St. Patrick Hospital
Listed in its price file as “Providence Health & Services - Montana”.
St. Patrick Hospital in Missoula, MT publishes cash prices for 349 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Montana median for 204 of 345 procedures and above it for 129. By typical cash price it ranks #10 of 29 Montana hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.
500 W Broadway, Missoula, MT 59806,902 N Orange St, Missoula, MT 59802 Collected Sep 23, 2026 Source price file Check a bill from this hospital (406) 543-7271
Acute care hospital Nonprofit hospital Emergency department CMS star rating 5 of 5 CCN 270014 · CMS hospital register NPI 1023032588
Financial assistance
Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply
St. Patrick Hospital is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.
You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.
Source: IRS, section 501(r) requirements for nonprofit hospitals.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Montana | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 HC CT ABDOMEN W & W/O CONTRAST | $1,629.60 | $2,037.00 | — | 17% below | 20% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT ABDOMEN W & W/O CONTRAST | $1,629.60 | $2,037.00 | — | — | 20% |
| Abdominal X-ray, 2 views CPT 74019 HC XR ABDOMEN 2 VIEWS | $267.20 | $334.00 | — | 1% below | 20% |
| Abdominal X-ray, 2 views inpatient CPT 74019 HC XR ABDOMEN 2 VIEWS | $267.20 | $334.00 | — | — | 20% |
| Ankle X-ray, complete, 3 or more views CPT 73610 HC XR ANKLE COMPLETE MIN 3 VIEWS | $182.40 | $228.00 | — | 16% below | 20% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC XR ANKLE COMPLETE MIN 3 VIEWS | $182.40 | $228.00 | — | — | 20% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL | $280.80 | $351.00 | — | 6% below | 20% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL | $280.80 | $351.00 | — | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTREMITY WO CONTRAST | $1,148.80 | $1,436.00 | — | 15% below | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPPER EXTREMITY WO CONTRAST | $1,148.80 | $1,436.00 | — | — | 20% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 HC XR ESOPHAGUS W CONTRAST | $657.60 | $822.00 | — | 85% above | 20% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC XR ESOPHAGUS W CONTRAST | $657.60 | $822.00 | — | — | 20% |
| Bone scan, whole body (nuclear medicine) CPT 78306 HC NM BONE AND OR JOINT IMAGING WHOLE BODY CDM | $1,540.00 | $1,925.00 | — | 14% above | 20% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NM BONE AND OR JOINT IMAGING WHOLE BODY CDM | $1,540.00 | $1,925.00 | — | — | 20% |
| Breast ultrasound, complete, one breast CPT 76641 HC US BREAST UNI COMPLETE | $453.60 | $567.00 | — | 66% above | 20% |
| Breast ultrasound, complete, one breast inpatient CPT 76641 HC US BREAST UNI COMPLETE | $453.60 | $567.00 | — | — | 20% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 HC US ED BREAST UNI LIMITED CDM | $261.60 | $327.00 | — | 6% above | 20% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 HC US BREAST UNI LIMITED | $275.20 | $344.00 | — | 11% above | 20% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US ED BREAST UNI LIMITED CDM | $261.60 | $327.00 | — | — | 20% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US BREAST UNI LIMITED | $275.20 | $344.00 | — | — | 20% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CTA ABDOMEN PELVIS | $2,934.40 | $3,668.00 | — | 6% above | 20% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CTA ABDOMEN PELVIS | $2,934.40 | $3,668.00 | — | — | 20% |
| CT angiography (CTA) of the head CPT 70496 HC CT ANGIOGRAPHY HEAD W CONTRAST | $1,218.40 | $1,523.00 | — | 43% below | 20% |
| CT angiography (CTA) of the head inpatient CPT 70496 HC CT ANGIOGRAPHY HEAD W CONTRAST | $1,218.40 | $1,523.00 | — | — | 20% |
| CT angiography (CTA) of the neck CPT 70498 HC CT ANGIOGRAPHY NECK W CONTRAST | $1,218.40 | $1,523.00 | — | 43% below | 20% |
| CT angiography (CTA) of the neck inpatient CPT 70498 HC CT ANGIOGRAPHY NECK W CONTRAST | $1,218.40 | $1,523.00 | — | — | 20% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT ANGIOGRAPHY CHEST | $1,866.40 | $2,333.00 | — | 16% below | 20% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT ANGIOGRAPHY CHEST | $1,866.40 | $2,333.00 | — | — | 20% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CCTA HEART ARTERIES/GRAFTS W/3D IMAGE W/ CONTRAST | $1,400.80 | $1,751.00 | — | 80% above | 20% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC CCTA HEART ARTERIES/GRAFTS W/3D IMAGE W/ CONTRAST | $1,400.80 | $1,751.00 | — | — | 20% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CCTA HEART W/ CALCIUM SCORING W/O CONTRAST | $443.20 | $554.00 | — | 8% above | 20% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CCTA HEART W/ CALCIUM SCORING W/O CONTRAST | $443.20 | $554.00 | — | — | 20% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD & PELVIS WO CONTRAST | $1,791.20 | $2,239.00 | — | 16% below | 20% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABD & PELVIS WO CONTRAST | $1,791.20 | $2,239.00 | — | — | 20% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST | $2,871.20 | $3,589.00 | — | 1% above | 20% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST | $2,871.20 | $3,589.00 | — | — | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABDOMEN & PELVIS W & W/O CONTRAST | $3,617.60 | $4,522.00 | — | 16% above | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABDOMEN & PELVIS W & W/O CONTRAST | $3,617.60 | $4,522.00 | — | — | 20% |
| CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W CONTRAST | $1,400.80 | $1,751.00 | — | 23% below | 20% |
| CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W CONTRAST | $1,400.80 | $1,751.00 | — | — | 20% |
| CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN WO CONTRAST | $1,148.80 | $1,436.00 | — | 16% below | 20% |
| CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN WO CONTRAST | $1,148.80 | $1,436.00 | — | — | 20% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST | $999.20 | $1,249.00 | — | 16% below | 20% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST | $999.20 | $1,249.00 | — | — | 20% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD/BRAIN WO CONTRAST | $999.20 | $1,249.00 | — | 15% below | 20% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD/BRAIN WO CONTRAST | $999.20 | $1,249.00 | — | — | 20% |
| CT scan of the head with contrast CPT 70460 HC CT HEAD/BRAIN W CONTRAST | $1,218.40 | $1,523.00 | — | 15% below | 20% |
| CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD/BRAIN W CONTRAST | $1,218.40 | $1,523.00 | — | — | 20% |
| CT scan of the head without and with contrast CPT 70470 HC CT HEAD/BRAIN W & W/O CONTRAST | $2,944.00 | $3,680.00 | — | 63% above | 20% |
| CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD/BRAIN W & W/O CONTRAST | $2,944.00 | $3,680.00 | — | — | 20% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE WO CONTRAST | $1,148.80 | $1,436.00 | — | 19% below | 20% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT LUMBAR SPINE WO CONTRAST | $1,148.80 | $1,436.00 | — | — | 20% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT NECK SPINE WO CONTRAST | $999.20 | $1,249.00 | — | 29% below | 20% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT NECK SPINE WO CONTRAST | $999.20 | $1,249.00 | — | — | 20% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST | $1,400.80 | $1,751.00 | — | 13% below | 20% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W CONTRAST | $1,400.80 | $1,751.00 | — | — | 20% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY | $936.00 | $1,170.00 | — | — | 20% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY | $936.00 | $1,170.00 | — | — | 20% |
| Chest CT scan without and with contrast CPT 71270 HC CT THORAX W & W/O CONTRAST | $2,622.40 | $3,278.00 | — | 32% above | 20% |
| Chest CT scan without and with contrast inpatient CPT 71270 HC CT THORAX W & W/O CONTRAST | $2,622.40 | $3,278.00 | — | — | 20% |
| Chest X-ray, 2 views CPT 71046 HC XR CHEST 2 VIEWS | $230.40 | $288.00 | — | 4% above | 20% |
| Chest X-ray, 2 views inpatient CPT 71046 HC XR CHEST 2 VIEWS | $230.40 | $288.00 | — | — | 20% |
| Chest X-ray, single view CPT 71045 HC XR CHEST PORTABLE 1 VIEW | $230.40 | $288.00 | — | 25% above | 20% |
| Chest X-ray, single view CPT 71045 HC XR CHEST 1 VIEW | $230.40 | $288.00 | — | 25% above | 20% |
| Chest X-ray, single view inpatient CPT 71045 HC XR CHEST PORTABLE 1 VIEW | $230.40 | $288.00 | — | — | 20% |
| Chest X-ray, single view inpatient CPT 71045 HC XR CHEST 1 VIEW | $230.40 | $288.00 | — | — | 20% |
| Collarbone (clavicle) X-ray, complete CPT 73000 HC XR CLAVICLE COMPLETE | $196.00 | $245.00 | — | 3% above | 20% |
| Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC XR CLAVICLE COMPLETE | $196.00 | $245.00 | — | — | 20% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITONEAL COMPLETE | $591.20 | $739.00 | — | 18% above | 20% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERITONEAL COMPLETE | $591.20 | $739.00 | — | — | 20% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC XR DXA BONE DENSITY STUDY AXIAL | $344.00 | $430.00 | — | 7% above | 20% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC XR DXA BONE DENSITY STUDY AXIAL | $344.00 | $430.00 | — | — | 20% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC BONE DENSITY PERIPHERAL SKELETON | $136.00 | $170.00 | — | 7% below | 20% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC BONE DENSITY PERIPHERAL SKELETON | $136.00 | $170.00 | — | — | 20% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US OB DETAILED SINGLE FETUS CDM | $844.00 | $1,055.00 | — | 94% above | 20% |
| Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC US OB DETAILED SINGLE FETUS CDM | $844.00 | $1,055.00 | — | — | 20% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX WO CONTRAST | $1,148.80 | $1,436.00 | — | 17% below | 20% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX W/O DYE F/U LUNG SCREENING | $1,148.80 | $1,436.00 | — | 17% below | 20% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT THORAX WO CONTRAST | $1,148.80 | $1,436.00 | — | — | 20% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT THORAX W/O DYE F/U LUNG SCREENING | $1,148.80 | $1,436.00 | — | — | 20% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT THORAX W CONTRAST | $1,866.40 | $2,333.00 | — | 13% above | 20% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT THORAX W CONTRAST | $1,866.40 | $2,333.00 | — | — | 20% |
| Diagnostic mammogram, both breasts CPT 77066 HC MAMMO DIAG BIL W CAD | $304.00 | $380.00 | — | 11% below | 20% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 HC MAMMO DIAG BIL W CAD | $304.00 | $380.00 | — | — | 20% |
| Diagnostic mammogram, one breast CPT 77065 HC MAMMO DIAG UNI W CAD | $273.60 | $342.00 | — | 7% above | 20% |
| Diagnostic mammogram, one breast inpatient CPT 77065 HC MAMMO DIAG UNI W CAD | $273.60 | $342.00 | — | — | 20% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY | $1,281.60 | $1,602.00 | — | — | 20% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY | $1,281.60 | $1,602.00 | — | — | 20% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY | $1,153.60 | $1,442.00 | — | — | 20% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY | $1,153.60 | $1,442.00 | — | — | 20% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC ECHO TTE 2D W DOPPLER COMPLETE | $1,156.00 | $1,445.00 | — | 26% below | 20% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC ECHO TTE 2D W DOPPLER COMPLETE | $1,156.00 | $1,445.00 | — | — | 20% |
| Elbow X-ray, 2 views CPT 73070 HC XR ELBOW LIMITED | $147.20 | $184.00 | — | 19% below | 20% |
| Elbow X-ray, 2 views CPT 73070 HC XR ELBOW 2 VIEWS | $182.40 | $228.00 | — | 1% above | 20% |
| Elbow X-ray, 2 views inpatient CPT 73070 HC XR ELBOW LIMITED | $147.20 | $184.00 | — | — | 20% |
| Elbow X-ray, 2 views inpatient CPT 73070 HC XR ELBOW 2 VIEWS | $182.40 | $228.00 | — | — | 20% |
| Elbow X-ray, complete, 3 or more views CPT 73080 HC XR ELBOW COMPLETE MIN 3 VIEWS | $182.40 | $228.00 | — | 15% below | 20% |
| Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC XR ELBOW COMPLETE MIN 3 VIEWS | $182.40 | $228.00 | — | — | 20% |
| Eye socket (orbit) CT scan without contrast CPT 70480 HC CT ORBIT/EAR/FOSSA WO CONTRAST | $999.20 | $1,249.00 | — | 23% below | 20% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT ORBIT/EAR/FOSSA WO CONTRAST | $999.20 | $1,249.00 | — | — | 20% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 HC XR FACIAL BONES MIN 3 VIEWS | $318.40 | $398.00 | — | 2% below | 20% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC XR FACIAL BONES MIN 3 VIEWS | $318.40 | $398.00 | — | — | 20% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 HC XR FOREARM 1 VIEW | $182.40 | $228.00 | — | 2% below | 20% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 HC XR FOREARM 2 VIEWS | $182.40 | $228.00 | — | 2% below | 20% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC XR FOREARM 2 VIEWS | $182.40 | $228.00 | — | — | 20% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC XR FOREARM 1 VIEW | $182.40 | $228.00 | — | — | 20% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM HEPATOBILIARY SYSTEM | $1,071.20 | $1,339.00 | — | 12% below | 20% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC NM HEPATOBILIARY SYSTEM | $1,071.20 | $1,339.00 | — | — | 20% |
| Hand X-ray, 2 views CPT 73120 HC XR HAND 1 VIEW | $124.00 | $155.00 | — | 28% below | 20% |
| Hand X-ray, 2 views CPT 73120 HC XR HAND 2 VIEWS | $256.00 | $320.00 | — | 49% above | 20% |
| Hand X-ray, 2 views inpatient CPT 73120 HC XR HAND 1 VIEW | $124.00 | $155.00 | — | — | 20% |
| Hand X-ray, 2 views inpatient CPT 73120 HC XR HAND 2 VIEWS | $256.00 | $320.00 | — | — | 20% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC XR HEEL MIN 2 VIEWS | $192.00 | $240.00 | — | 1% above | 20% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC XR HEEL MIN 2 VIEWS | $192.00 | $240.00 | — | — | 20% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC SLEEP STUDY UNATT&RESP EFFT | $189.60 | $237.00 | — | 38% below | 20% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HC SLEEP STUDY UNATT&RESP EFFT | $189.60 | $237.00 | — | — | 20% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOMNOGRAPHY W/CPAP REDUCED | $1,818.40 | $2,273.00 | — | 22% below | 20% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOMNOGRAPHY W/CPAP | $2,143.20 | $2,679.00 | — | 8% below | 20% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC POLYSOMNOGRAPHY W/CPAP REDUCED | $1,818.40 | $2,273.00 | — | — | 20% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC POLYSOMNOGRAPHY W/CPAP | $2,143.20 | $2,679.00 | — | — | 20% |
| Knee X-ray, 3 views CPT 73562 HC XR KNEE 3 VIEWS | $182.40 | $228.00 | — | 13% below | 20% |
| Knee X-ray, 3 views inpatient CPT 73562 HC XR KNEE 3 VIEWS | $182.40 | $228.00 | — | — | 20% |
