Cameron Memorial Community Hospital

All Charges

Charge

Type

Price

INPATIENT APRDRG 1142: DENTAL DISEASES AND DISORDERS

Facility IP

$7,589.81

Service Code	APR-DRG 1142
Hospital Charge Code	APRDRG 1142
Min. Negotiated Rate	$1,937.94
Max. Negotiated Rate	$7,589.81
Rate for Payer: Buckeye Health Medicaid OOS	$1,937.94
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$7,589.81
Rate for Payer: Managed Health Services Medicaid	$7,589.81
Rate for Payer: MDWise Medicaid	$7,589.81
Rate for Payer: Molina Healthcare of OH Medicare	$1,937.94

INPATIENT APRDRG 1143: DENTAL DISEASES AND DISORDERS

Facility IP

$11,384.71

Service Code	APR-DRG 1143
Hospital Charge Code	APRDRG 1143
Min. Negotiated Rate	$3,542.53
Max. Negotiated Rate	$11,384.71
Rate for Payer: Buckeye Health Medicaid OOS	$3,542.53
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$11,384.71
Rate for Payer: Managed Health Services Medicaid	$11,384.71
Rate for Payer: MDWise Medicaid	$11,384.71
Rate for Payer: Molina Healthcare of OH Medicare	$3,542.53

INPATIENT APRDRG 1144: DENTAL DISEASES AND DISORDERS

Facility IP

$13,953.70

Service Code	APR-DRG 1144
Hospital Charge Code	APRDRG 1144
Min. Negotiated Rate	$3,542.53
Max. Negotiated Rate	$13,953.70
Rate for Payer: Buckeye Health Medicaid OOS	$3,542.53
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$13,953.70
Rate for Payer: Managed Health Services Medicaid	$13,953.70
Rate for Payer: MDWise Medicaid	$13,953.70
Rate for Payer: Molina Healthcare of OH Medicare	$3,542.53

INPATIENT APRDRG 1151: OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

Facility IP

$11,371.14

Service Code	APR-DRG 1151
Hospital Charge Code	APRDRG 1151
Min. Negotiated Rate	$1,936.97
Max. Negotiated Rate	$11,371.14
Rate for Payer: Buckeye Health Medicaid OOS	$1,936.97
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$11,371.14
Rate for Payer: Managed Health Services Medicaid	$11,371.14
Rate for Payer: MDWise Medicaid	$11,371.14
Rate for Payer: Molina Healthcare of OH Medicare	$1,936.97

INPATIENT APRDRG 1152: OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

Facility IP

$11,371.14

Service Code	APR-DRG 1152
Hospital Charge Code	APRDRG 1152
Min. Negotiated Rate	$2,376.31
Max. Negotiated Rate	$11,371.14
Rate for Payer: Buckeye Health Medicaid OOS	$2,376.31
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$11,371.14
Rate for Payer: Managed Health Services Medicaid	$11,371.14
Rate for Payer: MDWise Medicaid	$11,371.14
Rate for Payer: Molina Healthcare of OH Medicare	$2,376.31

INPATIENT APRDRG 1153: OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

Facility IP

$19,591.17

Service Code	APR-DRG 1153
Hospital Charge Code	APRDRG 1153
Min. Negotiated Rate	$3,550.21
Max. Negotiated Rate	$19,591.17
Rate for Payer: Buckeye Health Medicaid OOS	$3,550.21
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$19,591.17
Rate for Payer: Managed Health Services Medicaid	$19,591.17
Rate for Payer: MDWise Medicaid	$19,591.17
Rate for Payer: Molina Healthcare of OH Medicare	$3,550.21

INPATIENT APRDRG 1154: OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

Facility IP

$23,300.97

Service Code	APR-DRG 1154
Hospital Charge Code	APRDRG 1154
Min. Negotiated Rate	$10,718.52
Max. Negotiated Rate	$23,300.97
Rate for Payer: Buckeye Health Medicaid OOS	$10,718.52
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$23,300.97
Rate for Payer: Managed Health Services Medicaid	$23,300.97
Rate for Payer: MDWise Medicaid	$23,300.97
Rate for Payer: Molina Healthcare of OH Medicare	$10,718.52

INPATIENT APRDRG 1201: MAJOR RESPIRATORY & CHEST PROCEDURES

Facility IP

$26,653.12

Service Code	APR-DRG 1201
Hospital Charge Code	APRDRG 1201
Min. Negotiated Rate	$7,040.87
Max. Negotiated Rate	$26,653.12
Rate for Payer: Buckeye Health Medicaid OOS	$7,040.87
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$26,653.12
Rate for Payer: Managed Health Services Medicaid	$26,653.12
Rate for Payer: MDWise Medicaid	$26,653.12
Rate for Payer: Molina Healthcare of OH Medicare	$7,040.87

