Deaconess Regional Medical Center
Deaconess Regional Medical Center in Bozeman, MT publishes cash prices for 507 common procedures listed here, from its own machine-readable price file updated Jan 16, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Montana median for 305 of 500 procedures and above it for 145. By typical cash price it ranks #8 of 29 Montana hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.
915 Highland Blvd, Bozeman, MT 59715 Collected Sep 28, 2026 Source price file Check a bill from this hospital (406) 585-5000
Acute care hospital Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 270057 · CMS hospital register NPI 1104295864
Financial assistance
Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply
Deaconess Regional Medical Center 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 WO THEN W CONT | $2,203.20 | $2,754.00 | $190.66–$2,754.00 | 12% above | 20% |
| Abdominal X-ray, 2 views CPT 74019 HC RADIOLOGIC EXAM ABDOMEN 2 VIEWS - XR ABDOMEN 2 VW POSTER W DECUBITUS | $196.80 | $246.00 | $34.78–$246.00 | 27% below | 20% |
| Ankle X-ray, complete, 3 or more views CPT 73610 CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS | $121.60 | $152.00 | $34.78–$152.00 | 44% below | 20% |
| Ankle X-ray, complete, 3 or more views CPT 73610 HC X-RAY ANKLE MIN 3 VIEWS | $195.20 | $244.00 | $34.78–$244.00 | 10% below | 20% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC VASC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 1-2 LEVEL | $342.40 | $428.00 | $78.07–$428.00 | 15% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT EXT UPPER WO CONT | $1,463.20 | $1,829.00 | $113.89–$1,829.00 | 9% above | 20% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 HC ESOPHAGRAM - FL ESOPHAGUS BARIUM SWALLOW | $232.80 | $291.00 | $92.31–$291.00 | 34% below | 20% |
| Bone scan, whole body (nuclear medicine) CPT 78306 HC BONE IMAGING WHOLE BODY - NM BONE WHOLE BODY | $932.80 | $1,166.00 | $255.46–$1,166.00 | 31% below | 20% |
| Breast ultrasound, complete, one breast both sides CPT 76641 HC ULTRASOUND BREAST COMPLETE - US BREAST BILATERAL COMPLETE | $328.80 | $411.00 | $97.37–$411.00 | — | 20% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 HC ED ULTRASOUND BREAST LIMITED - US BREAST LEFT LIMITED | $148.80 | $186.00 | $80.60–$186.00 | 40% below | 20% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 HC ULTRASOUND BREAST LIMITED - US BREAST LEFT LIMITED | $328.00 | $410.00 | $80.60–$410.00 | 33% above | 20% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CTA ABD PELVIS W CONTRAST+WO IF PERFORM | $3,352.80 | $4,191.00 | $370.20–$4,191.00 | 21% above | 20% |
| CT angiography (CTA) of the head CPT 70496 HC CT ANGIOHEAD COMBO - CT HEAD ANGIO W AND WO IV CONTRAST | $2,431.20 | $3,039.00 | $190.66–$3,039.00 | 14% above | 20% |
| CT angiography (CTA) of the neck CPT 70498 HC CT ANGIONECK COMBO - CT NECK ANGIO W AND WO IV CONTRAST | $2,431.20 | $3,039.00 | $190.66–$3,039.00 | 13% above | 20% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CTA CHEST WCONT +WO IF PERF | $2,529.60 | $3,162.00 | $190.66–$3,162.00 | 14% above | 20% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST | $727.20 | $909.00 | $274.40–$909.00 | 7% below | 20% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT HEART SCORE | $444.00 | $555.00 | $94.30–$555.00 | 8% above | 20% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD PELVIS WO CONTRAST | $2,429.60 | $3,037.00 | $177.96–$3,037.00 | 14% above | 20% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABD PELVIS W CONTRAST | $3,124.00 | $3,905.00 | $295.29–$3,905.00 | 10% above | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABD PELVIS WO THEN W CONT | $3,446.40 | $4,308.00 | $331.31–$4,308.00 | 11% above | 20% |
| CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W CONTRAST | $1,888.80 | $2,361.00 | $190.66–$2,361.00 | 4% above | 20% |
| CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN W/O DYE - CT ABDOMEN WO CONTRAST | $1,665.60 | $2,082.00 | $113.89–$2,082.00 | 22% above | 20% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT SCANMAXILLOFACIAL W/O CONTRAST - CT SINUS WO CONTRAST | $1,171.20 | $1,464.00 | $113.89–$1,464.00 | 2% below | 20% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT SCANHEAD/BRAINW/O CONTRAST MATL - CT HEAD WO CONTRAST | $1,388.00 | $1,735.00 | $103.06–$1,735.00 | 18% above | 20% |
| CT scan of the head with contrast CPT 70460 HC CT SCAN HEAD CONTRAST - CT HEAD W CONTRAST | $1,397.60 | $1,747.00 | $144.15–$1,747.00 | 3% below | 20% |
| CT scan of the head without and with contrast CPT 70470 HC CT SCAN HEAD COMBO - CT HEAD W WO CONTRAST | $1,744.80 | $2,181.00 | $168.81–$2,181.00 | 3% below | 20% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE WO CONT | $1,656.00 | $2,070.00 | $113.89–$2,070.00 | 16% above | 20% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT CERVICAL SPINE WO CONTRAST | $1,459.20 | $1,824.00 | $113.89–$1,824.00 | 3% above | 20% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST | $1,955.20 | $2,444.00 | $190.66–$2,444.00 | 22% above | 20% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 HC DUPLEX SCAN EXTRACRANIALBILAT - CAROTID DUPLEX | $1,052.80 | $1,316.00 | $180.19–$1,316.00 | 11% above | 20% |
| Chest CT scan without and with contrast CPT 71270 HC CT THORAX DIAGNOSTIC WO THEN W CONTRAST | $2,580.80 | $3,226.00 | $190.66–$3,226.00 | 30% above | 20% |
| Chest X-ray, 2 views CPT 71046 CHG RADIOLOGIC EXAM CHEST 2 VIEWS | $139.20 | $174.00 | $31.93–$174.00 | 37% below | 20% |
| Chest X-ray, 2 views CPT 71046 HC RADIOLOGIC EXAM CHEST 2 VIEWS - XR CHEST 2 VIEWS | $197.60 | $247.00 | $31.93–$247.00 | 11% below | 20% |
| Chest X-ray, single view CPT 71045 HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST 1 VIEW | $155.20 | $194.00 | $24.34–$194.00 | 16% below | 20% |
| Collarbone (clavicle) X-ray, complete CPT 73000 CHG RADEX CLAVICLE COMPLETE | $123.20 | $154.00 | $30.98–$154.00 | 35% below | 20% |
| Collarbone (clavicle) X-ray, complete CPT 73000 HC X-RAY CLAVICLE COMPLETE | $172.00 | $215.00 | $30.98–$215.00 | 9% below | 20% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITONEUM | $423.20 | $529.00 | $102.73–$529.00 | 16% below | 20% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC USRETROPERIT B-SCAN/REAL TIMECOMPLETE - US RETROPERITONEUM | $423.20 | $529.00 | $102.73–$529.00 | 16% below | 20% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC DXA BONE DENSITY AXIAL - DEXA BONE DENSITY | $283.20 | $354.00 | $36.99–$354.00 | 12% below | 20% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC DXA BONE DENSITY/PERIPHERAL - DEXA BONE DENSITY EXTREMITY | $233.60 | $292.00 | $30.03–$292.00 | 59% above | 20% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC OB US DETAILED SNGL FETUS - US OB DETAIL FETAL ANAT SING OR 1ST GEST | $355.20 | $444.00 | $168.19–$444.00 | 18% below | 20% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 CHG US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION | $508.00 | $635.00 | $168.19–$635.00 | 17% above | 20% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX DIAGNOSTIC WO CONTRAST | $1,546.40 | $1,933.00 | $113.89–$1,933.00 | 11% above | 20% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT THORAX DIAGNOSTIC WITH CONTRAST | $2,112.00 | $2,640.00 | $162.49–$2,640.00 | 28% above | 20% |
| Diagnostic mammogram, one breast CPT 77065 HC DX MAMMO W/CAD UNIL | $386.40 | $483.00 | $118.86–$483.00 | 51% above | 20% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DUPLEX LO EXTREM ART BILAT - LOWER EXTREMITY ARTERIAL DUPLEX | $1,607.20 | $2,009.00 | $227.92–$2,009.00 | — | 20% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DUP SCAN VENOUS EXTREMITIES COMPLT BI STUDY | $1,260.00 | $1,575.00 | $177.34–$1,575.00 | — | 20% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 HC VASC DUPLEX EXTREM VENOUSBILAT | $1,260.00 | $1,575.00 | $177.34–$1,575.00 | 34% above | 20% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC PF ECHO (2D) COMPLETE W DOPPLER & COLOR | $380.00 | $475.00 | $186.20–$610.72 | 76% below | 20% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC ECHO (2D) COMPLETE W DOPPLER & COLOR | $1,361.60 | $1,702.00 | $186.20–$1,702.00 | 13% below | 20% |
| Elbow X-ray, 2 views CPT 73070 CHG RADEX ELBOW 2 VIEWS | $122.40 | $153.00 | $27.82–$153.00 | 32% below | 20% |
| Elbow X-ray, 2 views CPT 73070 HC X-RAY ELBOW 2 VIEWS | $180.80 | $226.00 | $27.82–$226.00 | at median | 20% |
| Elbow X-ray, complete, 3 or more views CPT 73080 CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS | $204.80 | $256.00 | $31.29–$256.00 | 5% below | 20% |
| Elbow X-ray, complete, 3 or more views CPT 73080 HC X-RAY ELBOW MIN 3 VIEWS | $233.60 | $292.00 | $31.29–$292.00 | 9% above | 20% |
| Eye socket (orbit) CT scan without contrast CPT 70480 HC CT SCANORBIT/SELLA/POST FOSSA/EARW/O - CT AUDITORY CANALS WO CONT | $1,264.00 | $1,580.00 | $113.89–$1,580.00 | 3% below | 20% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS | $153.60 | $192.00 | $44.90–$192.00 | 53% below | 20% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 HC X-RAY FACIAL BONES 3+ VW - XR FACIAL BONES 3+ VIEWS | $306.40 | $383.00 | $44.90–$383.00 | 5% below | 20% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 CHG RADEX FOREARM 2 VIEWS | $123.20 | $154.00 | $27.82–$154.00 | 34% below | 20% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 HC X-RAY FOREARM 2 VIEWS | $184.00 | $230.00 | $27.82–$230.00 | 1% below | 20% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER - NM LIVER FUNCTION | $936.00 | $1,170.00 | $281.38–$1,170.00 | 23% below | 20% |
| Hand X-ray, 2 views CPT 73120 CHG RADEX HAND 2 VIEWS | $108.00 | $135.00 | $30.03–$135.00 | 37% below | 20% |
| Hand X-ray, 2 views CPT 73120 HC X-RAY HAND 2 VIEWS | $155.20 | $194.00 | $30.03–$194.00 | 10% below | 20% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 CHG RADEX CALCANEUS MINIMUM 2 VIEWS | $107.20 | $134.00 | $27.19–$134.00 | 44% below | 20% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC X-RAY HEEL/CALCANEUS 2 VIEWS | $156.80 | $196.00 | $27.19–$196.00 | 18% below | 20% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC SLEEP STUDY UNATTENDED W/ HEART RATE & 02 SAT EFFORT | $406.40 | $508.00 | $89.45–$508.00 | 33% above | 20% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC SLEEP STUDY SPLT NGHT | $2,320.80 | $2,901.00 | $618.69–$2,901.00 | at median | 20% |
| Knee X-ray, 3 views CPT 73562 CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS | $141.60 | $177.00 | $38.88–$177.00 | 33% below | 20% |
| Knee X-ray, 3 views CPT 73562 HC X-RAY KNEE 3 VIEWS | $196.00 | $245.00 | $38.88–$245.00 | 7% below | 20% |
| Knee X-ray, complete, 4 or more views CPT 73564 CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS | $135.20 | $169.00 | $44.90–$169.00 | 45% below | 20% |
| Knee X-ray, complete, 4 or more views CPT 73564 HC X-RAY KNEE MIN 4 VIEWS | $212.80 | $266.00 | $44.90–$266.00 | 14% below | 20% |
| Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXTREMITY WO CONTRAST | $1,712.00 | $2,140.00 | $113.89–$2,140.00 | 31% above | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMEN LIMITED - US ABDOMEN LIMITED | $339.20 | $424.00 | $82.51–$424.00 | 17% below | 20% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG | $94.40 | $118.00 | $60.05–$118.45 | 59% below | 20% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US LMTD JOINT/NONVASC EXTREMITY STRUCTURE | $462.40 | $578.00 | $60.05–$578.00 | 99% above | 20% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC ED US LMTD JT/NONVASC XTR STRUX | $462.40 | $578.00 | $60.05–$578.00 | 99% above | 20% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT THORAX LUNG CANCER SCR C- | $514.40 | $643.00 | $113.89–$643.00 | 29% below | 20% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS | $160.00 | $200.00 | $30.03–$200.00 | 18% below | 20% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC X-RAY TIB & FIB 2 VIEWS | $184.00 | $230.00 | $30.03–$230.00 | 6% below | 20% |
| MR angiography (MRA) of the head without contrast CPT 70544 HC MR ANGIO HEAD - MR HEAD ANGIO WO IV CONTRAST | $2,424.80 | $3,031.00 | $210.23–$3,031.00 | 33% above | 20% |
| MRI of both breasts, without and then with contrast dye both sides CPT 77049 HC MRI BREAST BILAT WO AND W CONT INC CAD | $2,940.00 | $3,675.00 | $334.15–$3,675.00 | — | 20% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOWER EXT JT WO CONTRAST | $1,824.80 | $2,281.00 | $197.58–$2,281.00 | 6% above | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXT JT WO THEN W CONT | $3,105.60 | $3,882.00 | $376.22–$3,882.00 | 15% above | 20% |
| MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN (MRI) - MRI ABDOMEN WO CONTRAST | $2,092.00 | $2,615.00 | $190.94–$2,615.00 | 17% above | 20% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN WO THEN W CONT | $3,328.80 | $4,161.00 | $329.74–$4,161.00 | 15% above | 20% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN - MRI BRAIN WO CONTRAST | $2,197.60 | $2,747.00 | $191.25–$2,747.00 | 23% above | 20% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN COMBO - MRI BRAIN W WO CONTRAST | $3,301.60 | $4,127.00 | $310.43–$4,127.00 | 17% above | 20% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI L SPINE WO CONTRAST | $2,082.40 | $2,603.00 | $186.51–$2,603.00 | 19% above | 20% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE - MRI LUMBAR SPINE WO CONTRAST | $2,082.40 | $2,603.00 | $186.51–$2,603.00 | 19% above | 20% |
| MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMBAR SPINE COMBO - MRI LUMBAR SPINE W WO CONTRAST | $3,163.20 | $3,954.00 | $311.38–$3,954.00 | 18% above | 20% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI DORSAL SPINE - MRI THORACIC SPINE WO CONTRAST | $2,016.00 | $2,520.00 | $185.56–$2,520.00 | 15% above | 20% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI CERV SPINE COMBO - MRI CERVICAL SPINE W WO CONTRAST | $3,163.20 | $3,954.00 | $312.02–$3,954.00 | 18% above | 20% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERV SPINE - MRI CERVICAL SPINE WO CONTRAST | $1,892.80 | $2,366.00 | $185.88–$2,366.00 | 5% above | 20% |
| MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS WO THEN W CONT | $3,355.20 | $4,194.00 | $328.47–$4,194.00 | 21% above | 20% |
| MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS WO CONTRAST | $2,230.40 | $2,788.00 | $223.51–$2,788.00 | 18% above | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI JOINT UPPER EXTREM WO CONTRAST | $1,824.80 | $2,281.00 | $197.89–$2,281.00 | 16% above | 20% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS | $150.40 | $188.00 | $50.90–$188.00 | 54% below | 20% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC RADEX SPINE CERVICAL 4 OR 5 VIEWS - XR CERVICAL SPINE COMP 4-5 VIEWS | $378.40 | $473.00 | $50.90–$473.00 | 16% above | 20% |
| Neck soft tissue CT scan with contrast CPT 70491 HC CT SOFT TISSUE NECK W CONTRAST | $1,842.40 | $2,303.00 | $179.24–$2,303.00 | 5% above | 20% |
| Neck soft tissue CT scan without contrast CPT 70490 HC CT SCANSOFT TISSUE NECKW/O CONTRAST - CT SOFT TISSUE NECK WO CONT | $960.80 | $1,201.00 | $113.89–$1,201.00 | 21% below | 20% |
| Neck soft tissue X-ray CPT 70360 HC X-RAY NECK SOFT TISSUE - XR NECK SOFT TISSUE | $97.60 | $122.00 | $29.72–$122.00 | 50% below | 20% |
| Neck soft tissue X-ray CPT 70360 CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE | $105.60 | $132.00 | $29.72–$132.00 | 46% below | 20% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM MYOCARDIAL SPECT MULT STDY | $2,167.20 | $2,709.00 | $410.69–$2,709.00 | at median | 20% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC HT MUSCLE IMAGE SPECT MULT - STRESS TEST EXERCISE W MYOCARD PERF | $2,167.20 | $2,709.00 | $410.69–$2,709.00 | at median | 20% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC HT MUSCLE IMAGE SPECT MULT - STRESS TEST REGADENOSON W MYOCARD PERF | $2,167.20 | $2,709.00 | $410.69–$2,709.00 | at median | 20% |
