Cameron Memorial Community Hospital

All Charges

Charge

Type

Price

Removal of tunneled central venous catheter, without subcutaneous port or pump

Facility OP

$1,242.31

Service Code	CPT 36589
Hospital Charge Code	CPT-36589
Hospital Revenue Code	360
Min. Negotiated Rate	$1,242.31
Max. Negotiated Rate	$1,242.31
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$1,242.31
Rate for Payer: Managed Health Services Medicaid	$1,242.31
Rate for Payer: MDWise Medicaid	$1,242.31

Repair, extensor tendon, finger, primary or secondary; without free graft, each tendon

Facility OP

$2,273.62

Service Code	CPT 26418
Hospital Charge Code	CPT-26418
Hospital Revenue Code	360
Min. Negotiated Rate	$2,273.62
Max. Negotiated Rate	$2,273.62
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$2,273.62
Rate for Payer: Managed Health Services Medicaid	$2,273.62
Rate for Payer: MDWise Medicaid	$2,273.62

Repair, flexor tendon, leg; primary, without graft, each tendon

Facility OP

$1,242.31

Service Code	CPT 27658
Hospital Charge Code	CPT-27658
Hospital Revenue Code	360
Min. Negotiated Rate	$1,242.31
Max. Negotiated Rate	$1,242.31
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$1,242.31
Rate for Payer: Managed Health Services Medicaid	$1,242.31
Rate for Payer: MDWise Medicaid	$1,242.31

Repair inguinal hernia, sliding, any age

Facility OP

$2,273.62

Service Code	CPT 49525
Hospital Charge Code	CPT-49525
Hospital Revenue Code	360
Min. Negotiated Rate	$2,273.62
Max. Negotiated Rate	$2,273.62
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$2,273.62
Rate for Payer: Managed Health Services Medicaid	$2,273.62
Rate for Payer: MDWise Medicaid	$2,273.62

Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated

Facility OP

$3,121.64

Service Code	CPT 49507
Hospital Charge Code	CPT-49507
Hospital Revenue Code	360
Min. Negotiated Rate	$3,121.64
Max. Negotiated Rate	$3,121.64
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$3,121.64
Rate for Payer: Managed Health Services Medicaid	$3,121.64
Rate for Payer: MDWise Medicaid	$3,121.64

Repair initial inguinal hernia, age 5 years or older; reducible

Facility OP

$2,273.62

Service Code	CPT 49505
Hospital Charge Code	CPT-49505
Hospital Revenue Code	360
Min. Negotiated Rate	$2,273.62
Max. Negotiated Rate	$2,273.62
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$2,273.62
Rate for Payer: Managed Health Services Medicaid	$2,273.62
Rate for Payer: MDWise Medicaid	$2,273.62

Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less

Facility OP

$648.18

Service Code	CPT 12051
Hospital Charge Code	CPT-12051
Hospital Revenue Code	360
Min. Negotiated Rate	$648.18
Max. Negotiated Rate	$648.18
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$648.18
Rate for Payer: Managed Health Services Medicaid	$648.18
Rate for Payer: MDWise Medicaid	$648.18

Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm

Facility OP

$1,044.85

Service Code	CPT 12052
Hospital Charge Code	CPT-12052
Hospital Revenue Code	360
Min. Negotiated Rate	$1,044.85
Max. Negotiated Rate	$1,044.85
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$1,044.85
Rate for Payer: Managed Health Services Medicaid	$1,044.85
Rate for Payer: MDWise Medicaid	$1,044.85

Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm

Facility OP

$1,283.57

Service Code	CPT 12053
Hospital Charge Code	CPT-12053
Hospital Revenue Code	360
Min. Negotiated Rate	$1,283.57
Max. Negotiated Rate	$1,283.57
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$1,283.57
Rate for Payer: Managed Health Services Medicaid	$1,283.57
Rate for Payer: MDWise Medicaid	$1,283.57

Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm

Facility OP

$1,044.85

Service Code	CPT 12042
Hospital Charge Code	CPT-12042
Hospital Revenue Code	360
Min. Negotiated Rate	$1,044.85
Max. Negotiated Rate	$1,044.85
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$1,044.85
Rate for Payer: Managed Health Services Medicaid	$1,044.85
Rate for Payer: MDWise Medicaid	$1,044.85

Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm

Facility OP

$1,044.85

Service Code	CPT 12032
Hospital Charge Code	CPT-12032
Hospital Revenue Code	360
Min. Negotiated Rate	$1,044.85
Max. Negotiated Rate	$1,044.85
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$1,044.85
Rate for Payer: Managed Health Services Medicaid	$1,044.85
Rate for Payer: MDWise Medicaid	$1,044.85

Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm

Facility OP

$1,728.79

Service Code	CPT 12034
Hospital Charge Code	CPT-12034
Hospital Revenue Code	360
Min. Negotiated Rate	$1,728.79
Max. Negotiated Rate	$1,728.79
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$1,728.79
Rate for Payer: Managed Health Services Medicaid	$1,728.79
Rate for Payer: MDWise Medicaid	$1,728.79

Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, incarcerated or strangulated