INPATIENT APRDRG 1202: MAJOR RESPIRATORY & CHEST PROCEDURES

Facility IP

$31,780.00

Service Code	APR-DRG 1202
Hospital Charge Code	APRDRG 1202
Min. Negotiated Rate	$8,169.94
Max. Negotiated Rate	$31,780.00
Rate for Payer: Buckeye Health Medicaid OOS	$8,169.94
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$31,780.00
Rate for Payer: Managed Health Services Medicaid	$31,780.00
Rate for Payer: MDWise Medicaid	$31,780.00
Rate for Payer: Molina Healthcare of OH Medicare	$8,169.94

INPATIENT APRDRG 1203: MAJOR RESPIRATORY & CHEST PROCEDURES

Facility IP

$44,326.48

Service Code	APR-DRG 1203
Hospital Charge Code	APRDRG 1203
Min. Negotiated Rate	$10,742.86
Max. Negotiated Rate	$44,326.48
Rate for Payer: Buckeye Health Medicaid OOS	$10,742.86
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$44,326.48
Rate for Payer: Managed Health Services Medicaid	$44,326.48
Rate for Payer: MDWise Medicaid	$44,326.48
Rate for Payer: Molina Healthcare of OH Medicare	$10,742.86

INPATIENT APRDRG 1204: MAJOR RESPIRATORY & CHEST PROCEDURES

Facility IP

$83,294.23

Service Code	APR-DRG 1204
Hospital Charge Code	APRDRG 1204
Min. Negotiated Rate	$22,365.35
Max. Negotiated Rate	$83,294.23
Rate for Payer: Buckeye Health Medicaid OOS	$22,365.35
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$83,294.23
Rate for Payer: Managed Health Services Medicaid	$83,294.23
Rate for Payer: MDWise Medicaid	$83,294.23
Rate for Payer: Molina Healthcare of OH Medicare	$22,365.35

INPATIENT APRDRG 1211: OTHER RESPIRATORY & CHEST PROCEDURES

Facility IP

$21,394.27

Service Code	APR-DRG 1211
Hospital Charge Code	APRDRG 1211
Min. Negotiated Rate	$4,914.00
Max. Negotiated Rate	$21,394.27
Rate for Payer: Buckeye Health Medicaid OOS	$4,914.00
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$21,394.27
Rate for Payer: Managed Health Services Medicaid	$21,394.27
Rate for Payer: MDWise Medicaid	$21,394.27
Rate for Payer: Molina Healthcare of OH Medicare	$4,914.00

INPATIENT APRDRG 1212: OTHER RESPIRATORY & CHEST PROCEDURES

Facility IP

$23,886.80

Service Code	APR-DRG 1212
Hospital Charge Code	APRDRG 1212
Min. Negotiated Rate	$6,484.01
Max. Negotiated Rate	$23,886.80
Rate for Payer: Buckeye Health Medicaid OOS	$6,484.01
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$23,886.80
Rate for Payer: Managed Health Services Medicaid	$23,886.80
Rate for Payer: MDWise Medicaid	$23,886.80
Rate for Payer: Molina Healthcare of OH Medicare	$6,484.01

INPATIENT APRDRG 1213: OTHER RESPIRATORY & CHEST PROCEDURES

Facility IP

$35,629.16

Service Code	APR-DRG 1213
Hospital Charge Code	APRDRG 1213
Min. Negotiated Rate	$8,901.63
Max. Negotiated Rate	$35,629.16
Rate for Payer: Buckeye Health Medicaid OOS	$8,901.63
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$35,629.16
Rate for Payer: Managed Health Services Medicaid	$35,629.16
Rate for Payer: MDWise Medicaid	$35,629.16
Rate for Payer: Molina Healthcare of OH Medicare	$8,901.63

INPATIENT APRDRG 1214: OTHER RESPIRATORY & CHEST PROCEDURES

Facility IP

$70,144.65

Service Code	APR-DRG 1214
Hospital Charge Code	APRDRG 1214
Min. Negotiated Rate	$15,947.94
Max. Negotiated Rate	$70,144.65
Rate for Payer: Buckeye Health Medicaid OOS	$15,947.94
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$70,144.65
Rate for Payer: Managed Health Services Medicaid	$70,144.65
Rate for Payer: MDWise Medicaid	$70,144.65
Rate for Payer: Molina Healthcare of OH Medicare	$15,947.94

INPATIENT APRDRG 1301: RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility IP

$50,676.81

Service Code	APR-DRG 1301
Hospital Charge Code	APRDRG 1301
Min. Negotiated Rate	$13,440.98
Max. Negotiated Rate	$50,676.81
Rate for Payer: Buckeye Health Medicaid OOS	$13,440.98
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$50,676.81
Rate for Payer: Managed Health Services Medicaid	$50,676.81
Rate for Payer: MDWise Medicaid	$50,676.81
Rate for Payer: Molina Healthcare of OH Medicare	$13,440.98

INPATIENT APRDRG 1302: RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility IP

$50,676.81

Service Code	APR-DRG 1302
Hospital Charge Code	APRDRG 1302
Min. Negotiated Rate	$13,440.98
Max. Negotiated Rate	$50,676.81
Rate for Payer: Buckeye Health Medicaid OOS	$13,440.98
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$50,676.81
Rate for Payer: Managed Health Services Medicaid	$50,676.81
Rate for Payer: MDWise Medicaid	$50,676.81
Rate for Payer: Molina Healthcare of OH Medicare	$13,440.98

