Cameron Memorial Community Hospital

All Charges

Charge

Type

Setting

Price

APIXABAN 2.5 MG ORAL TAB

Facility

$49.74

Service Code	NDC 00003089331
Hospital Charge Code	162266
Hospital Revenue Code	250
Min. Negotiated Rate	$37.31
Max. Negotiated Rate	$46.26
Rate for Payer: Aetna Commercial	$42.98
Rate for Payer: Cash Price	$30.84
Rate for Payer: Cigna All Commercial	$42.93
Rate for Payer: CORVEL All Commercial	$46.26
Rate for Payer: Coventry All Commercial	$43.77
Rate for Payer: Encore All Commercial	$45.79
Rate for Payer: Frontpath All Commercial	$45.76
Rate for Payer: Humana ChoiceCare	$42.96
Rate for Payer: Lutheran Preferred All Commercial	$44.77
Rate for Payer: PHCS All Commercial	$37.31
Rate for Payer: PHP All Commercial	$37.72
Rate for Payer: Sagamore Health Network All Products	$38.40
Rate for Payer: Signature Care EPO	$41.29
Rate for Payer: Signature Care PPO	$43.77
Rate for Payer: United Healthcare Commercial	$39.20

APRACLONIDINE 0.5 % OPHT DROP

Facility

$280.28

Service Code	NDC 17478071610
Hospital Charge Code	9119
Hospital Revenue Code	250
Min. Negotiated Rate	$9.56
Max. Negotiated Rate	$260.66
Rate for Payer: Aetna Commercial	$236.56
Rate for Payer: Aetna Medicare	$89.69
Rate for Payer: Anthem Blue Cross of IN Medicaid	$9.56
Rate for Payer: Anthem Blue Cross of IN Medicare	$86.89
Rate for Payer: Anthem Blue Cross of IN PPO/Pathway	$160.96
Rate for Payer: Anthem Blue Cross of IN Traditional	$175.20
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$9.56
Rate for Payer: CareSource Indiana of IN Just 4 Me	$103.14
Rate for Payer: CareSource Indiana of IN Medicare	$98.66
Rate for Payer: Cash Price	$173.77
Rate for Payer: Cash Price	$173.77
Rate for Payer: Centivo All Commercial	$152.47
Rate for Payer: Cigna All Commercial	$241.88
Rate for Payer: CORVEL All Commercial	$260.66
Rate for Payer: Coventry All Commercial	$246.65
Rate for Payer: Encore All Commercial	$258.00
Rate for Payer: Frontpath All Commercial	$257.86
Rate for Payer: Humana ChoiceCare	$242.08
Rate for Payer: Humana Medicare	$89.69
Rate for Payer: Lucent All Commercial	$152.47
Rate for Payer: Lutheran Preferred All Commercial	$252.25
Rate for Payer: Managed Health Services Medicaid	$9.56
Rate for Payer: MDWise Medicaid	$9.56
Rate for Payer: PHCS All Commercial	$210.21
Rate for Payer: PHP All Commercial	$212.56
Rate for Payer: Plain Church Group Ministry All Commercial	$109.31
Rate for Payer: Sagamore Health Network All Products	$216.38
Rate for Payer: Signature Care EPO	$232.63
Rate for Payer: Signature Care PPO	$246.65
Rate for Payer: Three Rivers Preferred All Commercial	$238.24
Rate for Payer: United Healthcare Commercial	$220.86
Rate for Payer: United Healthcare Medicare	$89.69

APRACLONIDINE 0.5 % OPHT DROP

Facility

$280.28

Service Code	NDC 17478071610
Hospital Charge Code	9119
Hospital Revenue Code	250
Min. Negotiated Rate	$210.21
Max. Negotiated Rate	$260.66
Rate for Payer: Aetna Commercial	$242.16
Rate for Payer: Cash Price	$173.77
Rate for Payer: Cigna All Commercial	$241.88
Rate for Payer: CORVEL All Commercial	$260.66
Rate for Payer: Coventry All Commercial	$246.65
Rate for Payer: Encore All Commercial	$258.00
Rate for Payer: Frontpath All Commercial	$257.86
Rate for Payer: Humana ChoiceCare	$242.08
Rate for Payer: Lutheran Preferred All Commercial	$252.25
Rate for Payer: PHCS All Commercial	$210.21
Rate for Payer: PHP All Commercial	$212.56
Rate for Payer: Sagamore Health Network All Products	$216.38
Rate for Payer: Signature Care EPO	$232.63
Rate for Payer: Signature Care PPO	$246.65
Rate for Payer: United Healthcare Commercial	$220.86

