Cameron Memorial Community Hospital

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 6113: NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY

Facility

$82,173.15

Service Code	APR-DRG 6113
Hospital Charge Code	APRDRG 6113
Min. Negotiated Rate	$19,905.46
Max. Negotiated Rate	$82,173.15
Rate for Payer: Buckeye Health Medicaid OOS	$19,905.46
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$82,173.15
Rate for Payer: Managed Health Services Medicaid	$82,173.15
Rate for Payer: MDWise Medicaid	$82,173.15
Rate for Payer: Molina Healthcare of OH Medicare	$19,905.46

INPATIENT APRDRG 6114: NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY

Facility

$160,959.61

Service Code	APR-DRG 6114
Hospital Charge Code	APRDRG 6114
Min. Negotiated Rate	$40,864.43
Max. Negotiated Rate	$160,959.61
Rate for Payer: Buckeye Health Medicaid OOS	$40,864.43
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$160,959.61
Rate for Payer: Managed Health Services Medicaid	$160,959.61
Rate for Payer: MDWise Medicaid	$160,959.61
Rate for Payer: Molina Healthcare of OH Medicare	$40,864.43

INPATIENT APRDRG 6121: NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$40,889.24

Service Code	APR-DRG 6121
Hospital Charge Code	APRDRG 6121
Min. Negotiated Rate	$8,510.01
Max. Negotiated Rate	$40,889.24
Rate for Payer: Buckeye Health Medicaid OOS	$8,510.01
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$40,889.24
Rate for Payer: Managed Health Services Medicaid	$40,889.24
Rate for Payer: MDWise Medicaid	$40,889.24
Rate for Payer: Molina Healthcare of OH Medicare	$8,510.01

INPATIENT APRDRG 6122: NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$59,403.73

Service Code	APR-DRG 6122
Hospital Charge Code	APRDRG 6122
Min. Negotiated Rate	$12,693.28
Max. Negotiated Rate	$59,403.73
Rate for Payer: Buckeye Health Medicaid OOS	$12,693.28
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$59,403.73
Rate for Payer: Managed Health Services Medicaid	$59,403.73
Rate for Payer: MDWise Medicaid	$59,403.73
Rate for Payer: Molina Healthcare of OH Medicare	$12,693.28

INPATIENT APRDRG 6123: NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$78,229.01

Service Code	APR-DRG 6123
Hospital Charge Code	APRDRG 6123
Min. Negotiated Rate	$17,303.40
Max. Negotiated Rate	$78,229.01
Rate for Payer: Buckeye Health Medicaid OOS	$17,303.40
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$78,229.01
Rate for Payer: Managed Health Services Medicaid	$78,229.01
Rate for Payer: MDWise Medicaid	$78,229.01
Rate for Payer: Molina Healthcare of OH Medicare	$17,303.40

INPATIENT APRDRG 6124: NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$87,808.15

Service Code	APR-DRG 6124
Hospital Charge Code	APRDRG 6124
Min. Negotiated Rate	$22,292.66
Max. Negotiated Rate	$87,808.15
Rate for Payer: Buckeye Health Medicaid OOS	$22,292.66
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$87,808.15
Rate for Payer: Managed Health Services Medicaid	$87,808.15
Rate for Payer: MDWise Medicaid	$87,808.15
Rate for Payer: Molina Healthcare of OH Medicare	$22,292.66

INPATIENT APRDRG 6131: NEONATE BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION

Facility

$32,982.48

Service Code	APR-DRG 6131
Hospital Charge Code	APRDRG 6131
Min. Negotiated Rate	$11,795.08
Max. Negotiated Rate	$32,982.48
Rate for Payer: Buckeye Health Medicaid OOS	$11,795.08
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$32,982.48
Rate for Payer: Managed Health Services Medicaid	$32,982.48
Rate for Payer: MDWise Medicaid	$32,982.48
Rate for Payer: Molina Healthcare of OH Medicare	$11,795.08

INPATIENT APRDRG 6132: NEONATE BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION

Facility

$32,982.48

Service Code	APR-DRG 6132
Hospital Charge Code	APRDRG 6132
Min. Negotiated Rate	$11,795.08
Max. Negotiated Rate	$32,982.48
Rate for Payer: Buckeye Health Medicaid OOS	$11,795.08
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$32,982.48
Rate for Payer: Managed Health Services Medicaid	$32,982.48
Rate for Payer: MDWise Medicaid	$32,982.48
Rate for Payer: Molina Healthcare of OH Medicare	$11,795.08

INPATIENT APRDRG 6133: NEONATE BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION

