Cameron Memorial Community Hospital

All Charges

Charge

Type

Price

INPATIENT APRDRG 6361: NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION

Facility IP

$14,366.86

Service Code	APR-DRG 6361
Hospital Charge Code	APRDRG 6361
Min. Negotiated Rate	$2,010.94
Max. Negotiated Rate	$14,366.86
Rate for Payer: Buckeye Health Medicaid OOS	$2,010.94
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$14,366.86
Rate for Payer: Managed Health Services Medicaid	$14,366.86
Rate for Payer: MDWise Medicaid	$14,366.86
Rate for Payer: Molina Healthcare of OH Medicare	$2,010.94

INPATIENT APRDRG 6362: NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION

Facility IP

$14,366.86

Service Code	APR-DRG 6362
Hospital Charge Code	APRDRG 6362
Min. Negotiated Rate	$3,943.12
Max. Negotiated Rate	$14,366.86
Rate for Payer: Buckeye Health Medicaid OOS	$3,943.12
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$14,366.86
Rate for Payer: Managed Health Services Medicaid	$14,366.86
Rate for Payer: MDWise Medicaid	$14,366.86
Rate for Payer: Molina Healthcare of OH Medicare	$3,943.12

INPATIENT APRDRG 6363: NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION

Facility IP

$14,366.86

Service Code	APR-DRG 6363
Hospital Charge Code	APRDRG 6363
Min. Negotiated Rate	$8,752.09
Max. Negotiated Rate	$14,366.86
Rate for Payer: Buckeye Health Medicaid OOS	$8,752.09
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$14,366.86
Rate for Payer: Managed Health Services Medicaid	$14,366.86
Rate for Payer: MDWise Medicaid	$14,366.86
Rate for Payer: Molina Healthcare of OH Medicare	$8,752.09

INPATIENT APRDRG 6364: NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION

Facility IP

$14,366.86

Service Code	APR-DRG 6364
Hospital Charge Code	APRDRG 6364
Min. Negotiated Rate	$8,752.09
Max. Negotiated Rate	$14,366.86
Rate for Payer: Buckeye Health Medicaid OOS	$8,752.09
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$14,366.86
Rate for Payer: Managed Health Services Medicaid	$14,366.86
Rate for Payer: MDWise Medicaid	$14,366.86
Rate for Payer: Molina Healthcare of OH Medicare	$8,752.09

INPATIENT APRDRG 6391: NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION

Facility IP

$18,127.23

Service Code	APR-DRG 6391
Hospital Charge Code	APRDRG 6391
Min. Negotiated Rate	$3,525.24
Max. Negotiated Rate	$18,127.23
Rate for Payer: Buckeye Health Medicaid OOS	$3,525.24
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$18,127.23
Rate for Payer: Managed Health Services Medicaid	$18,127.23
Rate for Payer: MDWise Medicaid	$18,127.23
Rate for Payer: Molina Healthcare of OH Medicare	$3,525.24

INPATIENT APRDRG 6392: NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION

Facility IP

$28,746.05

Service Code	APR-DRG 6392
Hospital Charge Code	APRDRG 6392
Min. Negotiated Rate	$5,248.95
Max. Negotiated Rate	$28,746.05
Rate for Payer: Buckeye Health Medicaid OOS	$5,248.95
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$28,746.05
Rate for Payer: Managed Health Services Medicaid	$28,746.05
Rate for Payer: MDWise Medicaid	$28,746.05
Rate for Payer: Molina Healthcare of OH Medicare	$5,248.95

INPATIENT APRDRG 6393: NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION

Facility IP

$39,927.26

Service Code	APR-DRG 6393
Hospital Charge Code	APRDRG 6393
Min. Negotiated Rate	$9,628.19
Max. Negotiated Rate	$39,927.26
Rate for Payer: Buckeye Health Medicaid OOS	$9,628.19
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$39,927.26
Rate for Payer: Managed Health Services Medicaid	$39,927.26
Rate for Payer: MDWise Medicaid	$39,927.26
Rate for Payer: Molina Healthcare of OH Medicare	$9,628.19

INPATIENT APRDRG 6394: NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION

Facility IP

$39,927.26

Service Code	APR-DRG 6394
Hospital Charge Code	APRDRG 6394
Min. Negotiated Rate	$9,628.19
Max. Negotiated Rate	$39,927.26
Rate for Payer: Buckeye Health Medicaid OOS	$9,628.19
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$39,927.26
Rate for Payer: Managed Health Services Medicaid	$39,927.26
Rate for Payer: MDWise Medicaid	$39,927.26
Rate for Payer: Molina Healthcare of OH Medicare	$9,628.19

INPATIENT APRDRG 6401: NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility IP

