Cameron Memorial Community Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 36.00: SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES

Facility

$6,657.08

Service Code	APR-DRG 3121
Min. Negotiated Rate	$4,721.82
Max. Negotiated Rate	$6,657.08
Rate for Payer: Anthem Blue Cross of IN Medicaid	$4,721.82
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$4,721.82
Rate for Payer: Managed Health Services Medicaid	$4,721.82
Rate for Payer: MDWise Medicaid	$4,721.82

APR-DRG 36.00: SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$7,132.59

Service Code	APR-DRG 3611
Min. Negotiated Rate	$4,158.02
Max. Negotiated Rate	$7,132.59
Rate for Payer: Anthem Blue Cross of IN Medicaid	$4,158.02
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$4,158.02
Rate for Payer: Managed Health Services Medicaid	$4,158.02
Rate for Payer: MDWise Medicaid	$4,158.02

APR-DRG 36.00: SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$23,213.33

Service Code	APR-DRG 3614
Min. Negotiated Rate	$10,747.44
Max. Negotiated Rate	$23,213.33
Rate for Payer: Anthem Blue Cross of IN Medicaid	$10,747.44
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$10,747.44
Rate for Payer: Managed Health Services Medicaid	$10,747.44
Rate for Payer: MDWise Medicaid	$10,747.44

APR-DRG 36.00: SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$9,466.89

Service Code	APR-DRG 3612
Min. Negotiated Rate	$5,743.71
Max. Negotiated Rate	$9,466.89
Rate for Payer: Anthem Blue Cross of IN Medicaid	$5,743.71
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$5,743.71
Rate for Payer: Managed Health Services Medicaid	$5,743.71
Rate for Payer: MDWise Medicaid	$5,743.71

APR-DRG 36.00: SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$13,054.80

Service Code	APR-DRG 3613
Min. Negotiated Rate	$7,223.69
Max. Negotiated Rate	$13,054.80
Rate for Payer: Anthem Blue Cross of IN Medicaid	$7,223.69
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$7,223.69
Rate for Payer: Managed Health Services Medicaid	$7,223.69
Rate for Payer: MDWise Medicaid	$7,223.69

APR-DRG 36.00: SKIN ULCERS

Facility

$3,242.09

Service Code	APR-DRG 3802
Min. Negotiated Rate	$3,065.66
Max. Negotiated Rate	$3,242.09
Rate for Payer: Anthem Blue Cross of IN Medicaid	$3,065.66
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$3,065.66
Rate for Payer: Managed Health Services Medicaid	$3,065.66
Rate for Payer: MDWise Medicaid	$3,065.66

APR-DRG 36.00: SKIN ULCERS

Facility

$2,507.21

Service Code	APR-DRG 3801
Min. Negotiated Rate	$1,515.21
Max. Negotiated Rate	$2,507.21
Rate for Payer: Anthem Blue Cross of IN Medicaid	$1,515.21
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$1,515.21
Rate for Payer: Managed Health Services Medicaid	$1,515.21
Rate for Payer: MDWise Medicaid	$1,515.21

APR-DRG 36.00: SKIN ULCERS

Facility

$4,971.20

Service Code	APR-DRG 3803
Min. Negotiated Rate	$4,933.25
Max. Negotiated Rate	$4,971.20
Rate for Payer: Anthem Blue Cross of IN Medicaid	$4,933.25
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$4,933.25
Rate for Payer: Managed Health Services Medicaid	$4,933.25
Rate for Payer: MDWise Medicaid	$4,933.25

APR-DRG 36.00: SKIN ULCERS

Facility

$8,645.56

Service Code	APR-DRG 3804
Min. Negotiated Rate	$5,003.73
Max. Negotiated Rate	$8,645.56
Rate for Payer: Anthem Blue Cross of IN Medicaid	$5,003.73
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$5,003.73
Rate for Payer: Managed Health Services Medicaid	$5,003.73
Rate for Payer: MDWise Medicaid	$5,003.73

APR-DRG 36.00: SPINAL DISORDERS & INJURIES

Facility

$6,354.49

Service Code	APR-DRG 0402
Min. Negotiated Rate	$4,298.98
Max. Negotiated Rate	$6,354.49
Rate for Payer: Anthem Blue Cross of IN Medicaid	$4,298.98
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$4,298.98
Rate for Payer: Managed Health Services Medicaid	$4,298.98
Rate for Payer: MDWise Medicaid	$4,298.98

APR-DRG 36.00: SPINAL DISORDERS & INJURIES

Facility

$4,668.60

Service Code	APR-DRG 0401
Min. Negotiated Rate	$3,347.56
Max. Negotiated Rate	$4,668.60
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: SPINAL DISORDERS & INJURIES

Facility

$8,775.24

Service Code	APR-DRG 0403
Min. Negotiated Rate	$6,483.70
Max. Negotiated Rate	$8,775.24
Rate for Payer: Anthem Blue Cross of IN Medicaid	$6,483.70
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$6,483.70
Rate for Payer: Managed Health Services Medicaid	$6,483.70
Rate for Payer: MDWise Medicaid	$6,483.70

APR-DRG 36.00: SPINAL DISORDERS & INJURIES

Facility

$13,918.81

Service Code	APR-DRG 0404
Min. Negotiated Rate	$12,319.92
Max. Negotiated Rate	$13,918.81
Rate for Payer: Anthem Blue Cross of IN Medicaid	$13,918.81
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$13,918.81
Rate for Payer: Managed Health Services Medicaid	$13,918.81
Rate for Payer: MDWise Medicaid	$13,918.81

