Cameron Memorial Community Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 36.00: RADIOTHERAPY

Facility

$7,781.00

Service Code	APR-DRG 6922
Min. Negotiated Rate	$6,977.02
Max. Negotiated Rate	$7,781.00
Rate for Payer: Anthem Blue Cross of IN Medicaid	$6,977.02
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$6,977.02
Rate for Payer: Managed Health Services Medicaid	$6,977.02
Rate for Payer: MDWise Medicaid	$6,977.02

APR-DRG 36.00: RADIOTHERAPY

Facility

$14,092.26

Service Code	APR-DRG 6924
Min. Negotiated Rate	$11,839.80
Max. Negotiated Rate	$14,092.26
Rate for Payer: Anthem Blue Cross of IN Medicaid	$11,839.80
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$11,839.80
Rate for Payer: Managed Health Services Medicaid	$11,839.80
Rate for Payer: MDWise Medicaid	$11,839.80

APR-DRG 36.00: RADIOTHERAPY

Facility

$11,239.23

Service Code	APR-DRG 6923
Min. Negotiated Rate	$6,977.02
Max. Negotiated Rate	$11,239.23
Rate for Payer: Anthem Blue Cross of IN Medicaid	$6,977.02
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$6,977.02
Rate for Payer: Managed Health Services Medicaid	$6,977.02
Rate for Payer: MDWise Medicaid	$6,977.02

APR-DRG 36.00: RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR

Facility

$7,651.32

Service Code	APR-DRG 4442
Min. Negotiated Rate	$5,814.19
Max. Negotiated Rate	$7,651.32
Rate for Payer: Anthem Blue Cross of IN Medicaid	$5,814.19
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$5,814.19
Rate for Payer: Managed Health Services Medicaid	$5,814.19
Rate for Payer: MDWise Medicaid	$5,814.19

APR-DRG 36.00: RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR

Facility

$5,533.16

Service Code	APR-DRG 4441
Min. Negotiated Rate	$5,320.86
Max. Negotiated Rate	$5,533.16
Rate for Payer: Anthem Blue Cross of IN Medicaid	$5,320.86
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$5,320.86
Rate for Payer: Managed Health Services Medicaid	$5,320.86
Rate for Payer: MDWise Medicaid	$5,320.86

APR-DRG 36.00: RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR

Facility

$17,334.35

Service Code	APR-DRG 4444
Min. Negotiated Rate	$11,311.24
Max. Negotiated Rate	$17,334.35
Rate for Payer: Anthem Blue Cross of IN Medicaid	$11,311.24
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$11,311.24
Rate for Payer: Managed Health Services Medicaid	$11,311.24
Rate for Payer: MDWise Medicaid	$11,311.24

APR-DRG 36.00: RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR

Facility

$10,850.18

Service Code	APR-DRG 4443
Min. Negotiated Rate	$8,879.85
Max. Negotiated Rate	$10,850.18
Rate for Payer: Anthem Blue Cross of IN Medicaid	$8,879.85
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$8,879.85
Rate for Payer: Managed Health Services Medicaid	$8,879.85
Rate for Payer: MDWise Medicaid	$8,879.85

APR-DRG 36.00: RESPIRATORY FAILURE

Facility

$5,100.88

Service Code	APR-DRG 1333
Min. Negotiated Rate	$4,616.11
Max. Negotiated Rate	$5,100.88
Rate for Payer: Anthem Blue Cross of IN Medicaid	$4,616.11
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$4,616.11
Rate for Payer: Managed Health Services Medicaid	$4,616.11
Rate for Payer: MDWise Medicaid	$4,616.11

APR-DRG 36.00: RESPIRATORY FAILURE

Facility

$8,342.97

Service Code	APR-DRG 1334
Min. Negotiated Rate	$7,717.01
Max. Negotiated Rate	$8,342.97
Rate for Payer: Anthem Blue Cross of IN Medicaid	$7,717.01
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$7,717.01
Rate for Payer: Managed Health Services Medicaid	$7,717.01
Rate for Payer: MDWise Medicaid	$7,717.01

APR-DRG 36.00: RESPIRATORY FAILURE

Facility

$2,593.67

Service Code	APR-DRG 1331
Min. Negotiated Rate	$2,184.72
Max. Negotiated Rate	$2,593.67
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,184.72
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,184.72
Rate for Payer: Managed Health Services Medicaid	$2,184.72
Rate for Payer: MDWise Medicaid	$2,184.72

APR-DRG 36.00: RESPIRATORY FAILURE

Facility

$3,458.22

Service Code	APR-DRG 1332
Min. Negotiated Rate	$3,171.38
Max. Negotiated Rate	$3,458.22
Rate for Payer: Anthem Blue Cross of IN Medicaid	$3,171.38
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$3,171.38
Rate for Payer: Managed Health Services Medicaid	$3,171.38
Rate for Payer: MDWise Medicaid	$3,171.38

APR-DRG 36.00: RESPIRATORY MALIGNANCY

Facility

$5,835.75

Service Code	APR-DRG 1363
Min. Negotiated Rate	$4,545.64
Max. Negotiated Rate	$5,835.75
Rate for Payer: Anthem Blue Cross of IN Medicaid	$4,545.64
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$4,545.64
Rate for Payer: Managed Health Services Medicaid	$4,545.64
Rate for Payer: MDWise Medicaid	$4,545.64

