commercial	$53.25
Rate for Payer: Humana ChoiceCare	$46.70
Rate for Payer: Humana Medicare	$38.30
Rate for Payer: Lucent All Commercial	$65.11
Rate for Payer: Lutheran Preferred All Commercial	$61.00
Rate for Payer: PHCS All Commercial	$87.68
Rate for Payer: PHP All Commercial	$65.01
Rate for Payer: Plain Church Group Ministry All Commercial	$38.30
Rate for Payer: Signature Care EPO	$80.75
Rate for Payer: Signature Care PPO	$80.75
Rate for Payer: Three Rivers Preferred All Commercial	$57.00
Rate for Payer: United Healthcare Commercial	$48.33
Rate for Payer: United Healthcare Medicare	$38.30

PR ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT

Professional

$500.00

Service Code	CPT 99483
Hospital Charge Code	z99483
Min. Negotiated Rate	$181.05
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Medicare	$184.63
Rate for Payer: CareSource Indiana of IN Just 4 Me	$212.32
Rate for Payer: CareSource Indiana of IN Medicare	$203.09
Rate for Payer: Cash Price	$310.00
Rate for Payer: Cash Price	$310.00
Rate for Payer: Coventry All Commercial	$221.56
Rate for Payer: Frontpath All Commercial	$200.82
Rate for Payer: Humana ChoiceCare	$253.43
Rate for Payer: Humana Medicare	$184.63
Rate for Payer: Lucent All Commercial	$313.87
Rate for Payer: PHCS All Commercial	$375.00
Rate for Payer: Plain Church Group Ministry All Commercial	$184.63
Rate for Payer: United Healthcare Commercial	$181.05
Rate for Payer: United Healthcare Medicare	$184.63

PR ATTENDANCE AT DELIVERY W INITIAL STABILIZATION

Professional

$135.46

Service Code	CPT 99464
Hospital Charge Code	z99464
Min. Negotiated Rate	$69.42
Max. Negotiated Rate	$255.00
Rate for Payer: Aetna Medicare	$69.42
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange	$126.00
Rate for Payer: Anthem Blue Cross of IN Traditional	$126.00
Rate for Payer: CareSource Indiana of IN Just 4 Me	$79.83
Rate for Payer: CareSource Indiana of IN Medicare	$76.36
Rate for Payer: Cash Price	$83.99
Rate for Payer: Cash Price	$83.99
Rate for Payer: Coventry All Commercial	$83.30
Rate for Payer: Frontpath All Commercial	$76.33
Rate for Payer: Humana ChoiceCare	$104.33
Rate for Payer: Humana Medicare	$69.42
Rate for Payer: Lucent All Commercial	$118.01
Rate for Payer: Lutheran Preferred All Commercial	$255.00
Rate for Payer: PHCS All Commercial	$101.60
Rate for Payer: PHP All Commercial	$69.76
Rate for Payer: Plain Church Group Ministry All Commercial	$69.42
Rate for Payer: Signature Care EPO	$74.68
Rate for Payer: Signature Care PPO	$74.68
Rate for Payer: Three Rivers Preferred All Commercial	$255.00
Rate for Payer: United Healthcare Commercial	$72.07
Rate for Payer: United Healthcare Medicare	$69.42

PR AUDEO M30-R BI

Professional

$2,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261BJ
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 AUDEO M30-R MONO

Professional

$1,000.00

Service Code	CPT V5257
Hospital Charge Code	zV5257CV
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 AUDEO M30-RT BI

Professional

$2,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261BE
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 AUDEO M30-RT MONO

Professional

$1,000.00

Service Code	CPT V5257
Hospital Charge Code	zV5257CL
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 AUDEO M50-R BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261BD
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 AUDEO M50-R MONO

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257CJ
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 AUDEO M50-RT BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261BF
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 AUDEO M50-RT MONO

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257CN
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 AUDEO M90-R BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261BH
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 AUDEO M90-R MONO

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257CR
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 AUDEO M90-RT BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261BG
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 AUDEO M90-RT MONO

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257CP
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 AUDEO P30-R BI

Professional

$2,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261BY
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 AUDEO P30-R MONO

Professional

$1,000.00

Service Code	CPT V5257
Hospital Charge Code	zV5257DL
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 AUDEO P30-RT BI

Professional

$2,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261BX
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 AUDEO P30-RT MONO

Professional

$1,000.00

Service Code	CPT V5257
Hospital Charge Code	zV5257DK
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 AUDEO P50-R BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261BW
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 AUDEO P50-R MONO

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257DJ
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 AUDEO P50-RT BI

Professional

$3,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261BV
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 AUDEO P50-RT MONO

Professional

$1,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257DI
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 AUDEO P90-R BI

Professional

$5,000.00

Service Code	CPT V5261
Hospital Charge Code	zV5261BU
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 AUDEO P90-R MONO

Professional

$2,500.00

Service Code	CPT V5257
Hospital Charge Code	zV5257DH
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.

All Charges