| Knee X-ray, complete, 4 or more views CPT 73564 HC XR KNEE 4/PLUS VIEWS | $256.00 | $320.00 | — | 4% above | 20% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC XR KNEE 4/PLUS VIEWS | $256.00 | $320.00 | — | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXTREMITY WO CONTRAST | $1,148.80 | $1,436.00 | — | 12% below | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT LOWER EXTREMITY WO CONTRAST | $1,148.80 | $1,436.00 | — | — | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ED ABDOMEN LIMITED CDM | $431.20 | $539.00 | — | 6% above | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMEN LIMITED | $453.60 | $567.00 | — | 11% above | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ED ABDOMEN LIMITED CDM | $431.20 | $539.00 | — | — | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ABDOMEN LIMITED | $453.60 | $567.00 | — | — | 20% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US ED LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM | $428.00 | $535.00 | — | 84% above | 20% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM | $450.40 | $563.00 | — | 94% above | 20% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US ED LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM | $428.00 | $535.00 | — | — | 20% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM | $450.40 | $563.00 | — | — | 20% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT THORAX LW DOSE LNG CA SCR WO CONTRAST CDM | $394.40 | $493.00 | — | 46% below | 20% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT THORAX LW DOSE LNG CA SCR WO CONTRAST CDM | $394.40 | $493.00 | — | — | 20% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC XR LOWER LEG 2 VIEWS | $182.40 | $228.00 | — | 6% below | 20% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC XR LOWER LEG LIMITED | $182.40 | $228.00 | — | 6% below | 20% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC XR LOWER LEG 2 VIEWS | $182.40 | $228.00 | — | — | 20% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC XR LOWER LEG LIMITED | $182.40 | $228.00 | — | — | 20% |
| MR angiography (MRA) of the head without contrast CPT 70544 HC MRA HEAD WO CONTRAST | $1,004.00 | $1,255.00 | — | 45% below | 20% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRA HEAD WO CONTRAST | $1,004.00 | $1,255.00 | — | — | 20% |
| MRI of both breasts, without and then with contrast dye CPT 77049 HC MRI BREAST W/O & W/ CONTRAST W/ CAD BIL | $1,331.20 | $1,664.00 | — | 29% below | 20% |
| MRI of both breasts, without and then with contrast dye inpatient CPT 77049 HC MRI BREAST W/O & W/ CONTRAST W/ CAD BIL | $1,331.20 | $1,664.00 | — | — | 20% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI JNT OF LWR EXTRE W/O DYE LIMITED | $1,154.40 | $1,443.00 | — | 33% below | 20% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOWER EXTREMITY JOINT WO CONTRAST | $1,331.20 | $1,664.00 | — | 23% below | 20% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI JNT OF LWR EXTRE W/O DYE LIMITED | $1,154.40 | $1,443.00 | — | — | 20% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LOWER EXTREMITY JOINT WO CONTRAST | $1,331.20 | $1,664.00 | — | — | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST | $2,905.60 | $3,632.00 | — | 7% above | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST | $2,905.60 | $3,632.00 | — | — | 20% |
| MRI of the abdomen without contrast CPT 74181 HC MRI MRCP ABDOMEN WO CONTRAST | $1,158.40 | $1,448.00 | — | 35% below | 20% |
| MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN WO CONTRAST | $1,331.20 | $1,664.00 | — | 26% below | 20% |
| MRI of the abdomen without contrast inpatient CPT 74181 HC MRI MRCP ABDOMEN WO CONTRAST | $1,158.40 | $1,448.00 | — | — | 20% |
| MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN WO CONTRAST | $1,331.20 | $1,664.00 | — | — | 20% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN WO & W CONTRAST | $2,892.00 | $3,615.00 | — | at median | 20% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN WO & W CONTRAST | $2,892.00 | $3,615.00 | — | — | 20% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN STEM W/O DYE | $1,342.40 | $1,678.00 | — | 25% below | 20% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN STEM W/O DYE | $1,342.40 | $1,678.00 | — | — | 20% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W/O & W/DYE | $2,696.80 | $3,371.00 | — | 4% below | 20% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN W/O & W/DYE | $2,696.80 | $3,371.00 | — | — | 20% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O DYE | $1,331.20 | $1,664.00 | — | 24% below | 20% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMBAR SPINE W/O DYE | $1,331.20 | $1,664.00 | — | — | 20% |
| MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMBAR SPINE W/O & W/DYE | $2,504.00 | $3,130.00 | — | 6% below | 20% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI LUMBAR SPINE W/O & W/DYE | $2,504.00 | $3,130.00 | — | — | 20% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI THORACIC SPINE W/O DYE | $1,331.20 | $1,664.00 | — | 24% below | 20% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI THORACIC SPINE W/O DYE | $1,331.20 | $1,664.00 | — | — | 20% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI CERVICAL SPINE W/O & W/DYE | $2,744.00 | $3,430.00 | — | 2% above | 20% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI CERVICAL SPINE W/O & W/DYE | $2,744.00 | $3,430.00 | — | — | 20% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERVICAL SPINE W/O DYE LIMITED | $747.20 | $934.00 | — | 59% below | 20% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERVICAL SPINE W/O DYE | $1,342.40 | $1,678.00 | — | 26% below | 20% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI CERVICAL SPINE W/O DYE LIMITED | $747.20 | $934.00 | — | — | 20% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI CERVICAL SPINE W/O DYE | $1,342.40 | $1,678.00 | — | — | 20% |
| MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS WO & W CONTRAST | $2,183.20 | $2,729.00 | — | 21% below | 20% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS WO & W CONTRAST | $2,183.20 | $2,729.00 | — | — | 20% |
| MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS WO CONTRAST | $1,331.20 | $1,664.00 | — | 30% below | 20% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS WO CONTRAST | $1,331.20 | $1,664.00 | — | — | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI UPPER EXTREMITY JOINT WO CONTRAST | $1,331.20 | $1,664.00 | — | 15% below | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI UPPER EXTREMITY JOINT WO CONTRAST | $1,331.20 | $1,664.00 | — | — | 20% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC XR SPINE CERVICAL 4 OR 5 VIEWS | $256.00 | $320.00 | — | 21% below | 20% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC XR SPINE CERVICAL 4 OR 5 VIEWS | $256.00 | $320.00 | — | — | 20% |
| Neck soft tissue CT scan with contrast CPT 70491 HC CT SOFT TISSUE NECK W CONTRAST | $1,621.60 | $2,027.00 | — | 8% below | 20% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT SOFT TISSUE NECK W CONTRAST | $1,621.60 | $2,027.00 | — | — | 20% |
| Neck soft tissue CT scan without contrast CPT 70490 HC CT SOFT TISSUE NECK WO CONTRAST | $1,218.40 | $1,523.00 | — | at median | 20% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT SOFT TISSUE NECK WO CONTRAST | $1,218.40 | $1,523.00 | — | — | 20% |
| Neck soft tissue X-ray CPT 70360 HC XR NECK SOFT TISSUE | $207.20 | $259.00 | — | 6% above | 20% |
| Neck soft tissue X-ray inpatient CPT 70360 HC XR NECK SOFT TISSUE | $207.20 | $259.00 | — | — | 20% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM MYCARD PERFUS SPECT MULTIPLE | $2,088.00 | $2,610.00 | — | 4% below | 20% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC NM MYCARD PERFUS SPECT MULTIPLE | $2,088.00 | $2,610.00 | — | — | 20% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC PET IMAGE W CT SKULL MID THIGH | $6,060.00 | $7,575.00 | — | 11% above | 20% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC PET IMAGE W CT SKULL MID THIGH | $6,060.00 | $7,575.00 | — | — | 20% |
| Pelvic CT scan without contrast CPT 72192 HC CT PELVIS WO CONTRAST | $1,148.80 | $1,436.00 | — | 17% below | 20% |
| Pelvic CT scan without contrast inpatient CPT 72192 HC CT PELVIS WO CONTRAST | $1,148.80 | $1,436.00 | — | — | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US ED EXAM PELVIC LIMITED CDM | $316.80 | $396.00 | — | 2% above | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US EXAM PELVIC LIMITED | $333.60 | $417.00 | — | 8% above | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US EXAM PELVIC FOLLICLE LIMITED | $333.60 | $417.00 | — | 8% above | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US ED EXAM PELVIC LIMITED CDM | $316.80 | $396.00 | — | — | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US EXAM PELVIC FOLLICLE LIMITED | $333.60 | $417.00 | — | — | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US EXAM PELVIC LIMITED | $333.60 | $417.00 | — | — | 20% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIC NON-OB COMPLETE | $481.60 | $602.00 | — | 11% below | 20% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIC NON-OB COMPLETE | $481.60 | $602.00 | — | — | 20% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB AFTER 1ST TRIMEST 1/1ST FETUS | $730.40 | $913.00 | — | 53% above | 20% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US OB AFTER 1ST TRIMEST 1/1ST FETUS | $730.40 | $913.00 | — | — | 20% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby one side CPT 76801 HC US OB LT 14 WKS SINGLE FETUS CDM | $644.80 | $806.00 | — | 45% above | 20% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient one side CPT 76801 HC US OB LT 14 WKS SINGLE FETUS CDM | $644.80 | $806.00 | — | — | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US OB LIMITED FETUS(S) CDM | $394.40 | $493.00 | — | 19% above | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US ED OB LIMITED FETUS(S) CDM | $394.40 | $493.00 | — | 19% above | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US ED OB LIMITED FETUS(S) CDM | $394.40 | $493.00 | — | — | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US OB LIMITED FETUS(S) CDM | $394.40 | $493.00 | — | — | 20% |
| Rib X-ray, one side, 2 views CPT 71100 HC XR RIBS UNI 2 VIEWS | $216.00 | $270.00 | — | 7% below | 20% |
| Rib X-ray, one side, 2 views inpatient CPT 71100 HC XR RIBS UNI 2 VIEWS | $216.00 | $270.00 | — | — | 20% |
| Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC XR RIBS/CHEST UNI MIN 3 VIEWS | $256.00 | $320.00 | — | 8% below | 20% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC XR RIBS/CHEST UNI MIN 3 VIEWS | $256.00 | $320.00 | — | — | 20% |
| Screening mammogram, both breasts CPT 77067 HC MAMMO SCREEN BIL W CAD | $237.60 | $297.00 | — | 14% below | 20% |
| Screening mammogram, both breasts CPT 77067 HC MAMMO SCREEN UNIL/BIL W CAD | $237.60 | $297.00 | — | 14% below | 20% |
| Screening mammogram, both breasts inpatient CPT 77067 HC MAMMO SCREEN BIL W CAD | $237.60 | $297.00 | — | — | 20% |
| Screening mammogram, both breasts inpatient CPT 77067 HC MAMMO SCREEN UNIL/BIL W CAD | $237.60 | $297.00 | — | — | 20% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 HC XR SHOULDER COMPLETE MIN 2 VIEWS | $182.40 | $228.00 | — | 16% below | 20% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC XR SHOULDER COMPLETE MIN 2 VIEWS | $182.40 | $228.00 | — | — | 20% |
| Sinus X-ray, complete, 3 or more views CPT 70220 HC XR SINUSES PARANASAL MIN 3 VIEWS | $219.20 | $274.00 | — | 15% below | 20% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC XR SINUSES PARANASAL MIN 3 VIEWS | $219.20 | $274.00 | — | — | 20% |
| Skull X-ray, fewer than 4 views CPT 70250 HC XR SKULL 1-3 VIEWS | $212.80 | $266.00 | — | 10% below | 20% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 HC XR SKULL 1-3 VIEWS | $212.80 | $266.00 | — | — | 20% |
| Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMNOGRAPHY 4 OR MORE | $1,885.60 | $2,357.00 | — | 10% below | 20% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOMNOGRAPHY 4 OR MORE | $1,885.60 | $2,357.00 | — | — | 20% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 HC XR RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY | $432.80 | $541.00 | — | at median | 20% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC XR RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY | $432.80 | $541.00 | — | — | 20% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC XR FEMUR MIN 2 VIEWS | $182.40 | $228.00 | — | 15% below | 20% |
| Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC XR FEMUR MIN 2 VIEWS | $182.40 | $228.00 | — | — | 20% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT CHEST SPINE WO CONTRAST | $1,148.80 | $1,436.00 | — | 19% below | 20% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT CHEST SPINE WO CONTRAST | $1,148.80 | $1,436.00 | — | — | 20% |
| Toe X-ray, 2 or more views CPT 73660 HC XR TOE(S) MIN 2 VIEWS | $184.00 | $230.00 | — | 6% above | 20% |
| Toe X-ray, 2 or more views inpatient CPT 73660 HC XR TOE(S) MIN 2 VIEWS | $184.00 | $230.00 | — | — | 20% |
| Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON-OB | $436.00 | $545.00 | — | 4% above | 20% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL NON-OB | $436.00 | $545.00 | — | — | 20% |
| Transvaginal ultrasound during pregnancy CPT 76817 HC US OB TRANSVAGINAL CDM | $436.00 | $545.00 | — | 9% above | 20% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US OB TRANSVAGINAL CDM | $436.00 | $545.00 | — | — | 20% |
| Ultrasound of the abdomen, complete CPT 76700 HC US EXAM ABDOMEN COMPLETE | $591.20 | $739.00 | — | 12% above | 20% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US EXAM ABDOMEN COMPLETE | $591.20 | $739.00 | — | — | 20% |
| Ultrasound of the scrotum and testicles CPT 76870 HC US EXAM SCROTUM & CONTENTS | $450.40 | $563.00 | — | 9% below | 20% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US EXAM SCROTUM & CONTENTS | $450.40 | $563.00 | — | — | 20% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US ED EXAM OF HEAD AND NECK CDM | $431.20 | $539.00 | — | at median | 20% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US EXAM OF HEAD AND NECK | $453.60 | $567.00 | — | 5% above | 20% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US ED EXAM OF HEAD AND NECK CDM | $431.20 | $539.00 | — | — | 20% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US EXAM OF HEAD AND NECK | $453.60 | $567.00 | — | — | 20% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC XR RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY CDM | $519.20 | $649.00 | — | 13% above | 20% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC XR RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY CDM | $519.20 | $649.00 | — | — | 20% |
| Upper arm X-ray (humerus), 2 views CPT 73060 HC XR HUMERUS MIN 2 VIEWS | $182.40 | $228.00 | — | 9% below | 20% |
| Upper arm X-ray (humerus), 2 views CPT 73060 HC XR HUMERUS 1 VIEW | $182.40 | $228.00 | — | 9% below | 20% |
| Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC XR HUMERUS MIN 2 VIEWS | $182.40 | $228.00 | — | — | 20% |
| Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC XR HUMERUS 1 VIEW | $182.40 | $228.00 | — | — | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY | $860.80 | $1,076.00 | — | 34% above | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY | $860.80 | $1,076.00 | — | — | 20% |
| Wrist X-ray, 2 views CPT 73100 HC XR WRIST 1 VIEW | $141.60 | $177.00 | — | 20% below | 20% |
| Wrist X-ray, 2 views CPT 73100 HC XR WRIST 2 VIEWS | $188.80 | $236.00 | — | 6% above | 20% |
| Wrist X-ray, 2 views inpatient CPT 73100 HC XR WRIST 1 VIEW | $141.60 | $177.00 | — | — | 20% |