APR-DRG 36.00: SPINAL PROCEDURES

Facility

$10,590.81

Service Code	APR-DRG 0232
Min. Negotiated Rate	$6,730.36
Max. Negotiated Rate	$10,590.81
Rate for Payer: Anthem Blue Cross of IN Medicaid	$6,730.36
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$6,730.36
Rate for Payer: Managed Health Services Medicaid	$6,730.36
Rate for Payer: MDWise Medicaid	$6,730.36

APR-DRG 36.00: SPINAL PROCEDURES

Facility

$16,729.16

Service Code	APR-DRG 0233
Min. Negotiated Rate	$11,064.58
Max. Negotiated Rate	$16,729.16
Rate for Payer: Anthem Blue Cross of IN Medicaid	$11,064.58
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$11,064.58
Rate for Payer: Managed Health Services Medicaid	$11,064.58
Rate for Payer: MDWise Medicaid	$11,064.58

APR-DRG 36.00: SPINAL PROCEDURES

Facility

$7,478.41

Service Code	APR-DRG 0231
Min. Negotiated Rate	$5,708.48
Max. Negotiated Rate	$7,478.41
Rate for Payer: Anthem Blue Cross of IN Medicaid	$5,708.48
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$5,708.48
Rate for Payer: Managed Health Services Medicaid	$5,708.48
Rate for Payer: MDWise Medicaid	$5,708.48

APR-DRG 36.00: SPINAL PROCEDURES

Facility

$24,250.80

Service Code	APR-DRG 0234
Min. Negotiated Rate	$18,534.92
Max. Negotiated Rate	$24,250.80
Rate for Payer: Anthem Blue Cross of IN Medicaid	$18,534.92
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$18,534.92
Rate for Payer: Managed Health Services Medicaid	$18,534.92
Rate for Payer: MDWise Medicaid	$18,534.92

APR-DRG 36.00: SPLENECTOMY

Facility

$6,354.49

Service Code	APR-DRG 6501
Min. Negotiated Rate	$5,497.05
Max. Negotiated Rate	$6,354.49
Rate for Payer: Anthem Blue Cross of IN Medicaid	$5,497.05
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$5,497.05
Rate for Payer: Managed Health Services Medicaid	$5,497.05
Rate for Payer: MDWise Medicaid	$5,497.05

APR-DRG 36.00: SPLENECTOMY

Facility

$11,498.59

Service Code	APR-DRG 6503
Min. Negotiated Rate	$10,359.83
Max. Negotiated Rate	$11,498.59
Rate for Payer: Anthem Blue Cross of IN Medicaid	$10,359.83
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$10,359.83
Rate for Payer: Managed Health Services Medicaid	$10,359.83
Rate for Payer: MDWise Medicaid	$10,359.83

APR-DRG 36.00: SPLENECTOMY

Facility

$18,242.13

Service Code	APR-DRG 6504
Min. Negotiated Rate	$10,994.10
Max. Negotiated Rate	$18,242.13
Rate for Payer: Anthem Blue Cross of IN Medicaid	$10,994.10
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$10,994.10
Rate for Payer: Managed Health Services Medicaid	$10,994.10
Rate for Payer: MDWise Medicaid	$10,994.10

APR-DRG 36.00: SPLENECTOMY

Facility

$9,250.75

Service Code	APR-DRG 6502
Min. Negotiated Rate	$5,497.05
Max. Negotiated Rate	$9,250.75
Rate for Payer: Anthem Blue Cross of IN Medicaid	$5,497.05
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$5,497.05
Rate for Payer: Managed Health Services Medicaid	$5,497.05
Rate for Payer: MDWise Medicaid	$5,497.05

APR-DRG 36.00: SYNCOPE & COLLAPSE

Facility

$3,285.31

Service Code	APR-DRG 2042
Min. Negotiated Rate	$2,431.39
Max. Negotiated Rate	$3,285.31
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,431.39
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,431.39
Rate for Payer: Managed Health Services Medicaid	$2,431.39
Rate for Payer: MDWise Medicaid	$2,431.39

APR-DRG 36.00: SYNCOPE & COLLAPSE

Facility

$2,896.26

Service Code	APR-DRG 2041
Min. Negotiated Rate	$2,360.91
Max. Negotiated Rate	$2,896.26
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,360.91
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,360.91
Rate for Payer: Managed Health Services Medicaid	$2,360.91
Rate for Payer: MDWise Medicaid	$2,360.91

APR-DRG 36.00: SYNCOPE & COLLAPSE

Facility

$4,193.10

Service Code	APR-DRG 2043
Min. Negotiated Rate	$3,805.65
Max. Negotiated Rate	$4,193.10
Rate for Payer: Anthem Blue Cross of IN Medicaid	$3,805.65
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$3,805.65
Rate for Payer: Managed Health Services Medicaid	$3,805.65
Rate for Payer: MDWise Medicaid	$3,805.65

APR-DRG 36.00: SYNCOPE & COLLAPSE

Facility

$6,743.54

Service Code	APR-DRG 2044
Min. Negotiated Rate	$4,757.06
Max. Negotiated Rate	$6,743.54
Rate for Payer: Anthem Blue Cross of IN Medicaid	$4,757.06
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$4,757.06
Rate for Payer: Managed Health Services Medicaid	$4,757.06
Rate for Payer: MDWise Medicaid	$4,757.06

Know your out-of-pocket cost for care.

All Charges