| OCT scan of the retina (optical coherence tomography) both sides CPT 92134 PR CPTRIZED OPH DX IMG PST SEGMENT UNI/BI RETINA | $96.80 | $121.00 | $38.26–$121.00 | — | 20% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC PET IMAGE W/CT SKULL-THIGH - PT/CT BONE SKULL BASE TO MID THIGH | $6,515.20 | $8,144.00 | $1,544.71–$8,144.00 | 19% above | 20% |
| Pelvic CT scan without contrast CPT 72192 HC CT PELVIS WO CONTRAST | $1,524.00 | $1,905.00 | $113.89–$1,905.00 | 10% above | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC SONO PELVIS LIMITED - US PELVIS LIMITED | $278.40 | $348.00 | $46.79–$348.00 | 10% below | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 CHG US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U | $289.60 | $362.00 | $46.79–$362.00 | 7% below | 20% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 CHG US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE | $351.20 | $439.00 | $99.90–$439.00 | 35% below | 20% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC PF US PELVIC COMPLETE | $383.20 | $479.00 | $99.90–$479.00 | 29% below | 20% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC ECHOPELVIC (NONOBSTETRIC) - US PELVIS | $404.00 | $505.00 | $99.90–$505.00 | 25% below | 20% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION | $420.80 | $526.00 | $113.89–$526.00 | 12% below | 20% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC OB US >/= 14 WKS SNGL FETUS - US OB 14+ WEEKS SINGLE OR FIRST GEST | $432.00 | $540.00 | $113.89–$540.00 | 9% below | 20% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 CHG US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT | $379.20 | $474.00 | $111.27–$474.00 | 15% below | 20% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC OB US < 14 WKS SINGLE FETUS - US OB < 14 WEEKS SINGLE OR FIRST GEST | $522.40 | $653.00 | $111.27–$653.00 | 18% above | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC ED OB US LIMITED FETUS(S) - US OB LIMITED 1+ FETUSES | $330.40 | $413.00 | $76.82–$413.00 | at median | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC OB US LIMITED FETUS(S) - US OB LIMITED 1+ FETUSES | $330.40 | $413.00 | $76.82–$413.00 | at median | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 CHG US PREGNANT UTERUS LIMITED 1/> FETUSES | $385.60 | $482.00 | $76.82–$482.00 | 16% above | 20% |
| Rib X-ray, one side, 2 views CPT 71100 HC X-RAY RIBS UNIL 2 VIEWS | $258.40 | $323.00 | $34.78–$323.00 | 11% above | 20% |
| Rib X-ray, one side, 2 views one side CPT 71100 CHG RADEX RIBS UNILATERAL 2 VIEWS | $137.60 | $172.00 | $34.78–$172.00 | 41% below | 20% |
| Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS | $120.80 | $151.00 | $40.16–$151.00 | 57% below | 20% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 HC RAD EXAM RIBS UNILAT W CHEST MIN 3 VWS | $312.80 | $391.00 | $40.16–$391.00 | 12% above | 20% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS | $128.80 | $161.00 | $33.19–$161.00 | 41% below | 20% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 HC X-RAY SHOULDER COMPLETE MIN 2 VIEWS | $222.40 | $278.00 | $33.19–$278.00 | 2% above | 20% |
| Sinus X-ray, complete, 3 or more views CPT 70220 HC X-RAY SINUSES 3+ VW - XR PARANASAL SINUSES 3+ VIEWS | $244.00 | $305.00 | $35.72–$305.00 | 5% below | 20% |
| Skull X-ray, fewer than 4 views CPT 70250 HC X-RAY SKULL <4 VW - XR SKULL 1-3 VIEWS | $224.00 | $280.00 | $34.14–$280.00 | 6% below | 20% |
| Sleep study in a lab (polysomnography) CPT 95810 HC SLEEP STUDY 6 Y/O+ W/4+PARAMETERS | $2,088.00 | $2,610.00 | $591.81–$2,610.00 | at median | 20% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC ECHO STRESS TTE COMPLETE | $780.00 | $975.00 | $220.03–$975.00 | 33% below | 20% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 HC CINE/VID X-RAY THROAT/ESOPH - FL ESOPH BARIUM SWLW W/ VIDEO & SPEECH | $276.00 | $345.00 | $118.25–$345.00 | 36% below | 20% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC X-RAY FEMUR MIN 2 VIEWS | $144.00 | $180.00 | $33.83–$180.00 | 33% below | 20% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS | $195.20 | $244.00 | $33.83–$244.00 | 9% below | 20% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT THORACIC SPINE WO CONT | $1,740.00 | $2,175.00 | $113.89–$2,175.00 | 23% above | 20% |
| Toe X-ray, 2 or more views CPT 73660 CHG RADEX TOE MINIMUM 2 VIEWS | $104.80 | $131.00 | $27.82–$131.00 | 40% below | 20% |
| Toe X-ray, 2 or more views CPT 73660 HC X-RAY TOE(S) MIN OF 2VIEWS | $108.00 | $135.00 | $27.82–$135.00 | 38% below | 20% |
| Transvaginal pelvic ultrasound CPT 76830 CHG US TRANSVAGINAL | $349.60 | $437.00 | $113.17–$437.00 | 17% below | 20% |
| Transvaginal pelvic ultrasound CPT 76830 HC ECHOGRAPHYTRANSVAGINAL - US PELVIS TRANSVAGINAL | $403.20 | $504.00 | $113.17–$504.00 | 4% below | 20% |
| Transvaginal ultrasound during pregnancy CPT 76817 HC TRANSVAGINAL US OBSTETRIC - US OB TRANSVAGINAL | $288.80 | $361.00 | $87.88–$361.00 | 28% below | 20% |
| Transvaginal ultrasound during pregnancy CPT 76817 CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG | $294.40 | $368.00 | $87.88–$368.00 | 26% below | 20% |
| Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMB-SCAN &/OR REAL TIMECOMPLETE - US ABDOMEN | $440.80 | $551.00 | $110.32–$551.00 | 17% below | 20% |
| Ultrasound of the scrotum and testicles CPT 76870 HC ECHOSCROTUM & CONTENTS - US SCROTUM | $412.00 | $515.00 | $94.84–$515.00 | 17% below | 20% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US SOFT TISSUE HEAD & NECK REAL TIME | $391.20 | $489.00 | $104.64–$489.00 | 9% below | 20% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US HEAD/NECK TISSUESREAL TIME - US HEAD NECK SOFT TISSUE | $391.20 | $489.00 | $104.64–$489.00 | 9% below | 20% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC X-RAY UPPER GI DELAY W/O KUB - FL UPPER GI WITHOUT KUB | $260.80 | $326.00 | $116.34–$326.00 | 43% below | 20% |
| Upper arm X-ray (humerus), 2 views CPT 73060 CHG RADEX HUMERUS MINIMUM 2 VIEWS | $140.00 | $175.00 | $30.35–$175.00 | 30% below | 20% |
| Upper arm X-ray (humerus), 2 views CPT 73060 HC X-RAY HUMERUS MIN 2 VIEWS | $184.00 | $230.00 | $30.35–$230.00 | 8% below | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC DUP SCAN EXTREMITY VEINS W/COMPRESSION & MANEUVERS - UNIL OR LMTD | $865.60 | $1,082.00 | $112.86–$1,082.00 | 35% above | 20% |
| Wrist X-ray, 2 views CPT 73100 HC X-RAY WRIST 2 VIEWS | $104.80 | $131.00 | $32.24–$131.00 | 41% below | 20% |
| Wrist X-ray, 2 views CPT 73100 CHG RADEX WRIST 2 VIEWS | $120.80 | $151.00 | $32.24–$151.00 | 32% below | 20% |
| Wrist X-ray, complete, 3 or more views CPT 73110 CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS | $128.80 | $161.00 | $39.21–$161.00 | 41% below | 20% |
| Wrist X-ray, complete, 3 or more views CPT 73110 HC X-RAY WRIST MIN 3 VIEWS | $221.60 | $277.00 | $39.21–$277.00 | 2% above | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC X-RAY HIP UNILATERAL 2 OR 3 VIEWS | $128.80 | $161.00 | $45.21–$161.00 | 39% below | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS | $137.60 | $172.00 | $45.21–$172.00 | 35% below | 20% |
| X-ray of the abdomen, 1 view CPT 74018 HC RADIOLOGIC EXAM ABDOMEN 1 VIEW - XR ABDOMEN 1 VIEW | $115.20 | $144.00 | $28.77–$144.00 | 36% below | 20% |
| X-ray of the ankle, 2 views CPT 73600 CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS | $108.00 | $135.00 | $30.67–$135.00 | 39% below | 20% |
| X-ray of the ankle, 2 views CPT 73600 HC X-RAY ANKLE 2 VIEWS | $168.00 | $210.00 | $30.67–$210.00 | 6% below | 20% |
| X-ray of the finger(s), 2 or more views CPT 73140 CHG RADEX FINGR MINIMUM 2 VIEWS | $122.40 | $153.00 | $36.36–$153.00 | 28% below | 20% |
| X-ray of the finger(s), 2 or more views CPT 73140 HC X-RAY FINGER(S) MIN 2 VIEWS | $156.80 | $196.00 | $36.36–$196.00 | 7% below | 20% |
| X-ray of the foot, 2 views CPT 73620 CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS | $124.00 | $155.00 | $27.19–$155.00 | 28% below | 20% |
| X-ray of the foot, 2 views CPT 73620 HC X-RAY FOOT 1 OR 2 VIEWS | $155.20 | $194.00 | $27.19–$194.00 | 10% below | 20% |
| X-ray of the foot, complete, 3 or more views CPT 73630 CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS | $168.80 | $211.00 | $32.57–$211.00 | 29% below | 20% |
| X-ray of the foot, complete, 3 or more views CPT 73630 HC X-RAY FOOT MIN 3 VIEWS | $173.60 | $217.00 | $32.57–$217.00 | 27% below | 20% |
| X-ray of the hand, 3 or more views CPT 73130 CHG RADEX HAND MINIMUM 3 VIEWS | $121.60 | $152.00 | $35.41–$152.00 | 47% below | 20% |
| X-ray of the hand, 3 or more views CPT 73130 HC X-RAY HAND MIN 3 VIEWS | $195.20 | $244.00 | $35.41–$244.00 | 15% below | 20% |
| X-ray of the knee, 1 or 2 views CPT 73560 CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS | $122.40 | $153.00 | $32.57–$153.00 | 31% below | 20% |
| X-ray of the knee, 1 or 2 views CPT 73560 HC X-RAY KNEE 1 OR 2 VIEWS | $160.00 | $200.00 | $32.57–$200.00 | 10% below | 20% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS | $122.40 | $153.00 | $37.94–$153.00 | 52% below | 20% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC X-RAY LUMBAR SPINE 2/3 VW - XR LUMBAR SPINE 2-3 VIEWS | $252.00 | $315.00 | $37.94–$315.00 | at median | 20% |
| X-ray of the lower back, 4 or more views CPT 72110 CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS | $164.00 | $205.00 | $49.32–$205.00 | 51% below | 20% |
| X-ray of the lower back, 4 or more views CPT 72110 HC X-RAY LUMBAR SPINE 4 VW - XR LUMBAR SPINE COMPLETE 4+ VIEWS | $306.40 | $383.00 | $49.32–$383.00 | 8% below | 20% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 CHG RADEX SPINE THORACIC 2 VIEWS | $194.40 | $243.00 | $31.29–$243.00 | 13% below | 20% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC X-RAY THORACIC SPINE 2 VW - XR THORACIC SPINE 2 VIEWS | $255.20 | $319.00 | $31.29–$319.00 | 14% above | 20% |
| X-ray of the nasal bones, 3 or more views CPT 70160 CHG RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS | $108.00 | $135.00 | $35.72–$135.00 | 49% below | 20% |
| X-ray of the nasal bones, 3 or more views CPT 70160 HC X-RAY NASAL BONES - XR NASAL BONES | $233.60 | $292.00 | $35.72–$292.00 | 11% above | 20% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC RADEX SPINE CERVICAL 2 OR 3 VIEWS - XR CERVICAL SPINE 2-3 VIEWS | $214.40 | $268.00 | $37.62–$268.00 | at median | 20% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS | $215.20 | $269.00 | $37.62–$269.00 | at median | 20% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS | $210.40 | $263.00 | $26.55–$263.00 | 3% below | 20% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 HC X-RAY PELVIS 1/2 VW - XR PELVIS 1-2 VIEWS | $233.60 | $292.00 | $26.55–$292.00 | 7% above | 20% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS | $217.60 | $272.00 | $30.98–$272.00 | 7% below | 20% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC X-RAY SACRUM/COCCYX 2+ VW - XR SACRUM COCCYX 2+ VIEWS | $284.80 | $356.00 | $30.98–$356.00 | 22% above | 20% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Montana | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 HC ASSAY OF ACTH - ACTH | $211.20 | $264.00 | $31.96–$264.00 | 6% below | 20% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC TRANSFERASE ALANINE AMINO (ALT) (SGPT) - ALT (SGPT) | $29.60 | $37.00 | $4.39–$37.00 | 43% below | 20% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 HC AST 84450 | $35.20 | $44.00 | $4.28–$44.00 | 30% below | 20% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS PANELACUTE - BUNDLED CHARGE | $205.60 | $257.00 | $39.42–$257.00 | 1% below | 20% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP | $254.40 | $318.00 | $39.42–$318.00 | 23% above | 20% |
| Albumin blood test CPT 82040 HC ASSAY OF SERUM ALBUMIN - ALBUMIN | $29.60 | $37.00 | $4.09–$37.00 | 4% below | 20% |
| Aldosterone blood test CPT 82088 HC ASSAY OF ALDOSTERONE - ALDOSTERONE | $235.20 | $294.00 | $33.72–$294.00 | 19% above | 20% |
| Alkaline phosphatase (ALP) blood test CPT 84075 CHG ASSAY OF PHOSPHATASE ALKALINE | $10.40 | $13.00 | $4.28–$13.00 | 82% below | 20% |
| Alkaline phosphatase (ALP) blood test CPT 84075 HC ASSAY ALKAL PHOSPHATASE - ALKALINE PHOSPHATASE | $30.40 | $38.00 | $4.28–$38.00 | 47% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 CHG ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH | $9.60 | $12.00 | $4.32–$12.00 | 80% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN WHEAT CULTIVATED IGE | $28.80 | $36.00 | $4.32–$36.00 | 39% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN ALPHA LACTALBUMIN IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN BARLEY IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN YEAST BREWER'S IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN WILLOW PUSSY IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN WHEAT IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN BETA LACTOGLOBULIN | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN BIRCH IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN BOTRYTIS CINEREA IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN CANDIDA ALBICANS IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN CASEIN IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN WALNUT IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN TROUT IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN TOMATO IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN CASHEW IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN CAT HAIR/DANDERSTAN | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN CEDAR MOUNTAIN IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN CLADOSPORIUM HERBARUM IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN CLAMS IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN THISTLE RUSSIAN IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN SOYBEAN IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN SHRIMP IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN SHEEP SORREL (DOCK) IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN SESAME SEED IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN SEASONAL INHALANTS PANEL | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN SCALLOP IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN SALMON IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN RYE IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN CODFISH IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN RICE IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN RABBIT EPITHELIUM IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN PECAN NUT IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN OYSTER IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN COTTONWOOD TREE IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN COW EPITHELIA/DANDER IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN CRAB IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN CURVULARIA LUNATA IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN DOG DANDER | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN EGG WHITE IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN OAT IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN EGG YOLK IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN ELM TREE IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN FOOD: LOBSTER IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN FOOD: PISTACHIO | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN FOOD: STRAWBERRY IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN HAZELNUT/FILBERT IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN HORSE DANDER IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN KOCHIA IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN MICROORGANISM: ALTERNARIA ALTERNATA | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN MUGWORT IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN MITE: DERMATOPHAGOIDES FARINAE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERG SPEC IGE QUANT | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN ON PANEL | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN MICROORGANISM: PENICILLIUM CHRYSOGENUM | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC RESPIRATORY PANEL REGION 9 (KS ND NE SD) | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC EARLY CHILDHOOD ALLERGY PNL & IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - LATEX IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN BANANA IGE | $30.40 | $38.00 | $4.32–$38.00 | 36% below | 20% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA-FETOPROTEIN SERUM - ALPHA-FETOPROTEIN MARKER | $97.60 | $122.00 | $13.88–$122.00 | 16% below | 20% |