| Wrist X-ray, 2 views inpatient CPT 73100 HC XR WRIST 2 VIEWS | $188.80 | $236.00 | — | — | 20% |
| Wrist X-ray, complete, 3 or more views CPT 73110 HC XR WRIST COMPLETE MIN 3 VIEWS | $202.40 | $253.00 | — | 7% below | 20% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC XR WRIST COMPLETE MIN 3 VIEWS | $202.40 | $253.00 | — | — | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC XR HIPS UNI W PELVIS WHEN PERFORMED 2-3 VIEWS | $222.40 | $278.00 | — | 6% above | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC XR HIPS UNI W PELVIS WHEN PERFORMED 2-3 VIEWS | $222.40 | $278.00 | — | — | 20% |
| X-ray of the abdomen, 1 view CPT 74018 HC XR ABDOMEN 1 VIEW | $189.60 | $237.00 | — | 5% above | 20% |
| X-ray of the abdomen, 1 view CPT 74018 HC XR ABDOMEN PORTABLE 1 VIEW | $236.00 | $295.00 | — | 31% above | 20% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 HC XR ABDOMEN 1 VIEW | $189.60 | $237.00 | — | — | 20% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 HC XR ABDOMEN PORTABLE 1 VIEW | $236.00 | $295.00 | — | — | 20% |
| X-ray of the ankle, 2 views CPT 73600 HC XR ANKLE 1 VIEW | $182.40 | $228.00 | — | 2% above | 20% |
| X-ray of the ankle, 2 views CPT 73600 HC XR ANKLE 2 VIEWS | $182.40 | $228.00 | — | 2% above | 20% |
| X-ray of the ankle, 2 views inpatient CPT 73600 HC XR ANKLE 2 VIEWS | $182.40 | $228.00 | — | — | 20% |
| X-ray of the ankle, 2 views inpatient CPT 73600 HC XR ANKLE 1 VIEW | $182.40 | $228.00 | — | — | 20% |
| X-ray of the finger(s), 2 or more views CPT 73140 HC XR FINGERS(S) MIN 2 VIEWS | $182.40 | $228.00 | — | 8% above | 20% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC XR FINGERS(S) MIN 2 VIEWS | $182.40 | $228.00 | — | — | 20% |
| X-ray of the foot, 2 views CPT 73620 HC XR FOOT 1 VIEW | $145.60 | $182.00 | — | 15% below | 20% |
| X-ray of the foot, 2 views CPT 73620 HC XR FOOT 2 VIEWS | $182.40 | $228.00 | — | 6% above | 20% |
| X-ray of the foot, 2 views inpatient CPT 73620 HC XR FOOT 1 VIEW | $145.60 | $182.00 | — | — | 20% |
| X-ray of the foot, 2 views inpatient CPT 73620 HC XR FOOT 2 VIEWS | $182.40 | $228.00 | — | — | 20% |
| X-ray of the foot, complete, 3 or more views CPT 73630 HC XR FOOT MIN 3 VIEWS | $182.40 | $228.00 | — | 23% below | 20% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC XR FOOT MIN 3 VIEWS | $182.40 | $228.00 | — | — | 20% |
| X-ray of the hand, 3 or more views CPT 73130 HC XR HAND MIN 3 VIEWS | $304.00 | $380.00 | — | 33% above | 20% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 HC XR HAND MIN 3 VIEWS | $304.00 | $380.00 | — | — | 20% |
| X-ray of the knee, 1 or 2 views CPT 73560 HC XR KNEE 1-2 VIEWS | $182.40 | $228.00 | — | 2% above | 20% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC XR KNEE 1-2 VIEWS | $182.40 | $228.00 | — | — | 20% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC XR SPINE LUMBOSACRAL 2 OR 3 VIEWS | $256.00 | $320.00 | — | 1% above | 20% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC XR SPINE LUMBOSACRAL 2 OR 3 VIEWS | $256.00 | $320.00 | — | — | 20% |
| X-ray of the lower back, 4 or more views CPT 72110 HC SPINE LUMBOSACRAL MIN 4 VIEWS | $256.00 | $320.00 | — | 23% below | 20% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC SPINE LUMBOSACRAL MIN 4 VIEWS | $256.00 | $320.00 | — | — | 20% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC XR SPINE THORACIC 2 VIEWS | $256.00 | $320.00 | — | 15% above | 20% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC XR SPINE THORACIC 2 VIEWS | $256.00 | $320.00 | — | — | 20% |
| X-ray of the nasal bones, 3 or more views CPT 70160 HC XR NASAL BONES MIN 3 VIEWS | $210.40 | $263.00 | — | at median | 20% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC XR NASAL BONES MIN 3 VIEWS | $210.40 | $263.00 | — | — | 20% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC XR SPINE CERVICAL 2 OR 3 VIEWS | $182.40 | $228.00 | — | 15% below | 20% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC XR SPINE CERVICAL 2 OR 3 VIEWS | $182.40 | $228.00 | — | — | 20% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 HC XR PELVIS 1-2 VIEWS NO HIP VIEWS | $256.00 | $320.00 | — | 17% above | 20% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC XR PELVIS 1-2 VIEWS NO HIP VIEWS | $256.00 | $320.00 | — | — | 20% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC XR TAILBONE MIN 2 VIEWS | $237.60 | $297.00 | — | 2% above | 20% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC XR TAILBONE MIN 2 VIEWS | $237.60 | $297.00 | — | — | 20% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Montana | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC SGPT (ALT) | $30.40 | $38.00 | — | 41% below | 20% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC SGPT (ALT) | $30.40 | $38.00 | — | — | 20% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 HC SGOT (AST) | $44.00 | $55.00 | — | 13% below | 20% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC SGOT (AST) | $44.00 | $55.00 | — | — | 20% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS ACUTE PANEL | $195.20 | $244.00 | — | 6% below | 20% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC HEPATITIS ACUTE PANEL | $195.20 | $244.00 | — | — | 20% |
| Albumin blood test CPT 82040 HC ASSAY OF SERUM ALBUMIN | $42.40 | $53.00 | — | 37% above | 20% |
| Albumin blood test inpatient CPT 82040 HC ASSAY OF SERUM ALBUMIN | $42.40 | $53.00 | — | — | 20% |
| Alkaline phosphatase (ALP) blood test CPT 84075 HC ALKALINE PHOS | $49.60 | $62.00 | — | 14% below | 20% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC ALKALINE PHOS | $49.60 | $62.00 | — | — | 20% |
| Ammonia blood test CPT 82140 HC ASSAY OF AMMONIA LAB | $98.40 | $123.00 | — | 21% below | 20% |
| Ammonia blood test inpatient CPT 82140 HC ASSAY OF AMMONIA LAB | $98.40 | $123.00 | — | — | 20% |
| Amylase blood test CPT 82150 HC ASSAY OF AMYLASE CDM | $40.80 | $51.00 | — | 29% below | 20% |
| Amylase blood test CPT 82150 HC AMYLASE | $40.80 | $51.00 | — | 29% below | 20% |
| Amylase blood test CPT 82150 HC ASSAY OF AMYLASE LAB | $40.80 | $51.00 | — | 29% below | 20% |
| Amylase blood test inpatient CPT 82150 HC AMYLASE | $40.80 | $51.00 | — | — | 20% |
| Amylase blood test inpatient CPT 82150 HC ASSAY OF AMYLASE LAB | $40.80 | $51.00 | — | — | 20% |
| Amylase blood test inpatient CPT 82150 HC ASSAY OF AMYLASE CDM | $40.80 | $51.00 | — | — | 20% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE LAB | $212.80 | $266.00 | — | 6% below | 20% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE | $212.80 | $266.00 | — | 6% below | 20% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE | $212.80 | $266.00 | — | — | 20% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE LAB | $212.80 | $266.00 | — | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE BACTERIA OTHER | $98.40 | $123.00 | — | 31% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL CDM | $112.00 | $140.00 | — | 49% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE BACTERIA OTHER | $98.40 | $123.00 | — | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL CDM | $112.00 | $140.00 | — | — | 20% |
| Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL | $53.60 | $67.00 | — | 43% below | 20% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL | $53.60 | $67.00 | — | — | 20% |
| Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL LAB | $49.60 | $62.00 | — | at median | 20% |
| Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL | $49.60 | $62.00 | — | at median | 20% |
| Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN TOTAL | $49.60 | $62.00 | — | — | 20% |
| Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN TOTAL LAB | $49.60 | $62.00 | — | — | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | $288.80 | $361.00 | — | 43% above | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM IV-T2 | $288.80 | $361.00 | — | 43% above | 20% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM IV-T2 | $288.80 | $361.00 | — | — | 20% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | $288.80 | $361.00 | — | — | 20% |
| Blood culture for bacteria CPT 87040 HC BLOOD CULTURE FOR BACTERIA | $117.60 | $147.00 | — | 22% below | 20% |
| Blood culture for bacteria inpatient CPT 87040 HC BLOOD CULTURE FOR BACTERIA | $117.60 | $147.00 | — | — | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE - PERIPHERAL LAB | $14.40 | $18.00 | — | 24% below | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC BLOOD DRAW VENIPUNCTURE CDM | $14.40 | $18.00 | — | 24% below | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ED ROUTINE VENIPUNCTURE OR LEGAL DRAW CDM | $14.40 | $18.00 | — | 24% below | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD CDM | $14.40 | $18.00 | — | 24% below | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC COLLECTION VENOUS BLOOD VENIPUNCTURE CDM | $96.80 | $121.00 | — | 409% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC BLOOD DRAW VENIPUNCTURE CDM | $14.40 | $18.00 | — | — | 20% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD CDM | $14.40 | $18.00 | — | — | 20% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC ED ROUTINE VENIPUNCTURE OR LEGAL DRAW CDM | $14.40 | $18.00 | — | — | 20% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC ROUTINE VENIPUNCTURE - PERIPHERAL LAB | $14.40 | $18.00 | — | — | 20% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC COLLECTION VENOUS BLOOD VENIPUNCTURE CDM | $96.80 | $121.00 | — | — | 20% |
| Blood glucose (sugar) test CPT 82947 HC GLUCOSE | $39.20 | $49.00 | — | at median | 20% |
| Blood glucose (sugar) test CPT 82947 HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP) | $39.20 | $49.00 | — | at median | 20% |
| Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP) | $39.20 | $49.00 | — | — | 20% |
| Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE | $39.20 | $49.00 | — | — | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC GONADOTROPIN CHORIONIC QUALITATIVE CDM | $55.20 | $69.00 | — | 23% below | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC GONADOTROPIN CHORIONIC QUALITATIVE CDM | $55.20 | $69.00 | — | — | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING SEROLOGIC ABO | $50.40 | $63.00 | — | 30% below | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING SEROLOGIC ABO LAB | $50.40 | $63.00 | — | 30% below | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPING SEROLOGIC ABO LAB | $50.40 | $63.00 | — | — | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPING SEROLOGIC ABO | $50.40 | $63.00 | — | — | 20% |
| Blood urea nitrogen (BUN) test CPT 84520 HC BUN | $29.60 | $37.00 | — | 38% below | 20% |
| Blood urea nitrogen (BUN) test CPT 84520 HC ASSAY OF UREA NITROGEN QUANTITATIVE LAB | $29.60 | $37.00 | — | 38% below | 20% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 HC BUN | $29.60 | $37.00 | — | — | 20% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 HC ASSAY OF UREA NITROGEN QUANTITATIVE LAB | $29.60 | $37.00 | — | — | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN | $36.00 | $45.00 | — | 45% below | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-REACTIVE PROTEIN | $36.00 | $45.00 | — | — | 20% |
| C. difficile toxin gene test (stool PCR) CPT 87493 HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE | $176.00 | $220.00 | — | 4% above | 20% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE | $176.00 | $220.00 | — | — | 20% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 CDM | $122.40 | $153.00 | — | 2% below | 20% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 CDM | $122.40 | $153.00 | — | — | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ LAB | $108.00 | $135.00 | — | 11% below | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ CDM | $108.00 | $135.00 | — | 11% below | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ LAB | $108.00 | $135.00 | — | — | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ CDM | $108.00 | $135.00 | — | — | 20% |
| Calcium blood test, total CPT 82310 HC CALCIUM TOTAL LAB | $29.60 | $37.00 | — | 15% below | 20% |
| Calcium blood test, total CPT 82310 HC CALCIUM SERUM | $29.60 | $37.00 | — | 15% below | 20% |
| Calcium blood test, total inpatient CPT 82310 HC CALCIUM SERUM | $29.60 | $37.00 | — | — | 20% |
| Calcium blood test, total inpatient CPT 82310 HC CALCIUM TOTAL LAB | $29.60 | $37.00 | — | — | 20% |
| Carcinoembryonic antigen (CEA) test CPT 82378 HC SPINAL FLUID - CEA | $86.40 | $108.00 | — | 19% below | 20% |
| Carcinoembryonic antigen (CEA) test CPT 82378 HC CARCINOEMBRYONIC ANTIGEN CEA CDM | $86.40 | $108.00 | — | 19% below | 20% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC SPINAL FLUID - CEA | $86.40 | $108.00 | — | — | 20% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC CARCINOEMBRYONIC ANTIGEN CEA CDM | $86.40 | $108.00 | — | — | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB | $78.40 | $98.00 | — | 14% below | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ | $92.80 | $116.00 | — | 2% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA TRACHOMATIS AMPLIFIED DNA | $92.80 | $116.00 | — | 2% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB | $78.40 | $98.00 | — | — | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ | $92.80 | $116.00 | — | — | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC CHLAMYDIA TRACHOMATIS AMPLIFIED DNA | $92.80 | $116.00 | — | — | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL LAB | $67.20 | $84.00 | — | 19% below | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL | $67.20 | $84.00 | — | 19% below | 20% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL | $67.20 | $84.00 | — | — | 20% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL LAB | $67.20 | $84.00 | — | — | 20% |
| Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $41.60 | $52.00 | — | 47% below | 20% |
| Complete blood count (CBC) with differential CPT 85025 HC CBC WITH DIFF AUTO | $41.60 | $52.00 | — | 47% below | 20% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC WITH DIFF AUTO | $41.60 | $52.00 | — | — | 20% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $41.60 | $52.00 | — | — | 20% |
| Complete blood count (CBC), no differential CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED | $53.60 | $67.00 | — | 7% above | 20% |
| Complete blood count (CBC), no differential CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED LAB | $53.60 | $67.00 | — | 7% above | 20% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED LAB | $53.60 | $67.00 | — | — | 20% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED | $53.60 | $67.00 | — | — | 20% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHEN METABOLIC PANEL | $60.00 | $75.00 | — | 54% below | 20% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHENSIVE METABOLIC PANEL | $60.00 | $75.00 | — | 54% below | 20% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHENSIVE METABOLIC PANEL | $60.00 | $75.00 | — | — | 20% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHEN METABOLIC PANEL | $60.00 | $75.00 | — | — | 20% |
| Cortisol blood test, total CPT 82533 HC CORTISOL | $87.20 | $109.00 | — | 22% below | 20% |
| Cortisol blood test, total CPT 82533 HC CORTISOL TOTAL LAB | $87.20 | $109.00 | — | 22% below | 20% |
| Cortisol blood test, total inpatient CPT 82533 HC CORTISOL | $87.20 | $109.00 | — | — | 20% |
