Hospital

Phillips County Hospital Assn

Phillips County Hospital Assn in Malta, MT publishes cash prices for 216 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are above the Montana median for 162 of 214 procedures and below it for 38. By typical cash price it ranks #12 of 14 Montana hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

311 S 8TH AVE E, PO BOX 640, MALTA, MT, 59538-0640 Collected Sep 27, 2026 Source price file (406) 654-1100

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 271312 · CMS hospital register

The price file shows no self-pay discount

For 633 of the 649 prices listed here, the cash price in Phillips County Hospital Assn's file equals its full list price (chargemaster), so the file publishes no self-pay discount. That is why it compares as expensive. Many hospitals still reduce bills for uninsured patients or offer financial assistance based on income: before a planned visit, ask the billing office for its self-pay rate and discount policy in writing.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Breast ultrasound, limited (one breast or one area) CPT 76642 ULTRASOUND EXAM BREAST(S)DON'T USE	$270.00	$270.00	—	3% above	—
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 ULTRASOUND EXAM BREAST(S)DON'T USE	$270.00	$270.00	—	—	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT CHEST ANGIOGRAM W CONTRAST	$2,314.00	$2,314.00	—	at median	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT CHEST PE PROTOCOL	$2,693.00	$2,693.00	—	16% above	—
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT CHEST ANGIOGRAM W CONTRAST	$2,314.00	$2,314.00	—	—	—
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT CHEST PE PROTOCOL	$2,693.00	$2,693.00	—	—	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD/PEL W/O CONTRAST	$2,389.00	$2,389.00	—	at median	—
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD/PEL W/O CONTRAST	$2,389.00	$2,389.00	—	—	—
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PEL W/ CONTRAST	$3,348.00	$3,348.00	—	13% above	—
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT IVP KIDNEYS-URETERS-BLADDER	$3,364.00	$3,364.00	—	13% above	—
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PEL W/ CONTRAST	$3,348.00	$3,348.00	—	—	—
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT IVP KIDNEYS-URETERS-BLADDER	$3,364.00	$3,364.00	—	—	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT PELVIS WO/W CONTRAST	$3,109.00	$3,109.00	—	7% below	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD/PEL W & W/O CONTRA	$4,173.00	$4,173.00	—	24% above	—
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT PELVIS WO/W CONTRAST	$3,109.00	$3,109.00	—	—	—
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD/PEL W & W/O CONTRA	$4,173.00	$4,173.00	—	—	—
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN WITH CONTRAST	$1,532.00	$1,532.00	—	15% below	—
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN WITH CONTRAST	$1,532.00	$1,532.00	—	—	—
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN WITH OUT CONTRAST	$1,561.00	$1,561.00	—	at median	—
CT scan of the abdomen without contrast CPT 74150 CT RENAL STONE	$1,646.00	$1,646.00	—	5% above	—
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN WITH OUT CONTRAST	$1,561.00	$1,561.00	—	—	—
CT scan of the abdomen without contrast inpatient CPT 74150 CT RENAL STONE	$1,646.00	$1,646.00	—	—	—
CT scan of the face and sinuses, no contrast dye CPT 70486 CT FACIAL-SINUS W/O CONTR	$1,501.00	$1,501.00	—	21% above	—
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT FACIAL-SINUS W/O CONTR	$1,501.00	$1,501.00	—	—	—
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD-BRAIN W/O CONTRAS	$1,715.00	$1,715.00	—	18% above	—
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD-BRAIN W/O CONTRAS	$1,715.00	$1,715.00	—	—	—
CT scan of the head with contrast CPT 70460 CT HEAD-BRAIN W CONTRAST	$1,690.00	$1,690.00	—	5% above	—
CT scan of the head with contrast inpatient CPT 70460 CT HEAD-BRAIN W CONTRAST	$1,690.00	$1,690.00	—	—	—
CT scan of the head without and with contrast CPT 70470 CT HEAD-BRAIN W/O+W CONTR	$2,062.00	$2,062.00	—	2% below	—
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD-BRAIN W/O+W CONTR	$2,062.00	$2,062.00	—	—	—
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT L SPINE W/O CONTRAST	$1,948.00	$1,948.00	—	24% above	—
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT L SPINE W/O CONTRAST	$1,948.00	$1,948.00	—	—	—
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT C SPINE W/O CONTRAST	$1,988.00	$1,988.00	—	33% above	—
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT C SPINE W/O CONTRAST	$1,988.00	$1,988.00	—	—	—
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W CONTRAST	$1,088.00	$1,088.00	—	42% below	—
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W CONTRAST	$1,088.00	$1,088.00	—	—	—
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US CAROTID DOPPLER COMPLETE	$1,328.00	$1,328.00	—	20% above	—
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US CAROTID DOPPLER COMPLETE	$1,328.00	$1,328.00	—	—	—
Chest X-ray, 2 views CPT 71046 CHEST 2V	$260.00	$260.00	—	15% above	—
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2V	$260.00	$260.00	—	—	—
Chest X-ray, single view CPT 71045 CHEST 1 VIEW	$245.00	$245.00	—	34% above	—
Chest X-ray, single view inpatient CPT 71045 CHEST 1 VIEW	$245.00	$245.00	—	—	—
Complete ultrasound of the back of the abdomen, such as both kidneys both sides CPT 76770 US RENAL BILATERAL	$474.00	$474.00	—	—	—
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US ABDOMINAL AORTA	$409.50	$455.00	—	15% below	10%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL COMPLETE	$518.00	$518.00	—	7% above	—
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient both sides CPT 76770 US RENAL BILATERAL	$474.00	$474.00	—	—	—
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL COMPLETE	$518.00	$518.00	—	—	—
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA BONE DENSITY SCN AXL	$529.00	$529.00	—	58% above	—
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA BONE DENSITY SCN AXL	$529.00	$529.00	—	—	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST HI RESOLUTION	$1,663.00	$1,663.00	—	13% above	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST-THORAX W/O CONTR	$1,840.00	$1,840.00	—	25% above	—
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST HI RESOLUTION	$1,663.00	$1,663.00	—	—	—
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST-THORAX W/O CONTR	$1,840.00	$1,840.00	—	—	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST-THORAX W CONTRAS	$2,421.00	$2,421.00	—	30% above	—
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST-THORAX W CONTRAS	$2,421.00	$2,421.00	—	—	—
Diagnostic mammogram, both breasts both sides CPT 77066 MAMMOGRAM BILAT BREAST DIAG	$203.00	$203.00	—	—	—
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMOGRAM BILAT BREAST DIAG	$203.00	$203.00	—	—	—
Duplex ultrasound of the leg arteries, both legs CPT 93925 US DUPLEX LWR EXTERM ARTIERIES COMPLETE	$2,042.00	$2,042.00	—	103% above	—
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US DUPLEX LWR EXTERM ARTIERIES COMPLETE	$2,042.00	$2,042.00	—	—	—
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US VENOUS LOWER EXT BILATERAL DOPPLER	$2,127.00	$2,127.00	—	—	—
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US VENOUS UPPER EXT BILATERAL DOPPLER	$2,127.00	$2,127.00	—	—	—
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US VENOUS LOWER EXT BILATERAL DOPPLER	$2,127.00	$2,127.00	—	—	—
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US VENOUS UPPER EXT BILATERAL DOPPLER	$2,127.00	$2,127.00	—	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMINAL GALL BLADDER/LIVER	$605.70	$673.00	—	56% above	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMINAL LIMITED	$734.00	$734.00	—	89% above	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMINAL LIMITED	$734.00	$734.00	—	—	—