Facility OP

$13,051.74

Service Code	CPT 49594
Hospital Charge Code	CPT-49594
Hospital Revenue Code	360
Min. Negotiated Rate	$13,051.74
Max. Negotiated Rate	$13,051.74
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$13,051.74
Rate for Payer: Managed Health Services Medicaid	$13,051.74
Rate for Payer: MDWise Medicaid	$13,051.74

Facility OP

$13,051.74

Service Code	CPT 49593
Hospital Charge Code	CPT-49593
Hospital Revenue Code	360
Min. Negotiated Rate	$13,051.74
Max. Negotiated Rate	$13,051.74
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$13,051.74
Rate for Payer: Managed Health Services Medicaid	$13,051.74
Rate for Payer: MDWise Medicaid	$13,051.74

Facility OP

$13,051.74

Service Code	CPT 49595
Hospital Charge Code	CPT-49595
Hospital Revenue Code	360
Min. Negotiated Rate	$13,051.74
Max. Negotiated Rate	$13,051.74
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$13,051.74
Rate for Payer: Managed Health Services Medicaid	$13,051.74
Rate for Payer: MDWise Medicaid	$13,051.74

Facility OP

$13,051.74

Service Code	CPT 49592
Hospital Charge Code	CPT-49592
Hospital Revenue Code	360
Min. Negotiated Rate	$13,051.74
Max. Negotiated Rate	$13,051.74
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$13,051.74
Rate for Payer: Managed Health Services Medicaid	$13,051.74
Rate for Payer: MDWise Medicaid	$13,051.74

Facility OP

$13,051.74

Service Code	CPT 49591
Hospital Charge Code	CPT-49591
Hospital Revenue Code	360
Min. Negotiated Rate	$13,051.74
Max. Negotiated Rate	$13,051.74
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$13,051.74
Rate for Payer: Managed Health Services Medicaid	$13,051.74
Rate for Payer: MDWise Medicaid	$13,051.74

Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, reducible

Facility OP

$13,051.74

Service Code	CPT 49613
Hospital Charge Code	CPT-49613
Hospital Revenue Code	360
Min. Negotiated Rate	$13,051.74
Max. Negotiated Rate	$13,051.74
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$13,051.74
Rate for Payer: Managed Health Services Medicaid	$13,051.74
Rate for Payer: MDWise Medicaid	$13,051.74

Repair of blepharoptosis; (tarso) levator resection or advancement, external approach

Facility OP

$2,273.62

Service Code	CPT 67904
Hospital Charge Code	CPT-67904
Hospital Revenue Code	360
Min. Negotiated Rate	$2,273.62
Max. Negotiated Rate	$2,273.62
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$2,273.62
Rate for Payer: Managed Health Services Medicaid	$2,273.62
Rate for Payer: MDWise Medicaid	$2,273.62

Repair of ectropion; extensive (eg, tarsal strip operations)

Facility OP

$2,273.62

Service Code	CPT 67917
Hospital Charge Code	CPT-67917
Hospital Revenue Code	360
Min. Negotiated Rate	$2,273.62
Max. Negotiated Rate	$2,273.62
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$2,273.62
Rate for Payer: Managed Health Services Medicaid	$2,273.62
Rate for Payer: MDWise Medicaid	$2,273.62

Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation)

Facility OP

$2,273.62

Service Code	CPT 67924
Hospital Charge Code	CPT-67924
Hospital Revenue Code	360
Min. Negotiated Rate	$2,273.62
Max. Negotiated Rate	$2,273.62
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$2,273.62
Rate for Payer: Managed Health Services Medicaid	$2,273.62
Rate for Payer: MDWise Medicaid	$2,273.62

Repair of nail bed

Facility OP

$1,044.85

Service Code	CPT 11760
Hospital Charge Code	CPT-11760
Hospital Revenue Code	360
Min. Negotiated Rate	$1,044.85
Max. Negotiated Rate	$1,044.85
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$1,044.85
Rate for Payer: Managed Health Services Medicaid	$1,044.85
Rate for Payer: MDWise Medicaid	$1,044.85

Repair of nonunion or malunion, radius OR ulna; without graft (eg, compression technique)

Facility OP

$1,905.42

Service Code	CPT 25400
Hospital Charge Code	CPT-25400
Hospital Revenue Code	360
Min. Negotiated Rate	$1,905.42
Max. Negotiated Rate	$1,905.42
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$1,905.42
Rate for Payer: Managed Health Services Medicaid	$1,905.42
Rate for Payer: MDWise Medicaid	$1,905.42

Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic

Facility OP

$3,957.76

Service Code	CPT 23412
Hospital Charge Code	CPT-23412
Hospital Revenue Code	360
Min. Negotiated Rate	$3,957.76
Max. Negotiated Rate	$3,957.76
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$3,957.76
Rate for Payer: Managed Health Services Medicaid	$3,957.76
Rate for Payer: MDWise Medicaid	$3,957.76

Repair, primary, disrupted ligament, ankle; collateral

Facility OP

$1,728.79

Service Code	CPT 27695
Hospital Charge Code	CPT-27695
Hospital Revenue Code	360
Min. Negotiated Rate	$1,728.79
Max. Negotiated Rate	$1,728.79
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$1,728.79
Rate for Payer: Managed Health Services Medicaid	$1,728.79
Rate for Payer: MDWise Medicaid	$1,728.79

Price Transparency.

All Charges