| Ammonia blood test CPT 82140 HC ASSAY OF AMMONIA - AMMONIA | $134.40 | $168.00 | $12.06–$168.00 | 8% above | 20% |
| Amylase blood test CPT 82150 HC ASSAY OF AMYLASE - AMYLASE | $48.00 | $60.00 | $5.36–$60.00 | 16% below | 20% |
| Amylase blood test CPT 82150 CHG ASSAY OF AMYLASE | $64.80 | $81.00 | $5.36–$81.00 | 13% above | 20% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY - CYCLIC CITRUL PEPTIDE ANTIBDY | $127.20 | $159.00 | $10.72–$159.00 | 32% above | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES - ANA (ANTINUCLEAR ANTIBODIES) | $60.00 | $75.00 | $10.00–$75.00 | 20% below | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTI-DENSE FINE SPECKLED 70 (DFS70) ANTIBODY | $111.20 | $139.00 | $10.00–$139.00 | 49% above | 20% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE - B-TYPE NATRIURETIC PEPTIDE (BNP) | $191.20 | $239.00 | $32.49–$239.00 | 16% below | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CHG CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL | $20.00 | $25.00 | $7.13–$25.00 | 73% below | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE: BACT RESPITOR | $80.80 | $101.00 | $7.13–$101.00 | 7% above | 20% |
| Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL CALCIUM TOTAL - BUNDLED CHARGE | $36.80 | $46.00 | $7.00–$46.00 | 61% below | 20% |
| Basic metabolic panel (blood test) CPT 80048 CHG BASIC METABOLIC PANEL CALCIUM TOTAL | $48.80 | $61.00 | $7.00–$61.00 | 48% below | 20% |
| Bilirubin blood test, total CPT 82247 CHG BILIRUBIN TOTAL | $8.80 | $11.00 | $4.15–$11.00 | 82% below | 20% |
| Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL - BILIRUBIN TOTAL AND DIRECT | $50.40 | $63.00 | $4.15–$63.00 | 2% above | 20% |
| Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL - BILIRUBIN BODY FLUID | $50.40 | $63.00 | $4.15–$63.00 | 2% above | 20% |
| Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL - BILIRUBIN TOTAL | $52.00 | $65.00 | $4.15–$65.00 | 5% above | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC SURGICAL PATH LEVEL IV | $247.20 | $309.00 | — | 23% above | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC PROSTATE BIOPSY | $247.20 | $309.00 | — | 23% above | 20% |
| Blood culture for bacteria CPT 87040 HC CULTURE BLOOD | $170.40 | $213.00 | $8.54–$213.00 | 13% above | 20% |
| Blood culture for bacteria CPT 87040 HC BRUCELLA CULTURE | $575.20 | $719.00 | $8.54–$719.00 | 280% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC CHG COLLECTION VENOUS BLOODVENIPUNCTURE - DRAW CHARGE | $21.60 | $27.00 | $8.39–$27.00 | 14% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC COLLECTION VENOUS BLOODVENIPUNCTURE - BUNDLED CHARGE | $22.40 | $28.00 | $8.39–$28.00 | 18% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ED CHG COLLECTION VENOUS BLOOD û LEGAL BLOOD ALCOHOL | $127.20 | $159.00 | $8.39–$159.00 | 569% above | 20% |
| Blood glucose (sugar) test CPT 82947 CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP | $17.60 | $22.00 | $3.25–$22.00 | 55% below | 20% |
| Blood glucose (sugar) test CPT 82947 HC ASSAY QUANTITATIVEBLOOD GLUCOSE - GLUCOSE RANDOM | $28.80 | $36.00 | $3.25–$36.00 | 27% below | 20% |
| Blood glucose (sugar) test CPT 82947 HC ASSAY QUANTITATIVEBLOOD GLUCOSE - POCT GLUCOMETER | $29.60 | $37.00 | $3.25–$37.00 | 24% below | 20% |
| Blood lead test CPT 83655 HC ASSAY OF LEAD - LEAD BLOOD | $27.20 | $34.00 | $10.02–$34.00 | 54% below | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 CHG GONADOTROPIN CHORIONIC QUALITATIVE | $34.40 | $43.00 | $6.22–$43.00 | 52% below | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC GONADOTROPIN CHORIONIC (HCG) QUALITATIVE | $43.20 | $54.00 | $6.22–$54.00 | 39% below | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 CHG BLOOD TYPING SEROLOGIC ABO | $20.80 | $26.00 | $2.47–$143.57 | 71% below | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING SEROLOGIC ABO - ABO/RH TYPE | $199.20 | $249.00 | $2.47–$249.00 | 177% above | 20% |
| Blood urea nitrogen (BUN) test CPT 84520 HC ASSAY UREA NITROGEN QUAN - BLOOD UREA NITROGEN | $26.40 | $33.00 | $3.27–$33.00 | 45% below | 20% |
| C-peptide blood test CPT 84681 HC ASSAY OF C-PEPTIDE - C-PEPTIDE | $94.40 | $118.00 | $17.22–$118.00 | 36% below | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN - C-REACTIVE PROTEIN | $36.00 | $45.00 | $4.28–$45.00 | 45% below | 20% |
| C. difficile toxin gene test (stool PCR) CPT 87493 HC C. DIFFICILE DNA BY PCR | $260.80 | $326.00 | $30.84–$326.00 | 55% above | 20% |
| CA 19-9 blood test (tumor marker) CPT 86301 HC IMMUNOASSAY TUMOR ANTIGEN CA 19-9 - CANCER ANTIGEN 19-9 | $104.00 | $130.00 | $17.22–$130.00 | 22% below | 20% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 HC IMMUNOASSAY TUMOR ANTIGEN CA 125 - CA 125 | $96.00 | $120.00 | $17.22–$120.00 | 23% below | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 CHG IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ | $154.40 | $193.00 | $42.46–$193.00 | 28% above | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC SARS-COV-2 NAD | $154.40 | $193.00 | $42.46–$193.00 | 28% above | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 CDMR SARS-COV-2 COVID-19 AMP PRB | $162.40 | $203.00 | $42.46–$203.00 | 34% above | 20% |
| Calcium blood test, total CPT 82310 HC ASSAY OF CALCIUM TOTAL - CALCIUM | $28.80 | $36.00 | $4.27–$36.00 | 17% below | 20% |
| Carcinoembryonic antigen (CEA) test CPT 82378 HC CEA | $103.20 | $129.00 | $15.68–$129.00 | 4% below | 20% |
| Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA ZOSTER SCREEN | $43.20 | $54.00 | $10.66–$54.00 | 13% below | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA TRACHOMATIS AMPLIFIED RNA | $44.80 | $56.00 | $29.03–$56.00 | 51% below | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 C TRACHOMATIS NUC. ACID | $105.60 | $132.00 | $29.03–$132.00 | 16% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ | $113.60 | $142.00 | $29.03–$142.00 | 25% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC C TRACHOMATIS NUC. ACID | $186.40 | $233.00 | $29.03–$233.00 | 105% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA BY AMPLIFICAT | $186.40 | $233.00 | $29.03–$233.00 | 105% above | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL - BUNDLED CHARGE | $39.20 | $49.00 | $11.08–$49.00 | 53% below | 20% |
| Complete blood count (CBC) with differential CPT 85025 HC COMPLETE CBC & AUTO DIFF WBC - ADDITIONAL CHARGE | $38.40 | $48.00 | $6.43–$48.00 | 51% below | 20% |
| Complete blood count (CBC) with differential CPT 85025 PR COMPLETE CBC & AUTO DIFF WBC | $42.40 | $53.00 | $6.43–$53.00 | 46% below | 20% |
| Complete blood count (CBC), no differential CPT 85027 CHG BLOOD COUNT COMPLETE AUTOMATED | $28.00 | $35.00 | $5.36–$35.00 | 44% below | 20% |
| Complete blood count (CBC), no differential CPT 85027 HC CBC AUTOMATED NO DIFF | $40.80 | $51.00 | $5.36–$51.00 | 19% below | 20% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC METABOLIC PANELCOMPREHENSIVE - BUNDLED CHARGE | $39.20 | $49.00 | $8.74–$49.00 | 70% below | 20% |
| Comprehensive metabolic panel (blood test) CPT 80053 CHG COMPREHENSIVE METABOLIC PANEL | $51.20 | $64.00 | $8.74–$64.00 | 61% below | 20% |
| Cortisol blood test, total CPT 82533 HC TOTAL CORTISOL - CORTISOL AM | $102.40 | $128.00 | $13.49–$128.00 | 9% below | 20% |
| Cortisol blood test, total CPT 82533 HC CORTISOL TOTAL SER | $102.40 | $128.00 | $13.49–$128.00 | 9% below | 20% |
| Cortisol blood test, total CPT 82533 HC TOTAL CORTISOL - ACTH STIMULATION 1 HOUR | $102.40 | $128.00 | $13.49–$128.00 | 9% below | 20% |
| Cortisol blood test, total CPT 82533 HC CORTISOL SALIVA | $102.40 | $128.00 | $13.49–$128.00 | 9% below | 20% |
| Creatine kinase (CK) blood test, total CPT 82550 HC ASSAY OF CK (CPK) - CK | $46.40 | $58.00 | $5.39–$58.00 | 17% below | 20% |
| Creatinine blood test CPT 82565 CHG CREATININE BLOOD | $22.40 | $28.00 | $4.24–$28.00 | 48% below | 20% |
| Creatinine blood test CPT 82565 HC ASSAY OF CREATININE - CREATININE SERUM | $40.80 | $51.00 | $4.24–$51.00 | 6% below | 20% |
| Cytomegalovirus (CMV) antibody test CPT 86644 HC CMV ANTIBODY - CMV IGG | $73.60 | $92.00 | $11.90–$92.00 | 29% below | 20% |
| D-dimer blood test (blood clot marker) CPT 85379 HC FIBRIN DEGRADPRODUCTSD-DIMER QUANT - D-DIMERQUANTITATIVE | $109.60 | $137.00 | $8.43–$137.00 | 3% below | 20% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 HC DEHYDROEPIANDROSTERONE-SULFATE - DHEA-SULFATE | $128.80 | $161.00 | $18.39–$161.00 | 15% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG OF ABUSE SCREEN | $186.40 | $233.00 | $51.41–$233.00 | 1% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC COMPREHENSIVE DRUG SCREEN UMBILICAL CORD TISSUE SO | $186.40 | $233.00 | $51.41–$233.00 | 1% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR - AMPHETAMINE QUAL URINE | $186.40 | $233.00 | $51.41–$233.00 | 1% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC MECONIUM SCR MY | $186.40 | $233.00 | $51.41–$233.00 | 1% below | 20% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 CHG ELECTROLYTE PANEL | $42.40 | $53.00 | $5.80–$53.00 | 42% below | 20% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTE PANEL - BUNDLED CHARGE | $45.60 | $57.00 | $5.80–$57.00 | 38% below | 20% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 HC EPSTEIN B VIRUS-VCA | $23.20 | $29.00 | $15.01–$29.00 | 75% below | 20% |
| Estradiol blood test CPT 82670 HC ASSAY OF ESTRADIOL - ESTRADIOL | $105.60 | $132.00 | $23.12–$132.00 | 29% below | 20% |
| FSH (follicle-stimulating hormone) test CPT 83001 HC GONADOTROPIN (FSH) - FSH | $211.20 | $264.00 | $15.37–$264.00 | 69% above | 20% |
| Fecal calprotectin (stool inflammation test) CPT 83993 HC CALPROTECTIN | $343.20 | $429.00 | $16.25–$429.00 | 33% above | 20% |
| Ferritin blood test (iron stores) CPT 82728 HC ASSAY OF FERRITIN - FERRITIN | $77.60 | $97.00 | $11.28–$97.00 | 16% below | 20% |
| Fibrinogen blood test CPT 85384 HC FIBRINOGEN ACTIVITY - FIBRINOGENQUANTITATIVE | $76.80 | $96.00 | $8.05–$96.00 | 17% below | 20% |
| Folate (folic acid) blood test CPT 82746 HC BLOOD FOLIC ACID SERUM - FOLATE | $86.40 | $108.00 | $12.16–$108.00 | 5% below | 20% |
| Free T3 thyroid hormone test CPT 84481 HC TRIIODOTHYRONINE FREE ASSAY (FT-3) - T3 FREE | $92.80 | $116.00 | $14.01–$116.00 | 16% below | 20% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 CHG ASSAY OF FREE THYROXINE | $32.00 | $40.00 | $7.47–$40.00 | 58% below | 20% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 HC ASSAY OF FREE THYROXINE - T4 FREE | $53.60 | $67.00 | $7.47–$67.00 | 29% below | 20% |
| Free testosterone test CPT 84402 HC ASSAY OF TESTOSTERONE - TESTOSTERONE TOTAL FREE | $132.80 | $166.00 | $21.07–$166.00 | at median | 20% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC ASSAY OF GGT - GAMMA GT | $42.40 | $53.00 | $5.96–$53.00 | at median | 20% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HC GENERAL HEALTH PANEL - BUNDLED CHARGE | $80.00 | $100.00 | $51.49–$100.00 | 71% below | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE & DOSE 82950 | $72.00 | $90.00 | $3.93–$90.00 | 17% above | 20% |
| Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE TEST (GTT) - GTT 2 HOUR | $156.80 | $196.00 | $10.65–$196.00 | 50% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC NEISSERIA GONORRHOEAE AMPLIFIED RNA | $44.80 | $56.00 | $29.03–$56.00 | 55% below | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N GONORRHOEAE NUC. ACID | $89.60 | $112.00 | $29.03–$112.00 | 10% below | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N.GONORRHOEAE DNA AMP PROB - GC DNA PCR | $103.20 | $129.00 | $29.03–$129.00 | 3% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | $113.60 | $142.00 | $29.03–$142.00 | 14% above | 20% |
| H. pylori stool antigen test CPT 87338 HC IAAD IA HPYLORI STOOL - H PYLORI ANTIGEN STOOL | $64.80 | $81.00 | $11.89–$81.00 | 24% below | 20% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV-1 QUANT&REVRSE TRNSCRPJ - HIV 1 RNA QUANT BY PCR | $248.80 | $311.00 | $70.41–$311.00 | 32% below | 20% |
| HIV-1 and HIV-2 antibody test CPT 86703 HC HIV-1/HIV-2 SINGLE ASSAY - RAPID HIV 1 AND 2 SCREEN | $66.40 | $83.00 | $11.34–$83.00 | 20% below | 20% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE | $65.60 | $82.00 | $19.92–$82.00 | 16% below | 20% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV1 AG HIV 1 2 AB | $83.20 | $104.00 | $19.92–$104.00 | 6% above | 20% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV DNA PROBE AMP | $124.80 | $156.00 | $29.03–$156.00 | 17% below | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 CHG HEMOGLOBIN GLYCOSYLATED A1C | $43.20 | $54.00 | $8.04–$54.00 | 35% below | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC GLYCOSYLATED HEMOGLOBIN TEST - HEMOGLOBIN A1C | $53.60 | $67.00 | $8.04–$67.00 | 20% below | 20% |
| Hemoglobin blood test CPT 85018 HC HEMOGLOBIN - HEMOGLOBIN | $18.40 | $23.00 | $1.96–$23.00 | 36% below | 20% |
| Hemoglobin blood test CPT 85018 CHG BLOOD COUNT HEMOGLOBIN | $19.20 | $24.00 | $1.96–$24.00 | 33% below | 20% |
| Hepatitis B core antibody test (total) CPT 86704 HC HEP B CORE AB TEST TOTAL - HEPATITIS B CORE ANTIBODY TOTAL | $68.80 | $86.00 | $9.98–$86.00 | 24% below | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURFACE AB TEST - HEPATITIS B SURFACE ANTIBODY | $73.60 | $92.00 | $8.88–$92.00 | 10% below | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN - HEPATITIS B SURFACE ANTIGEN | $84.80 | $106.00 | $8.55–$106.00 | 12% above | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C AB TEST - HEPATITIS C ANTIBODY | $116.00 | $145.00 | $11.81–$145.00 | 1% above | 20% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION - HCV QUANT PCR | $737.60 | $922.00 | $35.44–$922.00 | 45% above | 20% |
| Herpes blood test, HSV-1 antibody CPT 86695 HC HERPES SIMPLEX TEST TYPE 1 - HSV 1 IGG ANTIBODY | $62.40 | $78.00 | $10.92–$78.00 | 32% below | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES SIMPLEX TEST TYPE 2 - HSV 2 IGG ANTIBODY | $96.80 | $121.00 | $16.01–$121.00 | at median | 20% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-REACTIVE PROTEINHIGH SENSITIVITY - HIGH SENSITIVITY CRP | $66.40 | $83.00 | $10.72–$83.00 | 14% below | 20% |
| Homocysteine blood test CPT 83090 HC ASSAY OF HOMOCYSTINE - HOMOCYSTEINE TOTAL | $92.80 | $116.00 | $14.83–$116.00 | 31% below | 20% |
| Insulin blood test CPT 83525 HC ASSAY OF INSULINTOTAL - INSULIN TOTAL | $105.60 | $132.00 | $9.46–$132.00 | 21% above | 20% |
| Iron blood test (serum iron) CPT 83540 HC ASSAY OF IRON - IRON | $30.40 | $38.00 | $5.36–$38.00 | 52% below | 20% |
| Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING TEST - IRON AND IRON BINDING CAPACITY PANEL - SR OR PL | $39.20 | $49.00 | $7.23–$49.00 | 41% below | 20% |
| Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL - BUNDLED CHARGE | $32.80 | $41.00 | $7.18–$41.00 | 71% below | 20% |
| LH (luteinizing hormone) test CPT 83002 HC GONADOTROPIN (LH) - LUTEINIZING HORMONE | $100.80 | $126.00 | $15.32–$126.00 | 12% below | 20% |