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT CHEST SMOKER LOW DOSE	$1,582.00	$1,582.00	—	247% above	—
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT CHEST SMOKER LOW DOSE	$1,582.00	$1,582.00	—	—	—
MRI of both breasts, without and then with contrast dye CPT 77049 MRI BREAST W/O C FLWD BY C W/CAD BILATER	$1,884.60	$2,094.00	—	at median	10%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWER EXTREMITY ANY JOINT W/O CON	$1,799.10	$1,999.00	—	1% below	10%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP RIGHT WO	$1,363.00	$1,363.00	—	25% below	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE RIGHT WO	$1,363.00	$1,363.00	—	25% below	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE LEFT WO	$1,363.00	$1,363.00	—	25% below	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE RIGHT WO	$1,363.00	$1,363.00	—	25% below	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE LEFT WO	$1,363.00	$1,363.00	—	25% below	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI TOE RIGHT WO	$1,367.00	$1,367.00	—	25% below	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI TOE LEFT WO	$1,367.00	$1,367.00	—	25% below	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP RIGHT WO	$1,363.00	$1,363.00	—	—	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE RIGHT WO	$1,363.00	$1,363.00	—	—	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE LEFT WO	$1,363.00	$1,363.00	—	—	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE LEFT WO	$1,363.00	$1,363.00	—	—	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE RIGHT WO	$1,363.00	$1,363.00	—	—	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI TOE LEFT WO	$1,367.00	$1,367.00	—	—	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI TOE RIGHT WO	$1,367.00	$1,367.00	—	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LWR EXTRM ANY JOINT W/O C FLWD BY C	$2,511.90	$2,791.00	—	14% below	10%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI TOE RIGHT WO/W CON	$3,276.00	$3,276.00	—	12% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI TOE LEFT WO/W CON	$3,276.00	$3,276.00	—	12% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE RIGHT WO/W CON	$3,295.00	$3,295.00	—	13% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP LEFT WO/W CON	$3,295.00	$3,295.00	—	13% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP RIGHT WO/W CON	$3,295.00	$3,295.00	—	13% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE LEFT WO/W CON	$3,295.00	$3,295.00	—	13% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE RIGHT WO/W CON	$3,295.00	$3,295.00	—	13% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE LEFT WO/W CON	$3,295.00	$3,295.00	—	13% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI TOE RIGHT WO/W CON	$3,276.00	$3,276.00	—	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI TOE LEFT WO/W CON	$3,276.00	$3,276.00	—	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP LEFT WO/W CON	$3,295.00	$3,295.00	—	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE RIGHT WO/W CON	$3,295.00	$3,295.00	—	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP RIGHT WO/W CON	$3,295.00	$3,295.00	—	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE LEFT WO/W CON	$3,295.00	$3,295.00	—	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE LEFT WO/W CON	$3,295.00	$3,295.00	—	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE RIGHT WO/W CON	$3,295.00	$3,295.00	—	—	—
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST	$1,829.00	$1,829.00	—	9% below	—
MRI of the abdomen without contrast CPT 74181 MRI MRCP WO	$2,103.00	$2,103.00	—	5% above	—
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTRAST	$1,829.00	$1,829.00	—	—	—
MRI of the abdomen without contrast inpatient CPT 74181 MRI MRCP WO	$2,103.00	$2,103.00	—	—	—
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/O CON FOLLOWED BY CONTRAST	$2,664.90	$2,961.00	—	17% below	10%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN WO/W CON	$4,217.00	$4,217.00	—	32% above	—
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI MRCP WO/W CON	$4,217.00	$4,217.00	—	32% above	—
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN WO/W CON	$4,217.00	$4,217.00	—	—	—
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI MRCP WO/W CON	$4,217.00	$4,217.00	—	—	—
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST	$1,922.00	$1,922.00	—	3% below	—
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST	$1,922.00	$1,922.00	—	—	—
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/O CON FOLLOWED BY CON	$3,556.00	$3,556.00	—	9% above	—
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/O CON FOLLOWED BY CON	$3,556.00	$3,556.00	—	—	—
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O CONTRAST	$2,809.00	$2,809.00	—	38% above	—
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O CONTRAST	$2,809.00	$2,809.00	—	—	—
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W/O CON FOLLWED BY CON	$2,571.30	$2,857.00	—	13% below	10%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W/O CON FOLLOWED BY CON	$2,700.00	$3,000.00	—	9% below	10%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE W/O CONTRAST	$2,634.00	$2,634.00	—	29% above	—
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE W/O CONTRAST	$2,634.00	$2,634.00	—	—	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL SPINE W/O CON FLWD BY CON	$2,599.20	$2,888.00	—	10% below	10%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL SPINE W/O CON FOLWED BY CON	$2,599.20	$2,888.00	—	10% below	10%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL SPINE W/O CON FOLWD BY CON	$2,599.20	$2,888.00	—	10% below	10%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE W/O CON	$2,513.00	$2,513.00	—	26% above	—
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL SPINE W/O CON	$2,513.00	$2,513.00	—	—	—
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/O CON FOLLOWED BY CON	$3,106.00	$3,106.00	—	at median	—
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/O CON FOLLOWED BY CON	$3,106.00	$3,106.00	—	—	—
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST	$1,981.00	$1,981.00	—	13% below	—
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST	$1,981.00	$1,981.00	—	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UPR EXTREM ANY JOINT W/O CONTRAST	$1,829.70	$2,033.00	—	6% below	10%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER LEFT WO	$1,367.00	$1,367.00	—	29% below	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER RIGHT WO	$1,367.00	$1,367.00	—	29% below	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST LEFT WO	$1,367.00	$1,367.00	—	29% below	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST RIGHT WO	$1,367.00	$1,367.00	—	29% below	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER RIGHT WO	$1,367.00	$1,367.00	—	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST LEFT WO	$1,367.00	$1,367.00	—	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST RIGHT WO	$1,367.00	$1,367.00	—	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER LEFT WO	$1,367.00	$1,367.00	—	—	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US BLADDER	$389.00	$389.00	—	23% above	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC LIMITED	$389.00	$389.00	—	23% above	—
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US BLADDER	$389.00	$389.00	—	—	—
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC LIMITED	$389.00	$389.00	—	—	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC COMPLETE	$349.00	$349.00	—	27% below	—
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC COMPLETE	$349.00	$349.00	—	—	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREGNANCY < 14 WEEKS	$513.00	$513.00	—	4% below	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREGNANCY < 14 WEEKS	$513.00	$513.00	—	—	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREGNANCY LIMITED	$375.00	$375.00	—	7% above	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US PREGNANCY LIMITED	$375.00	$375.00	—	—	—
