Cameron Memorial Community Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 36.00: UTERINE & ADNEXA PROCEDURES FOR NONMALIGNANCY EXCEPT LEIOMYOMA

Facility

$9,380.43

Service Code	APR-DRG 5133
Min. Negotiated Rate	$6,131.32
Max. Negotiated Rate	$9,380.43
Rate for Payer: Anthem Blue Cross of IN Medicaid	$6,131.32
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$6,131.32
Rate for Payer: Managed Health Services Medicaid	$6,131.32
Rate for Payer: MDWise Medicaid	$6,131.32

APR-DRG 36.00: UTERINE & ADNEXA PROCEDURES FOR NONMALIGNANCY EXCEPT LEIOMYOMA

Facility

$5,706.07

Service Code	APR-DRG 5132
Min. Negotiated Rate	$4,193.26
Max. Negotiated Rate	$5,706.07
Rate for Payer: Anthem Blue Cross of IN Medicaid	$4,193.26
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$4,193.26
Rate for Payer: Managed Health Services Medicaid	$4,193.26
Rate for Payer: MDWise Medicaid	$4,193.26

APR-DRG 36.00: UTERINE & ADNEXA PROCEDURES FOR NONOVARIAN & NONADNEXAL MALIG

Facility

$20,057.70

Service Code	APR-DRG 5124
Min. Negotiated Rate	$10,007.45
Max. Negotiated Rate	$20,057.70
Rate for Payer: Anthem Blue Cross of IN Medicaid	$10,007.45
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$10,007.45
Rate for Payer: Managed Health Services Medicaid	$10,007.45
Rate for Payer: MDWise Medicaid	$10,007.45

APR-DRG 36.00: UTERINE & ADNEXA PROCEDURES FOR NONOVARIAN & NONADNEXAL MALIG

Facility

$6,181.58

Service Code	APR-DRG 5121
Min. Negotiated Rate	$5,391.34
Max. Negotiated Rate	$6,181.58
Rate for Payer: Anthem Blue Cross of IN Medicaid	$5,391.34
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$5,391.34
Rate for Payer: Managed Health Services Medicaid	$5,391.34
Rate for Payer: MDWise Medicaid	$5,391.34

APR-DRG 36.00: UTERINE & ADNEXA PROCEDURES FOR NONOVARIAN & NONADNEXAL MALIG

Facility

$7,089.36

Service Code	APR-DRG 5122
Min. Negotiated Rate	$5,391.34
Max. Negotiated Rate	$7,089.36
Rate for Payer: Anthem Blue Cross of IN Medicaid	$5,391.34
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$5,391.34
Rate for Payer: Managed Health Services Medicaid	$5,391.34
Rate for Payer: MDWise Medicaid	$5,391.34

APR-DRG 36.00: UTERINE & ADNEXA PROCEDURES FOR NONOVARIAN & NONADNEXAL MALIG

Facility

$11,714.73

Service Code	APR-DRG 5123
Min. Negotiated Rate	$6,800.84
Max. Negotiated Rate	$11,714.73
Rate for Payer: Anthem Blue Cross of IN Medicaid	$6,800.84
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$6,800.84
Rate for Payer: Managed Health Services Medicaid	$6,800.84
Rate for Payer: MDWise Medicaid	$6,800.84

APR-DRG 36.00: UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY

Facility

$6,181.58

Service Code	APR-DRG 5111
Min. Negotiated Rate	$4,686.59
Max. Negotiated Rate	$6,181.58
Rate for Payer: Anthem Blue Cross of IN Medicaid	$4,686.59
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$4,686.59
Rate for Payer: Managed Health Services Medicaid	$4,686.59
Rate for Payer: MDWise Medicaid	$4,686.59

APR-DRG 36.00: UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY

Facility

$7,478.41

Service Code	APR-DRG 5112
Min. Negotiated Rate	$5,814.19
Max. Negotiated Rate	$7,478.41
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: UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY

Facility

$11,455.37

Service Code	APR-DRG 5113
Min. Negotiated Rate	$7,787.49
Max. Negotiated Rate	$11,455.37
Rate for Payer: Anthem Blue Cross of IN Medicaid	$7,787.49
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$7,787.49
Rate for Payer: Managed Health Services Medicaid	$7,787.49
Rate for Payer: MDWise Medicaid	$7,787.49

APR-DRG 36.00: UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY

Facility

$20,965.48

Service Code	APR-DRG 5114
Min. Negotiated Rate	$14,482.61
Max. Negotiated Rate	$20,965.48
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: VAGINAL DELIVERY

Facility

$3,136.14

Service Code	APR-DRG 5603
Min. Negotiated Rate	$2,593.67
Max. Negotiated Rate	$3,136.14
Rate for Payer: Anthem Blue Cross of IN Medicaid	$3,136.14
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$3,136.14
Rate for Payer: Managed Health Services Medicaid	$3,136.14
Rate for Payer: MDWise Medicaid	$3,136.14

APR-DRG 36.00: VAGINAL DELIVERY

Facility

$2,290.44

Service Code	APR-DRG 5602
Min. Negotiated Rate	$1,729.11
Max. Negotiated Rate	$2,290.44
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,290.44
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,290.44
Rate for Payer: Managed Health Services Medicaid	$2,290.44
Rate for Payer: MDWise Medicaid	$2,290.44