$3,089.45

Service Code	APR-DRG 6401
Hospital Charge Code	APRDRG 6401
Min. Negotiated Rate	$670.21
Max. Negotiated Rate	$3,089.45
Rate for Payer: Buckeye Health Medicaid OOS	$670.21
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$3,089.45
Rate for Payer: Managed Health Services Medicaid	$3,089.45
Rate for Payer: MDWise Medicaid	$3,089.45
Rate for Payer: Molina Healthcare of OH Medicare	$670.21

INPATIENT APRDRG 6402: NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility IP

$4,002.10

Service Code	APR-DRG 6402
Hospital Charge Code	APRDRG 6402
Min. Negotiated Rate	$798.93
Max. Negotiated Rate	$4,002.10
Rate for Payer: Buckeye Health Medicaid OOS	$798.93
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$4,002.10
Rate for Payer: Managed Health Services Medicaid	$4,002.10
Rate for Payer: MDWise Medicaid	$4,002.10
Rate for Payer: Molina Healthcare of OH Medicare	$798.93

INPATIENT APRDRG 6403: NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility IP

$8,060.93

Service Code	APR-DRG 6403
Hospital Charge Code	APRDRG 6403
Min. Negotiated Rate	$1,251.40
Max. Negotiated Rate	$8,060.93
Rate for Payer: Buckeye Health Medicaid OOS	$1,251.40
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$8,060.93
Rate for Payer: Managed Health Services Medicaid	$8,060.93
Rate for Payer: MDWise Medicaid	$8,060.93
Rate for Payer: Molina Healthcare of OH Medicare	$1,251.40

INPATIENT APRDRG 6404: NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility IP

$8,060.93

Service Code	APR-DRG 6404
Hospital Charge Code	APRDRG 6404
Min. Negotiated Rate	$1,251.40
Max. Negotiated Rate	$8,060.93
Rate for Payer: Buckeye Health Medicaid OOS	$1,251.40
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$8,060.93
Rate for Payer: Managed Health Services Medicaid	$8,060.93
Rate for Payer: MDWise Medicaid	$8,060.93
Rate for Payer: Molina Healthcare of OH Medicare	$1,251.40

INPATIENT APRDRG 6501: SPLENECTOMY

Facility IP

$19,206.38

Service Code	APR-DRG 6501
Hospital Charge Code	APRDRG 6501
Min. Negotiated Rate	$5,111.90
Max. Negotiated Rate	$19,206.38
Rate for Payer: Buckeye Health Medicaid OOS	$5,111.90
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$19,206.38
Rate for Payer: Managed Health Services Medicaid	$19,206.38
Rate for Payer: MDWise Medicaid	$19,206.38
Rate for Payer: Molina Healthcare of OH Medicare	$5,111.90

INPATIENT APRDRG 6502: SPLENECTOMY

Facility IP

$19,206.38

Service Code	APR-DRG 6502
Hospital Charge Code	APRDRG 6502
Min. Negotiated Rate	$5,207.64
Max. Negotiated Rate	$19,206.38
Rate for Payer: Buckeye Health Medicaid OOS	$5,207.64
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$19,206.38
Rate for Payer: Managed Health Services Medicaid	$19,206.38
Rate for Payer: MDWise Medicaid	$19,206.38
Rate for Payer: Molina Healthcare of OH Medicare	$5,207.64

INPATIENT APRDRG 6503: SPLENECTOMY

Facility IP

$36,229.79

Service Code	APR-DRG 6503
Hospital Charge Code	APRDRG 6503
Min. Negotiated Rate	$9,775.17
Max. Negotiated Rate	$36,229.79
Rate for Payer: Buckeye Health Medicaid OOS	$9,775.17
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$36,229.79
Rate for Payer: Managed Health Services Medicaid	$36,229.79
Rate for Payer: MDWise Medicaid	$36,229.79
Rate for Payer: Molina Healthcare of OH Medicare	$9,775.17

INPATIENT APRDRG 6504: SPLENECTOMY

Facility IP

$38,502.78

Service Code	APR-DRG 6504
Hospital Charge Code	APRDRG 6504
Min. Negotiated Rate	$9,775.17
Max. Negotiated Rate	$38,502.78
Rate for Payer: Buckeye Health Medicaid OOS	$9,775.17
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$38,502.78
Rate for Payer: Managed Health Services Medicaid	$38,502.78
Rate for Payer: MDWise Medicaid	$38,502.78
Rate for Payer: Molina Healthcare of OH Medicare	$9,775.17

INPATIENT APRDRG 6511: OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS

Facility IP

$15,586.60

Service Code	APR-DRG 6511
Hospital Charge Code	APRDRG 6511
Min. Negotiated Rate	$3,783.97
Max. Negotiated Rate	$15,586.60
Rate for Payer: Buckeye Health Medicaid OOS	$3,783.97
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$15,586.60
Rate for Payer: Managed Health Services Medicaid	$15,586.60
Rate for Payer: MDWise Medicaid	$15,586.60
Rate for Payer: Molina Healthcare of OH Medicare	$3,783.97

