Cameron Memorial Community Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC

Facility

$42,305.04

Service Code	MSDRG 012
Min. Negotiated Rate	$23,093.90
Max. Negotiated Rate	$42,305.04
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$35,866.34
Rate for Payer: Anthem Blue Cross of IN Traditional	$42,305.04
Rate for Payer: Plain Church Group Ministry All Commercial	$23,093.90
Rate for Payer: Three Rivers Preferred All Commercial	$30,162.19

MS-DRG 42.00: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC

Facility

$55,626.33

Service Code	MSDRG 011
Min. Negotiated Rate	$30,365.86
Max. Negotiated Rate	$55,626.33
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$47,160.17
Rate for Payer: Anthem Blue Cross of IN Traditional	$55,626.33
Rate for Payer: Plain Church Group Ministry All Commercial	$30,365.86
Rate for Payer: Three Rivers Preferred All Commercial	$39,659.86

MS-DRG 42.00: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC

Facility

$27,318.85

Service Code	MSDRG 013
Min. Negotiated Rate	$14,913.09
Max. Negotiated Rate	$27,318.85
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$23,161.00
Rate for Payer: Anthem Blue Cross of IN Traditional	$27,318.85
Rate for Payer: Plain Church Group Ministry All Commercial	$14,913.09
Rate for Payer: Three Rivers Preferred All Commercial	$19,477.50

MS-DRG 42.00: TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES

Facility

$145,666.17

Service Code	MSDRG 004
Min. Negotiated Rate	$79,517.71
Max. Negotiated Rate	$145,666.17
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$123,496.20
Rate for Payer: Anthem Blue Cross of IN Traditional	$145,666.17
Rate for Payer: Plain Church Group Ministry All Commercial	$79,517.71
Rate for Payer: Three Rivers Preferred All Commercial	$103,855.50

MS-DRG 42.00: TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC

Facility

$8,248.23

Service Code	MSDRG 069
Min. Negotiated Rate	$4,502.63
Max. Negotiated Rate	$8,248.23
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$6,992.87
Rate for Payer: Anthem Blue Cross of IN Traditional	$8,248.23
Rate for Payer: Plain Church Group Ministry All Commercial	$4,502.63
Rate for Payer: Three Rivers Preferred All Commercial	$5,880.73

MS-DRG 42.00: TRANSURETHRAL PROCEDURES WITH CC

Facility

$15,953.18

Service Code	MSDRG 669
Min. Negotiated Rate	$8,708.68
Max. Negotiated Rate	$15,953.18
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$13,525.15
Rate for Payer: Anthem Blue Cross of IN Traditional	$15,953.18
Rate for Payer: Plain Church Group Ministry All Commercial	$8,708.68
Rate for Payer: Three Rivers Preferred All Commercial	$11,374.12

MS-DRG 42.00: TRANSURETHRAL PROCEDURES WITH MCC

Facility

$30,064.14

Service Code	MSDRG 668
Min. Negotiated Rate	$16,411.71
Max. Negotiated Rate	$30,064.14
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$25,488.46
Rate for Payer: Anthem Blue Cross of IN Traditional	$30,064.14
Rate for Payer: Plain Church Group Ministry All Commercial	$16,411.71
Rate for Payer: Three Rivers Preferred All Commercial	$21,434.81

MS-DRG 42.00: TRANSURETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$9,852.31

Service Code	MSDRG 670
Min. Negotiated Rate	$5,378.28
Max. Negotiated Rate	$9,852.31
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$8,352.82
Rate for Payer: Anthem Blue Cross of IN Traditional	$9,852.31
Rate for Payer: Plain Church Group Ministry All Commercial	$5,378.28
Rate for Payer: Three Rivers Preferred All Commercial	$7,024.40