APR-DRG 36.00: VAGINAL DELIVERY

Facility

$2,008.54

Service Code	APR-DRG 5601
Min. Negotiated Rate	$1,469.75
Max. Negotiated Rate	$2,008.54
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: VAGINAL DELIVERY

Facility

$5,497.05

Service Code	APR-DRG 5604
Min. Negotiated Rate	$5,187.34
Max. Negotiated Rate	$5,497.05
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: VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &/OR D&C

Facility

$3,890.50

Service Code	APR-DRG 5423
Min. Negotiated Rate	$2,748.53
Max. Negotiated Rate	$3,890.50
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,748.53
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,748.53
Rate for Payer: Managed Health Services Medicaid	$2,748.53
Rate for Payer: MDWise Medicaid	$2,748.53

APR-DRG 36.00: VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &/OR D&C

Facility

$10,677.27

Service Code	APR-DRG 5424
Min. Negotiated Rate	$3,418.04
Max. Negotiated Rate	$10,677.27
Rate for Payer: Anthem Blue Cross of IN Medicaid	$3,418.04
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$3,418.04
Rate for Payer: Managed Health Services Medicaid	$3,418.04
Rate for Payer: MDWise Medicaid	$3,418.04

APR-DRG 36.00: VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &/OR D&C

Facility

$2,537.10

Service Code	APR-DRG 5422
Min. Negotiated Rate	$2,074.93
Max. Negotiated Rate	$2,537.10
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,537.10
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,537.10
Rate for Payer: Managed Health Services Medicaid	$2,537.10
Rate for Payer: MDWise Medicaid	$2,537.10

APR-DRG 36.00: VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &/OR D&C

Facility

$2,255.20

Service Code	APR-DRG 5421
Min. Negotiated Rate	$1,685.88
Max. Negotiated Rate	$2,255.20
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,255.20
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,255.20
Rate for Payer: Managed Health Services Medicaid	$2,255.20
Rate for Payer: MDWise Medicaid	$2,255.20

APR-DRG 36.00: VAGINAL DELIVERY W STERILIZATION &/OR D&C

Facility

$2,854.24

Service Code	APR-DRG 5412
Min. Negotiated Rate	$2,766.58
Max. Negotiated Rate	$2,854.24
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,854.24
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,854.24
Rate for Payer: Managed Health Services Medicaid	$2,854.24
Rate for Payer: MDWise Medicaid	$2,854.24

APR-DRG 36.00: VAGINAL DELIVERY W STERILIZATION &/OR D&C

Facility

$2,642.81

Service Code	APR-DRG 5411
Min. Negotiated Rate	$2,463.98
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: VAGINAL DELIVERY W STERILIZATION &/OR D&C

Facility

$4,228.50

Service Code	APR-DRG 5413
Min. Negotiated Rate	$4,063.41
Max. Negotiated Rate	$4,228.50
Rate for Payer: Anthem Blue Cross of IN Medicaid	$4,228.50
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$4,228.50
Rate for Payer: Managed Health Services Medicaid	$4,228.50
Rate for Payer: MDWise Medicaid	$4,228.50

APR-DRG 36.00: VAGINAL DELIVERY W STERILIZATION &/OR D&C

Facility

$8,342.97

Service Code	APR-DRG 5414
Min. Negotiated Rate	$6,554.18
Max. Negotiated Rate	$8,342.97
Rate for Payer: Anthem Blue Cross of IN Medicaid	$6,554.18
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$6,554.18
Rate for Payer: Managed Health Services Medicaid	$6,554.18
Rate for Payer: MDWise Medicaid	$6,554.18

APR-DRG 36.00: VENTRICULAR SHUNT PROCEDURES

Facility

$11,498.59

Service Code	APR-DRG 0223
Min. Negotiated Rate	$8,844.61
Max. Negotiated Rate	$11,498.59
Rate for Payer: Anthem Blue Cross of IN Medicaid	$8,844.61
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$8,844.61
Rate for Payer: Managed Health Services Medicaid	$8,844.61
Rate for Payer: MDWise Medicaid	$8,844.61

APR-DRG 36.00: VENTRICULAR SHUNT PROCEDURES

Facility

$7,824.23

Service Code	APR-DRG 0222
Min. Negotiated Rate	$5,638.00
Max. Negotiated Rate	$7,824.23
Rate for Payer: Anthem Blue Cross of IN Medicaid	$5,638.00
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$5,638.00
Rate for Payer: Managed Health Services Medicaid	$5,638.00
Rate for Payer: MDWise Medicaid	$5,638.00

APR-DRG 36.00: VENTRICULAR SHUNT PROCEDURES

Facility

$20,792.57

Service Code	APR-DRG 0224
Min. Negotiated Rate	$13,989.29
Max. Negotiated Rate	$20,792.57
Rate for Payer: Anthem Blue Cross of IN Medicaid	$13,989.29
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$13,989.29
Rate for Payer: Managed Health Services Medicaid	$13,989.29
Rate for Payer: MDWise Medicaid	$13,989.29

Know your out-of-pocket cost for care.

All Charges