INPATIENT APRDRG 6512: OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS

Facility IP

$17,441.51

Service Code	APR-DRG 6512
Hospital Charge Code	APRDRG 6512
Min. Negotiated Rate	$6,465.76
Max. Negotiated Rate	$17,441.51
Rate for Payer: Buckeye Health Medicaid OOS	$6,465.76
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$17,441.51
Rate for Payer: Managed Health Services Medicaid	$17,441.51
Rate for Payer: MDWise Medicaid	$17,441.51
Rate for Payer: Molina Healthcare of OH Medicare	$6,465.76

INPATIENT APRDRG 6513: OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS

Facility IP

$23,118.44

Service Code	APR-DRG 6513
Hospital Charge Code	APRDRG 6513
Min. Negotiated Rate	$6,465.76
Max. Negotiated Rate	$23,118.44
Rate for Payer: Buckeye Health Medicaid OOS	$6,465.76
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$23,118.44
Rate for Payer: Managed Health Services Medicaid	$23,118.44
Rate for Payer: MDWise Medicaid	$23,118.44
Rate for Payer: Molina Healthcare of OH Medicare	$6,465.76

INPATIENT APRDRG 6514: OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS

Facility IP

$25,467.90

Service Code	APR-DRG 6514
Hospital Charge Code	APRDRG 6514
Min. Negotiated Rate	$6,465.76
Max. Negotiated Rate	$25,467.90
Rate for Payer: Buckeye Health Medicaid OOS	$6,465.76
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$25,467.90
Rate for Payer: Managed Health Services Medicaid	$25,467.90
Rate for Payer: MDWise Medicaid	$25,467.90
Rate for Payer: Molina Healthcare of OH Medicare	$6,465.76

INPATIENT APRDRG 6601: MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL

Facility IP

$8,310.06

Service Code	APR-DRG 6601
Hospital Charge Code	APRDRG 6601
Min. Negotiated Rate	$3,033.07
Max. Negotiated Rate	$8,310.06
Rate for Payer: Buckeye Health Medicaid OOS	$3,033.07
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$8,310.06
Rate for Payer: Managed Health Services Medicaid	$8,310.06
Rate for Payer: MDWise Medicaid	$8,310.06
Rate for Payer: Molina Healthcare of OH Medicare	$3,033.07

INPATIENT APRDRG 6602: MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL

Facility IP

$13,226.04

Service Code	APR-DRG 6602
Hospital Charge Code	APRDRG 6602
Min. Negotiated Rate	$3,532.28
Max. Negotiated Rate	$13,226.04
Rate for Payer: Buckeye Health Medicaid OOS	$3,532.28
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$13,226.04
Rate for Payer: Managed Health Services Medicaid	$13,226.04
Rate for Payer: MDWise Medicaid	$13,226.04
Rate for Payer: Molina Healthcare of OH Medicare	$3,532.28

INPATIENT APRDRG 6603: MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL

Facility IP

$21,480.60

Service Code	APR-DRG 6603
Hospital Charge Code	APRDRG 6603
Min. Negotiated Rate	$5,038.89
Max. Negotiated Rate	$21,480.60
Rate for Payer: Buckeye Health Medicaid OOS	$5,038.89
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$21,480.60
Rate for Payer: Managed Health Services Medicaid	$21,480.60
Rate for Payer: MDWise Medicaid	$21,480.60
Rate for Payer: Molina Healthcare of OH Medicare	$5,038.89

INPATIENT APRDRG 6604: MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL

Facility IP

$39,282.24

Service Code	APR-DRG 6604
Hospital Charge Code	APRDRG 6604
Min. Negotiated Rate	$14,577.10
Max. Negotiated Rate	$39,282.24
Rate for Payer: Buckeye Health Medicaid OOS	$14,577.10
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$39,282.24
Rate for Payer: Managed Health Services Medicaid	$39,282.24
Rate for Payer: MDWise Medicaid	$39,282.24
Rate for Payer: Molina Healthcare of OH Medicare	$14,577.10

INPATIENT APRDRG 6611: COAGULATION & PLATELET DISORDERS

Facility IP

$9,569.27

Service Code	APR-DRG 6611
Hospital Charge Code	APRDRG 6611
Min. Negotiated Rate	$2,796.11
Max. Negotiated Rate	$9,569.27
Rate for Payer: Buckeye Health Medicaid OOS	$2,796.11
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise	$9,569.27
Rate for Payer: Managed Health Services Medicaid	$9,569.27
Rate for Payer: MDWise Medicaid	$9,569.27
Rate for Payer: Molina Healthcare of OH Medicare	$2,796.11

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