Screening mammogram, both breasts CPT 77067 MAMMOGRAM SCREENING	$306.00	$306.00	—	9% above	—
Screening mammogram, both breasts inpatient CPT 77067 MAMMOGRAM SCREENING	$306.00	$306.00	—	—	—
Transvaginal pelvic ultrasound CPT 76830 US PELVIC TRANSVAGINAL	$399.00	$399.00	—	8% below	—
Transvaginal pelvic ultrasound inpatient CPT 76830 US PELVIC TRANSVAGINAL	$399.00	$399.00	—	—	—
Transvaginal ultrasound during pregnancy CPT 76817 US PREGNANCY TRANSVAGINAL	$421.00	$421.00	—	at median	—
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PREGNANCY TRANSVAGINAL	$421.00	$421.00	—	—	—
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE	$980.00	$980.00	—	86% above	—
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE	$980.00	$980.00	—	—	—
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM	$646.00	$646.00	—	38% above	—
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM	$646.00	$646.00	—	—	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US NECK NON VASCULAR	$381.00	$381.00	—	12% below	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID	$484.00	$484.00	—	12% above	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US NECK NON VASCULAR	$381.00	$381.00	—	—	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US THYROID	$484.00	$484.00	—	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP (RIGHT) 1-2 VIEWS	$193.00	$193.00	—	1% above	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP (RIGHT) 1-2 VIEWS	$193.00	$193.00	—	—	—
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN (KUB) 1 VIEW	$259.00	$259.00	—	44% above	—
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN (KUB) 1 VIEW	$259.00	$259.00	—	—	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 L SPINE 2-3 VIEWS	$318.00	$318.00	—	22% above	—
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 L SPINE 2-3 VIEWS	$318.00	$318.00	—	—	—
X-ray of the lower back, 4 or more views CPT 72110 L SPINE 4 VIEW	$315.00	$315.00	—	at median	—
X-ray of the lower back, 4 or more views inpatient CPT 72110 L SPINE 4 VIEW	$315.00	$315.00	—	—	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 THORACIC SPINE 2 VIEWS	$246.00	$246.00	—	1% above	—
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 THORACIC SPINE 2 VIEWS	$246.00	$246.00	—	—	—
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONE 3 VIEWS	$184.00	$184.00	—	17% below	—
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONE 3 VIEWS	$184.00	$184.00	—	—	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 C SPINE 2-3 VIEWS	$295.00	$295.00	—	21% above	—
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 C SPINE 2-3 VIEWS	$295.00	$295.00	—	—	—
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1-2 VIEWS	$226.00	$226.00	—	2% above	—
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1-2 VIEWS	$226.00	$226.00	—	—	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM / COCCYX 2-3 VIEWS	$245.00	$245.00	—	2% below	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM / COCCYX 2-3 VIEWS	$245.00	$245.00	—	—	—

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT	$56.00	$56.00	$4.24–$5.30	56% above	—
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT	$56.00	$56.00	$4.24–$5.30	—	—
AST (aspartate aminotransferase) enzyme test CPT 84450 AST	$48.00	$48.00	$4.14–$5.18	9% above	—
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST	$48.00	$48.00	$4.14–$5.18	—	—
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PANEL ACUTE W REFLEX HBsAg	$198.00	$198.00	$38.10–$47.63	at median	—
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANELso	$269.00	$269.00	$38.10–$47.63	36% above	—
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PANEL ACUTE W REFLEX HBsAg	$198.00	$198.00	$38.10–$47.63	—	—
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANELso	$269.00	$269.00	$38.10–$47.63	—	—
Allergy blood test, specific IgE, per allergen CPT 86003 COW DANDER IGEso	$32.00	$32.00	$4.18–$5.22	2% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 HORSE DANDER IGEso	$32.00	$32.00	$4.18–$5.22	2% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 SHORT RAGWEED IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 SUGAR IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 SHRIMP IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 COCONUT IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 SESAME SEED IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 RUSSIAN THISTLE IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 MUGWORT IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ASPERGILLUS FUMIGATUS IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 MOUNTAIN CEDAR IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 LATEX IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 HOUSE DUST MITES D. PTERONYSSINUSso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 HOUSE DUST MITES D. FARINAEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 BERMUDA GRASS IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 BOX ELD/MAPLE S IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 HELMINTHOSPORIUM HALODES IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 GREY ALDER IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 CANDIDA ALBICANS IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ELM IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 CASHEWS IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 DOG DANDER IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 CAT EPITHELIUM IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 CRAB IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 CHOCOLATE IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 CLADOSPORIUM IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 COTTONWOOD IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 COCKROACH IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 RED SORREL IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 PINAPPLE IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 PENICILLIUM CHRYSOGENUM IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 WATERMELON IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 PECAN IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 WALNUT IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 PEACH IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 OLIVE TREE IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 TIMOTHY GRASS IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 OAK IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ALMOND IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 MULBERRY IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ALTERNARIA TENUIS IGEso	$38.00	$38.00	$4.18–$5.22	16% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 RYE IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 GINGER IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 PORK IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 YEAST IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 SOYBEAN IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 WHEAT IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 CODFISH IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 STRAWBERRY IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 MILK IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 PEANUT IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 LOBSTER IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 BANANA IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 TUNA IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 CABBAGE IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 OAT IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 BARLEY IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 EGG WHITE IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 MUSHROOM IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 BEEF IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 GLUTEN IGEso	$39.00	$39.00	$4.18–$5.22	19% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ROUGH PIGWEED IGEso	$42.00	$42.00	$4.18–$5.22	28% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ASPERGILLUS NIGER IGEso	$42.00	$42.00	$4.18–$5.22	28% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 RICE IGEso	$43.00	$43.00	$4.18–$5.22	31% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 CORN IGEso	$43.00	$43.00	$4.18–$5.22	31% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 GALACTOSE ALPHA 1 3 GALACTOSE IGEso	$110.00	$110.00	$4.18–$5.22	235% above	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COW DANDER IGEso	$32.00	$32.