Facility

$46,458.88

Service Code	APR-DRG 6133
Hospital Charge Code	APRDRG 6133
Min. Negotiated Rate	$11,795.08
Max. Negotiated Rate	$46,458.88
Rate for Payer: Buckeye Health Medicaid OOS	$11,795.08
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$46,458.88
Rate for Payer: Managed Health Services Medicaid	$46,458.88
Rate for Payer: MDWise Medicaid	$46,458.88
Rate for Payer: Molina Healthcare of OH Medicare	$11,795.08

INPATIENT APRDRG 6134: NEONATE BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION

Facility

$46,458.88

Service Code	APR-DRG 6134
Hospital Charge Code	APRDRG 6134
Min. Negotiated Rate	$11,795.08
Max. Negotiated Rate	$46,458.88
Rate for Payer: Buckeye Health Medicaid OOS	$11,795.08
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$46,458.88
Rate for Payer: Managed Health Services Medicaid	$46,458.88
Rate for Payer: MDWise Medicaid	$46,458.88
Rate for Payer: Molina Healthcare of OH Medicare	$11,795.08

INPATIENT APRDRG 6141: NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$24,059.46

Service Code	APR-DRG 6141
Hospital Charge Code	APRDRG 6141
Min. Negotiated Rate	$4,454.82
Max. Negotiated Rate	$24,059.46
Rate for Payer: Buckeye Health Medicaid OOS	$4,454.82
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$24,059.46
Rate for Payer: Managed Health Services Medicaid	$24,059.46
Rate for Payer: MDWise Medicaid	$24,059.46
Rate for Payer: Molina Healthcare of OH Medicare	$4,454.82

INPATIENT APRDRG 6142: NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$41,679.80

Service Code	APR-DRG 6142
Hospital Charge Code	APRDRG 6142
Min. Negotiated Rate	$8,120.31
Max. Negotiated Rate	$41,679.80
Rate for Payer: Buckeye Health Medicaid OOS	$8,120.31
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$41,679.80
Rate for Payer: Managed Health Services Medicaid	$41,679.80
Rate for Payer: MDWise Medicaid	$41,679.80
Rate for Payer: Molina Healthcare of OH Medicare	$8,120.31

INPATIENT APRDRG 6143: NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$59,943.92

Service Code	APR-DRG 6143
Hospital Charge Code	APRDRG 6143
Min. Negotiated Rate	$13,372.78
Max. Negotiated Rate	$59,943.92
Rate for Payer: Buckeye Health Medicaid OOS	$13,372.78
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$59,943.92
Rate for Payer: Managed Health Services Medicaid	$59,943.92
Rate for Payer: MDWise Medicaid	$59,943.92
Rate for Payer: Molina Healthcare of OH Medicare	$13,372.78

INPATIENT APRDRG 6144: NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$59,943.92

Service Code	APR-DRG 6144
Hospital Charge Code	APRDRG 6144
Min. Negotiated Rate	$13,372.78
Max. Negotiated Rate	$59,943.92
Rate for Payer: Buckeye Health Medicaid OOS	$13,372.78
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$59,943.92
Rate for Payer: Managed Health Services Medicaid	$59,943.92
Rate for Payer: MDWise Medicaid	$59,943.92
Rate for Payer: Molina Healthcare of OH Medicare	$13,372.78

INPATIENT APRDRG 6211: NEONATE BWT 2000-2499G W MAJOR ANOMALY

Facility

$16,004.70

Service Code	APR-DRG 6211
Hospital Charge Code	APRDRG 6211
Min. Negotiated Rate	$4,063.20
Max. Negotiated Rate	$16,004.70
Rate for Payer: Buckeye Health Medicaid OOS	$4,063.20
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$16,004.70
Rate for Payer: Managed Health Services Medicaid	$16,004.70
Rate for Payer: MDWise Medicaid	$16,004.70
Rate for Payer: Molina Healthcare of OH Medicare	$4,063.20

INPATIENT APRDRG 6212: NEONATE BWT 2000-2499G W MAJOR ANOMALY

Facility

$24,795.75

Service Code	APR-DRG 6212
Hospital Charge Code	APRDRG 6212
Min. Negotiated Rate	$6,967.22
Max. Negotiated Rate	$24,795.75
Rate for Payer: Buckeye Health Medicaid OOS	$6,967.22
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$24,795.75
Rate for Payer: Managed Health Services Medicaid	$24,795.75
Rate for Payer: MDWise Medicaid	$24,795.75
Rate for Payer: Molina Healthcare of OH Medicare	$6,967.22

INPATIENT APRDRG 6213: NEONATE BWT 2000-2499G W MAJOR ANOMALY

Facility

$52,262.85

Service Code	APR-DRG 6213
Hospital Charge Code	APRDRG 6213
Min. Negotiated Rate	$16,721.58
Max. Negotiated Rate	$52,262.85
Rate for Payer: Buckeye Health Medicaid OOS	$16,721.58
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$52,262.85
Rate for Payer: Managed Health Services Medicaid	$52,262.85
Rate for Payer: MDWise Medicaid	$52,262.85
Rate for Payer: Molina Healthcare of OH Medicare	$16,721.58