APR-DRG 36.00: RESPIRATORY MALIGNANCY

Facility

$3,501.45

Service Code	APR-DRG 1361
Min. Negotiated Rate	$2,008.54
Max. Negotiated Rate	$3,501.45
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,008.54
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,008.54
Rate for Payer: Managed Health Services Medicaid	$2,008.54
Rate for Payer: MDWise Medicaid	$2,008.54

APR-DRG 36.00: RESPIRATORY MALIGNANCY

Facility

$4,193.10

Service Code	APR-DRG 1362
Min. Negotiated Rate	$3,347.56
Max. Negotiated Rate	$4,193.10
Rate for Payer: Anthem Blue Cross of IN Medicaid	$3,347.56
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$3,347.56
Rate for Payer: Managed Health Services Medicaid	$3,347.56
Rate for Payer: MDWise Medicaid	$3,347.56

APR-DRG 36.00: RESPIRATORY MALIGNANCY

Facility

$8,948.15

Service Code	APR-DRG 1364
Min. Negotiated Rate	$5,602.76
Max. Negotiated Rate	$8,948.15
Rate for Payer: Anthem Blue Cross of IN Medicaid	$5,602.76
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$5,602.76
Rate for Payer: Managed Health Services Medicaid	$5,602.76
Rate for Payer: MDWise Medicaid	$5,602.76

APR-DRG 36.00: RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$2,642.81

Service Code	APR-DRG 1441
Min. Negotiated Rate	$2,507.21
Max. Negotiated Rate	$2,642.81
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,642.81
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,642.81
Rate for Payer: Managed Health Services Medicaid	$2,642.81
Rate for Payer: MDWise Medicaid	$2,642.81

APR-DRG 36.00: RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$3,544.68

Service Code	APR-DRG 1442
Min. Negotiated Rate	$2,889.47
Max. Negotiated Rate	$3,544.68
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,889.47
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,889.47
Rate for Payer: Managed Health Services Medicaid	$2,889.47
Rate for Payer: MDWise Medicaid	$2,889.47

APR-DRG 36.00: RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$7,997.14

Service Code	APR-DRG 1444
Min. Negotiated Rate	$4,651.35
Max. Negotiated Rate	$7,997.14
Rate for Payer: Anthem Blue Cross of IN Medicaid	$4,651.35
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$4,651.35
Rate for Payer: Managed Health Services Medicaid	$4,651.35
Rate for Payer: MDWise Medicaid	$4,651.35

APR-DRG 36.00: RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$5,014.42

Service Code	APR-DRG 1443
Min. Negotiated Rate	$2,889.47
Max. Negotiated Rate	$5,014.42
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,889.47
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,889.47
Rate for Payer: Managed Health Services Medicaid	$2,889.47
Rate for Payer: MDWise Medicaid	$2,889.47

APR-DRG 36.00: RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility

$14,482.61

Service Code	APR-DRG 1301
Min. Negotiated Rate	$12,103.78
Max. Negotiated Rate	$14,482.61
Rate for Payer: Anthem Blue Cross of IN Medicaid	$14,482.61
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$14,482.61
Rate for Payer: Managed Health Services Medicaid	$14,482.61
Rate for Payer: MDWise Medicaid	$14,482.61

APR-DRG 36.00: RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility

$14,611.00

Service Code	APR-DRG 1302
Min. Negotiated Rate	$14,482.61
Max. Negotiated Rate	$14,611.00
Rate for Payer: Anthem Blue Cross of IN Medicaid	$14,482.61
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$14,482.61
Rate for Payer: Managed Health Services Medicaid	$14,482.61
Rate for Payer: MDWise Medicaid	$14,482.61

APR-DRG 36.00: RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility

$23,645.61

Service Code	APR-DRG 1304
Min. Negotiated Rate	$18,957.78
Max. Negotiated Rate	$23,645.61
Rate for Payer: Anthem Blue Cross of IN Medicaid	$18,957.78
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$18,957.78
Rate for Payer: Managed Health Services Medicaid	$18,957.78
Rate for Payer: MDWise Medicaid	$18,957.78

APR-DRG 36.00: RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility

$17,853.08

Service Code	APR-DRG 1303
Min. Negotiated Rate	$14,482.61
Max. Negotiated Rate	$17,853.08
Rate for Payer: Anthem Blue Cross of IN Medicaid	$14,482.61
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$14,482.61
Rate for Payer: Managed Health Services Medicaid	$14,482.61
Rate for Payer: MDWise Medicaid	$14,482.61

APR-DRG 36.00: SEIZURE

Facility

$3,371.77

Service Code	APR-DRG 0532
Min. Negotiated Rate	$2,642.81
Max. Negotiated Rate	$3,371.77
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,642.81
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,642.81
Rate for Payer: Managed Health Services Medicaid	$2,642.81
Rate for Payer: MDWise Medicaid	$2,642.81

APR-DRG 36.00: SEIZURE

Facility

$2,507.21

Service Code	APR-DRG 0531
Min. Negotiated Rate	$2,079.01
Max. Negotiated Rate	$2,507.21
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,079.01
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,079.01
Rate for Payer: Managed Health Services Medicaid	$2,079.01
Rate for Payer: MDWise Medicaid	$2,079.01

Know your out-of-pocket cost for care.

All Charges