| Cortisol blood test, total inpatient CPT 82533 HC CORTISOL TOTAL LAB | $87.20 | $109.00 | — | — | 20% |
| Creatine kinase (CK) blood test, total CPT 82550 HC CREATINE KINASE TOTAL LAB | $40.80 | $51.00 | — | 27% below | 20% |
| Creatine kinase (CK) blood test, total CPT 82550 HC CK TOTAL | $40.80 | $51.00 | — | 27% below | 20% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CK TOTAL | $40.80 | $51.00 | — | — | 20% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CREATINE KINASE TOTAL LAB | $40.80 | $51.00 | — | — | 20% |
| Creatinine blood test CPT 82565 HC ASSAY OF CREATININE | $28.00 | $35.00 | — | 35% below | 20% |
| Creatinine blood test CPT 82565 HC ASSAY CREATININE | $28.00 | $35.00 | — | 35% below | 20% |
| Creatinine blood test CPT 82565 HC CREATININE BLOOD LAB | $28.00 | $35.00 | — | 35% below | 20% |
| Creatinine blood test CPT 82565 HC CREATININE BLOOD | $28.00 | $35.00 | — | 35% below | 20% |
| Creatinine blood test inpatient CPT 82565 HC CREATININE BLOOD | $28.00 | $35.00 | — | — | 20% |
| Creatinine blood test inpatient CPT 82565 HC ASSAY OF CREATININE | $28.00 | $35.00 | — | — | 20% |
| Creatinine blood test inpatient CPT 82565 HC CREATININE BLOOD LAB | $28.00 | $35.00 | — | — | 20% |
| Creatinine blood test inpatient CPT 82565 HC ASSAY CREATININE | $28.00 | $35.00 | — | — | 20% |
| D-dimer blood test (blood clot marker) CPT 85379 HC DDIMER QUANT | $67.20 | $84.00 | — | 40% below | 20% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 HC DDIMER QUANT | $67.20 | $84.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUGS OF ABUSE URINE | $18.40 | $23.00 | — | 90% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR PER DOS | $154.40 | $193.00 | — | 18% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR OPIATES PER DOS | $154.40 | $193.00 | — | 18% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM | $163.20 | $204.00 | — | 13% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR ALCOHOL PER DOS | $163.20 | $204.00 | — | 13% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR SALICYLATE PER DOS LAB | $163.20 | $204.00 | — | 13% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE | $186.40 | $233.00 | — | 1% below | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUGS OF ABUSE URINE | $18.40 | $23.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR PER DOS | $154.40 | $193.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR OPIATES PER DOS | $154.40 | $193.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM | $163.20 | $204.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR SALICYLATE PER DOS LAB | $163.20 | $204.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR ALCOHOL PER DOS | $163.20 | $204.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE | $186.40 | $233.00 | — | — | 20% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTE PANEL | $26.40 | $33.00 | — | 64% below | 20% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC ELECTROLYTE PANEL | $26.40 | $33.00 | — | — | 20% |
| Ferritin blood test (iron stores) CPT 82728 HC ASSAY OF FERRITIN CDM | $69.60 | $87.00 | — | 25% below | 20% |
| Ferritin blood test (iron stores) inpatient CPT 82728 HC ASSAY OF FERRITIN CDM | $69.60 | $87.00 | — | — | 20% |
| Fibrinogen blood test CPT 85384 HC FIBRINOGEN | $50.40 | $63.00 | — | 46% below | 20% |
| Fibrinogen blood test inpatient CPT 85384 HC FIBRINOGEN | $50.40 | $63.00 | — | — | 20% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 HC ASSAY OF FREE THYROXINE CDM | $40.80 | $51.00 | — | 46% below | 20% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC ASSAY OF FREE THYROXINE CDM | $40.80 | $51.00 | — | — | 20% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC GAMMA GT TOTAL | $32.00 | $40.00 | — | 25% below | 20% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC GAMMA GT TOTAL | $32.00 | $40.00 | — | — | 20% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HC GENERAL HEALTH PANEL | $270.40 | $338.00 | — | 2% below | 20% |
| General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 HC GENERAL HEALTH PANEL | $270.40 | $338.00 | — | — | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GESTATIONAL GLUCOSE 1 HOUR | $43.20 | $54.00 | — | 30% below | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE POST GLUCOSE DOSE | $43.20 | $54.00 | — | 30% below | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GESTATIONAL GLUCOSE 1 HOUR | $43.20 | $54.00 | — | — | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE POST GLUCOSE DOSE | $43.20 | $54.00 | — | — | 20% |
| Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE(3 SPEC) | $110.40 | $138.00 | — | 5% above | 20% |
| Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE TEST 2 HRS | $110.40 | $138.00 | — | 5% above | 20% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE TEST 2 HRS | $110.40 | $138.00 | — | — | 20% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE(3 SPEC) | $110.40 | $138.00 | — | — | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB | $28.80 | $36.00 | — | 71% below | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | $92.80 | $116.00 | — | 7% below | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB | $28.80 | $36.00 | — | — | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | $92.80 | $116.00 | — | — | 20% |
| H. pylori stool antigen test CPT 87338 HC IAAD IA HPYLORI STOOL CDM | $72.00 | $90.00 | — | 16% below | 20% |
| H. pylori stool antigen test inpatient CPT 87338 HC IAAD IA HPYLORI STOOL CDM | $72.00 | $90.00 | — | — | 20% |
| HIV-1 and HIV-2 antibody test CPT 86703 HC HIV-1/HIV-2 SINGLE ASSAY | $122.40 | $153.00 | — | 47% above | 20% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV-1/HIV-2 SINGLE ASSAY | $122.40 | $153.00 | — | — | 20% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB | $78.40 | $98.00 | — | at median | 20% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB | $78.40 | $98.00 | — | — | 20% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB | $129.60 | $162.00 | — | 13% below | 20% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB | $129.60 | $162.00 | — | — | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC HEMOGLOBIN GLYCOSYLATED A1C CDM | $40.80 | $51.00 | — | 39% below | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC HEMOGLOBIN GLYCOSYLATED A1C CDM | $40.80 | $51.00 | — | — | 20% |
| Hemoglobin blood test CPT 85018 HC BLOOD COUNT HEMOGLOBIN LAB | $25.60 | $32.00 | — | 11% below | 20% |
| Hemoglobin blood test CPT 85018 HC HEMOGLOBIN (HGB) | $29.60 | $37.00 | — | 3% above | 20% |
| Hemoglobin blood test inpatient CPT 85018 HC BLOOD COUNT HEMOGLOBIN LAB | $25.60 | $32.00 | — | — | 20% |
| Hemoglobin blood test inpatient CPT 85018 HC HEMOGLOBIN (HGB) | $29.60 | $37.00 | — | — | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB LAB | $50.40 | $63.00 | — | 38% below | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB CDM | $57.60 | $72.00 | — | 30% below | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB LAB | $50.40 | $63.00 | — | — | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB CDM | $57.60 | $72.00 | — | — | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN CDM | $51.20 | $64.00 | — | 33% below | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB | $51.20 | $64.00 | — | 33% below | 20% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB | $51.20 | $64.00 | — | — | 20% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN CDM | $51.20 | $64.00 | — | — | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY LAB | $67.20 | $84.00 | — | 42% below | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY CDM | $77.60 | $97.00 | — | 33% below | 20% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C ANTIBODY LAB | $67.20 | $84.00 | — | — | 20% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C ANTIBODY CDM | $77.60 | $97.00 | — | — | 20% |
| Iron blood test (serum iron) CPT 83540 HC IRON | $28.00 | $35.00 | — | 55% below | 20% |
| Iron blood test (serum iron) CPT 83540 HC ASSAY OF IRON CDM | $28.00 | $35.00 | — | 55% below | 20% |
| Iron blood test (serum iron) inpatient CPT 83540 HC IRON | $28.00 | $35.00 | — | — | 20% |
| Iron blood test (serum iron) inpatient CPT 83540 HC ASSAY OF IRON CDM | $28.00 | $35.00 | — | — | 20% |
| Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY CDM | $40.00 | $50.00 | — | 40% below | 20% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING CAPACITY CDM | $40.00 | $50.00 | — | — | 20% |
| Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL CDM | $44.00 | $55.00 | — | 61% below | 20% |
| Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL CDM | $44.00 | $55.00 | — | — | 20% |
| Lactate (lactic acid) blood test CPT 83605 HC ASSAY OF LACTATE LAB | $75.20 | $94.00 | — | 46% below | 20% |
| Lactate (lactic acid) blood test CPT 83605 HC ASSAY OF LACTATE | $87.20 | $109.00 | — | 37% below | 20% |
| Lactate (lactic acid) blood test inpatient CPT 83605 HC ASSAY OF LACTATE LAB | $75.20 | $94.00 | — | — | 20% |
| Lactate (lactic acid) blood test inpatient CPT 83605 HC ASSAY OF LACTATE | $87.20 | $109.00 | — | — | 20% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 HC LDH BODY FLUID | $45.60 | $57.00 | — | 3% below | 20% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 HC LDH SERUM | $45.60 | $57.00 | — | 3% below | 20% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LDH BODY FLUID | $45.60 | $57.00 | — | — | 20% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LDH SERUM | $45.60 | $57.00 | — | — | 20% |
| Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE CDM | $49.60 | $62.00 | — | 43% below | 20% |
| Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE LAB | $49.60 | $62.00 | — | 43% below | 20% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC ASSAY OF LIPASE LAB | $49.60 | $62.00 | — | — | 20% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC ASSAY OF LIPASE CDM | $49.60 | $62.00 | — | — | 20% |
| Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL CDM | $48.00 | $60.00 | — | 38% below | 20% |
| Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL CDM | $48.00 | $60.00 | — | — | 20% |
| Lyme disease antibody test CPT 86618 HC LYME DISEASE ANTIBODY - IGG-IGM | $110.40 | $138.00 | — | 11% below | 20% |
| Lyme disease antibody test CPT 86618 HC LYME DISEASE ANTIBODY | $143.20 | $179.00 | — | 15% above | 20% |
| Lyme disease antibody test inpatient CPT 86618 HC LYME DISEASE ANTIBODY - IGG-IGM | $110.40 | $138.00 | — | — | 20% |
| Lyme disease antibody test inpatient CPT 86618 HC LYME DISEASE ANTIBODY | $143.20 | $179.00 | — | — | 20% |
| Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM CDM | $45.60 | $57.00 | — | 30% below | 20% |
| Magnesium blood test inpatient CPT 83735 HC ASSAY OF MAGNESIUM CDM | $45.60 | $57.00 | — | — | 20% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HC HETEROPHILE ANTIBODIES | $73.60 | $92.00 | — | 12% above | 20% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC HETEROPHILE ANTIBODIES | $73.60 | $92.00 | — | — | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB | $70.40 | $88.00 | — | 37% below | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM | $81.60 | $102.00 | — | 27% below | 20% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB | $70.40 | $88.00 | — | — | 20% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM | $81.60 | $102.00 | — | — | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS LAB | $48.00 | $60.00 | — | 40% below | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS | $63.20 | $79.00 | — | 20% below | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS LAB | $48.00 | $60.00 | — | — | 20% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS | $63.20 | $79.00 | — | — | 20% |
| Parathyroid hormone (PTH) blood test CPT 83970 HC ASSAY OF PARATHORMONE LAB | $160.80 | $201.00 | — | 22% below | 20% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC ASSAY OF PARATHORMONE LAB | $160.80 | $201.00 | — | — | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB | $48.00 | $60.00 | — | 17% below | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL | $48.00 | $60.00 | — | 17% below | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL | $48.00 | $60.00 | — | — | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB | $48.00 | $60.00 | — | — | 20% |
| Phosphorus (phosphate) blood test CPT 84100 HC ASSAY PHOSPHORUS | $31.20 | $39.00 | — | 41% below | 20% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 HC ASSAY PHOSPHORUS | $31.20 | $39.00 | — | — | 20% |
| Potassium blood test CPT 84132 HC POTASSIUM | $32.00 | $40.00 | — | 33% below | 20% |
| Potassium blood test inpatient CPT 84132 HC POTASSIUM | $32.00 | $40.00 | — | — | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME LAB | $36.00 | $45.00 | — | 9% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME | $39.20 | $49.00 | — | 19% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME 85610 | $39.20 | $49.00 | — | 19% above | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME LAB | $36.00 | $45.00 | — | — | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME 85610 | $39.20 | $49.00 | — | — | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME | $39.20 | $49.00 | — | — | 20% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC DRUG TEST PRSMV DIRECT OPT OBS PER DOS | $28.80 | $36.00 | — | 75% below | 20% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC DRUG TEST PRSMV DIRECT OPT OBS PER DOS | $28.80 | $36.00 | — | — | 20% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC IAADIADOO STREPTOCOCCUS GROUP A LAB | $68.00 | $85.00 | — | 39% above | 20% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC IAADIADOO STREPTOCOCCUS GROUP A LAB | $68.00 | $85.00 | — | — | 20% |
| Rh blood typing CPT 86901 HC RH TYPE | $57.60 | $72.00 | — | 3% above | 20% |
| Rh blood typing CPT 86901 HC BLOOD TYPING SEROLOGIC RH (D) LAB | $57.60 | $72.00 | — | 3% above | 20% |
| Rh blood typing inpatient CPT 86901 HC BLOOD TYPING SEROLOGIC RH (D) LAB | $57.60 | $72.00 | — | — | 20% |
| Rh blood typing inpatient CPT 86901 HC RH TYPE | $57.60 | $72.00 | — | — | 20% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC RBC SED RATE AUTOMATED | $49.60 | $62.00 | — | 17% above | 20% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC RBC SED RATE AUTOMATED | $49.60 | $62.00 | — | — | 20% |
| Sodium blood test CPT 84295 HC SODIUM BLOOD | $32.00 | $40.00 | — | 31% below | 20% |
| Sodium blood test CPT 84295 HC SODIUM | $32.00 | $40.00 | — | 31% below | 20% |
| Sodium blood test inpatient CPT 84295 HC SODIUM | $32.00 | $40.00 | — | — | 20% |
| Sodium blood test inpatient CPT 84295 HC SODIUM BLOOD | $32.00 | $40.00 | — | — | 20% |
| Stool ova and parasites exam CPT 87177 HC OVA AND PARASITES SMEARS | $74.40 | $93.00 | — | 8% above | 20% |
| Stool ova and parasites exam inpatient CPT 87177 HC OVA AND PARASITES SMEARS | $74.40 | $93.00 | — | — | 20% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM | $14.40 | $18.00 | — | 60% below | 20% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM | $14.40 | $18.00 | — | — | 20% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 CDM | $63.20 | $79.00 | — | 25% above | 20% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 CDM | $63.20 | $79.00 | — | — | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH | $74.40 | $93.00 | — | 18% below | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH REFLEX TO FT4 | $74.40 | $93.00 | — | 18% below | 20% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH | $74.40 | $93.00 | — | — | 20% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH REFLEX TO FT4 | $74.40 | $93.00 | — | — | 20% |