| Lactate (lactic acid) blood test CPT 83605 HC ASSAY OF LACTIC ACID - LACTATE | $115.20 | $144.00 | $9.58–$144.00 | 17% below | 20% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE | $39.20 | $49.00 | $5.00–$49.00 | 17% below | 20% |
| Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE - LIPASE | $52.00 | $65.00 | $5.70–$65.00 | 40% below | 20% |
| Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL - BUNDLED CHARGE | $38.40 | $48.00 | $6.76–$48.00 | 50% below | 20% |
| Lyme disease antibody test CPT 86618 HC LYMES TOTAL | $155.20 | $194.00 | $14.09–$194.00 | 25% above | 20% |
| Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM - MAGNESIUM | $64.80 | $81.00 | $5.55–$81.00 | at median | 20% |
| Magnesium blood test CPT 83735 HC SUPERSATURATION MAGNESIUM | $64.80 | $81.00 | $5.55–$81.00 | at median | 20% |
| Measles (rubeola) antibody test CPT 86765 HC RUBEOLA - RUBEOLA ANTIBODY IGG | $36.00 | $45.00 | $10.66–$45.00 | 43% below | 20% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HC HETEROPHILE ANTIBODIESSCREEN - MONONUCLEOSIS SCREEN | $20.00 | $25.00 | $4.28–$25.00 | 69% below | 20% |
| Mono test (heterophile antibody, Monospot) CPT 86308 CHG HETEROPHILE ANTIBODIES SCREEN | $20.00 | $25.00 | $4.28–$25.00 | 69% below | 20% |
| Mumps immunity blood test CPT 86735 HC MUMPS - MUMPS IGG ANTIBODY | $40.80 | $51.00 | $10.80–$51.00 | 20% below | 20% |
| Obstetric blood test panel CPT 80055 HC OBSTETRIC PANEL - BUNDLED CHARGE | $119.20 | $149.00 | $51.20–$149.00 | 60% below | 20% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC PSA FREE | $71.20 | $89.00 | $15.22–$89.00 | 38% below | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATE SPECIFIC ANTIGENTOTAL - PSA | $68.80 | $86.00 | $15.22–$86.00 | 39% below | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 CHG CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS | $64.80 | $81.00 | $22.02–$81.00 | 18% below | 20% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CHG CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN | $28.00 | $35.00 | $16.77–$35.00 | 55% below | 20% |
| Parathyroid hormone (PTH) blood test CPT 83970 HC ASSAY OF PARATHORMONE - PTH INTACT | $216.80 | $271.00 | $34.15–$271.00 | 5% above | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD | $24.00 | $30.00 | $4.97–$30.00 | 59% below | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLAS TIME PARTIAL - APTT | $48.00 | $60.00 | $4.97–$60.00 | 17% below | 20% |
| Phosphorus (phosphate) blood test CPT 84100 HC ASSAY OF INORGANIC PHOSPHORUS - PHOSPHORUS | $49.60 | $62.00 | $3.92–$62.00 | 6% below | 20% |
| Potassium blood test CPT 84132 HC ASSAY OF SERUM POTASSIUM - POTASSIUM | $40.80 | $51.00 | $3.94–$51.00 | 15% below | 20% |
| Progesterone blood test CPT 84144 HC ASSAY OF PROGESTERONE - PROGESTERONE | $139.20 | $174.00 | $17.26–$174.00 | 4% above | 20% |
| Prolactin blood test CPT 84146 HC ASSAY OF PROLACTIN - PROLACTIN | $105.60 | $132.00 | $16.04–$132.00 | 12% below | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 CHG PROTHROMBIN TIME | $24.00 | $30.00 | $3.55–$30.00 | 27% below | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME - PROTHROMBIN MIXING STUDY | $32.80 | $41.00 | $3.55–$41.00 | 1% below | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME - PROTIME-INR | $32.80 | $41.00 | $3.55–$41.00 | 1% below | 20% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC DRUG SCR PRESUMP DIRECT OPTICAL OBS | $128.00 | $160.00 | $10.42–$160.00 | 9% above | 20% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC NICOTINE SCREEN | $128.00 | $160.00 | $10.42–$160.00 | 9% above | 20% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC HAIR DRUG TEST | $253.60 | $317.00 | $10.42–$317.00 | 116% above | 20% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC MRO REVIEW-HAIR DRUG TESTING | $253.60 | $317.00 | $10.42–$317.00 | 116% above | 20% |
| Rapid flu test (influenza antigen) CPT 87804 CHG IAADIADOO INFLUENZA | $54.40 | $68.00 | $13.70–$68.00 | 3% below | 20% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 CHG IAADIADOO STREPTOCOCCUS GROUP A | $52.80 | $66.00 | $13.68–$66.00 | 8% above | 20% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC STREP A ASSAY W/OPTIC - RAPID STREP A SCREEN | $67.20 | $84.00 | $13.68–$84.00 | 38% above | 20% |
| Renin blood test CPT 84244 HC ASSAY OF RENIN - RENIN DIRECT ASSAY | $128.80 | $161.00 | $18.19–$161.00 | 25% below | 20% |
| Rh blood typing CPT 86901 CHG BLOOD TYPING SEROLOGIC RH (D) | $20.80 | $26.00 | $2.47–$43.72 | 63% below | 20% |
| Rh blood typing CPT 86901 HC BLOOD TYPING SEROLOGIC RH (D) û ABO/RH TYPE | $62.40 | $78.00 | $2.47–$78.00 | 12% above | 20% |
| Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QUANT - RHEUMATOID FACTOR | $38.40 | $48.00 | $4.69–$48.00 | 36% below | 20% |
| Rubella antibody test (immunity check) CPT 86762 HC RUBELLA ANTIBODY SCRN IGG | $52.00 | $65.00 | $11.90–$65.00 | 20% below | 20% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC RBC SED RATE AUTO - SEDIMENTATION RATE AUTOMATED | $18.40 | $23.00 | $2.23–$23.00 | 57% below | 20% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 CHG SEDIMENTATION RATE RBC AUTOMATED | $25.60 | $32.00 | $2.23–$32.00 | 40% below | 20% |
| Sodium blood test CPT 84295 HC ASSAY OF SERUM SODIUM - SODIUM | $46.40 | $58.00 | $3.98–$58.00 | at median | 20% |
| Stool ova and parasites exam CPT 87177 HC OVA AND PARASITES SMEARS - OVA AND PARASITE EXAMINATION | $67.20 | $84.00 | $7.36–$84.00 | 3% below | 20% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC BLD OCC FECAL HGB DETERM | $89.60 | $112.00 | $13.18–$112.00 | 77% above | 20% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 HC FLUORES TREPONEMAL AB | $32.80 | $41.00 | $10.95–$41.00 | 51% below | 20% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 HC SYPHILIS CONFIRMATION VDRL WITH TP PA | $62.40 | $78.00 | $10.95–$78.00 | 7% below | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - RAPID PLASMA REAGIN-SYP | $48.00 | $60.00 | $3.53–$60.00 | 5% below | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - VDRL CSF | $56.80 | $71.00 | $3.53–$71.00 | 12% above | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC RPR SCREEN W/ REFLEX TO TITERS | $88.00 | $110.00 | $3.53–$110.00 | 74% above | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON | $64.80 | $81.00 | $51.28–$81.00 | 66% below | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB TEST CELL MEDIATED ANTIGEN RESPONSEGAMMA INTERFRON - TB TEST | $162.40 | $203.00 | $51.28–$203.00 | 15% below | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 HC ASSAY OF TOTAL TESTOSTERONE - TESTOSTERONE | $150.40 | $188.00 | $21.36–$188.00 | 13% above | 20% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 HC ANTITHYROID AB ANTI TPO | $64.00 | $80.00 | $12.04–$80.00 | 30% below | 20% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 HC LIVER KDNEY MIC TYP1 AB | $64.00 | $80.00 | $12.04–$80.00 | 30% below | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH | $68.00 | $85.00 | $13.90–$85.00 | 25% below | 20% |
| Total IgE blood test CPT 82785 HC ASSAY OF GAMMAGLOBULIN IGE - IMMUNOGLOBULIN IGE | $64.80 | $81.00 | $13.62–$81.00 | 24% below | 20% |
| Total cholesterol blood test CPT 82465 HC ASSAY BLD/SERUM CHOLESTEROL - CHOLESTEROL TOTAL | $25.60 | $32.00 | $3.60–$32.00 | 27% below | 20% |
| Total thyroxine (T4) blood test CPT 84436 HC ASSAY OF TOTAL THYROXINE - T4 (THYROID HORMONE) | $44.00 | $55.00 | $5.68–$55.00 | 22% below | 20% |
| Total triiodothyronine (T3) blood test CPT 84480 HC TRIIODOTHYRONINE TOTAL ASSAY TT-3 - T3 (THYROID HORMONE) | $44.00 | $55.00 | $11.73–$55.00 | 51% below | 20% |
| Transferrin blood test CPT 84466 HC ASSAY OF TRANSFERRIN - TRANSFERRIN | $64.00 | $80.00 | $10.55–$80.00 | 43% below | 20% |
| Trichomonas test (NAAT) CPT 87661 HC NUCLEIC ACID TRICHOMON AMP | $111.20 | $139.00 | $29.03–$139.00 | 5% above | 20% |
| Trichomonas test (NAAT) CPT 87661 HC T.VAGINALIS MISC AMPLIFIED RNA | $117.60 | $147.00 | $29.03–$147.00 | 11% above | 20% |
| Triglycerides blood test CPT 84478 HC ASSAY OF TRIGLYCERIDES - TRIGLYCERIDES | $49.60 | $62.00 | $4.75–$62.00 | 18% above | 20% |
| Troponin test, quantitative CPT 84484 HC ASSAY OF TROPONIN QUANT - TROPONIN T | $88.80 | $111.00 | $10.32–$111.00 | 3% below | 20% |
| Troponin test, quantitative CPT 84484 CHG ASSAY OF TROPONIN QUANTITATIVE | $88.80 | $111.00 | $10.32–$111.00 | 3% below | 20% |
| Uric acid blood test CPT 84550 CHG ASSAY OF BLOOD/URIC ACID | $7.20 | $9.00 | $3.74–$9.00 | 82% below | 20% |
| Uric acid blood test CPT 84550 HC ASSAY OF URIC ACID BLOOD - URIC ACID | $28.80 | $36.00 | $3.74–$36.00 | 30% below | 20% |
| Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS AUTO W/SCOPE - URINALYSIS MICROSCOPIC | $19.20 | $24.00 | $2.62–$24.00 | 56% below | 20% |
| Urinalysis with microscope exam, automated CPT 81001 CHG URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY | $20.00 | $25.00 | $2.62–$25.00 | 54% below | 20% |
| Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTO W/O SCOPE - URINALYSIS CHEM ONLY | $14.40 | $18.00 | $1.86–$18.00 | 47% below | 20% |
| Urinalysis without microscope exam, automated CPT 81003 CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY | $15.20 | $19.00 | $1.86–$19.00 | 44% below | 20% |
| Urinalysis without microscope exam, manual CPT 81002 HC URINALYSIS DIP STICK NON-AUTO W/O MICROSCP | $14.40 | $18.00 | $2.88–$18.00 | 5% below | 20% |
| Urinalysis without microscope exam, manual CPT 81002 CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP | $15.20 | $19.00 | $2.88–$19.00 | at median | 20% |
| Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE | $35.20 | $44.00 | $6.68–$44.00 | 61% below | 20% |
| Urine culture for bacteria, with colony count CPT 87086 HC CULTURE URINE | $59.20 | $74.00 | $6.68–$74.00 | 35% below | 20% |
| Urine microalbumin (albumin) test CPT 82043 HC MICROALBUMIN QUANTITATIVE - MICROALBUMIN / CREATININE URINE RATIO | $43.20 | $54.00 | $4.78–$54.00 | 21% below | 20% |
| Urine microalbumin (albumin) test CPT 82043 HC MICROALBUMIN QUANTITATIVE - MICROALBUMIN 24HR URINE | $64.00 | $80.00 | $4.78–$80.00 | 17% above | 20% |
| Urine pregnancy test, read by color change CPT 81025 SERTRALINE HCL 25 MG PO TABS | $32.00 | $40.00 | $7.13–$40.00 | 27% below | 20% |
| Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY TEST - PREGNANCY URINE | $36.80 | $46.00 | $7.13–$46.00 | 16% below | 20% |
| Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN B-12 - VITAMIN B12 | $85.60 | $107.00 | $12.47–$107.00 | 7% below | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC ASSAY OF VIT DCALCIFEDIOL W FRACTIONS IF PERFORMED - VITAMIN D 25 | $97.60 | $122.00 | $24.49–$122.00 | 29% below | 20% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC ASSAY DIHYDROXYVITAMIN D W/FRACTIONS IF PERFORMED - VITAMIN D 1 | $221.60 | $277.00 | $31.85–$277.00 | at median | 20% |
| Zinc blood test CPT 84630 HC ASSAY OF ZINC - ZINC | $86.40 | $108.00 | $9.42–$108.00 | 9% below | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC CHORIONIC GONADOTROPIN QUANT - HCG QUANTITATIVE BLOOD | $82.40 | $103.00 | $12.45–$103.00 | 28% below | 20% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Montana | Off list |
|---|---|---|---|---|---|
| Adenoid removal (adenoidectomy), child under 12 CPT 42830 PR ADENOIDECTOMY PRIMARY <AGE 12 | $554.40 | $693.00 | $204.96–$3,612.26 | 7% below | 20% |
| Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 PR ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2 | $4,201.60 | $5,252.00 | $1,622.80–$14,331.57 | 41% below | 20% |
| Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 PR APPENDEC RPTD APPENDIX ABSC/PRITONITIS | $2,280.80 | $2,851.00 | $830.75–$2,851.00 | 11% above | 20% |
| Appendectomy, open surgery CPT 44950 PR APPENDECTOMY | $1,681.60 | $2,102.00 | $609.14–$6,950.08 | 11% above | 20% |
| Balloon dilation of the maxillary sinus opening, one side CPT 31295 PR NASAL/SINUS NDSC SURG W/DILATION MAXILLARY SINUS | $633.60 | $792.00 | $554.40–$7,710.53 | 64% below | 20% |
| Botox injections for chronic migraine CPT 64615 HC PF CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE | $356.00 | $445.00 | $146.29–$445.00 | 49% above | 20% |
| Botox injections for chronic migraine CPT 64615 PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE | $401.60 | $502.00 | $146.29–$502.00 | 68% above | 20% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC ED CLSD TX ANDKLE FX WO MANIP | $376.00 | $470.00 | $256.91–$470.00 | 22% below | 20% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC PF 27786 FX FIB DIST WO MAN | $818.40 | $1,023.00 | $256.91–$1,023.00 | 69% above | 20% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 PR CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ | $926.40 | $1,158.00 | $256.91–$1,158.00 | 91% above | 20% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 PR CLOSED TX METATARSAL FRACTURE W/O MANIPULATION | $624.00 | $780.00 | $213.89–$780.00 | 84% above | 20% |
| Cardiac catheterization with coronary angiogram one side CPT 93458 HC CATH PLACE/CORON ANGIO IMG SUPER/INTERPW LEFT HEART VENTRICULOGRAPHY | $6,600.00 | $8,250.00 | $971.95–$8,250.00 | 45% below | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTRIC EXT - TEE W/ DOPPLER COLOR AND CARDIOVERSION | $722.40 | $903.00 | $145.05–$903.00 | 17% below | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTRIC EXT - TRANSESOPHAGEAL ECHO W/ CARDIOVERSION | $722.40 | $903.00 | $145.05–$903.00 | 17% below | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC EP CARDIOVERSION ELECTIVE;EXTERN | $722.40 | $903.00 | $145.05–$903.00 | 17% below | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTRIC EXT - CARDIOVERSION EXTERNAL | $722.40 | $903.00 | $145.05–$903.00 | 17% below | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTRIC EXT - TEE COMPLETE W/ CARDIOVERSION | $722.40 | $903.00 | $145.05–$903.00 | 17% below | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTRIC EXT - TEE COMPLETE W/ COLOR AND CARDIOVERSION | $722.40 | $903.00 | $145.05–$903.00 | 17% below | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC ED CARDIOVERSION ELECTRIC EXT - CARDIOVERSION EXTERNAL | $722.40 | $903.00 | $145.05–$903.00 | 17% below | 20% |
| Cataract surgery with lens implant CPT 66984 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP | $1,706.40 | $2,133.00 | $510.02–$2,540.37 | 6% below | 20% |
| Cervical biopsy CPT 57500 HC PF BIOPSY CERVIX 1 OR MORE OR EXCISION OF LESION | $222.40 | $278.00 | $146.27–$969.86 | 38% below | 20% |
| Cervical biopsy CPT 57500 PR BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX | $477.60 | $597.00 | $146.27–$969.86 | 33% above | 20% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM | $7,088.00 | $8,860.00 | $3,143.17–$8,860.00 | 25% above | 20% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 HC PF CIRCUMCISION | $292.80 | $366.00 | $186.93–$2,281.71 | 48% below | 20% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 PR CIRCUMCISION AGE >28 DAYS | $607.20 | $759.00 | $186.93–$2,281.71 | 8% above | 20% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC PF CIRCUMCISION W REGIONAL BLOCK | $392.00 | $490.00 | $140.87–$2,281.71 | 88% above | 20% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 GUAIFENESIN-DM 100-10 MG/5ML PO SYRP | $406.40 | $508.00 | $140.87–$2,281.71 | 95% above | 20% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK | $586.40 | $733.00 | $140.87–$2,281.71 | 181% above | 20% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC CIRCUMCISION W REGIONAL BLOCK | $608.00 | $760.00 | $140.87–$2,281.71 | 191% above | 20% |
| Circumcision, surgical, older than a newborn CPT 54160 PR CIRCUMCISION NEONATE | $406.40 | $508.00 | $210.39–$743.45 | 28% above | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC ED CLSD TX DISTAL RADIAL FX | $717.60 | $897.00 | $256.91–$897.00 | 57% above | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC PF 25600 FX RAD DIST WO MAN | $737.60 | $922.00 | $256.91–$922.00 | 61% above | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 PR CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MNPJ | $819.20 | $1,024.00 | $256.91–$1,024.00 | 79% above | 20% |