MS-DRG 42.00: TRANSURETHRAL PROSTATECTOMY WITH CC/MCC

Facility

$14,906.81

Service Code	MSDRG 713
Min. Negotiated Rate	$8,137.48
Max. Negotiated Rate	$14,906.81
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$12,638.04
Rate for Payer: Anthem Blue Cross of IN Traditional	$14,906.81
Rate for Payer: Plain Church Group Ministry All Commercial	$8,137.48
Rate for Payer: Three Rivers Preferred All Commercial	$10,628.10

MS-DRG 42.00: TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC

Facility

$9,687.37

Service Code	MSDRG 714
Min. Negotiated Rate	$5,288.24
Max. Negotiated Rate	$9,687.37
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$8,212.98
Rate for Payer: Anthem Blue Cross of IN Traditional	$9,687.37
Rate for Payer: Plain Church Group Ministry All Commercial	$5,288.24
Rate for Payer: Three Rivers Preferred All Commercial	$6,906.80

MS-DRG 42.00: TRAUMATIC INJURY WITH MCC

Facility

$16,683.05

Service Code	MSDRG 913
Min. Negotiated Rate	$9,107.11
Max. Negotiated Rate	$16,683.05
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$14,143.94
Rate for Payer: Anthem Blue Cross of IN Traditional	$16,683.05
Rate for Payer: Plain Church Group Ministry All Commercial	$9,107.11
Rate for Payer: Three Rivers Preferred All Commercial	$11,894.50

MS-DRG 42.00: TRAUMATIC INJURY WITHOUT MCC

Facility

$9,447.17

Service Code	MSDRG 914
Min. Negotiated Rate	$5,157.11
Max. Negotiated Rate	$9,447.17
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$8,009.34
Rate for Payer: Anthem Blue Cross of IN Traditional	$9,447.17
Rate for Payer: Plain Church Group Ministry All Commercial	$5,157.11
Rate for Payer: Three Rivers Preferred All Commercial	$6,735.54

MS-DRG 42.00: TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC

Facility

$13,521.28

Service Code	MSDRG 086
Min. Negotiated Rate	$7,381.13
Max. Negotiated Rate	$13,521.28
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$11,463.38
Rate for Payer: Anthem Blue Cross of IN Traditional	$13,521.28
Rate for Payer: Plain Church Group Ministry All Commercial	$7,381.13
Rate for Payer: Three Rivers Preferred All Commercial	$9,640.26

MS-DRG 42.00: TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC

Facility

$14,333.63

Service Code	MSDRG 083
Min. Negotiated Rate	$7,824.59
Max. Negotiated Rate	$14,333.63
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$12,152.10
Rate for Payer: Anthem Blue Cross of IN Traditional	$14,333.63
Rate for Payer: Plain Church Group Ministry All Commercial	$7,824.59
Rate for Payer: Three Rivers Preferred All Commercial	$10,219.44

MS-DRG 42.00: TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC

Facility

$23,360.19

Service Code	MSDRG 085
Min. Negotiated Rate	$12,752.10
Max. Negotiated Rate	$23,360.19
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$19,804.84
Rate for Payer: Anthem Blue Cross of IN Traditional	$23,360.19
Rate for Payer: Plain Church Group Ministry All Commercial	$12,752.10
Rate for Payer: Three Rivers Preferred All Commercial	$16,655.10

MS-DRG 42.00: TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC

Facility

$23,918.94

Service Code	MSDRG 082
Min. Negotiated Rate	$13,057.11
Max. Negotiated Rate	$23,918.94
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$20,278.55
Rate for Payer: Anthem Blue Cross of IN Traditional	$23,918.94
Rate for Payer: Plain Church Group Ministry All Commercial	$13,057.11
Rate for Payer: Three Rivers Preferred All Commercial	$17,053.47

MS-DRG 42.00: TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC

Facility

$9,113.16

Service Code	MSDRG 087
Min. Negotiated Rate	$4,974.78
Max. Negotiated Rate	$9,113.16
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$7,726.16
Rate for Payer: Anthem Blue Cross of IN Traditional	$9,113.16
Rate for Payer: Plain Church Group Ministry All Commercial	$4,974.78
Rate for Payer: Three Rivers Preferred All Commercial	$6,497.40