| Total cholesterol blood test CPT 82465 HC CHOLESTEROL | $44.80 | $56.00 | — | 27% above | 20% |
| Total cholesterol blood test inpatient CPT 82465 HC CHOLESTEROL | $44.80 | $56.00 | — | — | 20% |
| Triglycerides blood test CPT 84478 HC ASSAY OF TRIGLYCERIDES LAB | $21.60 | $27.00 | — | 49% below | 20% |
| Triglycerides blood test CPT 84478 HC TRIGLYCERIDES | $21.60 | $27.00 | — | 49% below | 20% |
| Triglycerides blood test inpatient CPT 84478 HC TRIGLYCERIDES | $21.60 | $27.00 | — | — | 20% |
| Triglycerides blood test inpatient CPT 84478 HC ASSAY OF TRIGLYCERIDES LAB | $21.60 | $27.00 | — | — | 20% |
| Troponin test, quantitative CPT 84484 HC TROPONIN-T | $67.20 | $84.00 | — | 27% below | 20% |
| Troponin test, quantitative CPT 84484 HC TROPONIN QUANTITATIVE | $69.60 | $87.00 | — | 24% below | 20% |
| Troponin test, quantitative inpatient CPT 84484 HC TROPONIN-T | $67.20 | $84.00 | — | — | 20% |
| Troponin test, quantitative inpatient CPT 84484 HC TROPONIN QUANTITATIVE | $69.60 | $87.00 | — | — | 20% |
| Uric acid blood test CPT 84550 HC ASSAY OF BLOOD/URIC ACID CDM | $23.20 | $29.00 | — | 44% below | 20% |
| Uric acid blood test inpatient CPT 84550 HC ASSAY OF BLOOD/URIC ACID CDM | $23.20 | $29.00 | — | — | 20% |
| Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | $28.80 | $36.00 | — | 34% below | 20% |
| Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM | $32.80 | $41.00 | — | 25% below | 20% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | $28.80 | $36.00 | — | — | 20% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM | $32.80 | $41.00 | — | — | 20% |
| Urinalysis without microscope exam, automated CPT 81003 HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB | $31.20 | $39.00 | — | 15% above | 20% |
| Urinalysis without microscope exam, automated CPT 81003 HC PH URINE DIPSTICK AUTO W/O MICROSCOPY LAB | $36.00 | $45.00 | — | 33% above | 20% |
| Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTO W/O SCOPE | $36.00 | $45.00 | — | 33% above | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB | $31.20 | $39.00 | — | — | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC PH URINE DIPSTICK AUTO W/O MICROSCOPY LAB | $36.00 | $45.00 | — | — | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS AUTO W/O SCOPE | $36.00 | $45.00 | — | — | 20% |
| Urinalysis without microscope exam, manual CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM | $32.80 | $41.00 | — | 116% above | 20% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM | $32.80 | $41.00 | — | — | 20% |
| Urine culture for bacteria, with colony count CPT 87086 HC URINE CULTURE/COLONY COUNT | $90.40 | $113.00 | — | at median | 20% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 HC URINE CULTURE/COLONY COUNT | $90.40 | $113.00 | — | — | 20% |
| Urine microalbumin (albumin) test CPT 82043 HC MICROALBUMIN QUANTITATIVE | $31.20 | $39.00 | — | 43% below | 20% |
| Urine microalbumin (albumin) test inpatient CPT 82043 HC MICROALBUMIN QUANTITATIVE | $31.20 | $39.00 | — | — | 20% |
| Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY TEST | $44.80 | $56.00 | — | 2% above | 20% |
| Urine pregnancy test, read by color change inpatient CPT 81025 HC URINE PREGNANCY TEST | $44.80 | $56.00 | — | — | 20% |
| Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN-B12 | $75.20 | $94.00 | — | 18% below | 20% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC VITAMIN-B12 | $75.20 | $94.00 | — | — | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM | $112.00 | $140.00 | — | 18% below | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM | $112.00 | $140.00 | — | — | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC (HCG) QUANTITATIVE | $75.20 | $94.00 | — | 35% below | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB | $75.20 | $94.00 | — | 35% below | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB | $75.20 | $94.00 | — | — | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC GONADOTROPIN CHORIONIC (HCG) QUANTITATIVE | $75.20 | $94.00 | — | — | 20% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Montana | Off list |
|---|---|---|---|---|---|
| Balloon dilation of the maxillary sinus opening, one side CPT 31295 HC ED SINUS ENDO W/BALLOON DILATION CDM | $7,593.60 | $9,492.00 | — | 336% above | 20% |
| Balloon dilation of the maxillary sinus opening, one side inpatient CPT 31295 HC ED SINUS ENDO W/BALLOON DILATION CDM | $7,593.60 | $9,492.00 | — | — | 20% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC BX BREAST 1ST LESION STEREO | $2,821.60 | $3,527.00 | — | 31% above | 20% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC BX BREAST 1ST LESION STEREO | $2,821.60 | $3,527.00 | — | — | 20% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC PR ED 27786 CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM | $193.60 | $242.00 | — | 60% below | 20% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC ED CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM | $416.80 | $521.00 | — | 14% below | 20% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC PR ED 27786 CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM | $193.60 | $242.00 | — | — | 20% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC ED CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM | $416.80 | $521.00 | — | — | 20% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC ED TREAT METATARSAL FRACTURE W/O MANIPULATION CDM | $223.20 | $279.00 | — | 34% below | 20% |
| Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HC ED TREAT METATARSAL FRACTURE W/O MANIPULATION CDM | $223.20 | $279.00 | — | — | 20% |
| Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 HC ED CORRECTION OF BUNION CDM | $4,108.00 | $5,135.00 | — | 21% above | 20% |
| Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 HC ED CORRECTION OF BUNION CDM | $4,108.00 | $5,135.00 | — | — | 20% |
| Cardiac catheterization with coronary angiogram CPT 93458 HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I | $11,360.80 | $14,201.00 | — | 5% below | 20% |
| Cardiac catheterization with coronary angiogram inpatient CPT 93458 HC CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I | $11,360.80 | $14,201.00 | — | — | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC PR ED 92960 CARDIOVERSION ELECTIVE EXTERNAL CDM | $431.20 | $539.00 | — | 50% below | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL | $803.20 | $1,004.00 | — | 7% below | 20% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC PR ED 92960 CARDIOVERSION ELECTIVE EXTERNAL CDM | $431.20 | $539.00 | — | — | 20% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL | $803.20 | $1,004.00 | — | — | 20% |
| Carpal tunnel release, open surgery CPT 64721 HC ED NEUROPLASTY MEDIAN NERVE AT CARP TUNNEL CDM | $2,480.00 | $3,100.00 | — | 53% above | 20% |
| Carpal tunnel release, open surgery inpatient CPT 64721 HC ED NEUROPLASTY MEDIAN NERVE AT CARP TUNNEL CDM | $2,480.00 | $3,100.00 | — | — | 20% |
| Catheter ablation for atrial fibrillation CPT 93656 HC COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION | $24,150.40 | $30,188.00 | — | 25% below | 20% |
| Catheter ablation for atrial fibrillation inpatient CPT 93656 HC COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION | $24,150.40 | $30,188.00 | — | — | 20% |
| Cervical biopsy CPT 57500 HC ED BIOPSY OF CERVIX CDM | $970.40 | $1,213.00 | — | 171% above | 20% |
| Cervical biopsy inpatient CPT 57500 HC ED BIOPSY OF CERVIX CDM | $970.40 | $1,213.00 | — | — | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC ED TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/O MANIP CDM | $179.20 | $224.00 | — | 61% below | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC PR ED 25600 TREAT DISTAL RADIAL FRACTURE RADIUS/UNA W/O MANIP CDM | $634.40 | $793.00 | — | 39% above | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC ED TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/O MANIP CDM | $179.20 | $224.00 | — | — | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC PR ED 25600 TREAT DISTAL RADIAL FRACTURE RADIUS/UNA W/O MANIP CDM | $634.40 | $793.00 | — | — | 20% |
| Colonoscopy, diagnostic CPT 45378 HC ED COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM | $997.60 | $1,247.00 | — | 44% below | 20% |
| Colonoscopy, diagnostic inpatient CPT 45378 HC ED COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM | $997.60 | $1,247.00 | — | — | 20% |
| Coronary stent placement, one artery CPT 92928 HC INSERT COR STENT PERC TRLUML W/ANGIO ONE ART/BRNCH | $12,628.80 | $15,786.00 | — | 143% above | 20% |
| Coronary stent placement, one artery inpatient CPT 92928 HC INSERT COR STENT PERC TRLUML W/ANGIO ONE ART/BRNCH | $12,628.80 | $15,786.00 | — | — | 20% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC ED CYSTOURETHROSCOPY CDM | $767.20 | $959.00 | — | 73% above | 20% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC ED CYSTOURETHROSCOPY CDM | $767.20 | $959.00 | — | — | 20% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 HC ED DILATION AND CURETTAGE CDM | $3,901.60 | $4,877.00 | — | 427% above | 20% |
| D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 HC ED DILATION AND CURETTAGE CDM | $3,901.60 | $4,877.00 | — | — | 20% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC ED DESTRUCT PREMALG LESION FIRST LESION CDM | $139.20 | $174.00 | — | 19% below | 20% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC ED DESTRUCT PREMALG LESION FIRST LESION CDM | $139.20 | $174.00 | — | — | 20% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 HC ED REMOVE IMPACTED EAR WAX UNI CDM | $109.60 | $137.00 | — | 150% above | 20% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC PR ED 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT CDM | $25.60 | $32.00 | — | 42% below | 20% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC ED REMOVE IMPACTED EAR WAX UNI CDM | $109.60 | $137.00 | — | — | 20% |
| Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 HC PR ED 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT CDM | $25.60 | $32.00 | — | — | 20% |
| Earwax removal with instruments, one ear one side CPT 69210 HC PR ED 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM | $100.00 | $125.00 | — | 17% above | 20% |
| Earwax removal with instruments, one ear one side CPT 69210 HC ED REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM | $111.20 | $139.00 | — | 30% above | 20% |
| Earwax removal with instruments, one ear inpatient one side CPT 69210 HC PR ED 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM | $100.00 | $125.00 | — | — | 20% |
| Earwax removal with instruments, one ear inpatient one side CPT 69210 HC ED REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM | $111.20 | $139.00 | — | — | 20% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC ED ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX CDM | $245.60 | $307.00 | — | at median | 20% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC ED ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX CDM | $245.60 | $307.00 | — | — | 20% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC INJ W/NDL OR CATH PLCMNT EPIDRL C/T W/IMG | $1,030.40 | $1,288.00 | — | 11% below | 20% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC ED INJ INTERLAMINR CRV-THOR W IMG CDM | $1,030.40 | $1,288.00 | — | 11% below | 20% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC INJ W/NDL OR CATH PLCMNT EPIDRL C/T W/IMG | $1,030.40 | $1,288.00 | — | — | 20% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC ED INJ INTERLAMINR CRV-THOR W IMG CDM | $1,030.40 | $1,288.00 | — | — | 20% |
| Eye injection into the vitreous (intravitreal injection) CPT 67028 HC ED INTRAVITREAL NJX PHARMACOLOGIC AGT SPX CDM | $459.20 | $574.00 | — | at median | 20% |
| Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 HC ED INTRAVITREAL NJX PHARMACOLOGIC AGT SPX CDM | $459.20 | $574.00 | — | — | 20% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV | $1,310.40 | $1,638.00 | — | 17% above | 20% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV | $1,310.40 | $1,638.00 | — | — | 20% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HC ED SIGMOID DX FLX W WO SPEC COLL CDM | $997.60 | $1,247.00 | — | 8% below | 20% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 HC ED SIGMOID DX FLX W WO SPEC COLL CDM | $997.60 | $1,247.00 | — | — | 20% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 HC ED LAPARO CHOLECYSTECTOMY/GRAPH CDM | $7,512.80 | $9,391.00 | — | 282% above | 20% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 HC ED LAPARO CHOLECYSTECTOMY/GRAPH CDM | $7,512.80 | $9,391.00 | — | — | 20% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 HC ED HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS CDM | $1,147.20 | $1,434.00 | — | 73% above | 20% |
| Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HC ED HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS CDM | $1,147.20 | $1,434.00 | — | — | 20% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 HC ED HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP CDM | $3,545.60 | $4,432.00 | — | 330% above | 20% |
| Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HC ED HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP CDM | $3,545.60 | $4,432.00 | — | — | 20% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC CATHETER FOR HYSTEROGRAPHY | $234.40 | $293.00 | — | 21% below | 20% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC CATHETER FOR HYSTEROGRAPHY | $234.40 | $293.00 | — | — | 20% |
| IUD insertion (the device itself billed separately) CPT 58300 HC ED INSERTION INTRAUTERINE DEVICE IUD CDM | $92.80 | $116.00 | — | 68% below | 20% |