| Colonoscopy with endoscopic ultrasound CPT 45391 PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX | $865.60 | $1,082.00 | $239.64–$1,313.30 | at median | 20% |
| Colonoscopy with polyp removal CPT 45385 PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ | $1,015.20 | $1,269.00 | $429.69–$1,313.30 | 52% below | 20% |
| Colonoscopy with tissue sample CPT 45380 PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE | $761.60 | $952.00 | $410.48–$1,313.30 | 60% below | 20% |
| Colonoscopy, diagnostic CPT 45378 HC COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD - COLONOSCOPY | $416.00 | $520.00 | $321.95–$1,015.50 | 77% below | 20% |
| Colonoscopy, diagnostic CPT 45378 PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | $590.40 | $738.00 | $321.95–$1,015.50 | 67% below | 20% |
| Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 HC PF COLPOSCOPYCERVIX W/ADJ VAGW/LOOP BX | $920.00 | $1,150.00 | $298.52–$3,541.49 | 4% above | 20% |
| Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 PR COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX | $1,255.20 | $1,569.00 | $298.52–$3,541.49 | 42% above | 20% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC PF COLPOSCCERVIX W/ADJ VAGW/BX & CURRETAG | $304.00 | $380.00 | $161.01–$380.00 | 13% below | 20% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 PR COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE | $589.60 | $737.00 | $161.01–$737.00 | 69% above | 20% |
| Complex cataract surgery with lens implant CPT 66982 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH CPLX WO ECP | $2,016.00 | $2,520.00 | $698.64–$2,540.37 | 8% below | 20% |
| Coronary stent placement, one artery CPT 92928 HC CATH PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH | $1,978.40 | $2,473.00 | $541.87–$12,631.58 | 62% below | 20% |
| Coronary stent placement, one artery CPT 92928 PR PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH | $2,098.40 | $2,623.00 | $541.87–$12,631.58 | 60% below | 20% |
| Cystoscopy with ureteral stent placement CPT 52332 HC CYSTO W/INSERT URETERAL STENT | $4,038.40 | $5,048.00 | $378.92–$5,048.00 | 556% above | 20% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC PF CYSTOURETHROSCOPY | $239.20 | $299.00 | $209.30–$743.45 | 46% below | 20% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC CYSTOURETHROSCOPY | $540.00 | $675.00 | $227.24–$743.45 | 21% above | 20% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC | $740.00 | $925.00 | $284.82–$3,541.49 | at median | 20% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC PF DESTRUC BENIGN/PREMALFIRST LESION | $170.40 | $213.00 | $64.48–$221.32 | 1% below | 20% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 PR DESTRUCTION PREMALIGNANT LESION 1ST | $206.40 | $258.00 | $64.48–$258.00 | 20% above | 20% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 HC PF TYMPANOSTOMY (REQUIRING INSERT VENTILATING TUBE) GENERAL ANES | $553.60 | $692.00 | $152.86–$1,649.91 | 61% below | 20% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 HC PF CREATE EARDRUM OPENINGLOCAL ANESTH | $425.60 | $532.00 | $193.06–$567.23 | 2% below | 20% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 BUTALBITAL-ASA-CAFF-CODEINE 50-325-40-30 MG PO CAPS | $454.40 | $568.00 | $193.06–$568.00 | 4% above | 20% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC PF REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT | $22.40 | $28.00 | $15.17–$66.16 | 49% below | 20% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC ED 69209 REMOVAL IMPACTED CERUMEN UNILATERAL | $50.40 | $63.00 | $15.17–$66.16 | 15% above | 20% |
| Earwax removal with instruments, one ear CPT 69210 HC REMOVAL IMPACTED CERUMEN EAR WAX | $102.40 | $128.00 | $45.48–$128.00 | 20% above | 20% |
| Earwax removal with instruments, one ear one side CPT 69210 HC PF REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT | $122.40 | $153.00 | $45.48–$153.00 | 44% above | 20% |
| Earwax removal with instruments, one ear one side CPT 69210 HC ED REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT | $136.00 | $170.00 | $45.48–$170.00 | 60% above | 20% |
| Earwax removal with instruments, one ear one side CPT 69210 PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT | $153.60 | $192.00 | $45.48–$192.00 | 80% above | 20% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC PF BIOPSY OF UTERUS LINING | $169.60 | $212.00 | $96.62–$224.07 | 31% below | 20% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC BIOPSY OF UTERUS LINING | $184.80 | $231.00 | $96.62–$231.00 | 25% below | 20% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX | $283.20 | $354.00 | $96.62–$354.00 | 15% above | 20% |
| Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 PR NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY | $1,095.20 | $1,369.00 | $303.95–$7,710.53 | at median | 20% |
| Endoscopic sinus surgery: opening the frontal sinus CPT 31276 PR NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS | $1,381.60 | $1,727.00 | $355.70–$7,710.53 | 4% below | 20% |
| Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 PR NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY | $538.40 | $673.00 | $169.51–$4,106.67 | 18% below | 20% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 PR NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS | $872.00 | $1,090.00 | $249.97–$7,710.53 | at median | 20% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN | $1,424.00 | $1,780.00 | $249.38–$1,780.00 | 22% above | 20% |
| Eye injection into the vitreous (intravitreal injection) CPT 67028 HC ED INTRAVITREAL NJX PHARMACOLOGIC AGT SPX | $870.40 | $1,088.00 | $106.50–$1,088.00 | 90% above | 20% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ DX/THER AGNT PARAVERT FACET JOINTIMG GUIDELUMBAR/SAC 1ST LEVEL | $590.40 | $738.00 | $168.44–$991.64 | 47% below | 20% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 PR RPR AA HERNIA 1ST 3-10 CM REDUCIBLE | $840.00 | $1,050.00 | $540.56–$6,950.08 | 5% below | 20% |
| First repair of a front abdominal hernia larger than 10 cm CPT 49595 PR RPR AA HERNIA 1ST > 10 CM REDUCIBLE | $953.60 | $1,192.00 | $727.14–$6,950.08 | 90% below | 20% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 PR RPR AA HERNIA 1ST < 3 CM REDUCIBLE | $483.20 | $604.00 | $323.10–$3,930.80 | at median | 20% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD | $282.40 | $353.00 | $176.69–$1,015.50 | 74% below | 20% |
| Gallbladder removal, laparoscopic CPT 47562 HC PF LAP CHOLECYSTECTOMY | $1,801.60 | $2,252.00 | $628.10–$6,498.54 | 3% below | 20% |
| Gallbladder removal, laparoscopic CPT 47562 PR LAPAROSCOPY SURG CHOLECYSTECTOMY | $1,931.20 | $2,414.00 | $628.10–$6,498.54 | 3% above | 20% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY | $1,967.20 | $2,459.00 | $682.62–$6,498.54 | at median | 20% |
| Gallbladder removal, open surgery through a larger incision CPT 47600 PR CHOLECYSTECTOMY | $3,447.20 | $4,309.00 | $1,014.30–$4,309.00 | 20% above | 20% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 HC PF HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS | $673.60 | $842.00 | $269.50–$1,015.50 | 2% above | 20% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 HC PF HEMORRHOIDECTOMY INT & EXT SMPL | $1,353.60 | $1,692.00 | $494.26–$3,054.58 | 64% above | 20% |
| Hysterectomy through an abdominal incision (total) CPT 58150 PR TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY | $5,075.20 | $6,344.00 | $966.27–$6,344.00 | 41% above | 20% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC PF CATH/INJECT HYSTEROSALPINGOGRAM | $370.40 | $463.00 | $229.49–$463.00 | 25% above | 20% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC CATH/INJECT HYSTEROSALPINGOGRAM | $437.60 | $547.00 | $229.49–$547.00 | 48% above | 20% |
| Hysteroscopy with endometrial ablation CPT 58563 PR HYSTEROSCOPY ENDOMETRIAL ABLATION | $2,000.80 | $2,501.00 | $1,750.70–$5,498.42 | 18% below | 20% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C | $2,543.20 | $3,179.00 | $1,250.20–$3,541.49 | at median | 20% |
| IUD insertion (the device itself billed separately) CPT 58300 HC PF INSERT INTRAUTERINE DEVICE | $262.40 | $328.00 | $104.60–$328.00 | 9% below | 20% |
| IUD insertion (the device itself billed separately) CPT 58300 PR INSERTION INTRAUTERINE DEVICE IUD | $340.00 | $425.00 | $104.60–$425.00 | 18% above | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC PF DRAIN SKIN ABSCESS SIMPLE | $296.80 | $371.00 | $121.02–$371.00 | 35% above | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC DRAIN SKIN ABSCESS SIMPLE | $346.40 | $433.00 | $121.02–$433.00 | 57% above | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC ED DRAIN SKIN ABSCESS SIMPLE | $346.40 | $433.00 | $121.02–$433.00 | 57% above | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE | $349.60 | $437.00 | $121.02–$437.00 | 59% above | 20% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE | $1,474.40 | $1,843.00 | $498.88–$3,930.80 | 46% below | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC PF INJECT TENDON SHEATH/LIGAMENT | $260.80 | $326.00 | $54.96–$328.80 | 79% above | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJECT TENDON SHEATH/LIGAMENT | $348.80 | $436.00 | $54.96–$436.00 | 140% 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 | $252.80 | $316.00 | $61.88–$328.80 | 8% below | 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 | $252.80 | $316.00 | $61.88–$328.80 | 8% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC PF ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | $256.80 | $321.00 | $61.88–$328.80 | 7% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | $315.20 | $394.00 | $61.88–$394.00 | 14% above | 20% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC INSERTION DRUG DELIVERY IMPLANT | $331.20 | $414.00 | $95.67–$414.00 | 15% above | 20% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC PF INS IMPL DRUG DEL NON | $352.80 | $441.00 | $95.67–$441.00 | 23% above | 20% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 PR INSERTION DRUG DELIVERY IMPLANT | $430.40 | $538.00 | $95.67–$538.00 | 50% above | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC PF ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US | $256.80 | $321.00 | $52.43–$328.80 | 25% above | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US | $382.40 | $478.00 | $52.43–$478.00 | 87% above | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US | $382.40 | $478.00 | $52.43–$478.00 | 87% above | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC PF ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US | $250.40 | $313.00 | $51.17–$328.80 | 46% above | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ED ASP INJ JOINT BURSA SMALL WO US GUID | $348.80 | $436.00 | $51.17–$436.00 | 103% above | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US | $656.00 | $820.00 | $51.17–$820.00 | 281% above | 20% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 PR LAPAROSCOPIC APPENDECTOMY | $1,376.80 | $1,721.00 | $573.29–$6,498.54 | at median | 20% |
| Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 PR LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/< | $2,006.40 | $2,508.00 | $768.78–$11,596.44 | 6% below | 20% |
| Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 PR LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY | $2,264.00 | $2,830.00 | $865.66–$11,596.44 | 17% below | 20% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA | $974.40 | $1,218.00 | $413.77–$6,498.54 | at median | 20% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 PR LAPS SURG RPR RECURRENT INGUINAL HERNIA | $1,511.20 | $1,889.00 | $539.90–$6,498.54 | at median | 20% |
| Laparoscopic removal of an adjustable gastric band and its port CPT 43774 PR LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT | $2,444.80 | $3,056.00 | $911.12–$4,237.64 | at median | 20% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES | $1,463.20 | $1,829.00 | $620.06–$6,498.54 | at median | 20% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 PR POST-CATARACT LASER SURGERY | $796.80 | $996.00 | $315.43–$996.00 | 10% above | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC PF LAYR CLOS WND TRUNKARMLEG <2.5 CM | $553.60 | $692.00 | $249.96–$692.00 | 34% above | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC ED LAYR CLOS WND TRUNKARMLEG <2.5 CM | $606.40 | $758.00 | $249.96–$758.00 | 47% above | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< | $608.80 | $761.00 | $249.96–$761.00 | 48% above | 20% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN | $1,121.60 | $1,402.00 | $245.27–$1,402.00 | 83% above | 20% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN | $555.20 | $694.00 | $128.28–$991.64 | 31% above | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE 1 LEVEL | $361.60 | $452.00 | $233.89–$991.64 | 66% below | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL | $522.40 | $653.00 | $233.89–$991.64 | 50% below | 20% |
| Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 PR LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR | $2,614.40 | $3,268.00 | $877.99–$7,956.97 | 35% below | 20% |
| Lumbar fusion with interbody cage and posterolateral graft (TLIF), one level CPT 22633 PR ARTHRODESIS COMBINED TQ 1NTRSPC LUMBAR | $4,451.20 | $5,564.00 | $1,723.59–$20,483.57 | — | 20% |
| Lumbar laminectomy (spinal decompression), one level CPT 63047 PR LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT LUMBAR | $2,822.40 | $3,528.00 | $1,059.43–$7,956.97 | 34% below | 20% |
| Lumbar spinal fusion (posterior), one level CPT 22612 PR ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC LUMBAR | $4,871.20 | $6,089.00 | $1,506.58–$20,483.57 | at median | 20% |
| Lumpectomy (partial mastectomy) CPT 19301 PR MASTECTOMY PARTIAL | $1,658.40 | $2,073.00 | $628.47–$4,265.21 | at median | 20% |
| Mastectomy (total removal of the breast) CPT 19303 PR MASTECTOMY SIMPLE COMPLETE | $2,602.40 | $3,253.00 | $910.65–$7,263.86 | at median | 20% |
| Miscarriage treatment with D&C, first trimester CPT 59820 HC TX MISSED ABORTION FIRST TRIMESTER SURGICAL | $8,433.60 | $10,542.00 | $528.63–$10,542.00 | 203% above | 20% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC PF EXC BGN TRNK<0.5CM | $401.60 | $502.00 | $122.29–$783.68 | 79% above | 20% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/< | $413.60 | $517.00 | $122.29–$783.68 | 85% above | 20% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC PF EXC SKIN BENIG <0.5 CM FACEFACIAL | $400.80 | $501.00 | $136.85–$783.68 | 36% above | 20% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/< | $454.40 | $568.00 | $136.85–$783.68 | 54% above | 20% |
| Nail removal (partial or complete), one nail CPT 11730 HC PF REMOVAL OF NAIL PLATE | $194.40 | $243.00 | $109.35–$243.00 | 2% above | 20% |
| Nail removal (partial or complete), one nail CPT 11730 HC ED REMOVAL OF NAIL PLATE | $222.40 | $278.00 | $109.35–$278.00 | 17% above | 20% |
| Nail removal (partial or complete), one nail CPT 11730 HC REMOVAL OF NAIL PLATE | $222.40 | $278.00 | $109.35–$278.00 | 17% above | 20% |
| Nail removal (partial or complete), one nail CPT 11730 PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 | $240.00 | $300.00 | $109.35–$300.00 | 26% above | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 HC PF NJECT NERV BLCKGREAT OCCIPTL | $247.20 | $309.00 | $71.63–$328.80 | 16% below | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 HC ED NJECT NERV BLCKGREAT OCCIPTL | $339.20 | $424.00 | $71.63–$424.00 | 16% above | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 HC INJECTION AA&/STRD GREATER OCCIPITAL NERVE | $391.20 | $489.00 | $71.63–$489.00 | 33% above | 20% |
