Cameron Memorial Community Hospital

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 5121: UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG

Facility

$18,904.21

Service Code	APR-DRG 5121
Hospital Charge Code	APRDRG 5121
Min. Negotiated Rate	$3,573.91
Max. Negotiated Rate	$18,904.21
Rate for Payer: Buckeye Health Medicaid OOS	$3,573.91
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$18,904.21
Rate for Payer: Managed Health Services Medicaid	$18,904.21
Rate for Payer: MDWise Medicaid	$18,904.21
Rate for Payer: Molina Healthcare of OH Medicare	$3,573.91

INPATIENT APRDRG 5122: UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG

Facility

$18,904.21

Service Code	APR-DRG 5122
Hospital Charge Code	APRDRG 5122
Min. Negotiated Rate	$4,216.58
Max. Negotiated Rate	$18,904.21
Rate for Payer: Buckeye Health Medicaid OOS	$4,216.58
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$18,904.21
Rate for Payer: Managed Health Services Medicaid	$18,904.21
Rate for Payer: MDWise Medicaid	$18,904.21
Rate for Payer: Molina Healthcare of OH Medicare	$4,216.58

INPATIENT APRDRG 5123: UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG

Facility

$23,796.76

Service Code	APR-DRG 5123
Hospital Charge Code	APRDRG 5123
Min. Negotiated Rate	$8,894.26
Max. Negotiated Rate	$23,796.76
Rate for Payer: Buckeye Health Medicaid OOS	$8,894.26
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$23,796.76
Rate for Payer: Managed Health Services Medicaid	$23,796.76
Rate for Payer: MDWise Medicaid	$23,796.76
Rate for Payer: Molina Healthcare of OH Medicare	$8,894.26

INPATIENT APRDRG 5124: UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG

Facility

$35,033.47

Service Code	APR-DRG 5124
Hospital Charge Code	APRDRG 5124
Min. Negotiated Rate	$8,894.26
Max. Negotiated Rate	$35,033.47
Rate for Payer: Buckeye Health Medicaid OOS	$8,894.26
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$35,033.47
Rate for Payer: Managed Health Services Medicaid	$35,033.47
Rate for Payer: MDWise Medicaid	$35,033.47
Rate for Payer: Molina Healthcare of OH Medicare	$8,894.26

INPATIENT APRDRG 5131: UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$11,487.07

Service Code	APR-DRG 5131
Hospital Charge Code	APRDRG 5131
Min. Negotiated Rate	$2,912.35
Max. Negotiated Rate	$11,487.07
Rate for Payer: Buckeye Health Medicaid OOS	$2,912.35
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$11,487.07
Rate for Payer: Managed Health Services Medicaid	$11,487.07
Rate for Payer: MDWise Medicaid	$11,487.07
Rate for Payer: Molina Healthcare of OH Medicare	$2,912.35

INPATIENT APRDRG 5132: UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$14,629.55

Service Code	APR-DRG 5132
Hospital Charge Code	APRDRG 5132
Min. Negotiated Rate	$3,368.33
Max. Negotiated Rate	$14,629.55
Rate for Payer: Buckeye Health Medicaid OOS	$3,368.33
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$14,629.55
Rate for Payer: Managed Health Services Medicaid	$14,629.55
Rate for Payer: MDWise Medicaid	$14,629.55
Rate for Payer: Molina Healthcare of OH Medicare	$3,368.33

INPATIENT APRDRG 5133: UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$21,479.37

Service Code	APR-DRG 5133
Hospital Charge Code	APRDRG 5133
Min. Negotiated Rate	$5,904.75
Max. Negotiated Rate	$21,479.37
Rate for Payer: Buckeye Health Medicaid OOS	$5,904.75
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$21,479.37
Rate for Payer: Managed Health Services Medicaid	$21,479.37
Rate for Payer: MDWise Medicaid	$21,479.37
Rate for Payer: Molina Healthcare of OH Medicare	$5,904.75

INPATIENT APRDRG 5134: UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$23,257.81

Service Code	APR-DRG 5134
Hospital Charge Code	APRDRG 5134
Min. Negotiated Rate	$5,904.75
Max. Negotiated Rate	$23,257.81
Rate for Payer: Buckeye Health Medicaid OOS	$5,904.75
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$23,257.81
Rate for Payer: Managed Health Services Medicaid	$23,257.81
Rate for Payer: MDWise Medicaid	$23,257.81
Rate for Payer: Molina Healthcare of OH Medicare	$5,904.75

