Cameron Memorial Community Hospital

All Charges

Charge

Type

Price

INPATIENT APRDRG 0951: CLEFT LIP & PALATE REPAIR

Facility IP

$8,550.56

Service Code	APR-DRG 0951
Hospital Charge Code	APRDRG 0951
Min. Negotiated Rate	$2,229.01
Max. Negotiated Rate	$8,550.56
Rate for Payer: Buckeye Health Medicaid OOS	$2,229.01
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$8,550.56
Rate for Payer: Managed Health Services Medicaid	$8,550.56
Rate for Payer: MDWise Medicaid	$8,550.56
Rate for Payer: Molina Healthcare of OH Medicare	$2,229.01

INPATIENT APRDRG 0952: CLEFT LIP & PALATE REPAIR

Facility IP

$9,748.10

Service Code	APR-DRG 0952
Hospital Charge Code	APRDRG 0952
Min. Negotiated Rate	$3,196.38
Max. Negotiated Rate	$9,748.10
Rate for Payer: Buckeye Health Medicaid OOS	$3,196.38
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$9,748.10
Rate for Payer: Managed Health Services Medicaid	$9,748.10
Rate for Payer: MDWise Medicaid	$9,748.10
Rate for Payer: Molina Healthcare of OH Medicare	$3,196.38

INPATIENT APRDRG 0953: CLEFT LIP & PALATE REPAIR

Facility IP

$12,589.65

Service Code	APR-DRG 0953
Hospital Charge Code	APRDRG 0953
Min. Negotiated Rate	$3,196.38
Max. Negotiated Rate	$12,589.65
Rate for Payer: Buckeye Health Medicaid OOS	$3,196.38
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$12,589.65
Rate for Payer: Managed Health Services Medicaid	$12,589.65
Rate for Payer: MDWise Medicaid	$12,589.65
Rate for Payer: Molina Healthcare of OH Medicare	$3,196.38

INPATIENT APRDRG 0954: CLEFT LIP & PALATE REPAIR

Facility IP

$12,589.65

Service Code	APR-DRG 0954
Hospital Charge Code	APRDRG 0954
Min. Negotiated Rate	$3,196.38
Max. Negotiated Rate	$12,589.65
Rate for Payer: MDWise Medicaid	$12,589.65
Rate for Payer: Buckeye Health Medicaid OOS	$3,196.38
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$12,589.65
Rate for Payer: Managed Health Services Medicaid	$12,589.65
Rate for Payer: Molina Healthcare of OH Medicare	$3,196.38

INPATIENT APRDRG 0971: TONSIL & ADENOID PROCEDURES

Facility IP

$8,117.66

Service Code	APR-DRG 0971
Hospital Charge Code	APRDRG 0971
Min. Negotiated Rate	$2,418.90
Max. Negotiated Rate	$8,117.66
Rate for Payer: Buckeye Health Medicaid OOS	$2,418.90
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$8,117.66
Rate for Payer: Managed Health Services Medicaid	$8,117.66
Rate for Payer: MDWise Medicaid	$8,117.66
Rate for Payer: Molina Healthcare of OH Medicare	$2,418.90

INPATIENT APRDRG 0972: TONSIL & ADENOID PROCEDURES

Facility IP

$11,327.98

Service Code	APR-DRG 0972
Hospital Charge Code	APRDRG 0972
Min. Negotiated Rate	$3,014.81
Max. Negotiated Rate	$11,327.98
Rate for Payer: Buckeye Health Medicaid OOS	$3,014.81
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$11,327.98
Rate for Payer: Managed Health Services Medicaid	$11,327.98
Rate for Payer: MDWise Medicaid	$11,327.98
Rate for Payer: Molina Healthcare of OH Medicare	$3,014.81

INPATIENT APRDRG 0973: TONSIL & ADENOID PROCEDURES

Facility IP

$13,926.56

Service Code	APR-DRG 0973
Hospital Charge Code	APRDRG 0973
Min. Negotiated Rate	$4,448.41
Max. Negotiated Rate	$13,926.56
Rate for Payer: Buckeye Health Medicaid OOS	$4,448.41
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$13,926.56
Rate for Payer: Managed Health Services Medicaid	$13,926.56
Rate for Payer: MDWise Medicaid	$13,926.56
Rate for Payer: Molina Healthcare of OH Medicare	$4,448.41

INPATIENT APRDRG 0974: TONSIL & ADENOID PROCEDURES

Facility IP

$17,521.67

Service Code	APR-DRG 0974
Hospital Charge Code	APRDRG 0974
Min. Negotiated Rate	$4,448.41
Max. Negotiated Rate	$17,521.67
Rate for Payer: Buckeye Health Medicaid OOS	$4,448.41
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$17,521.67
Rate for Payer: Managed Health Services Medicaid	$17,521.67
Rate for Payer: MDWise Medicaid	$17,521.67
Rate for Payer: Molina Healthcare of OH Medicare	$4,448.41