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HORSE DANDER IGEso	$32.00	$32.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CRAB IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CASHEWS IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 DOG DANDER IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CANDIDA ALBICANS IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ELM IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 GREY ALDER IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BOX ELD/MAPLE S IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HELMINTHOSPORIUM HALODES IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BERMUDA GRASS IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HOUSE DUST MITES D. FARINAEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HOUSE DUST MITES D. PTERONYSSINUSso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LATEX IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SHRIMP IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ASPERGILLUS FUMIGATUS IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MOUNTAIN CEDAR IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALTERNARIA TENUIS IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MUGWORT IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALMOND IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MULBERRY IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SUGAR IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 OAK IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 TIMOTHY GRASS IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 OLIVE TREE IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PEACH IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WALNUT IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PECAN IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WATERMELON IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PENICILLIUM CHRYSOGENUM IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PINAPPLE IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RED SORREL IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RUSSIAN THISTLE IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SESAME SEED IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SHORT RAGWEED IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COCKROACH IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COCONUT IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CLADOSPORIUM IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COTTONWOOD IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CHOCOLATE IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CAT EPITHELIUM IGEso	$38.00	$38.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SOYBEAN IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 STRAWBERRY IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 YEAST IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WHEAT IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 TUNA IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BANANA IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BARLEY IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BEEF IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CABBAGE IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CODFISH IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 EGG WHITE IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 GINGER IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 GLUTEN IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LOBSTER IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MILK IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MUSHROOM IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 OAT IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PEANUT IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PORK IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RYE IGEso	$39.00	$39.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ASPERGILLUS NIGER IGEso	$42.00	$42.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ROUGH PIGWEED IGEso	$42.00	$42.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RICE IGEso	$43.00	$43.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CORN IGEso	$43.00	$43.00	$4.18–$5.22	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 GALACTOSE ALPHA 1 3 GALACTOSE IGEso	$110.00	$110.00	$4.18–$5.22	—	—
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPTID ANTI IgG IgA	$158.00	$158.00	$10.36–$12.95	74% above	—
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODIESso	$174.00	$174.00	$10.36–$12.95	91% above	—
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEPTID ANTI IgG IgA	$158.00	$158.00	$10.36–$12.95	—	—
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP ANTIBODIESso	$174.00	$174.00	$10.36–$12.95	—	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES so	$42.00	$42.00	$9.67–$12.09	38% below	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 CONNECTIVE TISSUE DISEASE CASCADE SERUM	$538.00	$538.00	$9.67–$12.09	692% above	—
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES so	$42.00	$42.00	$9.67–$12.09	—	—
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 CONNECTIVE TISSUE DISEASE CASCADE SERUM	$538.00	$538.00	$9.67–$12.09	—	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BTYPE NATRIURETIC PEPTIDE	$300.00	$300.00	$31.41–$39.26	72% above	—
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BTYPE NATRIURETIC PEPTIDE	$300.00	$300.00	$31.41–$39.26	—	—
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL ePOC	$116.00	$116.00	$6.77–$8.46	36% above	—
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$122.00	$122.00	$6.77–$8.46	43% above	—
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL ePOC	$116.00	$116.00	$6.77–$8.46	—	—
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$122.00	$122.00	$6.77–$8.46	—	—
Blood culture for bacteria CPT 87040 CULTURE BLOOD (AER&ANA) SET 1so	$206.00	$206.00	$8.26–$10.32	27% above	—
Blood culture for bacteria CPT 87040 CULTURE BLOOD (AER&ANA) SET 2so	$206.00	$206.00	$8.26–$10.32	27% above	—
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD (AER&ANA) SET 1so	$206.00	$206.00	$8.26–$10.32	—	—
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD (AER&ANA) SET 2so	$206.00	$206.00	$8.26–$10.32	—	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 SPECIMEN COLLECT CAPILLARY	$29.00	$29.00	$7.27–$9.09	37% above	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 SPECIMEN COLLECT VENOUS	$32.00	$32.00	$7.27–$9.09	51% above	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 SPECIMEN COLLECT CAPILLARY	$29.00	$29.00	$7.27–$9.09	—	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 SPECIMEN COLLECT VENOUS	$32.00	$32.00	$7.27–$9.09	—	—
Blood glucose (sugar) test CPT 82947 GLUCOSE	$48.00	$48.00	$3.14–$3.93	38% above	—
Blood glucose (sugar) test CPT 82947 GLUCOSE ePOC	$50.00	$50.00	$3.14–$3.93	44% above	—
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE	$48.00	$48.00	$3.14–$3.93	—	—
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE ePOC	$50.00	$50.00	$3.14–$3.93	—	—
Blood lead test CPT 83655 LEAD URINE 24 HRso	$102.00	$102.00	$9.69–$12.11	101% above	—
Blood lead test CPT 83655 LEADso	$102.00	$102.00	$9.69–$12.11	101% above	—
Blood lead test inpatient CPT 83655 LEAD URINE 24 HRso	$102.00	$102.00	$9.69–$12.11	—	—