| IUD insertion (the device itself billed separately) inpatient CPT 58300 HC ED INSERTION INTRAUTERINE DEVICE IUD CDM | $92.80 | $116.00 | — | — | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC PR ED 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM | $223.20 | $279.00 | — | 1% above | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC ED DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM | $339.20 | $424.00 | — | 54% above | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE | $397.60 | $497.00 | — | 81% above | 20% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC PR ED 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM | $223.20 | $279.00 | — | — | 20% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC ED DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM | $339.20 | $424.00 | — | — | 20% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE | $397.60 | $497.00 | — | — | 20% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC ED RPR 1ST INGUN HRNA AGE 5 YRS OR MORE REDUCIBLE CDM | $4,888.00 | $6,110.00 | — | 78% above | 20% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 HC ED RPR 1ST INGUN HRNA AGE 5 YRS OR MORE REDUCIBLE CDM | $4,888.00 | $6,110.00 | — | — | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC ED INJ TENDON SHEATH/LIGAMENT CDM | $375.20 | $469.00 | — | 158% above | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC ED INJ TENDON SHEATH/LIGAMENT CDM | $375.20 | $469.00 | — | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O US GUIDANCE CDM | $414.40 | $518.00 | — | 50% above | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR CDM | $414.40 | $518.00 | — | 50% above | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | $460.00 | $575.00 | — | 67% above | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ED ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US CDM | $460.00 | $575.00 | — | 67% above | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR CDM | $414.40 | $518.00 | — | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O US GUIDANCE CDM | $414.40 | $518.00 | — | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ED ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US CDM | $460.00 | $575.00 | — | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | $460.00 | $575.00 | — | — | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC PR ED 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE CDM | $113.60 | $142.00 | — | 45% below | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE | $460.00 | $575.00 | — | 124% above | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US CDM | $460.00 | $575.00 | — | 124% above | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC PR ED 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE CDM | $113.60 | $142.00 | — | — | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US CDM | $460.00 | $575.00 | — | — | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE | $460.00 | $575.00 | — | — | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC PR ED 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE CDM | $107.20 | $134.00 | — | 38% below | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ED ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US CDM | $460.00 | $575.00 | — | 167% above | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE | $460.00 | $575.00 | — | 167% above | 20% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC PR ED 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE CDM | $107.20 | $134.00 | — | — | 20% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC ED ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US CDM | $460.00 | $575.00 | — | — | 20% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE | $460.00 | $575.00 | — | — | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC ED INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM | $324.00 | $405.00 | — | 21% below | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC PR ED 12031 INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM | $464.80 | $581.00 | — | 13% above | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC ED INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM | $324.00 | $405.00 | — | — | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC PR ED 12031 INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM | $464.80 | $581.00 | — | — | 20% |
| Left heart catheterization, diagnostic one side CPT 93452 HC LEFT HRT CATH W/VENTRCLGRPHY | $9,330.40 | $11,663.00 | — | at median | 20% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 HC LEFT HRT CATH W/VENTRCLGRPHY | $9,330.40 | $11,663.00 | — | — | 20% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC ED INJ EPI LUMB/SACRAL W IMAGING CDM | $1,030.40 | $1,288.00 | — | 68% above | 20% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ W/NDL OR CATH PLCMNT EPIDRL L/S W/IMG | $1,030.40 | $1,288.00 | — | 68% above | 20% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC ED INJ EPI LUMB/SACRAL W IMAGING CDM | $1,030.40 | $1,288.00 | — | — | 20% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ W/NDL OR CATH PLCMNT EPIDRL L/S W/IMG | $1,030.40 | $1,288.00 | — | — | 20% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC ED INJ EPI LUMB/SACRAL WO IMAGING CDM | $991.20 | $1,239.00 | — | 135% above | 20% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN | $991.20 | $1,239.00 | — | 135% above | 20% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC ED INJ EPI LUMB/SACRAL WO IMAGING CDM | $991.20 | $1,239.00 | — | — | 20% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN | $991.20 | $1,239.00 | — | — | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ FORAMEN EPIDURAL L/S | $2,134.40 | $2,668.00 | — | 103% above | 20% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJ FORAMEN EPIDURAL L/S | $2,134.40 | $2,668.00 | — | — | 20% |
| Miscarriage treatment with D&C, first trimester CPT 59820 HC ED SPONTANEOUS ABORTION FAC CDM | $3,901.60 | $4,877.00 | — | 40% above | 20% |
| Miscarriage treatment with D&C, first trimester inpatient CPT 59820 HC ED SPONTANEOUS ABORTION FAC CDM | $3,901.60 | $4,877.00 | — | — | 20% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS | $57.60 | $72.00 | — | 74% below | 20% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM OR LESS CDM | $895.20 | $1,119.00 | — | 300% above | 20% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS CDM | $895.20 | $1,119.00 | — | 300% above | 20% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS | $57.60 | $72.00 | — | — | 20% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM OR LESS CDM | $895.20 | $1,119.00 | — | — | 20% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS CDM | $895.20 | $1,119.00 | — | — | 20% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM | $895.20 | $1,119.00 | — | 203% above | 20% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM | $895.20 | $1,119.00 | — | — | 20% |
| Nail removal (partial or complete), one nail CPT 11730 HC PR ED 11730 REMOVAL OF NAIL PLATE CDM | $189.60 | $237.00 | — | at median | 20% |
| Nail removal (partial or complete), one nail CPT 11730 HC ED REMOVAL OF NAIL PLATE CDM | $206.40 | $258.00 | — | 9% above | 20% |
| Nail removal (partial or complete), one nail CPT 11730 HC AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 CDM | $397.60 | $497.00 | — | 109% above | 20% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 HC PR ED 11730 REMOVAL OF NAIL PLATE CDM | $189.60 | $237.00 | — | — | 20% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 HC ED REMOVAL OF NAIL PLATE CDM | $206.40 | $258.00 | — | — | 20% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 HC AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 CDM | $397.60 | $497.00 | — | — | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 HC PR ED 64405 NERVE BLOCK INJ OCCIPITAL CDM | $191.20 | $239.00 | — | 35% below | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 HC PR 64405 NERVE BLOCK INJ OCCIPITAL | $191.20 | $239.00 | — | 35% below | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 HC ED NERVE BLOCK INJ OCCIPITAL CDM | $404.80 | $506.00 | — | 38% above | 20% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 HC PR ED 64405 NERVE BLOCK INJ OCCIPITAL CDM | $191.20 | $239.00 | — | — | 20% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 HC PR 64405 NERVE BLOCK INJ OCCIPITAL | $191.20 | $239.00 | — | — | 20% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 HC ED NERVE BLOCK INJ OCCIPITAL CDM | $404.80 | $506.00 | — | — | 20% |
| Pacemaker implant (dual chamber) CPT 33208 HC INSERTION PERM AV PACER | $17,318.40 | $21,648.00 | — | 12% below | 20% |
| Pacemaker implant (dual chamber) inpatient CPT 33208 HC INSERTION PERM AV PACER | $17,318.40 | $21,648.00 | — | — | 20% |
| Paracentesis with imaging guidance CPT 49083 HC PR ED 49083 ABD PARACENT W/IMAG GUIDANCE CDM | $212.80 | $266.00 | — | 74% below | 20% |
| Paracentesis with imaging guidance CPT 49083 HC ED ABD PARACENTESIS W/IMAG GUIDANCE CDM | $2,761.60 | $3,452.00 | — | 240% above | 20% |
| Paracentesis with imaging guidance CPT 49083 HC ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM | $2,761.60 | $3,452.00 | — | 240% above | 20% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC PR ED 49083 ABD PARACENT W/IMAG GUIDANCE CDM | $212.80 | $266.00 | — | — | 20% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM | $2,761.60 | $3,452.00 | — | — | 20% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC ED ABD PARACENTESIS W/IMAG GUIDANCE CDM | $2,761.60 | $3,452.00 | — | — | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC PR ED 11750 REMOVAL OF NAIL BED CDM | $430.40 | $538.00 | — | 15% above | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC ED REMOVAL OF NAIL BED CDM | $720.00 | $900.00 | — | 93% above | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC EXCISION NAIL MATRIX PERMANENT REMOVAL | $799.20 | $999.00 | — | 114% above | 20% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC PR ED 11750 REMOVAL OF NAIL BED CDM | $430.40 | $538.00 | — | — | 20% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC ED REMOVAL OF NAIL BED CDM | $720.00 | $900.00 | — | — | 20% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC EXCISION NAIL MATRIX PERMANENT REMOVAL | $799.20 | $999.00 | — | — | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 HC ED REMOVE FOREIGN BODY SIMPLE CDM | $237.60 | $297.00 | — | 24% below | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 HC PR ED 10120 REMOVE FOREIGN BODY SIMPLE CDM | $293.60 | $367.00 | — | 6% below | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 HC INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE | $799.20 | $999.00 | — | 157% above | 20% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 HC ED REMOVE FOREIGN BODY SIMPLE CDM | $237.60 | $297.00 | — | — | 20% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 HC PR ED 10120 REMOVE FOREIGN BODY SIMPLE CDM | $293.60 | $367.00 | — | — | 20% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 HC INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE | $799.20 | $999.00 | — | — | 20% |
| Septoplasty to straighten the nasal septum CPT 30520 HC ED REPAIR OF NASAL SEPTUM CDM | $3,926.40 | $4,908.00 | — | 179% above | 20% |
| Septoplasty to straighten the nasal septum inpatient CPT 30520 HC ED REPAIR OF NASAL SEPTUM CDM | $3,926.40 | $4,908.00 | — | — | 20% |
| Short arm cast (elbow to hand) CPT 29075 HC ED SHORT ARM CAST APPLICATION CDM | $331.20 | $414.00 | — | 55% above | 20% |
| Short arm cast (elbow to hand) inpatient CPT 29075 HC ED SHORT ARM CAST APPLICATION CDM | $331.20 | $414.00 | — | — | 20% |
| Short arm splint (forearm and hand) CPT 29125 HC ED SHORT ARM SPLINT APPLICATION CDM | $130.40 | $163.00 | — | 18% below | 20% |
| Short arm splint (forearm and hand) CPT 29125 HC PR ED 29125 SHORT ARM SPLINT APPLICATION CDM | $136.00 | $170.00 | — | 14% below | 20% |
| Short arm splint (forearm and hand) inpatient CPT 29125 HC ED SHORT ARM SPLINT APPLICATION CDM | $130.40 | $163.00 | — | — | 20% |
| Short arm splint (forearm and hand) inpatient CPT 29125 HC PR ED 29125 SHORT ARM SPLINT APPLICATION CDM | $136.00 | $170.00 | — | — | 20% |
| Short leg cast (below the knee) CPT 29405 HC ED SHORT LEG CAST APPLICATION CDM | $331.20 | $414.00 | — | 48% above | 20% |
| Short leg cast (below the knee) inpatient CPT 29405 HC ED SHORT LEG CAST APPLICATION CDM | $331.20 | $414.00 | — | — | 20% |
| Short leg splint (calf to foot) CPT 29515 HC ED SHORT LEG SPLINT APPLICATION CDM | $131.20 | $164.00 | — | 31% below | 20% |
| Short leg splint (calf to foot) CPT 29515 HC PR ED 29515 SHORT LEG SPLINT APPLICATION CDM | $146.40 | $183.00 | — | 23% below | 20% |
| Short leg splint (calf to foot) inpatient CPT 29515 HC ED SHORT LEG SPLINT APPLICATION CDM | $131.20 | $164.00 | — | — | 20% |
| Short leg splint (calf to foot) inpatient CPT 29515 HC PR ED 29515 SHORT LEG SPLINT APPLICATION CDM | $146.40 | $183.00 | — | — | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC ED REPAIR SUPERFIC WOUND(S)LT/2.5CM SLP NK AX EXGEN TRNK EXTR HND FT CDM | $208.80 | $261.00 | — | 16% below | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC PR ED 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM | $290.40 | $363.00 | — | 17% above | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC ED REPAIR SUPERFIC WOUND(S)LT/2.5CM SLP NK AX EXGEN TRNK EXTR HND FT CDM | $208.80 | $261.00 | — | — | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC PR ED 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM | $290.40 | $363.00 | — | — | 20% |
| Skin biopsy, punch, one lesion CPT 11104 HC PR 11104 PUNCH BIOPSY SKIN SINGLE LESION | $56.80 | $71.00 | — | 82% below | 20% |
| Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BIOPSY SKIN SINGLE LESION | $345.60 | $432.00 | — | 8% above | 20% |
| Skin biopsy, punch, one lesion CPT 11104 HC ED PUNCH BIOPSY SKIN SINGLE LESION CDM | $345.60 | $432.00 | — | 8% above | 20% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 HC PR 11104 PUNCH BIOPSY SKIN SINGLE LESION | $56.80 | $71.00 | — | — | 20% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 HC ED PUNCH BIOPSY SKIN SINGLE LESION CDM | $345.60 | $432.00 | — | — | 20% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 HC PUNCH BIOPSY SKIN SINGLE LESION | $345.60 | $432.00 | — | — | 20% |
| Skin tag removal, up to 15 tags CPT 11200 HC REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 | $342.40 | $428.00 | — | 85% above | 20% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 HC REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 | $342.40 | $428.00 | — | — | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC PR 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM | $92.80 | $116.00 | — | 79% below | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC PR ED 62270 SPINAL FLUID TAP DIAGNOSTIC CDM | $500.00 | $625.00 | — | 15% above | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE | $761.60 | $952.00 | — | 75% above | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC ED SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM | $761.60 | $952.00 | — | 75% above | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC PR 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM | $1,546.40 | $1,933.00 | — | 255% above | 20% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC PR 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM | $92.80 | $116.00 | — | — | 20% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC PR ED 62270 SPINAL FLUID TAP DIAGNOSTIC CDM | $500.00 | $625.00 | — | — | 20% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC ED SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM | $761.60 | $952.00 | — | — | 20% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE | $761.60 | $952.00 | — | — | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC ED REPAIR SUPERFICIAL WND(S) 2.6-7.5CM SLP NK AX EXGEN TRNK E CDM | $232.80 | $291.00 | — | 16% below | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC PR ED 12002 REPAIR SUPERFIC WOUND(S) 2.6 TO 7.5CM SLP NK AX EXGEN T CDM | $307.20 | $384.00 | — | 11% above | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC ED REPAIR SUPERFICIAL WND(S) 2.6-7.5CM SLP NK AX EXGEN TRNK E CDM | $232.80 | $291.00 | — | — | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC PR ED 12002 REPAIR SUPERFIC WOUND(S) 2.6 TO 7.5CM SLP NK AX EXGEN T CDM | $307.20 | $384.00 | — | — | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC PR ED 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS CDM | $307.20 | $384.00 | — | 13% below | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair one side CPT 12011 HC ED REPAIR SUPERFICIAL WOUND(S) LT/2.5 FACE ERS EYLD NSE LPS MUC CDM | $216.00 | $270.00 | — | 39% below | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC PR ED 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS CDM | $307.20 | $384.00 | — | — | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient one side CPT 12011 HC ED REPAIR SUPERFICIAL WOUND(S) LT/2.5 FACE ERS EYLD NSE LPS MUC CDM | $216.00 | $270.00 | — | — | 20% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC ED TANGENTIAL BIOPSY SKIN SINGLE LESION CDM | $249.60 | $312.00 | — | 7% above | 20% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION | $397.60 | $497.00 | — | 71% above | 20% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC ED TANGENTIAL BIOPSY SKIN SINGLE LESION CDM | $249.60 | $312.00 | — | — | 20% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION | $397.60 | $497.00 | — | — | 20% |
