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Patient Price Information List

Disclaimer: Cameron Memorial Hospital determines its standard charges for patient items and services through the use of a chargemaster system, which is a list of charges for the components of patient care that go into every patient’s bill. These are the baseline rates for items and services provided at the Hospital. The chargemaster is similar in concept to the manufacturer’s suggested retail price (“MSRP”) on a particular product or good. The charges listed provide only a general starting point in determining the potential costs of an individual patient’s care at the Hospital. This list does not reflect the actual out-of-pocket costs that may be paid by a patient for any particular service, it is not binding, and the actual charges for items and services may vary.

Many factors may influence the actual cost of an item or service, including insurance coverage, rates negotiated with payors, and so on. Government payors, such as Medicare and Medicaid for example, do not pay the chargemaster rates, but rather have their own set rates that hospitals are obligated to accept. Commercial insurance payments are based on contract negotiations with payors and may or may not reflect the standard charges. The cost of treatment also may be impacted by variables involved in a patient’s actual care, such as specific equipment or supplies required, the length of time spent in surgery or recovery, additional tests, or any changes in care or unexpected conditions or complications that arise. Moreover, the foregoing list of charges for services only includes charges from the Hospital. It does not reflect the charges for physicians, such as the surgeon, anesthesiologist, radiologist, pathologist, or other physician specialists or providers who may be involved in providing particular services to a patient. These charges are billed separately.

Individuals with questions about their out-of-pocket costs of service and other financial information should contact the hospital or consider contacting their insurers for further information.

LOCAL MARKET HOSPITALS

In order to present a meaningful comparison, Cameron Memorial Hospital has partnered with Hospital Pricing Specialists LLC to analyze current charges, based off CMS adjudicated claims through 3/31/2020. Cameron Memorial Hospital's charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

Dupont Hospital

Fort Wayne

IN

Lutheran Hospital

Fort Wayne

IN

Parkview DeKalb Hospital

Auburn

IN

Parkview LaGrange Hospital

LaGrange

IN

Parkview Noble Hospital

Kendallville

IN

Parkview Regional Medical Center

Fort Wayne

IN

ProMedica Coldwater Regional Hospital

Coldwater

MI

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$1,550
$1,730

10% lower than market

Swing Bed

$1,450
$1,450

Approximately equal to market

Intensive Care Unit

$3,000
$3,135

4% lower than market

OUTPATIENT PHYSICAL THERAPY CHARGES

The following charges reflect the most common services offered by our Physical Therapy department. Patients may have additional charges, depending on the services performed.

Description

Our Charge
Market Charge

Variance

Application of electrical stimulation to 1 or more areas, each 15 minutes [CPT 97032]

$135
$149

10% lower than market

Evaluation of physical therapy, typically 30 minutes [CPT 97162]

$401
$399

Approximately equal to market

Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes [CPT 97112]

$135
$143

6% lower than market

Manual (physical) therapy techniques to 1 or more regions, each 15 minutes [CPT 97140]

$135
$151

11% lower than market

Evaluation of physical therapy, typically 20 minutes [CPT 97161]

$264
$334

21% lower than market

OUTPATIENT OCCUPATIONAL THERAPY CHARGES

The following charges reflect the most common services offered by our Occupational Therapy department. Patients may have additional charges, depending on the services performed.

Description

Our Charge
Market Charge

Variance

Self-care or home management training, each 15 minutes [CPT 97535]

$135
$142

5% lower than market

Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes [CPT 97530]

$135
$127

6% higher than market

OUTPATIENT PULMONARY THERAPY CHARGES

The following charges reflect the most common services offered by our Pulmonary Therapy department. Patients may have additional charges, depending on the services performed.

Description

Our Charge
Market Charge

Variance

Routine electrocardiogram (EKG) with tracing using at least 12 leads [CPT 93005]

$305
$327

7% lower than market

OUTPATIENT SPEECH THERAPY CHARGES

Description

Our Charge
Market Charge

Variance

Treatment of speech, language, voice, communication, and/or hearing processing disorder [CPT 92507]

$298
$316

6% lower than market

Evaluation of swallowing function [CPT 92610]

$487
$514

5% lower than market

OUTPATIENT LABORATORY AND PATHOLOGY CHARGES

The following charges reflect our most common laboratory procedures. For all lab specimens collected via blood draw, the venipuncture will be charged separately.