INPATIENT APRDRG 5141: FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

$13,746.50

Service Code	APR-DRG 5141
Hospital Charge Code	APRDRG 5141
Min. Negotiated Rate	$3,075.02
Max. Negotiated Rate	$13,746.50
Rate for Payer: Buckeye Health Medicaid OOS	$3,075.02
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$13,746.50
Rate for Payer: Managed Health Services Medicaid	$13,746.50
Rate for Payer: MDWise Medicaid	$13,746.50
Rate for Payer: Molina Healthcare of OH Medicare	$3,075.02

INPATIENT APRDRG 5142: FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

$14,692.45

Service Code	APR-DRG 5142
Hospital Charge Code	APRDRG 5142
Min. Negotiated Rate	$3,782.37
Max. Negotiated Rate	$14,692.45
Rate for Payer: Buckeye Health Medicaid OOS	$3,782.37
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$14,692.45
Rate for Payer: Managed Health Services Medicaid	$14,692.45
Rate for Payer: MDWise Medicaid	$14,692.45
Rate for Payer: Molina Healthcare of OH Medicare	$3,782.37

INPATIENT APRDRG 5143: FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

$14,898.42

Service Code	APR-DRG 5143
Hospital Charge Code	APRDRG 5143
Min. Negotiated Rate	$3,782.37
Max. Negotiated Rate	$14,898.42
Rate for Payer: Buckeye Health Medicaid OOS	$3,782.37
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$14,898.42
Rate for Payer: Managed Health Services Medicaid	$14,898.42
Rate for Payer: MDWise Medicaid	$14,898.42
Rate for Payer: Molina Healthcare of OH Medicare	$3,782.37

INPATIENT APRDRG 5144: FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

$14,898.42

Service Code	APR-DRG 5144
Hospital Charge Code	APRDRG 5144
Min. Negotiated Rate	$3,782.37
Max. Negotiated Rate	$14,898.42
Rate for Payer: Buckeye Health Medicaid OOS	$3,782.37
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$14,898.42
Rate for Payer: Managed Health Services Medicaid	$14,898.42
Rate for Payer: MDWise Medicaid	$14,898.42
Rate for Payer: Molina Healthcare of OH Medicare	$3,782.37

INPATIENT APRDRG 5171: DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$9,088.28

Service Code	APR-DRG 5171
Hospital Charge Code	APRDRG 5171
Min. Negotiated Rate	$2,261.03
Max. Negotiated Rate	$9,088.28
Rate for Payer: Buckeye Health Medicaid OOS	$2,261.03
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$9,088.28
Rate for Payer: Managed Health Services Medicaid	$9,088.28
Rate for Payer: MDWise Medicaid	$9,088.28
Rate for Payer: Molina Healthcare of OH Medicare	$2,261.03

INPATIENT APRDRG 5172: DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$10,057.66

Service Code	APR-DRG 5172
Hospital Charge Code	APRDRG 5172
Min. Negotiated Rate	$2,447.72
Max. Negotiated Rate	$10,057.66
Rate for Payer: Buckeye Health Medicaid OOS	$2,447.72
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$10,057.66
Rate for Payer: Managed Health Services Medicaid	$10,057.66
Rate for Payer: MDWise Medicaid	$10,057.66
Rate for Payer: Molina Healthcare of OH Medicare	$2,447.72

INPATIENT APRDRG 5173: DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$25,218.77

Service Code	APR-DRG 5173
Hospital Charge Code	APRDRG 5173
Min. Negotiated Rate	$4,405.50
Max. Negotiated Rate	$25,218.77
Rate for Payer: Buckeye Health Medicaid OOS	$4,405.50
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$25,218.77
Rate for Payer: Managed Health Services Medicaid	$25,218.77
Rate for Payer: MDWise Medicaid	$25,218.77
Rate for Payer: Molina Healthcare of OH Medicare	$4,405.50

INPATIENT APRDRG 5174: DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$31,444.54

Service Code	APR-DRG 5174
Hospital Charge Code	APRDRG 5174
Min. Negotiated Rate	$4,405.50
Max. Negotiated Rate	$31,444.54
Rate for Payer: Buckeye Health Medicaid OOS	$4,405.50
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$31,444.54
Rate for Payer: Managed Health Services Medicaid	$31,444.54
Rate for Payer: MDWise Medicaid	$31,444.54
Rate for Payer: Molina Healthcare of OH Medicare	$4,405.50

INPATIENT APRDRG 5181: OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$12,659.95

Service Code	APR-DRG 5181
Hospital Charge Code	APRDRG 5181
Min. Negotiated Rate	$2,619.67
Max. Negotiated Rate	$12,659.95
Rate for Payer: Buckeye Health Medicaid OOS	$2,619.67
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$12,659.95
Rate for Payer: Managed Health Services Medicaid	$12,659.95
Rate for Payer: MDWise Medicaid	$12,659.95
Rate for Payer: Molina Healthcare of OH Medicare	$2,619.67