INPATIENT APRDRG 0981: OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

Facility IP

$11,324.28

Service Code	APR-DRG 0981
Hospital Charge Code	APRDRG 0981
Min. Negotiated Rate	$3,075.02
Max. Negotiated Rate	$11,324.28
Rate for Payer: Buckeye Health Medicaid OOS	$3,075.02
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$11,324.28
Rate for Payer: Managed Health Services Medicaid	$11,324.28
Rate for Payer: MDWise Medicaid	$11,324.28
Rate for Payer: Molina Healthcare of OH Medicare	$3,075.02

INPATIENT APRDRG 0982: OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

Facility IP

$14,633.25

Service Code	APR-DRG 0982
Hospital Charge Code	APRDRG 0982
Min. Negotiated Rate	$3,770.52
Max. Negotiated Rate	$14,633.25
Rate for Payer: Buckeye Health Medicaid OOS	$3,770.52
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$14,633.25
Rate for Payer: Managed Health Services Medicaid	$14,633.25
Rate for Payer: MDWise Medicaid	$14,633.25
Rate for Payer: Molina Healthcare of OH Medicare	$3,770.52

INPATIENT APRDRG 0983: OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

Facility IP

$25,904.50

Service Code	APR-DRG 0983
Hospital Charge Code	APRDRG 0983
Min. Negotiated Rate	$6,771.25
Max. Negotiated Rate	$25,904.50
Rate for Payer: Buckeye Health Medicaid OOS	$6,771.25
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$25,904.50
Rate for Payer: Managed Health Services Medicaid	$25,904.50
Rate for Payer: MDWise Medicaid	$25,904.50
Rate for Payer: Molina Healthcare of OH Medicare	$6,771.25

INPATIENT APRDRG 0984: OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

Facility IP

$46,409.55

Service Code	APR-DRG 0984
Hospital Charge Code	APRDRG 0984
Min. Negotiated Rate	$10,796.66
Max. Negotiated Rate	$46,409.55
Rate for Payer: Buckeye Health Medicaid OOS	$10,796.66
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$46,409.55
Rate for Payer: Managed Health Services Medicaid	$46,409.55
Rate for Payer: MDWise Medicaid	$46,409.55
Rate for Payer: Molina Healthcare of OH Medicare	$10,796.66

INPATIENT APRDRG 1101: EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES

Facility IP

$7,621.87

Service Code	APR-DRG 1101
Hospital Charge Code	APRDRG 1101
Min. Negotiated Rate	$3,772.12
Max. Negotiated Rate	$7,621.87
Rate for Payer: Buckeye Health Medicaid OOS	$3,772.12
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$7,621.87
Rate for Payer: Managed Health Services Medicaid	$7,621.87
Rate for Payer: MDWise Medicaid	$7,621.87
Rate for Payer: Molina Healthcare of OH Medicare	$3,772.12

INPATIENT APRDRG 1102: EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES

Facility IP

$9,397.84

Service Code	APR-DRG 1102
Hospital Charge Code	APRDRG 1102
Min. Negotiated Rate	$3,772.12
Max. Negotiated Rate	$9,397.84
Rate for Payer: Buckeye Health Medicaid OOS	$3,772.12
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$9,397.84
Rate for Payer: Managed Health Services Medicaid	$9,397.84
Rate for Payer: MDWise Medicaid	$9,397.84
Rate for Payer: Molina Healthcare of OH Medicare	$3,772.12

INPATIENT APRDRG 1103: EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES

Facility IP

$14,181.86

Service Code	APR-DRG 1103
Hospital Charge Code	APRDRG 1103
Min. Negotiated Rate	$3,772.12
Max. Negotiated Rate	$14,181.86
Rate for Payer: Buckeye Health Medicaid OOS	$3,772.12
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$14,181.86
Rate for Payer: Managed Health Services Medicaid	$14,181.86
Rate for Payer: MDWise Medicaid	$14,181.86
Rate for Payer: Molina Healthcare of OH Medicare	$3,772.12

INPATIENT APRDRG 1104: EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES

Facility IP

$24,204.99

Service Code	APR-DRG 1104
Hospital Charge Code	APRDRG 1104
Min. Negotiated Rate	$6,682.23
Max. Negotiated Rate	$24,204.99
Rate for Payer: Buckeye Health Medicaid OOS	$6,682.23
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$24,204.99
Rate for Payer: Managed Health Services Medicaid	$24,204.99
Rate for Payer: MDWise Medicaid	$24,204.99
Rate for Payer: Molina Healthcare of OH Medicare	$6,682.23

INPATIENT APRDRG 1111: VERTIGO & OTHER LABYRINTH DISORDERS

Facility IP

$5,985.27

Service Code	APR-DRG 1111
Hospital Charge Code	APRDRG 1111
Min. Negotiated Rate	$1,374.04
Max. Negotiated Rate	$5,985.27
Rate for Payer: Buckeye Health Medicaid OOS	$1,374.04
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$5,985.27
Rate for Payer: Managed Health Services Medicaid	$5,985.27
Rate for Payer: MDWise Medicaid	$5,985.27
Rate for Payer: Molina Healthcare of OH Medicare	$1,374.04