| Thoracentesis with imaging guidance CPT 32555 HC PR ED 32555 THORACENTESIS/ASPIR W IMG GD CDM | $223.20 | $279.00 | — | 76% below | 20% |
| Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING | $1,737.60 | $2,172.00 | — | 87% above | 20% |
| Thoracentesis with imaging guidance CPT 32555 HC ED THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING CDM | $1,737.60 | $2,172.00 | — | 87% above | 20% |
| Thoracentesis with imaging guidance inpatient CPT 32555 HC PR ED 32555 THORACENTESIS/ASPIR W IMG GD CDM | $223.20 | $279.00 | — | — | 20% |
| Thoracentesis with imaging guidance inpatient CPT 32555 HC ED THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING CDM | $1,737.60 | $2,172.00 | — | — | 20% |
| Thoracentesis with imaging guidance inpatient CPT 32555 HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING | $1,737.60 | $2,172.00 | — | — | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC PR ED 20552 INJ TRIGGER POINT 1/2 MUSCL CDM | $106.40 | $133.00 | — | 42% below | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC ED INJ TRIGGER POINT 1/2 MUSCL CDM | $344.80 | $431.00 | — | 89% above | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC IR INJ TRIGGER POINT(S)1TO2 MUSC | $344.80 | $431.00 | — | 89% above | 20% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC PR ED 20552 INJ TRIGGER POINT 1/2 MUSCL CDM | $106.40 | $133.00 | — | — | 20% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC ED INJ TRIGGER POINT 1/2 MUSCL CDM | $344.80 | $431.00 | — | — | 20% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC IR INJ TRIGGER POINT(S)1TO2 MUSC | $344.80 | $431.00 | — | — | 20% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST 1ST LESION US IMAG | $4,821.60 | $6,027.00 | — | 208% above | 20% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC BX BREAST 1ST LESION US IMAG | $4,821.60 | $6,027.00 | — | — | 20% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 HC ED UGI W DILATION ESOPHAGUS BAL CDM | $2,089.60 | $2,612.00 | — | 57% above | 20% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 HC ED UGI W DILATION ESOPHAGUS BAL CDM | $2,089.60 | $2,612.00 | — | — | 20% |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC ED EGD TRANSORAL BIOPSY SINGLE/MULTIPLE CDM | $990.40 | $1,238.00 | — | 36% below | 20% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC ED EGD TRANSORAL BIOPSY SINGLE/MULTIPLE CDM | $990.40 | $1,238.00 | — | — | 20% |
| Upper endoscopy (EGD), diagnostic CPT 43235 HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM | $990.40 | $1,238.00 | — | 6% below | 20% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM | $990.40 | $1,238.00 | — | — | 20% |
| Wart removal, up to 14 warts CPT 17110 HC DESTRUCTION BENIGN LESIONS UP TO 14 CDM | $249.60 | $312.00 | — | 31% above | 20% |
| Wart removal, up to 14 warts CPT 17110 HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM | $249.60 | $312.00 | — | 31% above | 20% |
| Wart removal, up to 14 warts inpatient CPT 17110 HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM | $249.60 | $312.00 | — | — | 20% |
| Wart removal, up to 14 warts inpatient CPT 17110 HC DESTRUCTION BENIGN LESIONS UP TO 14 CDM | $249.60 | $312.00 | — | — | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC PR ED 11042 DEB SUBQ TISSUE FIRST 20 SQ CM OR LESS CDM | $294.40 | $368.00 | — | 10% above | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEB SUBQ TISSUE FIRST 20 SQ CM OR LESS | $478.40 | $598.00 | — | 79% above | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC ED DEB SUBQ TISSUE 20 SQ CM OR LESS - DEBRIDE SKIN CDM | $478.40 | $598.00 | — | 79% above | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC PR ED 11042 DEB SUBQ TISSUE FIRST 20 SQ CM OR LESS CDM | $294.40 | $368.00 | — | — | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC ED DEB SUBQ TISSUE 20 SQ CM OR LESS - DEBRIDE SKIN CDM | $478.40 | $598.00 | — | — | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEB SUBQ TISSUE FIRST 20 SQ CM OR LESS | $478.40 | $598.00 | — | — | 20% |
| Wrist fracture surgery (plate and screws), distal radius CPT 25607 HC ED TREAT FX RAD EXTRA-ARTICUL CDM | $9,128.00 | $11,410.00 | — | 45% above | 20% |
| Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 HC ED TREAT FX RAD EXTRA-ARTICUL CDM | $9,128.00 | $11,410.00 | — | — | 20% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Montana | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION EA UNIT CDM | $359.20 | $449.00 | — | 53% below | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION EA UNIT CDM | $359.20 | $449.00 | — | — | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC ED INHALATION TREATMENT CDM | $388.00 | $485.00 | — | 253% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INHALATION TREATMENT DAILY | $388.00 | $485.00 | — | 253% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC INHALATION TREATMENT DAILY | $388.00 | $485.00 | — | — | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC ED INHALATION TREATMENT CDM | $388.00 | $485.00 | — | — | 20% |
| Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO IV INFUSION INITIAL HR CDM | $618.40 | $773.00 | — | 23% above | 20% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO IV INFUSION INITIAL HR CDM | $618.40 | $773.00 | — | — | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 HC PR ED 99291 CRITICAL CARE FIRST HOUR CDM | $527.20 | $659.00 | — | 72% below | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 HC ED CRITICAL CARE FIRST HOUR CDM | $2,822.40 | $3,528.00 | — | 53% above | 20% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 HC PR ED 99291 CRITICAL CARE FIRST HOUR CDM | $527.20 | $659.00 | — | — | 20% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 HC ED CRITICAL CARE FIRST HOUR CDM | $2,822.40 | $3,528.00 | — | — | 20% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 HC ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY | $797.60 | $997.00 | — | at median | 20% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY | $797.60 | $997.00 | — | — | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC ECG 12 LEAD TRACING ONLY | $153.60 | $192.00 | — | 1% below | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC ECG 12 LEAD TRACING ONLY | $153.60 | $192.00 | — | — | 20% |
| Electroconvulsive therapy (ECT), one session CPT 90870 HC ELECTROCONVULSIVE THERAPY 1 HOUR | $1,896.00 | $2,370.00 | — | — | 20% |
| Electroconvulsive therapy (ECT), one session inpatient CPT 90870 HC ELECTROCONVULSIVE THERAPY 1 HOUR | $1,896.00 | $2,370.00 | — | — | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ED FAC E&M VISIT LEVEL 1 CDM | $252.00 | $315.00 | — | 21% above | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ED FAC E&M VISIT LEVEL 1 CDM | $252.00 | $315.00 | — | — | 20% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED FAC E&M VISIT LEVEL 2 CDM | $372.00 | $465.00 | — | 5% above | 20% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ED FAC E&M VISIT LEVEL 2 CDM | $372.00 | $465.00 | — | — | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED FAC E&M VISIT LEVEL 3 CDM | $580.80 | $726.00 | — | 9% above | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ED FAC E&M VISIT LEVEL 3 CDM | $580.80 | $726.00 | — | — | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED SEXUAL ASSAULT EXAM CDM | $554.40 | $693.00 | — | 35% below | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED FAC E&M VISIT LEVEL 4 CDM | $1,062.40 | $1,328.00 | — | 25% above | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ED SEXUAL ASSAULT EXAM CDM | $554.40 | $693.00 | — | — | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ED FAC E&M VISIT LEVEL 4 CDM | $1,062.40 | $1,328.00 | — | — | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ED FAC E&M VISIT LEVEL 5 CDM | $1,407.20 | $1,759.00 | — | 10% above | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ED FAC E&M VISIT LEVEL 5 CDM | $1,407.20 | $1,759.00 | — | — | 20% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY | $538.40 | $673.00 | — | 7% below | 20% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY | $538.40 | $673.00 | — | — | 20% |
| Family therapy with the patient, 50 minutes CPT 90847 HC PR 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS | $160.00 | $200.00 | — | at median | 20% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC PR 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS | $160.00 | $200.00 | — | — | 20% |
| Group psychotherapy session CPT 90853 HC PSYCHOTHERAPY GROUP PER DISTINCT/SEPARATE SESSION CDM | $228.80 | $286.00 | — | 228% above | 20% |
| Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY 60 MIN | $228.80 | $286.00 | — | 228% above | 20% |
| Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY 60 MIN | $228.80 | $286.00 | — | — | 20% |
| Group psychotherapy session inpatient CPT 90853 HC PSYCHOTHERAPY GROUP PER DISTINCT/SEPARATE SESSION CDM | $228.80 | $286.00 | — | — | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV HYDRATION INITIAL HR CDM | $236.00 | $295.00 | — | 7% below | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC ED IV HYDRATION INITIAL HR CDM | $236.00 | $295.00 | — | 7% below | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV HYDRATION INITIAL HR CDM | $236.00 | $295.00 | — | — | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC ED IV HYDRATION INITIAL HR CDM | $236.00 | $295.00 | — | — | 20% |
| IV infusion of a medicine, first hour CPT 96365 HC ED IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR CDM | $443.20 | $554.00 | — | 29% above | 20% |
| IV infusion of a medicine, first hour CPT 96365 HC IV INFUSION INITIAL HR CDM | $443.20 | $554.00 | — | 29% above | 20% |
| IV infusion of a medicine, first hour inpatient CPT 96365 HC ED IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR CDM | $443.20 | $554.00 | — | — | 20% |
| IV infusion of a medicine, first hour inpatient CPT 96365 HC IV INFUSION INITIAL HR CDM | $443.20 | $554.00 | — | — | 20% |
| IV push of a medicine, first drug CPT 96374 HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH SINGLE/1ST SBST/DRUG CDM | $276.80 | $346.00 | — | 73% above | 20% |
| IV push of a medicine, first drug CPT 96374 HC INJ IV PUSH INITIAL DRUG CDM | $276.80 | $346.00 | — | 73% above | 20% |
| IV push of a medicine, first drug inpatient CPT 96374 HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH SINGLE/1ST SBST/DRUG CDM | $276.80 | $346.00 | — | — | 20% |
| IV push of a medicine, first drug inpatient CPT 96374 HC INJ IV PUSH INITIAL DRUG CDM | $276.80 | $346.00 | — | — | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC PR 96372 THER/PROPH/DIAG INJ SC/IM | $48.00 | $60.00 | — | 39% below | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC ED THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM CDM | $136.80 | $171.00 | — | 74% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJ SQ OR IM CDM | $136.80 | $171.00 | — | 74% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC PR 96372 THER/PROPH/DIAG INJ SC/IM | $48.00 | $60.00 | — | — | 20% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC ED THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM CDM | $136.80 | $171.00 | — | — | 20% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJ SQ OR IM CDM | $136.80 | $171.00 | — | — | 20% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PR 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION | $192.00 | $240.00 | — | 13% below | 20% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PR 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION | $192.00 | $240.00 | — | — | 20% |
| Neuromuscular re-education, 15 minutes CPT 97112 HC CRISIS TELEH 97112 NEUROMUSCUL REEDUCAT EA 15 MIN CDM | $68.00 | $85.00 | — | 23% below | 20% |
| Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSC REEDUCA THER PX 1 OR MORE AREAS EACH 15 MIN | $68.00 | $85.00 | — | 23% below | 20% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEUROMUSC REEDUCA THER PX 1 OR MORE AREAS EACH 15 MIN | $68.00 | $85.00 | — | — | 20% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC CRISIS TELEH 97112 NEUROMUSCUL REEDUCAT EA 15 MIN CDM | $68.00 | $85.00 | — | — | 20% |
| New patient office visit, about 30 minutes CPT 99203 HC PR 99203 NEW PT VISIT - LEVEL 3 | $148.00 | $185.00 | — | 11% below | 20% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC PR 99203 NEW PT VISIT - LEVEL 3 | $148.00 | $185.00 | — | — | 20% |
| New patient office visit, about 45 minutes CPT 99204 HC PR 99204 NEW PT VISIT - LEVEL 4 | $269.60 | $337.00 | — | 14% above | 20% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC PR 99204 NEW PT VISIT - LEVEL 4 | $269.60 | $337.00 | — | — | 20% |
| New patient office visit, about 60 minutes CPT 99205 HC PR 99205 NEW PT VISIT - LEVEL 5 | $305.60 | $382.00 | — | 8% below | 20% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC PR 99205 NEW PT VISIT - LEVEL 5 | $305.60 | $382.00 | — | — | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC PR 99202 NEW PT VISIT - LEVEL 2 | $197.60 | $247.00 | — | 38% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC PR 99202 NEW PT VISIT - LEVEL 2 | $197.60 | $247.00 | — | — | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MEDICAL NUTRITION INDIV INITIAL THERAPY EA 15 MIN CDM | $36.80 | $46.00 | — | 19% below | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MEDICAL NUTRITION INDIV INITIAL THERAPY EA 15 MIN CDM | $36.80 | $46.00 | — | — | 20% |
| Occupational therapy evaluation, low complexity CPT 97165 HC OT EVALUATION LOW COMPLEX | $119.20 | $149.00 | — | 30% below | 20% |