| Pacemaker implant (dual chamber) CPT 33208 HC EP INSER HART PACER XVENOUS ATR/VENTR | $19,609.60 | $24,512.00 | $480.91–$24,512.00 | at median | 20% |
| Paracentesis with imaging guidance CPT 49083 HC PF ABD PARACENTESIS WIMAGING | $320.00 | $400.00 | $275.29–$1,044.30 | 61% below | 20% |
| Paracentesis with imaging guidance CPT 49083 HC ABD PARACENTESIS W IMAGING | $1,078.40 | $1,348.00 | $275.29–$1,348.00 | 33% above | 20% |
| Paracentesis with imaging guidance CPT 49083 HC ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE | $1,078.40 | $1,348.00 | $275.29–$1,348.00 | 33% above | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC PF REMOVAL OF NAIL BED | $537.60 | $672.00 | $152.96–$672.00 | 44% above | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC ED REMOVAL OF NAIL BED | $645.60 | $807.00 | $152.96–$807.00 | 73% above | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC EXCISION NAIL MATRIX PERMANENT REMOVAL | $645.60 | $807.00 | $152.96–$807.00 | 73% above | 20% |
| Prostate biopsy CPT 55700 HC PF BIOPSY OF PROSTATENEEDLE/PUNCH | $670.40 | $838.00 | $228.42–$2,281.71 | 1% above | 20% |
| Prostate biopsy CPT 55700 HC BIOPSY OF PROSTATENEEDLE/PUNCH | $821.60 | $1,027.00 | $228.42–$2,281.71 | 24% above | 20% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 HC PF LAP RADICAL PROSTAT | $5,024.80 | $6,281.00 | $1,121.66–$11,596.44 | 3% below | 20% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 PR LAPS PROSTECT RETROPUBIC RAD W/NRV SPARING ROBOT | $5,384.80 | $6,731.00 | $1,121.66–$11,596.44 | 3% above | 20% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DESTROY LUMB SAC FACET JNT | $342.40 | $428.00 | $299.60–$2,175.08 | 76% below | 20% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL | $1,031.20 | $1,289.00 | $419.10–$2,175.08 | 27% below | 20% |
| Removal of a breast lump, open surgery CPT 19120 PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION | $1,118.40 | $1,398.00 | $496.40–$4,265.21 | at median | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 HC PF REMOVE FOREIGN BODY SIMPLE | $264.80 | $331.00 | $145.05–$445.02 | 15% below | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 HC INCISION AND REMOVAL FOREIGN BODY SUBQ SIMPLE | $274.40 | $343.00 | $145.05–$445.02 | 12% below | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 HC ED REMOVE FOREIGN BODY SIMPLE | $760.00 | $950.00 | $145.05–$950.00 | 144% above | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 HC TX RM INCISION RMV FB SUBQ SMP | $955.20 | $1,194.00 | $145.05–$1,194.00 | 207% above | 20% |
| Removal of one lobe of the thyroid (lobectomy) CPT 60220 PR TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY | $2,059.20 | $2,574.00 | $672.40–$6,498.54 | at median | 20% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 PR COLON CA SCRN NOT HI RSK IND | $589.60 | $737.00 | $322.25–$1,015.50 | 69% below | 20% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 PR COLORECTAL SCRN; HI RISK IND | $589.60 | $737.00 | $321.95–$1,015.50 | 56% below | 20% |
| Septoplasty to straighten the nasal septum CPT 30520 PR SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF | $1,406.40 | $1,758.00 | $645.34–$3,612.26 | at median | 20% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 HC LITHOTRIPSY EXTRACORPOREAL SHOCK WAVE | $1,814.40 | $2,268.00 | $703.09–$3,841.60 | 14% below | 20% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 PR LITHOTRIPSY XTRCORP SHOCK WAVE | $3,019.20 | $3,774.00 | $703.09–$3,841.60 | 42% above | 20% |
| Short arm cast (elbow to hand) CPT 29075 HC ED 29075 APPL CAST FOREARM ARM | $213.60 | $267.00 | $84.96–$295.82 | at median | 20% |
| Short arm cast (elbow to hand) CPT 29075 HC PF APPLY FOREARM CAST | $244.00 | $305.00 | $84.96–$305.00 | 14% above | 20% |
| Short arm cast (elbow to hand) CPT 29075 PR APPLICATION CAST ELBOW FINGER SHORT ARM | $252.00 | $315.00 | $84.96–$315.00 | 18% above | 20% |
| Short arm splint (forearm and hand) CPT 29125 HC APPL SHORT ARM SPLINT STATIC | $96.80 | $121.00 | $64.76–$143.57 | 39% below | 20% |
| Short arm splint (forearm and hand) CPT 29125 HC PF APPLY FOREARM SPLINTSTATIC | $157.60 | $197.00 | $64.76–$197.00 | 1% below | 20% |
| Short arm splint (forearm and hand) CPT 29125 HC ED APPLY FOREARM SPLINTSTATIC | $198.40 | $248.00 | $64.76–$248.00 | 25% above | 20% |
| Short leg cast (below the knee) CPT 29405 HC ED 29405 APPL CAST SHORT LEG | $206.40 | $258.00 | $77.70–$295.82 | 8% below | 20% |
| Short leg cast (below the knee) CPT 29405 PR APPLICATION SHORT LEG CAST BELOW KNEE-TOE | $260.80 | $326.00 | $77.70–$326.00 | 16% above | 20% |
| Short leg splint (calf to foot) CPT 29515 HC PF APPLY LOWER LEG SPLINT | $105.60 | $132.00 | $69.82–$175.75 | 45% below | 20% |
| Short leg splint (calf to foot) CPT 29515 HC ED APPLY LOWER LEG SPLINT | $328.00 | $410.00 | $69.82–$410.00 | 72% above | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC PF RESUPERF WND BODY <2.5CM | $256.00 | $320.00 | $89.70–$320.00 | 3% above | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC ED RESUPERF WND BODY <2.5CM | $357.60 | $447.00 | $89.70–$447.00 | 45% above | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< | $368.00 | $460.00 | $89.70–$460.00 | 49% above | 20% |
| Skin biopsy, punch, one lesion CPT 11104 HC PF SURG PUNCH BX SKIN SINGLE LESION | $163.20 | $204.00 | $118.84–$445.02 | 49% below | 20% |
| Skin biopsy, punch, one lesion CPT 11104 HC SURG PUNCH BX SKIN SINGLE LESION | $976.80 | $1,221.00 | $118.84–$1,221.00 | 205% above | 20% |
| Skin biopsy, punch, one lesion CPT 11104 HC ED SURG PUNCH BX SKIN SINGLE LESION | $1,024.80 | $1,281.00 | $118.84–$1,281.00 | 220% above | 20% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC PF 11600 EXC LSN MAL TRK<0.5CM | $589.60 | $737.00 | $188.01–$783.68 | 79% above | 20% |
| Skin tag removal, up to 15 tags CPT 11200 HC PF REMOVAL OF SKIN TAGS UP TO 15 | $213.60 | $267.00 | $88.16–$267.00 | 16% above | 20% |
| Skin tag removal, up to 15 tags CPT 11200 HC ED REMOVAL OF SKIN TAGS UP TO 15 | $256.00 | $320.00 | $88.16–$320.00 | 39% above | 20% |
| Skin tag removal, up to 15 tags CPT 11200 HC REMOVAL OF SKIN TAGS UP TO 15 | $273.60 | $342.00 | $88.16–$342.00 | 48% above | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC PF SPINAL PUNCTURELUMBARDIAGNOSTIC | $436.00 | $545.00 | $138.63–$771.36 | at median | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC ED SPINAL PUNCTURELUMBARDIAGNOSTIC | $501.60 | $627.00 | $138.63–$771.36 | 15% above | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC SPINAL PUNCTURELUMBARDIAGNOSTIC | $501.60 | $627.00 | $138.63–$771.36 | 15% above | 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 PF RESUP NPTERF WND BODY 2.6-7.5 CM | $185.60 | $232.00 | $108.63–$232.00 | 33% 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 ED RESUP NPTERF WND BODY 2.6-7.5 CM | $440.80 | $551.00 | $108.63–$551.00 | 59% above | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC PF RESUPERF WND FACE <2.5 CM | $456.80 | $571.00 | $106.74–$571.00 | 30% above | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC ED RESUPERF WND FACE <2.5 CM | $558.40 | $698.00 | $106.74–$698.00 | 59% above | 20% |
| TURP (transurethral resection of the prostate) CPT 52601 HC TRANSURETHRAL ELECTROSURGICAL RESECTION PROSTATE WCONTROL POSTOP BLEED | $1,693.60 | $2,117.00 | $686.05–$5,662.34 | 56% below | 20% |
| TURP (transurethral resection of the prostate) CPT 52601 PR TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE | $3,876.80 | $4,846.00 | $686.05–$5,662.34 | at median | 20% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC PF SURG TANGENTIAL BX SKIN SINGLE LESION | $531.20 | $664.00 | $95.46–$664.00 | 128% above | 20% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC ED TANGENTIAL BX SKIN - SINGLE LESION | $976.80 | $1,221.00 | $95.46–$1,221.00 | 320% above | 20% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC SURG TANGENTIAL BX SKIN SINGLE LESION | $976.80 | $1,221.00 | $95.46–$1,221.00 | 320% above | 20% |
| Thoracentesis with imaging guidance CPT 32555 HC PF ASPIRATE PLEURA W IMAGING | $522.40 | $653.00 | $295.53–$688.65 | 44% below | 20% |
| Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING | $2,552.80 | $3,191.00 | $295.53–$3,191.00 | 175% above | 20% |
| Tonsil and adenoid removal, age 12 or older CPT 42821 PR TONSILLECTOMY & ADENOIDECTOMY AGE 12/> | $812.00 | $1,015.00 | $291.76–$3,612.26 | at median | 20% |
| Tonsil and adenoid removal, child under 12 CPT 42820 PR TONSILLECTOMY & ADENOIDECTOMY <AGE 12 | $780.00 | $975.00 | $279.43–$6,589.10 | at median | 20% |
| Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 PR TONSILLECTOMY PRIMARY/SECONDARY AGE 12/> | $672.00 | $840.00 | $245.68–$3,612.26 | at median | 20% |
| Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 PR TONSILLECTOMY PRIMARY/SECONDARY <AGE 12 | $851.20 | $1,064.00 | $258.01–$6,589.10 | at median | 20% |
| Total thyroid removal (thyroidectomy) CPT 60240 PR THYROIDECTOMY TOTAL/COMPLETE | $3,272.00 | $4,090.00 | $870.36–$6,498.54 | at median | 20% |
| Trigger finger release surgery CPT 26055 PR TENDON SHEATH INCISION | $705.60 | $882.00 | $562.80–$1,782.60 | at median | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC PF INJECT TRIGGER POINT 1 OR 2 | $271.20 | $339.00 | $49.90–$339.00 | 49% above | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC ED INJECT TRIGGER POINT 1 OR 2 | $289.60 | $362.00 | $49.90–$362.00 | 59% above | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES | $289.60 | $362.00 | $49.90–$362.00 | 59% above | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC INJECT TRIGGER POINT 1 OR 2 | $289.60 | $362.00 | $49.90–$362.00 | 59% above | 20% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 PR LAPAROSCOPY FULGURATION OVIDUCTS | $2,449.60 | $3,062.00 | $355.05–$6,498.54 | 27% above | 20% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM | $628.80 | $786.00 | $550.20–$2,112.95 | 53% below | 20% |
| Upper endoscopy (EGD) with biopsy CPT 43239 PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE | $619.20 | $774.00 | $356.50–$1,044.30 | 60% below | 20% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 PR ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION | $549.60 | $687.00 | $379.91–$1,044.30 | 19% below | 20% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH | $688.00 | $860.00 | $467.41–$2,112.95 | 62% below | 20% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS | $658.40 | $823.00 | $391.25–$1,044.30 | at median | 20% |
| Upper endoscopy (EGD), diagnostic CPT 43235 PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $540.00 | $675.00 | $272.73–$1,044.30 | 49% below | 20% |
| Upper endoscopy with drainage of a pseudocyst through the stomach wall CPT 43240 HC EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST | $13,208.80 | $16,511.00 | $364.34–$16,511.00 | 1099% above | 20% |
| Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 PR CYSTO W/URETEROSCOPY W/LITHOTRIPSY | $3,396.80 | $4,246.00 | $364.30–$5,662.34 | at median | 20% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 HC CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT | $6,320.80 | $7,901.00 | $386.38–$7,901.00 | 48% above | 20% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 PR ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB | $7,000.80 | $8,751.00 | $2,411.83–$8,751.00 | 34% above | 20% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM | $5,370.40 | $6,713.00 | $2,847.27–$6,713.00 | 11% above | 20% |
| Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS | $1,888.80 | $2,361.00 | $318.80–$2,361.00 | — | 20% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 HC PF VASECT WPOSTOP SEME | $1,286.40 | $1,608.00 | $318.80–$2,281.71 | 21% below | 20% |
| Vein ablation, radiofrequency, first vein CPT 36475 HC PF ENDOVENOUS RF 1ST VEIN | $3,381.60 | $4,227.00 | $1,001.97–$4,227.00 | 19% above | 20% |
| Vein ablation, radiofrequency, first vein CPT 36475 PR ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN | $6,535.20 | $8,169.00 | $1,001.97–$8,169.00 | 130% above | 20% |
| Wart removal, up to 14 warts CPT 17110 HC PF DESTRUCTION BENIGN LESIONS UP TO 14 | $129.60 | $162.00 | $108.42–$221.32 | 32% below | 20% |
| Wart removal, up to 14 warts CPT 17110 PR DESTRUCTION BENIGN LESIONS UP TO 14 | $244.80 | $306.00 | $108.42–$306.00 | 29% above | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC PF DEBRIDEMENT SKIN SUB-Q TISSUE=<20 SQ CM | $154.40 | $193.00 | $123.23–$445.02 | 42% below | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 THYROID 60 MG PO TABS | $297.60 | $372.00 | $123.23–$445.02 | 12% above | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBRIDEMENT SKIN SUB-Q TISSUE=<20 SQ CM | $437.60 | $547.00 | $123.23–$547.00 | 64% above | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC ED DEBRIDEMENT SKIN SUB-Q TISSUE=<20 SQ CM | $437.60 | $547.00 | $123.23–$547.00 | 64% above | 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 ED BLOOD TRANSFUSION SERVICE | $1,038.40 | $1,298.00 | $40.15–$1,298.00 | 37% above | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION SERVICE | $1,038.40 | $1,298.00 | $40.15–$1,298.00 | 37% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC EZ PAP INITIAL | $68.00 | $85.00 | $7.58–$226.54 | 38% below | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC EZ PAP SUBSEQUENT | $68.00 | $85.00 | $7.58–$226.54 | 38% below | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC PF NEBULIZER TREATMENT | $96.80 | $121.00 | $7.58–$226.54 | 12% below | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 EPINEPHRINE FOR INHALATION 1 MG/ML | $251.20 | $314.00 | $7.58–$314.00 | 129% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 HC RT DIAGNOSTIC SPUTUM | $68.00 | $85.00 | $7.58–$226.54 | 38% below | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 HC RT HAND HELD NEBULIZER | $80.80 | $101.00 | $7.58–$226.54 | 26% below | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 HC RT INHALATION TREATMENT - SUBSEQ DAY | $80.80 | $101.00 | $7.58–$226.54 | 26% below | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 HC RT INHALATION TREATMENT | $80.80 | $101.00 | $7.58–$226.54 | 26% below | 20% |
| Chemotherapy IV infusion, first hour CPT 96413 HC ED CHEMOTHER IV INFUSION 1 HR | $424.80 | $531.00 | $122.65–$531.00 | 16% below | 20% |
| Chemotherapy IV infusion, first hour CPT 96413 HC CHEMOTHER IV INFUSION 1 HR | $490.40 | $613.00 | $122.65–$613.00 | 3% below | 20% |
| Chemotherapy IV infusion, first hour CPT 96413 PR CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG | $500.80 | $626.00 | $122.65–$626.00 | 1% below | 20% |
| Comprehensive eye exam by an eye doctor, new patient CPT 92004 PR OPH SVCS MEDICAL XM&EVAL COMPRE NEW PT 1/> VST | $221.60 | $277.00 | $138.02–$277.00 | at median | 20% |
| Comprehensive eye exam, returning patient CPT 92014 PR OPH SVCS MEDICAL XM&EVAL COMPRE EST PT 1/>VST | $178.40 | $223.00 | $119.19–$223.00 | at median | 20% |
| Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 HC COMPREHENSIVE HEARING TEST | $102.40 | $128.00 | $34.46–$174.27 | 16% below | 20% |
| Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 PR COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ | $160.80 | $201.00 | $34.46–$201.00 | 32% above | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 HC ED CRITICAL CARE E&M 30-74 MIN | $1,831.20 | $2,289.00 | $258.38–$2,289.00 | 1% below | 20% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 HC PF ELECTROENCEPHALOGRAM (EEG) WAWAKE & DROWSY RECORD | $1,380.00 | $1,725.00 | $333.51–$1,725.00 | 73% above | 20% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEGW/AWAKE & DROWSY RECORD - EEG AWAKE OR DROWSY PORTABLE | $1,432.00 | $1,790.00 | $333.51–$1,790.00 | 80% above | 20% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R | $55.20 | $69.00 | $13.59–$69.00 | at median | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC ELECTROCARDIOGRAM TRACING | $137.60 | $172.00 | $5.99–$172.00 | 11% below | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC EMERGENCY DEPARTMENT LEVEL 1 VISIT LIMITED/MINOR PROB | $191.20 | $239.00 | $10.74–$239.00 | 8% below | 20% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC EMERGENCY DEPARTMENT LEVEL 2 VISIT LOW/MODER SEVERITY | $352.00 | $440.00 | $39.15–$440.00 | at median | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC EMERGENCY DEPARTMENT LEVEL 3 VISIT MODERATE SEVERITY | $613.60 | $767.00 | $66.61–$767.00 | 15% above | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED E/M VISIT - LEVEL 4 | $966.40 | $1,208.00 | $113.33–$1,208.00 | 14% above | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED 99284 SANE VISIT LEVEL 4 | $966.40 | $1,208.00 | $113.33–$1,208.00 | 14% above | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED VISIT LEVEL 4 W PROCEDURE | $966.40 | $1,208.00 | $113.33–$1,208.00 | 14% above | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC EMERGENCY DEPARTMENT LEVEL 5 VISIT HIGH SEVERITY&THREAT FUNC | $1,384.00 | $1,730.00 | $164.15–$1,730.00 | 8% above | 20% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 HC CARDIAC STRESS TSTTRACING - REGADENOSON W MYOCARDIAL PERFUSION MULT | $294.40 | $368.00 | $35.72–$368.00 | 49% below | 20% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 HC CARDIAC STRESS TSTTRACING - EXERCISE W MYOCARDIAL PERF SPECT SING | $294.40 | $368.00 | $35.72–$368.00 | 49% below | 20% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 HC CARDIAC STRESS TSTTRACING ONLY | $294.40 | $368.00 | $35.72–$368.00 | 49% below | 20% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 HC CARDIAC STRESS TSTTRACING - REGADENOSON W MYOCARDIAL PERFUSION SING | $294.40 | $368.00 | $35.72–$368.00 | 49% below | 20% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 HC CARDIAC STRESS TSTTRACING - EXERCISE W MYOCARDIAL PERFUSION MULT | $294.40 | $368.00 | $35.72–$368.00 | 49% below | 20% |
| Eye exam, returning patient, intermediate CPT 92012 PR OPH SVCS MEDICAL XM&EVAL INTERMEDIATE EST PT | $118.40 | $148.00 | $84.42–$148.00 | at median | 20% |
| Family therapy with the patient, 50 minutes CPT 90847 HC PF FAMILY PSYCHOTHERAPY W PHYS | $151.20 | $189.00 | $97.03–$189.00 | 6% below | 20% |
| Family therapy with the patient, 50 minutes CPT 90847 PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS | $349.60 | $437.00 | $97.03–$437.00 | 118% above | 20% |
| Family therapy without the patient, 50 minutes CPT 90846 HC PF 90846 FAMILY THERAPY PT NOT | $104.80 | $131.00 | $91.70–$178.96 | 33% below | 20% |
| Family therapy without the patient, 50 minutes CPT 90846 PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS | $259.20 | $324.00 | $92.61–$324.00 | 65% above | 20% |
| Group psychotherapy session CPT 90853 PR GROUP PSYCHOTHERAPY | $92.00 | $115.00 | $26.24–$115.00 | 32% above | 20% |
| Holter monitor, heart rhythm recording up to 48 hours, with report CPT 93224 PR XTRNL ECG REC<48 HRS RECORDING SCAN A/R R&I | $408.00 | $510.00 | $68.29–$510.00 | at median | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC ED IV INFUSION HYDRATION 31-60 MIN | $305.60 | $382.00 | $30.67–$382.00 | 20% above | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV INFUSION HYDRATION 31-60 MIN | $332.00 | $415.00 | $30.67–$415.00 | 31% above | 20% |
| IV infusion of a medicine, first hour CPT 96365 HC ED IV INFUSION THERAP/PROPH/DIAGNOSTINITIAL1ST HOUR | $312.80 | $391.00 | $59.42–$391.00 | 9% below | 20% |
| IV infusion of a medicine, first hour CPT 96365 HC IV INFUSION THERAP/PROPH/DIAGNOSTINITIAL1ST HOUR | $330.40 | $413.00 | $59.42–$413.00 | 4% below | 20% |
| IV push of a medicine, first drug CPT 96374 HC INJECTIONTHERAP/PROPH/DIAGNOST IV PUSH INITIAL DRUG | $177.60 | $222.00 | $34.78–$234.68 | 11% above | 20% |
| IV push of a medicine, first drug CPT 96374 HC ED INJECTIONTHERAP/PROPH/DIAGNOST IV PUSH INITIAL DRUG | $177.60 | $222.00 | $34.78–$234.68 | 11% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJECTIONTHERAP/PROPH/DIAGNOST IM OR SUBCUT | $103.20 | $129.00 | $13.59–$129.00 | 31% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC ED INJECTIONTHERAP/PROPH/DIAGNOST IM OR SUBCUT | $103.20 | $129.00 | $13.59–$129.00 | 31% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC PF INJECTIONTHERAP/PROPH/DIAGNOST IM OR SUBCUT | $160.00 | $200.00 | $13.59–$200.00 | 104% above | 20% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PF PSYCHIATRIC DIAGNOSTIC EVALUATION | $260.80 | $326.00 | $163.43–$326.00 | 18% above | 20% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 PR PSYCHIATRIC DIAGNOSTIC EVALUATION | $478.40 | $598.00 | $163.43–$598.00 | 117% above | 20% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC PF NERVE CONDUCTION STUDY 7-8 | $248.80 | $311.00 | $165.96–$346.85 | 2% below | 20% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 PR NERVE CONDUCTION STUDIES 7-8 STUDIES | $641.60 | $802.00 | $165.96–$802.00 | 153% above | 20% |
| Neuromuscular re-education, 15 minutes CPT 97112 PR THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA | $85.60 | $107.00 | $31.93–$107.00 | 3% below | 20% |
| New patient office visit, about 30 minutes CPT 99203 HC OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES | $85.60 | $107.00 | $74.90–$107.00 | 49% below | 20% |
| New patient office visit, about 30 minutes CPT 99203 HC L&D TRIAGE NEW PATIENT LVL 3 | $204.80 | $256.00 | $105.82–$256.00 | 23% above | 20% |
| New patient office visit, about 30 minutes CPT 99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES | $381.60 | $477.00 | $105.82–$477.00 | 129% above | 20% |
| New patient office visit, about 45 minutes CPT 99204 HC OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES | $86.40 | $108.00 | $75.60–$158.57 | 64% below | 20% |
| New patient office visit, about 45 minutes CPT 99204 HC L&D TRIAGE NEW PATIENT LVL 4 | $332.80 | $416.00 | $158.57–$416.00 | 41% above | 20% |
| New patient office visit, about 45 minutes CPT 99204 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES | $537.60 | $672.00 | $158.57–$672.00 | 127% above | 20% |
| New patient office visit, about 60 minutes CPT 99205 HC OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES | $84.80 | $106.00 | $74.20–$209.11 | 75% below | 20% |
| New patient office visit, about 60 minutes CPT 99205 HC L&D TRIAGE NEW PATIENT LVL 5 | $452.80 | $566.00 | $209.11–$566.00 | 36% above | 20% |
| New patient office visit, about 60 minutes CPT 99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES | $676.80 | $846.00 | $209.11–$846.00 | 103% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES | $84.80 | $106.00 | $68.56–$106.00 | 41% below | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC L&D TRIAGE NEW PATIENT LVL 2 | $117.60 | $147.00 | $68.56–$147.00 | 18% below | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC L&D TRIAGE NEW PATIENT LVL 1 | $117.60 | $147.00 | $68.56–$147.00 | 18% below | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 PR OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES | $266.40 | $333.00 | $68.56–$333.00 | 86% above | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MED NUTR THER 1ST INDIV EA 15 MIN | $32.00 | $40.00 | $28.00–$40.00 | 29% below | 20% |
| Occupational therapy evaluation, low complexity CPT 97165 PR OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS | $184.00 | $230.00 | $96.10–$230.00 | 8% above | 20% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PR PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS | $190.40 | $238.00 | $95.16–$238.00 | 5% below | 20% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PR PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS | $190.40 | $238.00 | $95.16–$238.00 | 12% above | 20% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PR PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS | $190.40 | $238.00 | $95.16–$238.00 | at median | 20% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PR MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES | $79.20 | $99.00 | $25.60–$99.00 | 1% above | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PR THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES | $85.60 | $107.00 | $27.82–$107.00 | 2% above | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 BZN LIMITED PHYSICAL NEW 18-39 YO | $40.00 | $50.00 | $35.00–$122.29 | 80% below | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 SPORTS, CAMP, OTHER SPECIAL PX NEW PT 18-39YR | $40.00 | $50.00 | $35.00–$122.29 | 80% below | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 EMPLOYMENT PX NEW PT 18-39YR | $40.00 | $50.00 | $35.00–$122.29 | 80% below | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 MSU SPORTS PHYSICAL NEW 18-39 YO | $76.00 | $95.00 | $66.50–$122.29 | 62% below | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 DOT PX NEW PT 18-39YR | $80.80 | $101.00 | $70.70–$122.29 | 59% below | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC PF FAC PREVENT MED NEW18-39Y | $118.40 | $148.00 | $103.60–$148.00 | 40% below | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 FAA FLIGHT PX NEW PT 18-39YR | $144.80 | $181.00 | $122.29–$181.00 | 27% below | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS | $370.40 | $463.00 | $122.29–$463.00 | 86% above | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 BZN LIMITED PHYSICAL NEW 40-64 YO | $40.00 | $50.00 | $35.00–$140.94 | 83% below | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 SPORTS, CAMP, OTHER SPECIAL PX NEW PT 40-64 YR | $40.00 | $50.00 | $35.00–$140.94 | 83% below | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 EMPLOYMENT PX NEW PT 40-64YR | $40.00 | $50.00 | $35.00–$140.94 | 83% below | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 DOT PX NEW PT 40-64YR | $80.80 | $101.00 | $70.70–$140.94 | 65% below | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC PF FAC PREVENT MED NEW40-64Y | $140.00 | $175.00 | $122.50–$175.00 | 39% below | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 FAA FLIGHT PX NEW PT 40-64 YO | $144.80 | $181.00 | $126.70–$181.00 | 37% below | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS | $436.80 | $546.00 | $140.94–$546.00 | 90% above | 20% |
| Preventive checkup, new patient aged 65 or older CPT 99387 BZN LIMITED PHYSICAL NEW 65 AND OVER | $40.00 | $50.00 | $35.00–$152.95 | 82% below | 20% |
| Preventive checkup, new patient aged 65 or older CPT 99387 SPORTS, CAMP, OTHER SPECIAL PX NEW PT 65+YR | $40.00 | $50.00 | $35.00–$152.95 | 82% below | 20% |
| Preventive checkup, new patient aged 65 or older CPT 99387 DOT PX NEW PT 65+YR | $80.80 | $101.00 | $70.70–$152.95 | 64% below | 20% |
| Preventive checkup, new patient aged 65 or older CPT 99387 HC PF FAC PREVENT MED NEW>65YR | $428.80 | $536.00 | $152.95–$536.00 | 89% above | 20% |
| Preventive checkup, new patient aged 65 or older CPT 99387 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&> | $459.20 | $574.00 | $152.95–$574.00 | 102% above | 20% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 BZN LIMITED PHYSICAL EST 18-39 YO | $39.20 | $49.00 | $34.30–$110.29 | 78% below | 20% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 SPORTS, CAMP, OTHER SPECIAL PX EST PT 18-39YR | $40.00 | $50.00 | $35.00–$110.29 | 78% below | 20% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 EMPLOYMENT PX EST PT 18-39YR | $40.00 | $50.00 | $35.00–$110.29 | 78% below | 20% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 MSU SPORTS PHYSICAL EST 18-39 YO | $76.00 | $95.00 | $66.50–$110.29 | 57% below | 20% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 DOT PX EST PT 18-39YR | $80.80 | $101.00 | $70.70–$110.29 | 55% below | 20% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 HC PREVENTIVE MED EST PATIENT 18-39 YRS | $107.20 | $134.00 | $93.80–$134.00 | 40% below | 20% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 FAA FLIGHT PX EST PT 18-39YR | $144.80 | $181.00 | $110.29–$181.00 | 19% below | 20% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 PR PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS | $304.80 | $381.00 | $110.29–$381.00 | 71% above | 20% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 EMPLOYMENT PX EST PT 40-64YR | $40.00 | $50.00 | $35.00–$117.24 | 79% below | 20% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 SPORTS, CAMP, OTHER SPECIAL PX EST PT 40-64YR | $40.00 | $50.00 | $35.00–$117.24 | 79% below | 20% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 BZN LIMITED PHYSICAL EST 40-64 YO | $40.00 | $50.00 | $35.00–$117.24 | 79% below | 20% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 DOT PX EST PT 40-64 YR | $80.80 | $101.00 | $70.70–$117.24 | 58% below | 20% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 DOT (MN) PX EST PT 40-64 YR | $80.80 | $101.00 | $70.70–$117.24 | 58% below | 20% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 HC PF FAC PREVENT MED EST40-64Y | $116.00 | $145.00 | $101.50–$145.00 | 39% below | 20% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 FAA FLIGHT PX EST PT 40-64YR | $144.80 | $181.00 | $117.24–$181.00 | 24% below | 20% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 PR PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS | $337.60 | $422.00 | $117.24–$422.00 | 76% above | 20% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 HC PF FAC PREVENT MED EST >65YR | $54.40 | $68.00 | $47.60–$126.09 | 71% below | 20% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 DOT PX EST PT 65+ YR | $80.80 | $101.00 | $70.70–$126.09 | 57% below | 20% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 FAA FLIGHT PX EST PT 65+ YR | $144.80 | $181.00 | $126.09–$181.00 | 23% below | 20% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 PR PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER | $361.60 | $452.00 | $126.09–$452.00 | 93% above | 20% |
| Psychiatric evaluation with medical services CPT 90792 HC PF 90792 PSYCH DX EVAL WMED SERV | $155.20 | $194.00 | $135.80–$194.00 | 49% below | 20% |
| Psychiatric evaluation with medical services CPT 90792 HC PF PSYCH DX EVAL W MED SVCS | $319.20 | $399.00 | $172.08–$399.00 | 4% above | 20% |
| Psychiatric evaluation with medical services CPT 90792 PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES | $354.40 | $443.00 | $172.08–$443.00 | 16% above | 20% |
| Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 HC PF PSYCH TESTING EVAL SERVICES; FIRST HR | $103.20 | $129.00 | $90.30–$346.85 | 61% below | 20% |
| Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR | $266.40 | $333.00 | $113.76–$346.85 | at median | 20% |
| Psychotherapy for crisis, first 60 minutes CPT 90839 HC PF PSYCH THERAPY CRISIS 1ST 60 MINS | $297.60 | $372.00 | $139.08–$372.00 | 42% above | 20% |
| Psychotherapy for crisis, first 60 minutes CPT 90839 PR PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES | $352.80 | $441.00 | $139.08–$441.00 | 68% above | 20% |
| Psychotherapy session, 30 minutes CPT 90832 HC PF PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES | $39.20 | $49.00 | $34.30–$178.96 | 65% below | 20% |
| Psychotherapy session, 30 minutes CPT 90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES | $164.80 | $206.00 | $74.28–$206.00 | 47% above | 20% |
| Psychotherapy session, 45 minutes CPT 90834 HC PF PSYCHOTHERAPY INDIVIDUAL 38-52 MIN | $51.20 | $64.00 | $44.80–$178.96 | 64% below | 20% |
| Psychotherapy session, 45 minutes CPT 90834 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES | $234.40 | $293.00 | $97.99–$293.00 | 63% above | 20% |
| Psychotherapy session, 60 minutes CPT 90837 HC PF PSYCHOTHERAPY INDIVIDUAL 53+ MIN | $74.40 | $93.00 | $65.10–$178.96 | 60% below | 20% |