INPATIENT APRDRG 1112: VERTIGO & OTHER LABYRINTH DISORDERS

Facility IP

$8,829.28

Service Code	APR-DRG 1112
Hospital Charge Code	APRDRG 1112
Min. Negotiated Rate	$1,826.18
Max. Negotiated Rate	$8,829.28
Rate for Payer: Buckeye Health Medicaid OOS	$1,826.18
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$8,829.28
Rate for Payer: Managed Health Services Medicaid	$8,829.28
Rate for Payer: MDWise Medicaid	$8,829.28
Rate for Payer: Molina Healthcare of OH Medicare	$1,826.18

INPATIENT APRDRG 1113: VERTIGO & OTHER LABYRINTH DISORDERS

Facility IP

$8,829.28

Service Code	APR-DRG 1113
Hospital Charge Code	APRDRG 1113
Min. Negotiated Rate	$2,228.37
Max. Negotiated Rate	$8,829.28
Rate for Payer: Buckeye Health Medicaid OOS	$2,228.37
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$8,829.28
Rate for Payer: Managed Health Services Medicaid	$8,829.28
Rate for Payer: MDWise Medicaid	$8,829.28
Rate for Payer: Molina Healthcare of OH Medicare	$2,228.37

INPATIENT APRDRG 1114: VERTIGO & OTHER LABYRINTH DISORDERS

Facility IP

$8,829.28

Service Code	APR-DRG 1114
Hospital Charge Code	APRDRG 1114
Min. Negotiated Rate	$2,228.37
Max. Negotiated Rate	$8,829.28
Rate for Payer: Buckeye Health Medicaid OOS	$2,228.37
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$8,829.28
Rate for Payer: Managed Health Services Medicaid	$8,829.28
Rate for Payer: MDWise Medicaid	$8,829.28
Rate for Payer: Molina Healthcare of OH Medicare	$2,228.37

INPATIENT APRDRG 1131: INFECTIONS OF UPPER RESPIRATORY TRACT

Facility IP

$5,509.21

Service Code	APR-DRG 1131
Hospital Charge Code	APRDRG 1131
Min. Negotiated Rate	$1,513.33
Max. Negotiated Rate	$5,509.21
Rate for Payer: Buckeye Health Medicaid OOS	$1,513.33
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$5,509.21
Rate for Payer: Managed Health Services Medicaid	$5,509.21
Rate for Payer: MDWise Medicaid	$5,509.21
Rate for Payer: Molina Healthcare of OH Medicare	$1,513.33

INPATIENT APRDRG 1132: INFECTIONS OF UPPER RESPIRATORY TRACT

Facility IP

$6,722.79

Service Code	APR-DRG 1132
Hospital Charge Code	APRDRG 1132
Min. Negotiated Rate	$1,934.73
Max. Negotiated Rate	$6,722.79
Rate for Payer: Buckeye Health Medicaid OOS	$1,934.73
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$6,722.79
Rate for Payer: Managed Health Services Medicaid	$6,722.79
Rate for Payer: MDWise Medicaid	$6,722.79
Rate for Payer: Molina Healthcare of OH Medicare	$1,934.73

INPATIENT APRDRG 1133: INFECTIONS OF UPPER RESPIRATORY TRACT

Facility IP

$12,534.15

Service Code	APR-DRG 1133
Hospital Charge Code	APRDRG 1133
Min. Negotiated Rate	$3,000.73
Max. Negotiated Rate	$12,534.15
Rate for Payer: Buckeye Health Medicaid OOS	$3,000.73
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$12,534.15
Rate for Payer: Managed Health Services Medicaid	$12,534.15
Rate for Payer: MDWise Medicaid	$12,534.15
Rate for Payer: Molina Healthcare of OH Medicare	$3,000.73

INPATIENT APRDRG 1134: INFECTIONS OF UPPER RESPIRATORY TRACT

Facility IP

$14,685.05

Service Code	APR-DRG 1134
Hospital Charge Code	APRDRG 1134
Min. Negotiated Rate	$7,074.17
Max. Negotiated Rate	$14,685.05
Rate for Payer: Buckeye Health Medicaid OOS	$7,074.17
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$14,685.05
Rate for Payer: Managed Health Services Medicaid	$14,685.05
Rate for Payer: MDWise Medicaid	$14,685.05
Rate for Payer: Molina Healthcare of OH Medicare	$7,074.17

INPATIENT APRDRG 1141: DENTAL DISEASES AND DISORDERS

Facility IP

$6,975.62

Service Code	APR-DRG 1141
Hospital Charge Code	APRDRG 1141
Min. Negotiated Rate	$1,821.70
Max. Negotiated Rate	$6,975.62
Rate for Payer: Buckeye Health Medicaid OOS	$1,821.70
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$6,975.62
Rate for Payer: Managed Health Services Medicaid	$6,975.62
Rate for Payer: MDWise Medicaid	$6,975.62
Rate for Payer: Molina Healthcare of OH Medicare	$1,821.70

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