Description

Our Charge
Market Charge

Variance

Bacterial blood culture [CPT 87040]

$263
$243

8% higher than market

Bacterial culture for aerobic isolates [CPT 87077]

$121
$114

7% higher than market

Bacterial colony count, urine [CPT 87086]

$73
$109

34% lower than market

Blood creatinine level [CPT 82565]

$45
$51

11% lower than market

Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide) [CPT 80051]

$88
$92

5% lower than market

Blood test, basic group of blood chemicals (Calcium, total) [CPT 80048]

$108
$128

16% lower than market

Blood test, clotting time [CPT 85610]

$50
$48

5% higher than market

Blood test, comprehensive group of blood chemicals [CPT 80053]

$148
$198

25% lower than market

Blood test, lipids (cholesterol and triglycerides) [CPT 80061]

$125
$163

23% lower than market

Blood test, thyroid stimulating hormone (TSH) [CPT 84443]

$150
$159

6% lower than market

Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count [CPT 85025]

$79
$78

2% higher than market

Complete blood cell count (red cells, white blood cell, platelets), automated test [CPT 85027]

$57
$63

9% lower than market

Amplifed DNA or RNA probe detection of severe acute respiratory syndrome coronavirus 2 (Covid-19) antigen [CPT 87635]

$189
$273

31% lower than market

Creatine kinase (cardiac enzyme) level, total [CPT 82550]

$81
$80

2% higher than market

Creatine kinase (cardiac enzyme) level, MB fraction only [CPT 82553]

$224
$207

8% higher than market

Gonadotropin (reproductive hormone) analysis [CPT 84703]

$107
$122

12% lower than market

Hemoglobin A1C level [CPT 83036]

$96
$111

14% lower than market

Blood count, hemoglobin [CPT 85018]

$59
$56

5% higher than market

Lactic acid level [CPT 83605]

$182
$175

4% higher than market

Lipase (fat enzyme) level [CPT 83690]

$168
$162

4% higher than market

Liver enzyme (SGOT), level [CPT 84450]

$47
$58

18% lower than market

Liver function blood test panel [CPT 80076]

$90
$121

26% lower than market

Magnesium level [CPT 83735]

$106
$102

4% higher than market

Measurement C-reactive protein for detection of infection or inflammation, high sensitivity [CPT 86141]

$162
$186

13% lower than market

Red blood cell concentration measurement [CPT 85014]

$56
$52

8% higher than market

Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution [CPT 87186]

$113
$146

23% lower than market

Thyroxine (thyroid chemical), free [CPT 84439]

$121
$187

35% lower than market

Troponin (protein) analysis, quantitative [CPT 84484]

$254
$232

9% higher than market

Urea nitrogen level to assess kidney function, quantitative [CPT 84520]

$40
$47

16% lower than market

Uric acid level [CPT 84560]

$89
$108

17% lower than market

Manual urinalysis test with examination using microscope, automated [CPT 81001]

$70
$87

19% lower than market

Automated urinalysis test [CPT 81003]

$56
$53

6% higher than market

OUTPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Measurement and recording of brain wave (EEG) activity, awake and drowsy [CPT 95816]

$1,157
$1,432

19% lower than market

Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session [CPT 93798]

$230
$272

15% lower than market

Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube [CPT 95811]

$6,484
$6,996

7% lower than market

Sleep monitoring of patient (6 years or older) in sleep lab [CPT 95810]

$5,585
$6,015

7% lower than market

Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes [CPT 97113]

$132
$111

19% higher than market

OUTPATIENT SURGICAL SERVICES CHARGES

Description

Our Charge
Market Charge

Variance

Insertion of needle into vein for collection of blood sample [CPT 36415]

$36
$38

6% lower than market

OUTPATIENT X-RAY AND RADIOLOGICAL CHARGES

The following charges reflect our most common x-ray and radiological procedures. For all exams requiring contrast, the contrast will be charged separately.