MS-DRG 42.00: TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC

Facility

$9,856.43

Service Code	MSDRG 084
Min. Negotiated Rate	$5,380.53
Max. Negotiated Rate	$9,856.43
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$8,356.31
Rate for Payer: Anthem Blue Cross of IN Traditional	$9,856.43
Rate for Payer: Plain Church Group Ministry All Commercial	$5,380.53
Rate for Payer: Three Rivers Preferred All Commercial	$7,027.34

MS-DRG 42.00: TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC

Facility

$15,316.08

Service Code	MSDRG 604
Min. Negotiated Rate	$8,360.90
Max. Negotiated Rate	$15,316.08
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$12,985.02
Rate for Payer: Anthem Blue Cross of IN Traditional	$15,316.08
Rate for Payer: Plain Church Group Ministry All Commercial	$8,360.90
Rate for Payer: Three Rivers Preferred All Commercial	$10,919.90

MS-DRG 42.00: TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC

Facility

$9,522.42

Service Code	MSDRG 605
Min. Negotiated Rate	$5,198.20
Max. Negotiated Rate	$9,522.42
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$8,073.14
Rate for Payer: Anthem Blue Cross of IN Traditional	$9,522.42
Rate for Payer: Plain Church Group Ministry All Commercial	$5,198.20
Rate for Payer: Three Rivers Preferred All Commercial	$6,789.19

MS-DRG 42.00: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC

Facility

$51,579.02

Service Code	MSDRG 278
Min. Negotiated Rate	$28,156.47
Max. Negotiated Rate	$51,579.02
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$43,728.84
Rate for Payer: Anthem Blue Cross of IN Traditional	$51,579.02
Rate for Payer: Plain Church Group Ministry All Commercial	$28,156.47
Rate for Payer: Three Rivers Preferred All Commercial	$36,774.25

MS-DRG 42.00: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC

Facility

$33,034.16

Service Code	MSDRG 279
Min. Negotiated Rate	$18,033.02
Max. Negotiated Rate	$33,034.16
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$28,006.46
Rate for Payer: Anthem Blue Cross of IN Traditional	$33,034.16
Rate for Payer: Plain Church Group Ministry All Commercial	$18,033.02
Rate for Payer: Three Rivers Preferred All Commercial	$23,552.34

MS-DRG 42.00: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM

Facility

$31,634.20

Service Code	MSDRG 173
Min. Negotiated Rate	$17,268.79
Max. Negotiated Rate	$31,634.20
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$26,819.56
Rate for Payer: Anthem Blue Cross of IN Traditional	$31,634.20
Rate for Payer: Plain Church Group Ministry All Commercial	$17,268.79
Rate for Payer: Three Rivers Preferred All Commercial	$22,554.21

MS-DRG 42.00: UNCOMPLICATED PEPTIC ULCER WITH MCC

Facility

$13,032.64

Service Code	MSDRG 383
Min. Negotiated Rate	$7,114.39
Max. Negotiated Rate	$13,032.64
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$11,049.11
Rate for Payer: Anthem Blue Cross of IN Traditional	$13,032.64
Rate for Payer: Plain Church Group Ministry All Commercial	$7,114.39
Rate for Payer: Three Rivers Preferred All Commercial	$9,291.87

MS-DRG 42.00: UNCOMPLICATED PEPTIC ULCER WITHOUT MCC

Facility

$8,964.71

Service Code	MSDRG 384
Min. Negotiated Rate	$4,893.74
Max. Negotiated Rate	$8,964.71
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$7,600.30
Rate for Payer: Anthem Blue Cross of IN Traditional	$8,964.71
Rate for Payer: Plain Church Group Ministry All Commercial	$4,893.74
Rate for Payer: Three Rivers Preferred All Commercial	$6,391.56

Know your out-of-pocket cost for care.

All Charges