INPATIENT APRDRG 6214: NEONATE BWT 2000-2499G W MAJOR ANOMALY

Facility

$132,042.14

Service Code	APR-DRG 6214
Hospital Charge Code	APRDRG 6214
Min. Negotiated Rate	$33,522.88
Max. Negotiated Rate	$132,042.14
Rate for Payer: Buckeye Health Medicaid OOS	$33,522.88
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$132,042.14
Rate for Payer: Managed Health Services Medicaid	$132,042.14
Rate for Payer: MDWise Medicaid	$132,042.14
Rate for Payer: Molina Healthcare of OH Medicare	$33,522.88

INPATIENT APRDRG 6221: NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$30,356.75

Service Code	APR-DRG 6221
Hospital Charge Code	APRDRG 6221
Min. Negotiated Rate	$5,752.00
Max. Negotiated Rate	$30,356.75
Rate for Payer: Buckeye Health Medicaid OOS	$5,752.00
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$30,356.75
Rate for Payer: Managed Health Services Medicaid	$30,356.75
Rate for Payer: MDWise Medicaid	$30,356.75
Rate for Payer: Molina Healthcare of OH Medicare	$5,752.00

INPATIENT APRDRG 6222: NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$41,551.53

Service Code	APR-DRG 6222
Hospital Charge Code	APRDRG 6222
Min. Negotiated Rate	$9,399.24
Max. Negotiated Rate	$41,551.53
Rate for Payer: Buckeye Health Medicaid OOS	$9,399.24
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$41,551.53
Rate for Payer: Managed Health Services Medicaid	$41,551.53
Rate for Payer: MDWise Medicaid	$41,551.53
Rate for Payer: Molina Healthcare of OH Medicare	$9,399.24

INPATIENT APRDRG 6223: NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$46,421.88

Service Code	APR-DRG 6223
Hospital Charge Code	APRDRG 6223
Min. Negotiated Rate	$9,399.24
Max. Negotiated Rate	$46,421.88
Rate for Payer: Buckeye Health Medicaid OOS	$9,399.24
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$46,421.88
Rate for Payer: Managed Health Services Medicaid	$46,421.88
Rate for Payer: MDWise Medicaid	$46,421.88
Rate for Payer: Molina Healthcare of OH Medicare	$9,399.24

INPATIENT APRDRG 6224: NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$71,049.90

Service Code	APR-DRG 6224
Hospital Charge Code	APRDRG 6224
Min. Negotiated Rate	$18,038.30
Max. Negotiated Rate	$71,049.90
Rate for Payer: Buckeye Health Medicaid OOS	$18,038.30
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$71,049.90
Rate for Payer: Managed Health Services Medicaid	$71,049.90
Rate for Payer: MDWise Medicaid	$71,049.90
Rate for Payer: Molina Healthcare of OH Medicare	$18,038.30

INPATIENT APRDRG 6231: NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION

Facility

$12,664.89

Service Code	APR-DRG 6231
Hospital Charge Code	APRDRG 6231
Min. Negotiated Rate	$3,528.44
Max. Negotiated Rate	$12,664.89
Rate for Payer: Buckeye Health Medicaid OOS	$3,528.44
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$12,664.89
Rate for Payer: Managed Health Services Medicaid	$12,664.89
Rate for Payer: MDWise Medicaid	$12,664.89
Rate for Payer: Molina Healthcare of OH Medicare	$3,528.44

INPATIENT APRDRG 6232: NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION

Facility

$24,843.85

Service Code	APR-DRG 6232
Hospital Charge Code	APRDRG 6232
Min. Negotiated Rate	$6,307.26
Max. Negotiated Rate	$24,843.85
Rate for Payer: Buckeye Health Medicaid OOS	$6,307.26
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$24,843.85
Rate for Payer: Managed Health Services Medicaid	$24,843.85
Rate for Payer: MDWise Medicaid	$24,843.85
Rate for Payer: Molina Healthcare of OH Medicare	$6,307.26

INPATIENT APRDRG 6233: NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION

Facility

$24,843.85

Service Code	APR-DRG 6233
Hospital Charge Code	APRDRG 6233
Min. Negotiated Rate	$6,307.26
Max. Negotiated Rate	$24,843.85
Rate for Payer: Buckeye Health Medicaid OOS	$6,307.26
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$24,843.85
Rate for Payer: Managed Health Services Medicaid	$24,843.85
Rate for Payer: MDWise Medicaid	$24,843.85
Rate for Payer: Molina Healthcare of OH Medicare	$6,307.26

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