INPATIENT APRDRG 5182: OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$16,514.05

Service Code	APR-DRG 5182
Hospital Charge Code	APRDRG 5182
Min. Negotiated Rate	$3,498.98
Max. Negotiated Rate	$16,514.05
Rate for Payer: Buckeye Health Medicaid OOS	$3,498.98
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$16,514.05
Rate for Payer: Managed Health Services Medicaid	$16,514.05
Rate for Payer: MDWise Medicaid	$16,514.05
Rate for Payer: Molina Healthcare of OH Medicare	$3,498.98

INPATIENT APRDRG 5183: OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$26,143.76

Service Code	APR-DRG 5183
Hospital Charge Code	APRDRG 5183
Min. Negotiated Rate	$7,591.31
Max. Negotiated Rate	$26,143.76
Rate for Payer: Buckeye Health Medicaid OOS	$7,591.31
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$26,143.76
Rate for Payer: Managed Health Services Medicaid	$26,143.76
Rate for Payer: MDWise Medicaid	$26,143.76
Rate for Payer: Molina Healthcare of OH Medicare	$7,591.31

INPATIENT APRDRG 5184: OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$29,901.66

Service Code	APR-DRG 5184
Hospital Charge Code	APRDRG 5184
Min. Negotiated Rate	$7,591.31
Max. Negotiated Rate	$29,901.66
Rate for Payer: Buckeye Health Medicaid OOS	$7,591.31
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$29,901.66
Rate for Payer: Managed Health Services Medicaid	$29,901.66
Rate for Payer: MDWise Medicaid	$29,901.66
Rate for Payer: Molina Healthcare of OH Medicare	$7,591.31

INPATIENT APRDRG 5191: UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$12,428.09

Service Code	APR-DRG 5191
Hospital Charge Code	APRDRG 5191
Min. Negotiated Rate	$2,870.72
Max. Negotiated Rate	$12,428.09
Rate for Payer: Buckeye Health Medicaid OOS	$2,870.72
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$12,428.09
Rate for Payer: Managed Health Services Medicaid	$12,428.09
Rate for Payer: MDWise Medicaid	$12,428.09
Rate for Payer: Molina Healthcare of OH Medicare	$2,870.72

INPATIENT APRDRG 5192: UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$13,587.40

Service Code	APR-DRG 5192
Hospital Charge Code	APRDRG 5192
Min. Negotiated Rate	$3,458.95
Max. Negotiated Rate	$13,587.40
Rate for Payer: Buckeye Health Medicaid OOS	$3,458.95
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$13,587.40
Rate for Payer: Managed Health Services Medicaid	$13,587.40
Rate for Payer: MDWise Medicaid	$13,587.40
Rate for Payer: Molina Healthcare of OH Medicare	$3,458.95

INPATIENT APRDRG 5193: UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$23,330.57

Service Code	APR-DRG 5193
Hospital Charge Code	APRDRG 5193
Min. Negotiated Rate	$5,899.62
Max. Negotiated Rate	$23,330.57
Rate for Payer: Buckeye Health Medicaid OOS	$5,899.62
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$23,330.57
Rate for Payer: Managed Health Services Medicaid	$23,330.57
Rate for Payer: MDWise Medicaid	$23,330.57
Rate for Payer: Molina Healthcare of OH Medicare	$5,899.62

INPATIENT APRDRG 5194: UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$23,330.57

Service Code	APR-DRG 5194
Hospital Charge Code	APRDRG 5194
Min. Negotiated Rate	$5,899.62
Max. Negotiated Rate	$23,330.57
Rate for Payer: Buckeye Health Medicaid OOS	$5,899.62
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$23,330.57
Rate for Payer: Managed Health Services Medicaid	$23,330.57
Rate for Payer: MDWise Medicaid	$23,330.57
Rate for Payer: Molina Healthcare of OH Medicare	$5,899.62

INPATIENT APRDRG 5301: FEMALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility

$5,355.04

Service Code	APR-DRG 5301
Hospital Charge Code	APRDRG 5301
Min. Negotiated Rate	$2,496.39
Max. Negotiated Rate	$5,355.04
Rate for Payer: Buckeye Health Medicaid OOS	$2,496.39
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$5,355.04
Rate for Payer: Managed Health Services Medicaid	$5,355.04
Rate for Payer: MDWise Medicaid	$5,355.04
Rate for Payer: Molina Healthcare of OH Medicare	$2,496.39

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