APR-DRG 36.00: ABDOMINAL PAIN

Facility

$6,440.94

Service Code	APR-DRG 2514
Min. Negotiated Rate	$3,241.85
Max. Negotiated Rate	$6,440.94
Rate for Payer: Anthem Blue Cross of IN Medicaid	$3,241.85
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$3,241.85
Rate for Payer: Managed Health Services Medicaid	$3,241.85
Rate for Payer: MDWise Medicaid	$3,241.85

APR-DRG 36.00: ABDOMINAL PAIN

Facility

$2,939.49

Service Code	APR-DRG 2511
Min. Negotiated Rate	$2,290.44
Max. Negotiated Rate	$2,939.49
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: ABDOMINAL PAIN

Facility

$3,501.45

Service Code	APR-DRG 2512
Min. Negotiated Rate	$2,607.57
Max. Negotiated Rate	$3,501.45
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,607.57
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,607.57
Rate for Payer: Managed Health Services Medicaid	$2,607.57
Rate for Payer: MDWise Medicaid	$2,607.57

APR-DRG 36.00: ABDOMINAL PAIN

Facility

$4,279.55

Service Code	APR-DRG 2513
Min. Negotiated Rate	$3,241.85
Max. Negotiated Rate	$4,279.55
Rate for Payer: Anthem Blue Cross of IN Medicaid	$3,241.85
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$3,241.85
Rate for Payer: Managed Health Services Medicaid	$3,241.85
Rate for Payer: MDWise Medicaid	$3,241.85

APR-DRG 36.00: ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$7,651.32

Service Code	APR-DRG 5644
Min. Negotiated Rate	$2,325.68
Max. Negotiated Rate	$7,651.32
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,325.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,325.68
Rate for Payer: Managed Health Services Medicaid	$2,325.68
Rate for Payer: MDWise Medicaid	$2,325.68

APR-DRG 36.00: ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$2,507.21

Service Code	APR-DRG 5642
Min. Negotiated Rate	$2,325.68
Max. Negotiated Rate	$2,507.21
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,325.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,325.68
Rate for Payer: Managed Health Services Medicaid	$2,325.68
Rate for Payer: MDWise Medicaid	$2,325.68

APR-DRG 36.00: ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$3,587.91

Service Code	APR-DRG 5643
Min. Negotiated Rate	$2,325.68
Max. Negotiated Rate	$3,587.91
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,325.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,325.68
Rate for Payer: Managed Health Services Medicaid	$2,325.68
Rate for Payer: MDWise Medicaid	$2,325.68

APR-DRG 36.00: ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$1,685.88

Service Code	APR-DRG 5641
Min. Negotiated Rate	$1,092.36
Max. Negotiated Rate	$1,685.88
Rate for Payer: Anthem Blue Cross of IN Medicaid	$1,092.36
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$1,092.36
Rate for Payer: Managed Health Services Medicaid	$1,092.36
Rate for Payer: MDWise Medicaid	$1,092.36

APR-DRG 36.00: ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$6,873.22

Service Code	APR-DRG 1454
Min. Negotiated Rate	$4,510.40
Max. Negotiated Rate	$6,873.22
Rate for Payer: Anthem Blue Cross of IN Medicaid	$4,510.40
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$4,510.40
Rate for Payer: Managed Health Services Medicaid	$4,510.40
Rate for Payer: MDWise Medicaid	$4,510.40

APR-DRG 36.00: ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$2,463.98

Service Code	APR-DRG 1451
Min. Negotiated Rate	$1,973.30
Max. Negotiated Rate	$2,463.98
Rate for Payer: Anthem Blue Cross of IN Medicaid	$1,973.30
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$1,973.30
Rate for Payer: Managed Health Services Medicaid	$1,973.30
Rate for Payer: MDWise Medicaid	$1,973.30