INPATIENT APRDRG 1303: RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility IP

$50,676.81

Service Code	APR-DRG 1303
Hospital Charge Code	APRDRG 1303
Min. Negotiated Rate	$15,398.45
Max. Negotiated Rate	$50,676.81
Rate for Payer: Buckeye Health Medicaid OOS	$15,398.45
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$50,676.81
Rate for Payer: Managed Health Services Medicaid	$50,676.81
Rate for Payer: MDWise Medicaid	$50,676.81
Rate for Payer: Molina Healthcare of OH Medicare	$15,398.45

INPATIENT APRDRG 1304: RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility IP

$66,348.51

Service Code	APR-DRG 1304
Hospital Charge Code	APRDRG 1304
Min. Negotiated Rate	$17,887.47
Max. Negotiated Rate	$66,348.51
Rate for Payer: Buckeye Health Medicaid OOS	$17,887.47
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$66,348.51
Rate for Payer: Managed Health Services Medicaid	$66,348.51
Rate for Payer: MDWise Medicaid	$66,348.51
Rate for Payer: Molina Healthcare of OH Medicare	$17,887.47

INPATIENT APRDRG 1311: CYSTIC FIBROSIS - PULMONARY DISEASE

Facility IP

$31,581.43

Service Code	APR-DRG 1311
Hospital Charge Code	APRDRG 1311
Min. Negotiated Rate	$8,859.36
Max. Negotiated Rate	$31,581.43
Rate for Payer: Buckeye Health Medicaid OOS	$8,859.36
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$31,581.43
Rate for Payer: Managed Health Services Medicaid	$31,581.43
Rate for Payer: MDWise Medicaid	$31,581.43
Rate for Payer: Molina Healthcare of OH Medicare	$8,859.36

INPATIENT APRDRG 1312: CYSTIC FIBROSIS - PULMONARY DISEASE

Facility IP

$31,581.43

Service Code	APR-DRG 1312
Hospital Charge Code	APRDRG 1312
Min. Negotiated Rate	$10,530.88
Max. Negotiated Rate	$31,581.43
Rate for Payer: Buckeye Health Medicaid OOS	$10,530.88
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$31,581.43
Rate for Payer: Managed Health Services Medicaid	$31,581.43
Rate for Payer: MDWise Medicaid	$31,581.43
Rate for Payer: Molina Healthcare of OH Medicare	$10,530.88

INPATIENT APRDRG 1313: CYSTIC FIBROSIS - PULMONARY DISEASE

Facility IP

$31,581.43

Service Code	APR-DRG 1313
Hospital Charge Code	APRDRG 1313
Min. Negotiated Rate	$11,476.15
Max. Negotiated Rate	$31,581.43
Rate for Payer: Buckeye Health Medicaid OOS	$11,476.15
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$31,581.43
Rate for Payer: Managed Health Services Medicaid	$31,581.43
Rate for Payer: MDWise Medicaid	$31,581.43
Rate for Payer: Molina Healthcare of OH Medicare	$11,476.15

INPATIENT APRDRG 1314: CYSTIC FIBROSIS - PULMONARY DISEASE

Facility IP

$40,742.48

Service Code	APR-DRG 1314
Hospital Charge Code	APRDRG 1314
Min. Negotiated Rate	$13,732.06
Max. Negotiated Rate	$40,742.48
Rate for Payer: Buckeye Health Medicaid OOS	$13,732.06
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$40,742.48
Rate for Payer: Managed Health Services Medicaid	$40,742.48
Rate for Payer: MDWise Medicaid	$40,742.48
Rate for Payer: Molina Healthcare of OH Medicare	$13,732.06

INPATIENT APRDRG 1321: BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD

Facility IP

$8,469.16

Service Code	APR-DRG 1321
Hospital Charge Code	APRDRG 1321
Min. Negotiated Rate	$2,150.24
Max. Negotiated Rate	$8,469.16
Rate for Payer: Buckeye Health Medicaid OOS	$2,150.24
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$8,469.16
Rate for Payer: Managed Health Services Medicaid	$8,469.16
Rate for Payer: MDWise Medicaid	$8,469.16
Rate for Payer: Molina Healthcare of OH Medicare	$2,150.24

INPATIENT APRDRG 1322: BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD

Facility IP

$12,779.58

Service Code	APR-DRG 1322
Hospital Charge Code	APRDRG 1322
Min. Negotiated Rate	$4,154.46
Max. Negotiated Rate	$12,779.58
Rate for Payer: Buckeye Health Medicaid OOS	$4,154.46
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$12,779.58
Rate for Payer: Managed Health Services Medicaid	$12,779.58
Rate for Payer: MDWise Medicaid	$12,779.58
Rate for Payer: Molina Healthcare of OH Medicare	$4,154.46

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