Blood lead test inpatient CPT 83655 LEADso	$102.00	$102.00	$9.69–$12.11	—	—
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG SERUM	$106.00	$106.00	$6.02–$7.52	117% above	—
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG URINE	$118.00	$118.00	$6.02–$7.52	142% above	—
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG SERUM	$106.00	$106.00	$6.02–$7.52	—	—
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG URINE	$118.00	$118.00	$6.02–$7.52	—	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BB ABO BLOOD TYPE	$51.00	$51.00	$2.39–$2.99	52% below	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BB ABO BLOOD TYPE	$51.00	$51.00	$2.39–$2.99	—	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CRPso	$104.00	$104.00	$4.14–$5.18	120% above	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CRPso	$104.00	$104.00	$4.14–$5.18	—	—
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9so	$192.00	$192.00	$16.65–$20.81	56% above	—
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9so	$192.00	$192.00	$16.65–$20.81	—	—
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125so	$199.00	$199.00	$16.65–$20.81	63% above	—
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125so	$199.00	$199.00	$16.65–$20.81	—	—
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$154.00	$154.00	$10.71–$13.39	105% above	—
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$154.00	$154.00	$10.71–$13.39	—	—
Complete blood count (CBC) with differential CPT 85025 .CBC W AUTO DIFFERENTIAL CHARGE ONLY	$91.00	$91.00	$6.22–$7.77	67% above	—
Complete blood count (CBC) with differential inpatient CPT 85025 .CBC W AUTO DIFFERENTIAL CHARGE ONLY	$91.00	$91.00	$6.22–$7.77	—	—
Complete blood count (CBC), no differential CPT 85027 CBC ONLY	$48.00	$48.00	$5.18–$6.47	at median	—
Complete blood count (CBC), no differential CPT 85027 .HEMOGRAM CHARGE ONLY	$48.00	$48.00	$5.18–$6.47	at median	—
Complete blood count (CBC), no differential inpatient CPT 85027 .HEMOGRAM CHARGE ONLY	$48.00	$48.00	$5.18–$6.47	—	—
Complete blood count (CBC), no differential inpatient CPT 85027 CBC ONLY	$48.00	$48.00	$5.18–$6.47	—	—
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$231.00	$231.00	$8.45–$10.56	124% above	—
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL	$231.00	$231.00	$8.45–$10.56	—	—
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER	$155.00	$155.00	$8.14–$10.18	49% above	—
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER	$155.00	$155.00	$8.14–$10.18	—	—
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATEso	$200.00	$200.00	$17.78–$22.23	57% above	—
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATEso	$200.00	$200.00	$17.78–$22.23	—	—
Estradiol blood test CPT 82670 ESTRADIOLso	$233.00	$233.00	$22.35–$27.94	73% above	—
Estradiol blood test inpatient CPT 82670 ESTRADIOLso	$233.00	$233.00	$22.35–$27.94	—	—
FSH (follicle-stimulating hormone) test CPT 83001 FSHso	$152.00	$152.00	$14.86–$18.58	21% above	—
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSHso	$152.00	$152.00	$14.86–$18.58	—	—
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTINso	$225.00	$225.00	$15.70–$19.63	23% below	—
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTINso	$225.00	$225.00	$15.70–$19.63	—	—
Ferritin blood test (iron stores) CPT 82728 FERRITINso	$123.00	$123.00	$10.90–$13.63	33% above	—
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITINso	$123.00	$123.00	$10.90–$13.63	—	—
Folate (folic acid) blood test CPT 82746 FOLATEso	$149.00	$149.00	$11.76–$14.70	60% above	—
Folate (folic acid) blood test inpatient CPT 82746 FOLATEso	$149.00	$149.00	$11.76–$14.70	—	—
Free T3 thyroid hormone test CPT 84481 T3 FREEso	$207.00	$207.00	$13.55–$16.94	69% above	—
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREEso	$207.00	$207.00	$13.55–$16.94	—	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREEso	$141.00	$141.00	$7.22–$9.02	132% above	—
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREEso	$141.00	$141.00	$7.22–$9.02	—	—
Free testosterone test CPT 84402 FREE TESTOSTERONEso	$231.00	$231.00	$20.38–$25.47	65% above	—
Free testosterone test inpatient CPT 84402 FREE TESTOSTERONEso	$231.00	$231.00	$20.38–$25.47	—	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 3-HR POSTPRANDIAL	$62.00	$62.00	$3.80–$4.75	at median	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 1-HR POSTPRANDIAL	$65.00	$65.00	$3.80–$4.75	5% above	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 2-HR POSTPRANDIAL	$65.00	$65.00	$3.80–$4.75	5% above	—
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE 3-HR POSTPRANDIAL	$62.00	$62.00	$3.80–$4.75	—	—
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE 2-HR POSTPRANDIAL	$65.00	$65.00	$3.80–$4.75	—	—
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE 1-HR POSTPRANDIAL	$65.00	$65.00	$3.80–$4.75	—	—
H. pylori antibody blood test CPT 86677 H. PYLORI	$167.00	$167.00	$13.48–$16.85	56% above	—
H. pylori antibody blood test inpatient CPT 86677 H. PYLORI	$167.00	$167.00	$13.48–$16.85	—	—
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV1 VIRAL RNA QUALITATIVE PCRso	$431.00	$431.00	$68.08–$85.10	66% above	—
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV1 VIRAL RNA QUALITATIVE PCRso	$431.00	$431.00	$68.08–$85.10	—	—
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1 & 2 ANTIGEN/ANTIBODIESso	$133.00	$133.00	$10.97–$13.71	62% above	—
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1 & 2 ANTIGEN/ANTIBODIESso	$133.00	$133.00	$10.97–$13.71	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 A1C WITH AVERAGE GLUCOSE	$136.00	$136.00	$7.77–$9.71	141% above	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 A1C WITH AVERAGE GLUCOSE	$136.00	$136.00	$7.77–$9.71	—	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY TITERso	$107.00	$107.00	$8.59–$10.74	42% above	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODYso	$107.00	$107.00	$8.59–$10.74	42% above	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B VIRUS PAST EXPOSURE PANEL	$266.00	$266.00	$8.59–$10.74	254% above	—
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE ANTIBODYso	$107.00	$107.00	$8.59–$10.74	—	—
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE ANTIBODY TITERso	$107.00	$107.00	$8.59–$10.74	—	—
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B VIRUS PAST EXPOSURE PANEL	$266.00	$266.00	$8.59–$10.74	—	—
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE ANTIGENso	$88.00	$88.00	$8.26–$10.33	41% above	—
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE ANTIGENso	$88.00	$88.00	$8.26–$10.33	—	—
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODYso	$116.00	$116.00	$11.42–$14.27	at median	—
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C VIRUS ANTIBODY REFLEX	$557.00	$557.00	$11.42–$14.27	380% above	—
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODYso	$116.00	$116.00	$11.42–$14.27	—	—
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C VIRUS ANTIBODY REFLEX	$557.00	$557.00	$11.42–$14.27	—	—
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C VIRAL RNA PCRso	$592.00	$592.00	$34.27–$42.84	16% above	—
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C VIRAL RNA PCRso	$592.00	$592.00	$34.27–$42.84	—	—
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE I IGGso	$102.00	$102.00	$10.55–$13.19	34% above	—
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX TYPE I IGGso	$102.00	$102.00	$10.55–$13.19	—	—
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE II IGGso	$102.00	$102.00	$15.48–$19.35	1% above	—
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX TYPE II IGGso	$102.00	$102.00	$15.48–$19.35	—	—
High-sensitivity CRP (hs-CRP) test CPT 86141 HS-CRPso	$116.00	$116.00	$10.36–$12.95	67% above	—
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HS-CRPso	$116.00	$116.00	$10.36–$12.95	—	—
Homocysteine blood test CPT 83090 HOMOCYSTEINEso	$140.00	$140.00	$14.34–$17.92	21% above	—
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINEso	$140.00	$140.00	$14.34–$17.92	—	—