| Occupational therapy evaluation, low complexity CPT 97165 HC CRISIS TELEH 97165 OT EVALUATION LOW COMPLEX CDM | $119.20 | $149.00 | — | 30% below | 20% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 HC CRISIS TELEH 97165 OT EVALUATION LOW COMPLEX CDM | $119.20 | $149.00 | — | — | 20% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVALUATION LOW COMPLEX | $119.20 | $149.00 | — | — | 20% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC CRISIS TELEH 97163 PT EVALUATION HIGH COMPLEX CDM | $187.20 | $234.00 | — | 7% below | 20% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVALUATION HIGH COMPLEX | $187.20 | $234.00 | — | 7% below | 20% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVALUATION HIGH COMPLEX | $187.20 | $234.00 | — | — | 20% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC CRISIS TELEH 97163 PT EVALUATION HIGH COMPLEX CDM | $187.20 | $234.00 | — | — | 20% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVALUATION LOW COMPLEX CDM | $119.20 | $149.00 | — | 30% below | 20% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC CRISIS TELEH 97161 PT EVALUATION LOW COMPLEX CDM | $119.20 | $149.00 | — | 30% below | 20% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVALUATION LOW COMPLEX CDM | $119.20 | $149.00 | — | — | 20% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC CRISIS TELEH 97161 PT EVALUATION LOW COMPLEX CDM | $119.20 | $149.00 | — | — | 20% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVALUATION MOD COMPLEX CDM | $146.40 | $183.00 | — | 23% below | 20% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC CRISIS TELEH 97162 PT EVALUATION MOD COMPLEX CDM | $146.40 | $183.00 | — | 23% below | 20% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVALUATION MOD COMPLEX CDM | $146.40 | $183.00 | — | — | 20% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC CRISIS TELEH 97162 PT EVALUATION MOD COMPLEX CDM | $146.40 | $183.00 | — | — | 20% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THERAPY TQS 1 OR MORE REGIONS EACH 15 MINUTES | $59.20 | $74.00 | — | 25% below | 20% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THERAPY TQS 1 OR MORE REGIONS EACH 15 MINUTES | $59.20 | $74.00 | — | — | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN | $64.00 | $80.00 | — | 24% below | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC CRISIS TELEH 97110 THERAPEUTIC EXERCISES EA 15 MIN CDM | $64.00 | $80.00 | — | 24% below | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN | $64.00 | $80.00 | — | — | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC CRISIS TELEH 97110 THERAPEUTIC EXERCISES EA 15 MIN CDM | $64.00 | $80.00 | — | — | 20% |
| Psychiatric evaluation with medical services CPT 90792 HC PR 90792 PSYCH DIAG EVAL W MED SRVCS RHC | $318.40 | $398.00 | — | 4% above | 20% |
| Psychiatric evaluation with medical services CPT 90792 HC PSYCHIATRIC DIAG EVAL W MED SVCS CDM | $366.40 | $458.00 | — | 20% above | 20% |
| Psychiatric evaluation with medical services inpatient CPT 90792 HC PR 90792 PSYCH DIAG EVAL W MED SRVCS RHC | $318.40 | $398.00 | — | — | 20% |
| Psychiatric evaluation with medical services inpatient CPT 90792 HC PSYCHIATRIC DIAG EVAL W MED SVCS CDM | $366.40 | $458.00 | — | — | 20% |
| Psychotherapy for crisis, first 60 minutes CPT 90839 HC PR 90839 PSYCHOTHERAPY FOR CRISIS INITIAL 60 MIN | $200.00 | $250.00 | — | 5% below | 20% |
| Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC PR 90839 PSYCHOTHERAPY FOR CRISIS INITIAL 60 MIN | $200.00 | $250.00 | — | — | 20% |
| Psychotherapy session, 30 minutes CPT 90832 HC PR 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES | $98.40 | $123.00 | — | 12% below | 20% |
| Psychotherapy session, 30 minutes CPT 90832 HC PR 90832 PSYTX W PT 30 MIN RHC | $318.40 | $398.00 | — | 184% above | 20% |
| Psychotherapy session, 30 minutes CPT 90832 HC PSYCHOTHERAPY W PT 30 MIN CDM | $366.40 | $458.00 | — | 227% above | 20% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC PR 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES | $98.40 | $123.00 | — | — | 20% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC PR 90832 PSYTX W PT 30 MIN RHC | $318.40 | $398.00 | — | — | 20% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSYCHOTHERAPY W PT 30 MIN CDM | $366.40 | $458.00 | — | — | 20% |
| Psychotherapy session, 45 minutes CPT 90834 HC PR 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES | $137.60 | $172.00 | — | 4% below | 20% |
| Psychotherapy session, 45 minutes CPT 90834 HC PR 90834 PSYTX W PT 45 MIN RHC | $423.20 | $529.00 | — | 195% above | 20% |
| Psychotherapy session, 45 minutes CPT 90834 HC PSYCHOTHERAPY W PT 45 MIN CDM | $486.40 | $608.00 | — | 239% above | 20% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC PR 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES | $137.60 | $172.00 | — | — | 20% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC PR 90834 PSYTX W PT 45 MIN RHC | $423.20 | $529.00 | — | — | 20% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSYCHOTHERAPY W PT 45 MIN CDM | $486.40 | $608.00 | — | — | 20% |
| Psychotherapy session, 60 minutes CPT 90837 HC PR 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES | $184.00 | $230.00 | — | at median | 20% |
| Psychotherapy session, 60 minutes CPT 90837 HC PR 90837 PSYTX W PT 60 MIN RHC | $528.80 | $661.00 | — | 187% above | 20% |
| Psychotherapy session, 60 minutes CPT 90837 HC PSYCHOTHERAPY W PT 60 MIN CDM | $608.00 | $760.00 | — | 230% above | 20% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC PR 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES | $184.00 | $230.00 | — | — | 20% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC PR 90837 PSYTX W PT 60 MIN RHC | $528.80 | $661.00 | — | — | 20% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSYCHOTHERAPY W PT 60 MIN CDM | $608.00 | $760.00 | — | — | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC PR 99215 ESTAB PT VISIT - LEVEL 5 | $311.20 | $389.00 | — | 13% above | 20% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC PR 99215 ESTAB PT VISIT - LEVEL 5 | $311.20 | $389.00 | — | — | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC PR 99213 ESTAB PT VISIT - LEVEL 3 | $155.20 | $194.00 | — | 10% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC PR 99213 ESTAB PT VISIT - LEVEL 3 | $155.20 | $194.00 | — | — | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC PR 99214 ESTAB PT VISIT - LEVEL 4 | $244.00 | $305.00 | — | 22% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC PR 99214 ESTAB PT VISIT - LEVEL 4 | $244.00 | $305.00 | — | — | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC PR 99212 ESTAB PT VISIT - LEVEL 2 | $82.40 | $103.00 | — | 22% below | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC PR 99212 ESTAB PT VISIT - LEVEL 2 | $82.40 | $103.00 | — | — | 20% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 HC PR 99243 OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES CDM | $172.80 | $216.00 | — | 42% below | 20% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 HC PR 99243 OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES CDM | $172.80 | $216.00 | — | — | 20% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC PR 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES CDM | $277.60 | $347.00 | — | 28% below | 20% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 HC PR 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES CDM | $277.60 | $347.00 | — | — | 20% |
| Speech and language evaluation CPT 92523 HC EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION CDM | $224.80 | $281.00 | — | 38% below | 20% |
| Speech and language evaluation CPT 92523 HC CRISIS TELEH 92523 SPEECH SOUND LANG COMPREHEN CDM | $224.80 | $281.00 | — | 38% below | 20% |
| Speech and language evaluation inpatient CPT 92523 HC CRISIS TELEH 92523 SPEECH SOUND LANG COMPREHEN CDM | $224.80 | $281.00 | — | — | 20% |
| Speech and language evaluation inpatient CPT 92523 HC EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION CDM | $224.80 | $281.00 | — | — | 20% |
| Speech therapy session, individual CPT 92507 HC TX SPEECH/LANG/VOICE COMMJ/AUDITORY PROCESS - INDIVIDUAL | $131.20 | $164.00 | — | 29% below | 20% |
| Speech therapy session, individual CPT 92507 HC CRISIS TELEH 92507 SPEECH/HEARING THERAPY - INDIV CDM | $131.20 | $164.00 | — | 29% below | 20% |
| Speech therapy session, individual inpatient CPT 92507 HC TX SPEECH/LANG/VOICE COMMJ/AUDITORY PROCESS - INDIVIDUAL | $131.20 | $164.00 | — | — | 20% |
| Speech therapy session, individual inpatient CPT 92507 HC CRISIS TELEH 92507 SPEECH/HEARING THERAPY - INDIV CDM | $131.20 | $164.00 | — | — | 20% |
| Spirometry (breathing test) CPT 94010 HC BEDSIDE SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ CDM | $164.80 | $206.00 | — | 8% above | 20% |
| Spirometry (breathing test) CPT 94010 HC SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ | $164.80 | $206.00 | — | 8% above | 20% |
| Spirometry (breathing test) inpatient CPT 94010 HC SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ | $164.80 | $206.00 | — | — | 20% |
| Spirometry (breathing test) inpatient CPT 94010 HC BEDSIDE SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ CDM | $164.80 | $206.00 | — | — | 20% |
| Spirometry before and after a bronchodilator CPT 94060 HC SPIROMETRY PRE POST BRONCHODILATOR CDM | $291.20 | $364.00 | — | 35% below | 20% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 HC SPIROMETRY PRE POST BRONCHODILATOR CDM | $291.20 | $364.00 | — | — | 20% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 HC THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN | $60.00 | $75.00 | — | 31% below | 20% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN | $60.00 | $75.00 | — | — | 20% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC ED PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE CDM | $154.40 | $193.00 | — | 5% below | 20% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE | $154.40 | $193.00 | — | 5% below | 20% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE | $154.40 | $193.00 | — | — | 20% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC ED PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE CDM | $154.40 | $193.00 | — | — | 20% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Montana | Off list |
|---|---|---|---|---|---|
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 HC PR RX COVID-19 VACCINE SINGLE DOSE (MODERNA) PF IM 50 MCG/0.5 ML | $233.60 | $292.00 | — | 43% above | 20% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 HC PR RX COVID-19 VACCINE SINGLE DOSE (MODERNA) PF IM 50 MCG/0.5 ML | $233.60 | $292.00 | — | — | 20% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 HC PR RX COVID-19 VACCINE SINGLE DOSE (PFIZER) PF TRIS-SUC IM 30 MCG/0.3 ML | $209.60 | $262.00 | — | 51% above | 20% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 HC PR RX COVID-19 VACCINE SINGLE DOSE (PFIZER) PF TRIS-SUC IM 30 MCG/0.3 ML | $209.60 | $262.00 | — | — | 20% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VAC LIVE FOR INJ 1350 PFU/0.5ML | $427.51 | $534.39 | — | 99% above | 20% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VAC LIVE FOR INJ 1350 PFU/0.5ML | $427.51 | $534.39 | — | — | 20% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPH, ACELLULAR PERT & TET TOX INJ 25 LF-58 MCG-10 LF/0.5ML | $157.21 | $196.51 | — | 208% above | 20% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPH, ACELLULAR PERT & TET TOX INJ 15 LF-23 MCG-5 LF/0.5ML | $159.42 | $199.28 | — | 213% above | 20% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPH, ACELLULAR PERT & TET TOX INJ 25 LF-58 MCG-10 LF/0.5ML | $157.21 | $196.51 | — | — | 20% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPH, ACELLULAR PERT & TET TOX INJ 15 LF-23 MCG-5 LF/0.5ML | $159.42 | $199.28 | — | — | 20% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HC PR RX 9VHPV VACCINE 2/3 DOSE IM 0.5 ML | $152.80 | $191.00 | — | 56% below | 20% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HC PR RX 9VHPV VACCINE 2/3 DOSE IM 0.5 ML | $152.80 | $191.00 | — | — | 20% |
| Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE SUSP PREFILLED SYR 1440 EL UNIT/ML | $390.65 | $488.31 | — | 307% above | 20% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE SUSP PREFILLED SYR 1440 EL UNIT/ML | $390.65 | $488.31 | — | — | 20% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HAEMOPHILUS B POLYSACCHARIDE CONJUGATE VACCINE FOR INJ | $69.94 | $87.42 | — | 98% above | 20% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HAEMOPHILUS B POLYSACCHARIDE CONJUGATE VACCINE FOR INJ | $69.94 | $87.42 | — | — | 20% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES-MUMPS-RUBELLA VIRUS VACCINES FOR INJ SOLN | $505.65 | $632.06 | — | 287% above | 20% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES-MUMPS-RUBELLA VIRUS VACCINES FOR INJ SOLN | $505.65 | $632.06 | — | — | 20% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL (A, C, Y, AND W-135) TETANUS CONJUGATE VACCINE | $620.07 | $775.09 | — | 241% above | 20% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL (A, C, Y, AND W-135) TETANUS CONJUGATE VACCINE | $620.07 | $775.09 | — | — | 20% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL VAC B (RECOMB OMV ADJUV) INJ PREFILLED SYRINGE | $404.86 | $506.07 | — | 45% above | 20% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL VAC B (RECOMB OMV ADJUV) INJ PREFILLED SYRINGE | $404.86 | $506.07 | — | — | 20% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML | $634.68 | $793.35 | — | 100% above | 20% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML | $634.68 | $793.35 | — | — | 20% |
| Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC FOR INJ | $1,609.96 | $2,012.45 | — | 196% above | 20% |
| Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC FOR INJ | $1,609.96 | $2,012.45 | — | — | 20% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LF/0.5ML | $229.37 | $286.71 | — | 238% above | 20% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LF/0.5ML | $229.37 | $286.71 | — | — | 20% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TET-DIPH-ACELL PERTUSS AD PREF SYR 5-2.5-18.5 LF-MCG/0.5ML | $220.49 | $275.61 | — | 112% above | 20% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TET-DIPH-ACELL PERTUSS AD PREF SYR 5-2.5-18.5 LF-MCG/0.5ML | $220.49 | $275.61 | — | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN HEPATITIS B VACCINE CDM | $17.06 | $21.32 | — | 65% below | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN INFLUENZA VIRUS VAC CDM | $56.00 | $70.00 | — | 15% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZATION ADMIN CDM | $56.00 | $70.00 | — | 15% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN PNEUMOCOCCAL VACCINE CDM | $56.00 | $70.00 | — | 15% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN HEPATITIS B VACCINE CDM | $17.06 | $21.32 | — | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN PNEUMOCOCCAL VACCINE CDM | $56.00 | $70.00 | — | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN INFLUENZA VIRUS VAC CDM | $56.00 | $70.00 | — | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZATION ADMIN CDM | $56.00 | $70.00 | — | — | 20% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZATION ADMIN EACH ADD CDM | $56.00 | $70.00 | — | 75% above | 20% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC IMMUNIZATION ADMIN EACH ADD CDM | $56.00 | $70.00 | — | — | 20% |
Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More
Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More
List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More
Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More
Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.
Off list How much lower the cash price is than the list price.
No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More
At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More
Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.
Source file: https://pricetransparency.providence.org/wamt/live/810231793_st-patrick-hospital_standardcharges.json