APR-DRG 36.00: ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$4,149.87

Service Code	APR-DRG 1453
Min. Negotiated Rate	$3,241.85
Max. Negotiated Rate	$4,149.87
Rate for Payer: Anthem Blue Cross of IN Medicaid	$3,241.85
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$3,241.85
Rate for Payer: Managed Health Services Medicaid	$3,241.85
Rate for Payer: MDWise Medicaid	$3,241.85

APR-DRG 36.00: ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$3,069.17

Service Code	APR-DRG 1452
Min. Negotiated Rate	$2,290.44
Max. Negotiated Rate	$3,069.17
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: ACUTE KIDNEY INJURY

Facility

$2,334.30

Service Code	APR-DRG 4691
Min. Negotiated Rate	$2,008.54
Max. Negotiated Rate	$2,334.30
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: ACUTE KIDNEY INJURY

Facility

$10,893.41

Service Code	APR-DRG 4694
Min. Negotiated Rate	$9,337.94
Max. Negotiated Rate	$10,893.41
Rate for Payer: Anthem Blue Cross of IN Medicaid	$9,337.94
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$9,337.94
Rate for Payer: Managed Health Services Medicaid	$9,337.94
Rate for Payer: MDWise Medicaid	$9,337.94

APR-DRG 36.00: ACUTE KIDNEY INJURY

Facility

$5,662.84

Service Code	APR-DRG 4693
Min. Negotiated Rate	$4,158.02
Max. Negotiated Rate	$5,662.84
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: ACUTE KIDNEY INJURY

Facility

$3,285.31

Service Code	APR-DRG 4692
Min. Negotiated Rate	$2,713.29
Max. Negotiated Rate	$3,285.31
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,713.29
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,713.29
Rate for Payer: Managed Health Services Medicaid	$2,713.29
Rate for Payer: MDWise Medicaid	$2,713.29

APR-DRG 36.00: ACUTE LEUKEMIA

Facility

$14,135.49

Service Code	APR-DRG 6902
Min. Negotiated Rate	$10,113.16
Max. Negotiated Rate	$14,135.49
Rate for Payer: Anthem Blue Cross of IN Medicaid	$10,113.16
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$10,113.16
Rate for Payer: Managed Health Services Medicaid	$10,113.16
Rate for Payer: MDWise Medicaid	$10,113.16

APR-DRG 36.00: ACUTE LEUKEMIA

Facility

$28,357.44

Service Code	APR-DRG 6904
Min. Negotiated Rate	$21,635.83
Max. Negotiated Rate	$28,357.44
Rate for Payer: Anthem Blue Cross of IN Medicaid	$21,635.83
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$21,635.83
Rate for Payer: Managed Health Services Medicaid	$21,635.83
Rate for Payer: MDWise Medicaid	$21,635.83

APR-DRG 36.00: ACUTE LEUKEMIA

Facility

$9,293.98

Service Code	APR-DRG 6901
Min. Negotiated Rate	$3,347.56
Max. Negotiated Rate	$9,293.98
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: ACUTE LEUKEMIA

Facility

$21,700.36

Service Code	APR-DRG 6903
Min. Negotiated Rate	$20,895.84
Max. Negotiated Rate	$21,700.36
Rate for Payer: Anthem Blue Cross of IN Medicaid	$20,895.84
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$20,895.84
Rate for Payer: Managed Health Services Medicaid	$20,895.84
Rate for Payer: MDWise Medicaid	$20,895.84

APR-DRG 36.00: ACUTE MYOCARDIAL INFARCTION

Facility

$4,971.20

Service Code	APR-DRG 1903
Min. Negotiated Rate	$4,087.55
Max. Negotiated Rate	$4,971.20
Rate for Payer: Anthem Blue Cross of IN Medicaid	$4,087.55
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$4,087.55
Rate for Payer: Managed Health Services Medicaid	$4,087.55
Rate for Payer: MDWise Medicaid	$4,087.55

APR-DRG 36.00: ACUTE MYOCARDIAL INFARCTION

Facility

$3,242.09

Service Code	APR-DRG 1901
Min. Negotiated Rate	$2,924.71
Max. Negotiated Rate	$3,242.09
Rate for Payer: Anthem Blue Cross of IN Medicaid	$2,924.71
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP	$2,924.71
Rate for Payer: Managed Health Services Medicaid	$2,924.71
Rate for Payer: MDWise Medicaid	$2,924.71

Know your out-of-pocket cost for care.

All Charges