Insulin blood test CPT 83525 INSULINso	$155.00	$155.00	$9.14–$11.43	57% above	—
Insulin blood test inpatient CPT 83525 INSULINso	$155.00	$155.00	$9.14–$11.43	—	—
Iron blood test (serum iron) CPT 83540 IRONso	$82.00	$82.00	$5.18–$6.47	117% above	—
Iron blood test (serum iron) inpatient CPT 83540 IRONso	$82.00	$82.00	$5.18–$6.47	—	—
Iron-binding capacity (TIBC) test CPT 83550 TIBCso	$75.00	$75.00	$6.99–$8.74	64% above	—
Iron-binding capacity (TIBC) test inpatient CPT 83550 TIBCso	$75.00	$75.00	$6.99–$8.74	—	—
Kidney function blood test panel CPT 80069 RENAL PANEL	$154.00	$154.00	$6.94–$8.68	49% above	—
Kidney function blood test panel inpatient CPT 80069 RENAL PANEL	$154.00	$154.00	$6.94–$8.68	—	—
LH (luteinizing hormone) test CPT 83002 LHso	$152.00	$152.00	$14.82–$18.52	30% above	—
LH (luteinizing hormone) test inpatient CPT 83002 LHso	$152.00	$152.00	$14.82–$18.52	—	—
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$108.00	$108.00	$5.51–$6.89	78% above	—
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$108.00	$108.00	$5.51–$6.89	—	—
Liver function blood test panel CPT 80076 HEPATIC PANEL	$134.00	$134.00	$6.54–$8.17	74% above	—
Liver function blood test panel inpatient CPT 80076 HEPATIC PANEL	$134.00	$134.00	$6.54–$8.17	—	—
Lyme disease antibody test CPT 86618 LYME'S ANTIBODY SEROLOGYso	$65.00	$65.00	$13.62–$17.03	48% below	—
Lyme disease antibody test CPT 86618 TICK BORNE DISEASE ANTI PANEL SERUM	$665.00	$665.00	$13.62–$17.03	435% above	—
Lyme disease antibody test inpatient CPT 86618 LYME'S ANTIBODY SEROLOGYso	$65.00	$65.00	$13.62–$17.03	—	—
Lyme disease antibody test inpatient CPT 86618 TICK BORNE DISEASE ANTI PANEL SERUM	$665.00	$665.00	$13.62–$17.03	—	—
Magnesium blood test CPT 83735 MAGNESIUM	$83.00	$83.00	$5.36–$6.70	38% above	—
Magnesium blood test CPT 83735 MAGNESIUM ON RED CELLso	$136.00	$136.00	$5.36–$6.70	127% above	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$83.00	$83.00	$5.36–$6.70	—	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM ON RED CELLso	$136.00	$136.00	$5.36–$6.70	—	—
Measles (rubeola) antibody test CPT 86765 MEASLES (RUBEOLA) ANTIBODY IGGso	$78.00	$78.00	$10.30–$12.88	88% above	—
Measles (rubeola) antibody test CPT 86765 MEASLES (RUBEOLA) ANTIBODY IGMso	$78.00	$78.00	$10.30–$12.88	88% above	—
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES (RUBEOLA) ANTIBODY IGMso	$78.00	$78.00	$10.30–$12.88	—	—
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES (RUBEOLA) ANTIBODY IGGso	$78.00	$78.00	$10.30–$12.88	—	—
Mono test (heterophile antibody, Monospot) CPT 86308 MONOSPOT	$72.00	$72.00	$4.14–$5.18	43% above	—
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOSPOT	$72.00	$72.00	$4.14–$5.18	—	—
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREEso	$132.00	$132.00	$14.71–$18.39	56% above	—
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREEso	$132.00	$132.00	$14.71–$18.39	—	—
PSA (prostate-specific antigen) blood test, total CPT 84153 PSAso	$165.00	$165.00	$14.71–$18.39	47% above	—
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSAso	$165.00	$165.00	$14.71–$18.39	—	—
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT- NO REFLEXso	$314.00	$314.00	$33.02–$41.28	54% above	—
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT- NO REFLEXso	$314.00	$314.00	$33.02–$41.28	—	—
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT REFERENCE LABso	$87.00	$87.00	$4.81–$6.01	56% above	—
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$99.00	$99.00	$4.81–$6.01	78% above	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT REFERENCE LABso	$87.00	$87.00	$4.81–$6.01	—	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$99.00	$99.00	$4.81–$6.01	—	—
Progesterone blood test CPT 84144 PROGESTERONEso	$166.00	$166.00	$16.69–$20.86	13% above	—
Progesterone blood test inpatient CPT 84144 PROGESTERONEso	$166.00	$166.00	$16.69–$20.86	—	—
Prolactin blood test CPT 84146 PROLACTINso	$166.00	$166.00	$15.50–$19.38	27% above	—
Prolactin blood test inpatient CPT 84146 PROLACTINso	$166.00	$166.00	$15.50–$19.38	—	—
Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR REFERENCE LABORATORYso	$51.00	$51.00	$3.43–$4.29	42% above	—
Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR	$63.00	$63.00	$3.43–$4.29	75% above	—
Prothrombin time (PT/INR) clotting test CPT 85610 LUPUS ANTICOAGULANT PROFILE PLASMA	$1,248.00	$1,248.00	$3.43–$4.29	3367% above	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR REFERENCE LABORATORYso	$51.00	$51.00	$3.43–$4.29	—	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR	$63.00	$63.00	$3.43–$4.29	—	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 LUPUS ANTICOAGULANT PROFILE PLASMA	$1,248.00	$1,248.00	$3.43–$4.29	—	—
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 UDS NEW EMPLOYEE	$75.00	$75.00	$10.08–$12.60	at median	—
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 UDS ER/MEDICAL DRUG SCREEN	$123.00	$123.00	$10.08–$12.60	64% above	—
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 UDS NEW EMPLOYEE	$75.00	$75.00	$10.08–$12.60	—	—
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 UDS ER/MEDICAL DRUG SCREEN	$123.00	$123.00	$10.08–$12.60	—	—
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANTITATIVEso	$93.00	$93.00	$4.54–$5.67	118% above	—
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR IGG IGA PANELso	$117.00	$117.00	$4.54–$5.67	174% above	—
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANTITATIVEso	$93.00	$93.00	$4.54–$5.67	—	—
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR IGG IGA PANELso	$117.00	$117.00	$4.54–$5.67	—	—
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODIES IGGso	$65.00	$65.00	$11.51–$14.39	14% above	—
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA ANTIBODIES IGGso	$65.00	$65.00	$11.51–$14.39	—	—
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HEMOCULT	$8.00	$8.00	$12.74–$15.92	86% below	—
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HEMOCULT	$8.00	$8.00	$12.74–$15.92	—	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPRso	$78.00	$78.00	$3.42–$4.27	47% above	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPRso	$78.00	$78.00	$3.42–$4.27	—	—
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON GOLDso	$221.00	$221.00	$49.58–$61.98	39% above	—
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON GOLDso	$221.00	$221.00	$49.58–$61.98	—	—
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONEso	$191.00	$191.00	$20.65–$25.81	38% above	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONEso	$191.00	$191.00	$20.65–$25.81	—	—
Thyroid peroxidase (TPO) antibody test CPT 86376 TPO ANTIBODIESso	$134.00	$134.00	$11.64–$14.55	64% above	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 TPO ANTIBODIESso	$134.00	$134.00	$11.64–$14.55	—	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSHso	$108.00	$108.00	$13.44–$16.80	41% above	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH CASCADEso	$112.00	$112.00	$13.44–$16.80	47% above	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSHso	$108.00	$108.00	$13.44–$16.80	—	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH CASCADEso	$112.00	$112.00	$13.44–$16.80	—	—
Uric acid blood test CPT 84550 URIC ACID	$72.00	$72.00	$3.62–$4.52	55% above	—
Uric acid blood test inpatient CPT 84550 URIC ACID	$72.00	$72.00	$3.62–$4.52	—	—
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS WITH MICROSCOPY	$52.00	$52.00	$2.54–$3.17	1% below	—
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS WITH MICROSCOPY	$52.00	$52.00	$2.54–$3.17	—	—
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS DIPSTICK	$32.00	$32.00	$1.80–$2.25	at median	—
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS ROUTINE REFLEX CULTURE	$45.00	$45.00	$1.80–$2.25	41% above	—
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS DIPSTICK	$32.00	$32.00	$1.80–$2.25	—	—
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS ROUTINE REFLEX CULTURE	$45.00	$45.00	$1.80–$2.25	—	—