Description

Our Charge
Market Charge

Variance

CT scan of abdomen and pelvis with contrast [CPT 74177]

$3,200
$4,050

21% lower than market

CT scan of abdomen and pelvis [CPT 74176]

$2,400
$3,082

22% lower than market

Diagnostic CT scan of chest with contrast [CPT 71260]

$1,999
$2,180

8% lower than market

Diagnostic CT scan of chest [CPT 71250]

$1,700
$1,970

14% lower than market

CT scan head or brain [CPT 70450]

$1,700
$1,724

1% lower than market

CT scan of upper spine [CPT 72125]

$1,700
$2,320

27% lower than market

X-ray of chest, 2 views [CPT 71046]

$406
$474

14% lower than market

X-ray of chest, 1 view [CPT 71045]

$353
$323

9% higher than market

X-ray of abdomen, 1 view [CPT 74018]

$496
$466

6% higher than market

MRI scan of arm joint [CPT 73221]

$1,700
$2,188

22% lower than market

MRI scan of brain before and after contrast [CPT 70553]

$2,600
$3,036

14% lower than market

MRI scan brain [CPT 70551]

$1,700
$2,293

26% lower than market

MRI scan of leg joint [CPT 73721]

$1,700
$2,381

29% lower than market

MRI scan of upper spinal canal [CPT 72141]

$1,999
$2,320

14% lower than market

MRI scan of lower spinal canal [CPT 72148]

$1,999
$2,360

15% lower than market

Nuclear medicine study with CT imaging skull base to mid-thigh [CPT 78815]

$8,680
$9,130

5% lower than market

Screening mammography of both breasts [CPT 77067]

$263
$444

41% lower than market

Screening digital tomography of both breasts [CPT 77063]

$82
$77

5% higher than market

Ultrasound of abdomen, limited [CPT 76705]

$1,255
$1,230

2% higher than market

Ultrasound behind abdominal cavity [CPT 76770]

$1,192
$1,110

7% higher than market

Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck [CPT 93880]

$1,522
$1,595

5% lower than market

Ultrasound of pelvis, complete, not pregnancy related [CPT 76856]

$991
$1,139

13% lower than market

Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers [CPT 93971]

$1,007
$1,105

9% lower than market

X-ray of ankle, minimum of 3 views [CPT 73610]

$500
$456

10% higher than market

X-ray of foot, minimum of 3 views [CPT 73630]

$502
$500

Approximately equal to market

X-ray of hand, minimum of 3 views [CPT 73130]

$441
$456

3% lower than market

X-ray of hip with pelvis, 2-3 views [CPT 73502]

$467
$471

1% lower than market

X-ray of shoulder, minimum of 2 views [CPT 73030]

$510
$522

2% lower than market

BILLING PROCESS AND INFORMATION

How You Can Help

Thank you for choosing Cameron Memorial Hospital for your healthcare needs. We want to make understanding and paying your bill as easy as possible. Here are some ways you can help us as we work to make the billing process go smoothly.

• Please give us complete health insurance information.

In addition to your health insurance card, we may ask for a photo ID. If you have been seen at Cameron Memorial Hospital, let us know if your personal information or insurance information has changed since your last visit.

• Please understand and follow the requirements of your health plan.

Be sure to know your benefits, obtain proper authorization for services and submit referral claim forms if necessary. Many insurance plans require patients to pay a co-payment or deductible amount. You are responsible for paying co-payments required by your insurance provider and Cameron Memorial Hospital is responsible for collecting co-payments. Please come to your appointment prepared to make your co-payment.

• Please respond promptly to any requests from your insurance provider.

You may receive multiple bills from your hospital visit, including your family doctor, specialists, physicians that read x-rays, providers that give anesthesia, or physicians that interpret blood work. Insurance benefits are the result of your contract with your insurance company. We are a third-party to those benefits and may need your help with your insurance. If your insurance plan does not pay the bill within 90 days after billing, or your claim is denied, you will receive a statement from Cameron Memorial Hospital indicating the bill is now your responsibility. All bills sent to you are due upon receipt.

Questions about Price and Billing Information

Our goal is for each of our patients and their families to have the best healthcare experience possible. Part of our commitment is to provide you with information that helps you make well informed decisions about your own care.

To ask questions or get more information about a bill for services you've received, please contact our Billing Department at 260-665-2141.

If you need more information about the price of a future service, please contact our Customer Service at 260-665-2141. A physician’s order or CPT code is strongly encouraged when you call to assist us in providing you with the most accurate estimate. You can obtain the CPT code from the ordering physician.