ONE TRILLIUM WAY LOWER LEVEL, CORBIN, KY, 40701-
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| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 1 | $2,670 | $2,670 | $2,003 | $2,003 | $2,003 |
| CT head with contrast | CPT | 70460 | 1 | $2,104 | $2,104 | $1,578 | $1,578 | $1,578 |
| CT head with and without contrast | CPT | 70470 | 1 | $3,239 | $3,239 | $2,429 | $2,429 | $2,429 |
| Chest X-ray single view | CPT | 71045 | 1 | $427 | $427 | $320 | $320 | $320 |
| Chest X-ray 2 views | CPT | 71046 | 1 | $432 | $432 | $324 | $324 | $324 |
| CT chest without contrast | CPT | 71250 | 1 | $2,675 | $2,675 | $2,006 | $2,006 | $2,006 |
| CT chest with contrast | CPT | 71260 | 1 | $4,862 | $4,862 | $2,595 | $3,121 | $3,647 |
| CT chest with and without contrast | CPT | 71270 | 1 | $3,985 | $3,985 | $2,989 | $2,989 | $2,989 |
| CT cervical spine without contrast | CPT | 72125 | 1 | $2,836 | $2,836 | $2,127 | $2,127 | $2,127 |
| CT pelvis with contrast | CPT | 72193 | 1 | $3,447 | $3,447 | $2,585 | $2,585 | $2,585 |
| CT abdomen with contrast | CPT | 74160 | 1 | $3,306 | $3,306 | $2,480 | $2,480 | $2,480 |
| CT abdomen with and without contrast | CPT | 74170 | 1 | $3,806 | $3,806 | $2,855 | $2,855 | $2,855 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 1 | $5,928 | $5,928 | $4,446 | $4,446 | $4,446 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 1 | $6,848 | $6,848 | $5,136 | $5,136 | $5,136 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 1 | $9,013 | $9,013 | $6,760 | $6,760 | $6,760 |
| Abdominal ultrasound complete | CPT | 76700 | 1 | $759 | $759 | $569 | $569 | $569 |
| Abdominal ultrasound limited | CPT | 76705 | 1 | $762 | $762 | $572 | $572 | $572 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 1 | $884 | $884 | $663 | $663 | $663 |
| Transvaginal ultrasound | CPT | 76830 | 1 | $699 | $699 | $524 | $524 | $524 |
| EKG tracing only | CPT | 93005 | 1 | $165 | $165 | $124 | $124 | $124 |
| inpatient | ||||||||
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 9 | $125,815 | $125,815 | $1,500 | $1,809 | $113,234 |
| Heart failure & shock w MCC | MS-DRG | 291 | 9 | $105,663 | $105,663 | $1,500 | $1,809 | $95,097 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 9 | $148,161 | $148,161 | $1,500 | $1,809 | $133,345 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 9 | $669 | $669 | $468 | $1,754.5 | $2,352 |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 1 | $1,900 | $1,900 | $1,425 | $1,425 | $1,425 |
| Payer | Codes covered | Median rate |
|---|---|---|
| Anthem BCBS | 25 | $1,809 |
| baptist health community health | 4 | $1,500 |
| center care | 4 | $1,500 |
| gateway health plan | 4 | $1,899 |
| Molina | 4 | $1,990 |
| Multiplan | 4 | $81,018 |
| united va | 4 | $1,809 |
| Aetna | 4 | $1,809 |
| WellCare | 4 | $2,080.5 |