Urinalysis without microscope exam, manual CPT 81002 ACETONE URINE	$25.00	$25.00	$2.78–$3.48	56% above	—
Urinalysis without microscope exam, manual inpatient CPT 81002 ACETONE URINE	$25.00	$25.00	$2.78–$3.48	—	—
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINEso	$100.00	$100.00	$6.46–$8.07	35% above	—
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINEso	$100.00	$100.00	$6.46–$8.07	—	—
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12so	$134.00	$134.00	$12.06–$15.08	41% above	—
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12so	$134.00	$134.00	$12.06–$15.08	—	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25-OH D2 & D3so	$88.00	$88.00	$23.68–$29.60	3% below	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25-OHso	$139.00	$139.00	$23.68–$29.60	53% above	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25-OH D2 & D3so	$88.00	$88.00	$23.68–$29.60	—	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25-OHso	$139.00	$139.00	$23.68–$29.60	—	—
Zinc blood test CPT 84630 ZINCso	$159.00	$159.00	$9.11–$11.39	94% above	—
Zinc blood test CPT 84630 ZINC ON RED CELLso	$159.00	$159.00	$9.11–$11.39	94% above	—
Zinc blood test inpatient CPT 84630 ZINCso	$159.00	$159.00	$9.11–$11.39	—	—
Zinc blood test inpatient CPT 84630 ZINC ON RED CELLso	$159.00	$159.00	$9.11–$11.39	—	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 B-HCG QUANTITATIVEso	$159.00	$159.00	$12.04–$15.05	41% above	—
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 B-HCG QUANTITATIVEso	$159.00	$159.00	$12.04–$15.05	—	—

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION PREMALIGNANT 1ST LESION	$194.00	$194.00	$194.17–$286.05	18% above	—
Earwax removal by irrigation (rinsing), one ear CPT 69209 IRRIGATION - EAR	$25.00	$25.00	—	2% below	—
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 IRRIGATION - EAR	$25.00	$25.00	—	—	—
Earwax removal with instruments, one ear CPT 69210 REMOVAL IMPACTED CERUMEN W INSTR	$155.00	$155.00	$194.17–$286.05	120% above	—
Hemorrhoid banding (rubber band ligation) CPT 46221 HEMMORHOID BANDING	$338.00	$338.00	$194.17–$286.05	34% below	—
IUD insertion (the device itself billed separately) CPT 58300 IUD INSERTION	$399.00	$399.00	$194.17–$286.05	126% above	—
Incision and drainage of a simple or single skin abscess CPT 10060 INCISION AND DRAINAGE SIMPLE/SINGLE	$282.00	$282.00	$194.17–$286.05	30% above	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ SINGLE TENDON SHEATH/LIGAMENT	$228.00	$228.00	$194.17–$286.05	11% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 MAJOR JOINT ASPIRATION/INJECTION	$285.00	$285.00	$194.17–$286.05	at median	—
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERTION NEXPLANON	$374.00	$374.00	$194.17–$286.05	25% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 INTERMEDIATE JOINT INJ /ASPIRATION	$217.00	$217.00	$194.17–$286.05	18% above	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 MINOR JOINT INJ/ASP (FINGERS & TOES)	$227.00	$227.00	$194.17–$286.05	99% above	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC BEN LES 0.5 <(TRUNK ARMS LEGS)	$303.00	$303.00	$194.17–$286.05	33% above	—
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EX BEN LES 0.5CM OR LESS (FACE EAR)	$403.00	$403.00	$194.17–$286.05	6% above	—
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION PRTL/COM SIM/SIN	$220.00	$220.00	$194.17–$286.05	45% above	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL PERMANENT	$492.00	$492.00	$194.17–$286.05	38% above	—
Removal of a foreign object under the skin, simple CPT 10120 FB REMOVAL SUBCUTANEOUS TISSUE	$436.00	$436.00	$194.17–$286.05	76% above	—
Short arm cast (elbow to hand) CPT 29075 APP SHORT ARM CAST	$384.00	$384.00	$194.17–$286.05	104% above	—
Short arm splint (forearm and hand) CPT 29125 APP SHORT ARM SPLINT	$249.00	$249.00	$194.17–$286.05	105% above	—
Short leg cast (below the knee) CPT 29405 SHORT LEG CAST	$394.00	$394.00	$194.17–$286.05	118% above	—
Short leg splint (calf to foot) CPT 29515 APP SHORT LEG SPLINT	$206.00	$206.00	$194.17–$286.05	43% above	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 LAC REPAIR SIM 2.5<SCALP NECK EXTREMITIE	$472.00	$472.00	$194.17–$286.05	105% above	—
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY SKIN	$307.00	$307.00	$194.17–$286.05	24% above	—
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC MAL LES 0.5<(TRUNK ARMS LEGS)	$563.00	$563.00	$194.17–$286.05	57% above	—
Skin tag removal, up to 15 tags CPT 11200 SKIN TAG REMOVAL ANY METHOD UP TO 15	$234.00	$234.00	$194.17–$286.05	72% above	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 LAC REPAIR SIM 2.6-7.5 SLP NCKTRNKEXTGEN	$615.00	$615.00	$194.17–$286.05	162% above	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 LAC REPAIR SIM2.5<(FACE EARS EYELID NOSE	$608.00	$608.00	$194.17–$286.05	135% above	—
Tangential (shave-style) skin biopsy, one lesion CPT 11102 BX OF SKIN-DIAG/SHAVE, SCOOP, CURE, SAUC	$250.00	$250.00	$194.17–$286.05	44% above	—
Trigger point injections, 1 or 2 muscles CPT 20552 TRIGGER POINT INJ 1 OR 2 MUSCLES	$269.00	$269.00	$194.17–$286.05	121% above	—
Wart removal, up to 14 warts CPT 17110 CRYO/DESTRUCT-WART/MOLLUSCUM-14 LESION	$243.00	$243.00	$194.17–$286.05	12% above	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT SUBQ TISSUE 20 SQ CM/<	$336.00	$336.00	$194.17–$286.05	78% above	—

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BB BLOOD PRODUCT TRANSFUSION	$362.00	$362.00	—	63% below	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BB BLOOD PRODUCT TRANSFUSION	$362.00	$362.00	—	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEBULIZER TX	$60.00	$60.00	$194.17–$286.05	54% below	—
Critical care, first 30 to 74 minutes CPT 99291 ER LEVEL 6 - FIRST 74 MINS -NURSING	$1,012.00	$1,012.00	$199.04	71% above	—
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE 1ST HR	$1,227.00	$1,227.00	$199.04	107% above	—
Critical care, first 30 to 74 minutes inpatient CPT 99291 ER LEVEL 6 - FIRST 74 MINS -NURSING	$1,012.00	$1,012.00	$199.04	—	—
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE 1ST HR	$1,227.00	$1,227.00	$199.04	—	—
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG INTERPRETATION	$35.00	$35.00	$194.17–$286.05	65% below	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG	$229.00	$229.00	—	49% above	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG	$229.00	$229.00	—	—	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER LEVEL 1 - NURSING CHARGE	$224.00	$224.00	$11.02	155% above	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER LEVEL 1 - PROVIDER CHARGE	$254.00	$254.00	$11.02	189% above	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER LEVEL 1 - NURSING CHARGE	$224.00	$224.00	$11.02	—	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER LEVEL 1 - PROVIDER CHARGE	$254.00	$254.00	$11.02	—	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER LEVEL 2 - PROVIDER CHARGE	$350.00	$350.00	$40.41	149% above	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER LEVEL 2 - NURSING CHARGE	$403.00	$403.00	$40.41	187% above	—
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER LEVEL 2 - PROVIDER CHARGE	$350.00	$350.00	$40.41	—	—
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER LEVEL 2 - NURSING CHARGE	$403.00	$403.00	$40.41	—	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER LEVEL 3 - PROVIDER CHARGE	$652.00	$652.00	$69.46	181% above	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER LEVEL 3 - NURSING CHARGE	$717.00	$717.00	$69.46	209% above	—
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER LEVEL 3 - PROVIDER CHARGE	$652.00	$652.00	$69.46	—	—
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER LEVEL 3 - NURSING CHARGE	$717.00	$717.00	$69.46	—	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER LEVEL 4 - PROVIDER CHARGE	$823.00	$823.00	$118.22	99% above	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER LEVEL 4 - NURSING CHARGE	$898.00	$898.00	$118.22	117% above	—
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER LEVEL 4 - PROVIDER CHARGE	$823.00	$823.00	$118.22	—	—
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER LEVEL 4 - NURSING CHARGE	$898.00	$898.00	$118.22	—	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER LEVEL 5 - PROVIDER CHARGE	$1,179.00	$1,179.00	$171.31	113% above	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER LEVEL 5 - NURSING CHARGE	$1,341.00	$1,341.00	$171.31	143% above	—
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER LEVEL 5 - PROVIDER CHARGE	$1,179.00	$1,179.00	$171.31	—	—
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER LEVEL 5 - NURSING CHARGE	$1,341.00	$1,341.00	$171.31	—	—
Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYTX WITH PATIENT 50 MIN	$182.00	$182.00	$194.17–$286.05	14% above	—
Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYTX W/O PATIENT 50 MIN	$201.00	$201.00	—	18% above	—
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYTX W/O PATIENT 50 MIN	$201.00	$201.00	—	—	—
Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY	$125.00	$125.00	$194.17–$286.05	27% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION, 1ST INITIAL HR	$254.00	$254.00	—	7% below	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION, 1ST INITIAL HR	$254.00	$254.00	—	—	—
IV infusion of a medicine, first hour CPT 96365 IV INFUSE MED, INITIAL 1ST HR	$442.00	$442.00	—	28% above	—
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSE MED, INITIAL 1ST HR	$442.00	$442.00	—	—	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION FEE SQ/IM	$17.00	$17.00	—	78% below	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC 1 SHOT	$18.00	$18.00	—	77% below	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC 2 SHOTS	$37.00	$37.00	—	52% below	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC 3 SHOTS	$54.00	$54.00	—	30% below	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION FEE SQ/IM	$17.00	$17.00	—	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC 1 SHOT	$18.00	$18.00	—	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC 2 SHOTS	$37.00	$37.00	—	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC 3 SHOTS	$54.00	$54.00	—	—	—
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYTX DIAGNOSTIC EVALUATION	$241.00	$241.00	$194.17–$286.05	2% above	—
Neuromuscular re-education, 15 minutes CPT 97112 OT NEUROMUSCULAR REEDUCATION	$104.00	$104.00	—	27% above	—
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT NEUROMUSCULAR REEDUCATION	$104.00	$104.00	—	—	—
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT CLINIC LEVEL 3	$296.00	$296.00	$194.17–$286.05	83% above	—
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT CLINIC LEVEL 4	$400.00	$400.00	$194.17–$286.05	41% above	—
New patient office visit, about 60 minutes CPT 99205 CLINIC NEW PATIENT LEVEL 5	$533.00	$533.00	$194.17–$286.05	55% above	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT CLINIC LEVEL 2	$199.00	$199.00	$194.17–$286.05	43% above	—
Preventive checkup, new patient aged 18–39 CPT 99385 NEW PATIENT WELLNESS 18-39 YRS	$411.00	$411.00	$194.17–$286.05	119% above	—
Preventive checkup, new patient aged 40–64 CPT 99386 NEW PATIENT WELLNESS 40-64 YRS	$436.00	$436.00	$194.17–$286.05	92% above	—
Preventive checkup, new patient aged 65 or older CPT 99387 NEW PATIENT WELLNESS 65+ NON MEDICARE	$490.00	$490.00	$194.17–$286.05	46% above	—
Preventive checkup, returning patient aged 18–39 CPT 99395 ADULT WELLNESS 18-39 YRS	$300.00	$300.00	$194.17–$286.05	84% above	—
Preventive checkup, returning patient aged 40–64 CPT 99396 ADULT WELLNESS 40-64	$377.00	$377.00	$194.17–$286.05	136% above	—
Preventive checkup, returning patient aged 65 or older CPT 99397 ADULT WELLNESS 65+ NON-MEDICARE	$411.00	$411.00	$194.17–$286.05	136% above	—
Psychiatric evaluation with medical services CPT 90792 PSYCHIATRIC DIAGNOSTIC EVAL W/ MED SERV	$493.00	$493.00	$194.17–$286.05	62% above	—
Psychotherapy for crisis, first 60 minutes CPT 90839 PSYTX CRISIS INITIAL 60 MIN	$234.00	$234.00	$194.17–$286.05	17% above	—
Psychotherapy session, 30 minutes CPT 90832 PSYTX WITH PATIENT 30 MINUTES	$136.00	$136.00	$194.17–$286.05	14% above	—
Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHERAPY 30 MINUTES (SF)	$198.00	$198.00	$194.17–$286.05	65% above	—
Psychotherapy session, 45 minutes CPT 90834 PSYTX WITH PATIENT 45 MIN	$172.00	$172.00	$194.17–$286.05	17% above	—
Psychotherapy session, 45 minutes CPT 90834 zPSYCHOTHERAPY 45 MINUTES(DON'T USE)	$198.00	$220.00	$194.17–$286.05	34% above	10%
Psychotherapy session, 45 minutes inpatient CPT 90834 zPSYCHOTHERAPY 45 MINUTES(DON'T USE)	$198.00	$220.00	$194.17–$286.05	—	10%
Psychotherapy session, 60 minutes CPT 90837 PSYTX WITH PATIENT 60 MINUTES	$172.00	$172.00	$194.17–$286.05	8% below	—
Psychotherapy session, 60 minutes CPT 90837 BH PSYTX WITH PATIENT 60 MINUTES	$172.00	$172.00	$194.17–$286.05	8% below	—
Psychotherapy session, 60 minutes CPT 90837 zPSYCHOTHERAPY 60 MINUTES(DON'T USE)	$202.50	$225.00	$194.17–$286.05	8% above	10%
Psychotherapy session, 60 minutes inpatient CPT 90837 zPSYCHOTHERAPY 60 MINUTES(DON'T USE)	$202.50	$225.00	$194.17–$286.05	—	10%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING CESSATION COUNSELING 3-10 MIN	$64.00	$64.00	$194.17–$286.05	148% above	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 CLINIC VISIT LEVEL 5	$379.00	$379.00	$194.17–$286.05	48% above	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 40-54 MIN E/M MED MANAGEMENT	$450.00	$450.00	$194.17–$286.05	76% above	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 XXSWING BED ROUNDXX	$143.00	$143.00	—	11% above	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 CLINIC VISIT LEVEL 3	$166.00	$166.00	$194.17–$286.05	29% above	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 20-29 MIN E/M MED MANAGEMENT	$237.00	$237.00	$194.17–$286.05	84% above	—
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 XXSWING BED ROUNDXX	$143.00	$143.00	—	—	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 DOT EXAM	$231.00	$231.00	$194.17–$286.05	14% above	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 CLINIC VISIT LEVEL 4	$253.00	$253.00	$194.17–$286.05	25% above	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 CLINIC VISIT LEVEL 2	$124.00	$124.00	$194.17–$286.05	44% above	—
Spirometry (breathing test) CPT 94010 PFT (SPIROMETRY)	$153.00	$153.00	$194.17–$286.05	at median	—
Spirometry before and after a bronchodilator CPT 94060 SPIROMETRY PRE/POST BRONCHODILATOR	$194.00	$194.00	$194.17–$286.05	25% below	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY	$114.00	$114.00	—	37% below	—
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY	$114.00	$114.00	—	—	—

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 VAC-HEPATITIS B INJ 20MCG/ML ENGERIX	$242.00	$242.00	—	115% above	—
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 VAC-HEPATITIS B INJ 20MCG/ML ENGERIX	$242.00	$242.00	—	—	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 VAC-PNEUMOCOCCAL INJ 0.5ML SYR PNEUMO	$441.00	$441.00	—	222% above	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 VAC-PNEUMOCOCCAL INJ 0.5ML SYR PNEUMO	$441.00	$441.00	—	—	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 VAC-TETANUS, DIPTH INJ 0.5ML Td	$189.00	$189.00	—	92% above	—
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 VAC-TETANUS, DIPTH INJ 0.5ML Td	$189.00	$189.00	—	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 VAC-TET, DIPTH, PERT INJ 0.5ML Tdap	$189.00	$189.00	—	34% above	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 VAC-TET, DIPTH, PERT INJ 0.5ML Tdap	$189.00	$189.00	—	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IM ADMIN 1 VACCINE	$55.00	$55.00	—	12% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IM ADMIN 1 VACCINE	$55.00	$55.00	—	—	—

Source file: https://pchospital.us/wp-content/uploads/2026/06/816016152_phillips-county-hospital-assn_standardcharges2.csv