| Psychotherapy session, 60 minutes CPT 90837 PR PSYCHOTHERAPY W/PATIENT 60 MINUTES | $269.60 | $337.00 | $144.45–$337.00 | 46% above | 20% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC PF SMOK CESS CONS INTMD | $24.00 | $30.00 | $13.91–$33.19 | 20% below | 20% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES | $50.40 | $63.00 | $13.91–$63.00 | 68% above | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN | $82.40 | $103.00 | $72.10–$171.25 | 70% below | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC L&D TRIAGE ESTAB PATIENT LVL 5 | $359.20 | $449.00 | $171.25–$449.00 | 31% above | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN | $484.00 | $605.00 | $171.25–$605.00 | 76% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN | $83.20 | $104.00 | $72.80–$104.00 | 41% below | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC L&D TRIAGE ESTAB PATIENT LVL 3 | $164.80 | $206.00 | $86.26–$206.00 | 17% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN | $246.40 | $308.00 | $86.26–$308.00 | 75% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN | $210.40 | $263.00 | $121.66–$263.00 | 5% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC L&D TRIAGE ESTAB PATIENT LVL 4 | $242.40 | $303.00 | $121.66–$303.00 | 21% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN | $304.00 | $380.00 | $121.66–$380.00 | 52% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN | $84.00 | $105.00 | $53.72–$105.00 | 21% below | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC L&D TRIAGE ESTAB PATIENT LVL 2 | $88.00 | $110.00 | $53.72–$110.00 | 17% below | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN | $189.60 | $237.00 | $53.72–$237.00 | 79% above | 20% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 HC PF FAC OFFICE CONSULT LVL 3 | $407.20 | $509.00 | $106.50–$509.00 | 36% above | 20% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES | $436.80 | $546.00 | $106.50–$546.00 | 46% above | 20% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC PF FAC OFFICE CONSULT LVL 4 | $494.40 | $618.00 | $151.99–$618.00 | 28% above | 20% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES | $531.20 | $664.00 | $151.99–$664.00 | 37% above | 20% |
| Speech and language evaluation CPT 92523 PR EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION | $317.60 | $397.00 | $216.24–$397.00 | 13% below | 20% |
| Speech therapy session, individual CPT 92507 PR TX SPEECH LANG VOICE COMMJ&/AUD PROC DO INDIV | $180.00 | $225.00 | $72.40–$225.00 | 2% below | 20% |
| Spirometry (breathing test) CPT 94010 HC PFT SCREEN SPIROMETRY (NO BD) | $93.60 | $117.00 | $25.93–$174.27 | 39% below | 20% |
| Spirometry (breathing test) CPT 94010 HC BREATHING CAPACITY TEST - OFFICE SPIROMETRY | $140.80 | $176.00 | $25.93–$176.00 | 8% below | 20% |
| Spirometry (breathing test) CPT 94010 PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ | $161.60 | $202.00 | $25.93–$202.00 | 6% above | 20% |
| Spirometry before and after a bronchodilator CPT 94060 HC PF 94060 SPIRO PFT PRE&POST B | $169.60 | $212.00 | $36.99–$346.85 | 62% below | 20% |
| Spirometry before and after a bronchodilator CPT 94060 HC EVAL OF BRONCHOSPASM - SPIROMETRY WITH BRONCHODILATOR | $410.40 | $513.00 | $36.99–$513.00 | 8% below | 20% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 PR THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN | $86.40 | $108.00 | $34.78–$108.00 | 1% below | 20% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMY | $281.60 | $352.00 | $90.73–$352.00 | 73% above | 20% |
| Treadmill or drug stress test with ECG, supervision and report CPT 93015 PR CV STRS TST XERS&/OR RX CONT ECG W/SI&R | $412.80 | $516.00 | $68.28–$516.00 | 5% above | 20% |
| Visual field test, extended both sides CPT 92083 PR EXTENDED VISUAL FIELD XM UNI/BI I&R | $152.00 | $190.00 | $60.08–$190.00 | — | 20% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Montana | Off list |
|---|---|---|---|---|---|
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 PR IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE | $63.20 | $79.00 | $55.30–$79.32 | 18% above | 20% |
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 HC SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE | $163.20 | $204.00 | $142.80–$204.00 | at median | 20% |
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 PR SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE | $163.20 | $204.00 | $142.80–$204.00 | at median | 20% |
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 COVID-19 MRNA VACC (MODERNA) 50 MCG/0.5ML IM SUSY | $163.20 | $204.00 | $142.80–$204.00 | at median | 20% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 PR SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE | $138.40 | $173.00 | $121.10–$173.00 | at median | 20% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR | $176.00 | $220.00 | $154.00–$220.00 | 18% below | 20% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 HC PF VAR VACCINE LIVE FOR SUBCUTANEOUS USE | $211.20 | $264.00 | $184.28–$264.00 | 2% below | 20% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE | $211.20 | $264.00 | $184.28–$264.00 | 2% below | 20% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTAP-IPV VACCINE 0.5 ML IM SUSY | $71.20 | $89.00 | $62.26–$89.00 | 14% below | 20% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE | $71.20 | $89.00 | $62.26–$89.00 | 14% below | 20% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 HC PF DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE | $71.20 | $89.00 | $62.26–$89.00 | 14% below | 20% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTAP-IPV VACCINE IM SUSP | $71.20 | $89.00 | $62.26–$89.00 | 14% below | 20% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP | $32.80 | $41.00 | $28.70–$41.00 | 36% below | 20% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 HC PF DTAP IMMUNIZATION IM <7 YO | $32.80 | $41.00 | $28.70–$41.00 | 36% below | 20% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 PR DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM | $32.80 | $41.00 | $28.70–$41.00 | 36% below | 20% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR | $111.20 | $139.00 | $97.30–$139.00 | at median | 20% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 HC PF DTAP-HEPB-IPV VACCINE INTRAMUSCULAR | $111.20 | $139.00 | $97.30–$139.00 | at median | 20% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DTAP-HEPATITIS B RECOMB-IPV IM SUSY | $112.00 | $140.00 | $98.00–$140.00 | 1% above | 20% |
| DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 HC DTAP - HIB - IPV VACCINE IM USE | $130.40 | $163.00 | $114.10–$163.00 | at median | 20% |
| DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE | $130.40 | $163.00 | $114.10–$163.00 | at median | 20% |
| DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTAP-IPV-HIB VACCINE IM SUSR | $131.20 | $164.00 | $114.80–$164.00 | 1% above | 20% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 HC IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE | $36.80 | $46.00 | $21.23–$46.00 | 52% above | 20% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY | $36.80 | $46.00 | $21.23–$46.00 | 52% above | 20% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE | $36.80 | $46.00 | $21.23–$46.00 | 52% above | 20% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HC PF 9VHPV VACC 2/3 DOSE SCHED IM USE | $353.60 | $442.00 | $309.40–$442.00 | 1% above | 20% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV 9-VALENT RECOMB VACCINE IM SUSP | $353.60 | $442.00 | $309.40–$442.00 | 1% above | 20% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV 9-VALENT RECOMB VACCINE IM (WRAPPED) | $353.60 | $442.00 | $309.40–$442.00 | 1% above | 20% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV 9-VALENT RECOMB VACCINE IM SUSY | $353.60 | $442.00 | $309.40–$442.00 | 1% above | 20% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 PR 9VHPV VACC 2/3 DOSE SCHED IM USE | $353.60 | $442.00 | $309.40–$442.00 | 1% above | 20% |
| Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HC PF HEPAT A&B VACC ADULT | $145.60 | $182.00 | $127.08–$182.00 | at median | 20% |
| Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 PR HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM | $145.60 | $182.00 | $127.08–$182.00 | at median | 20% |
| Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEPATITIS A-HEP B RECOMB VAC 720-20 ELU-MCG/ML IM SUSY | $146.40 | $183.00 | $127.08–$183.00 | 1% above | 20% |
| Hepatitis A vaccine, adult dose CPT 90632 HC PF HEPAT A VACC ADULT | $96.00 | $120.00 | $66.96–$120.00 | at median | 20% |
| Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE 1440 EL U/ML IM SUSP | $96.00 | $120.00 | $66.96–$120.00 | at median | 20% |
| Hepatitis A vaccine, adult dose CPT 90632 PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE | $96.00 | $120.00 | $66.96–$120.00 | at median | 20% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HC PF HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE | $44.00 | $55.00 | $38.50–$55.00 | 9% below | 20% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE | $44.00 | $55.00 | $38.50–$55.00 | 9% below | 20% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VACCINE 720 EL U/0.5ML IM SUSP | $44.80 | $56.00 | $38.69–$56.00 | 7% below | 20% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VACCINE 25 UNIT/0.5ML IM SUSP | $44.80 | $56.00 | $38.69–$56.00 | 7% below | 20% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE | $80.80 | $101.00 | $66.86–$101.00 | 15% below | 20% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HC PF HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE | $80.80 | $101.00 | $66.86–$101.00 | 15% below | 20% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSY | $80.80 | $101.00 | $66.86–$101.00 | 15% below | 20% |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 PR HEPB VACCINE ADULT 2/4 DOSE SCHEDULE FOR IM USE | $168.00 | $210.00 | $147.00–$210.00 | 8% above | 20% |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HC PF HEP B VACC ADULT 2 DOSE IM | $168.00 | $210.00 | $147.00–$210.00 | 8% above | 20% |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HEPATITIS B VAC RECOMB ADJ 20 MCG/0.5ML IM SOSY | $170.40 | $213.00 | $149.10–$213.00 | 10% above | 20% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY | $28.80 | $36.00 | $25.20–$36.00 | 20% below | 20% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM | $32.00 | $40.00 | $28.00–$40.00 | 11% below | 20% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HC PF HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM | $32.00 | $40.00 | $28.00–$40.00 | 11% below | 20% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSP | $32.00 | $40.00 | $28.00–$40.00 | 11% below | 20% |
| Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE | $34.40 | $43.00 | $30.10–$43.00 | 28% below | 20% |
| Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HAEMOPHILUS B POLYSAC CONJ VAC 7.5 MCG/0.5 ML IM SUSP | $35.20 | $44.00 | $30.79–$44.00 | 26% below | 20% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE | $30.40 | $38.00 | $12.95–$38.00 | 14% below | 20% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HC HEMOPHILUS INFLUENZA B VACCINE(HIB) PRP-T CONJUGATE(4 DOSE SCHEDULE) I | $30.40 | $38.00 | $12.95–$38.00 | 14% below | 20% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM | $76.00 | $95.00 | $66.50–$95.00 | 11% below | 20% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY | $76.00 | $95.00 | $66.50–$95.00 | 11% below | 20% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 HC IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM | $76.00 | $95.00 | $66.50–$95.00 | 11% below | 20% |
| Japanese encephalitis vaccine (Ixiaro), 2-dose schedule CPT 90738 PR JAPANESE ENCEPHALITIS VACCINE INACTIVATED IM | $477.60 | $597.00 | $417.90–$597.00 | — | 20% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 HC PF MMR VIRUS IMMUNIZATION SUBCUT | $109.60 | $137.00 | $94.51–$137.00 | 16% below | 20% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR | $109.60 | $137.00 | $94.51–$137.00 | 16% below | 20% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 PR MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ | $109.60 | $137.00 | $94.51–$137.00 | 16% below | 20% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 PR MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ | $320.00 | $400.00 | $280.00–$400.00 | 13% below | 20% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MEASLES-MUMPS-RUBELLA-VARICELL SC SUSR | $320.00 | $400.00 | $280.00–$400.00 | 13% below | 20% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 HC PF COMBINED VACCINEMMR+VARICELLASUB-Q | $320.00 | $400.00 | $280.00–$400.00 | 13% below | 20% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE | $181.60 | $227.00 | $158.90–$227.00 | at median | 20% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 HC PF MENING CONJ VACC-QUADRIVALENT IM | $181.60 | $227.00 | $158.90–$227.00 | at median | 20% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL A C Y&W-135 OLIG IM SOLN | $181.60 | $227.00 | $158.90–$227.00 | at median | 20% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY | $257.60 | $322.00 | $208.45–$322.00 | 8% below | 20% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 HC PF MENINGOCOCCAL RECOMB PROTEIN OMV SEROGRP B 2 DOSE IM | $257.60 | $322.00 | $208.45–$322.00 | 8% below | 20% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 PR MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM | $257.60 | $322.00 | $208.45–$322.00 | 8% below | 20% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PR PCV13 VACCINE FOR INTRAMUSCULAR USE | $240.00 | $300.00 | $210.00–$300.00 | 16% below | 20% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PR PCV20 VACCINE FOR INTRAMUSCULAR USE | $302.40 | $378.00 | $264.60–$378.00 | 5% below | 20% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY | $302.40 | $378.00 | $264.60–$378.00 | 5% below | 20% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 HC PF 90677 PNEUMO VACC 20 VAL IM | $302.40 | $378.00 | $264.60–$378.00 | 5% below | 20% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 HC PF PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE | $135.20 | $169.00 | $118.30–$169.00 | 5% below | 20% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE | $135.20 | $169.00 | $118.30–$169.00 | 5% below | 20% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY | $136.00 | $170.00 | $119.00–$170.00 | 4% below | 20% |
| Polio vaccine, inactivated (IPV) CPT 90713 PR POLIOVIRUS VACCINE INACTIVATED SUBQ/IM | $48.80 | $61.00 | $42.70–$61.00 | 41% below | 20% |
| Polio vaccine, inactivated (IPV) CPT 90713 HC PF POLIOMYELITIS IMMUNIZATNINACTVSUB-Q | $48.80 | $61.00 | $42.70–$61.00 | 41% below | 20% |
| Polio vaccine, inactivated (IPV) CPT 90713 POLIOVIRUS VACCINE INACTIVATED IJ INJ | $489.60 | $612.00 | $42.94–$612.00 | 490% above | 20% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 NIRSEVIMAB-ALIP 100 MG/ML IM SOSY | $499.20 | $624.00 | $436.80–$624.00 | 56% below | 20% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 PR RSV MONOC ANTB SEASN 1 ML IM | $523.20 | $654.00 | $457.80–$654.00 | 54% below | 20% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 PR RSV MONOC ANTB SEASN .5ML IM | $296.00 | $370.00 | $259.00–$523.39 | 75% below | 20% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5ML IM SOSY | $499.20 | $624.00 | $436.80–$624.00 | 59% below | 20% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE | $340.00 | $425.00 | $297.07–$425.00 | 13% below | 20% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV PRE-FUSION F A&B VAC RCMB 120 MCG/0.5ML IM SOLR | $340.00 | $425.00 | $297.07–$425.00 | 13% below | 20% |
| RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 RSVPREF3 VAC RECOMB ADJUVANTED 120 MCG/0.5ML IM SUSR | $339.20 | $424.00 | $296.06–$424.00 | 13% above | 20% |
| RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 PR RSV VACC PREF RECOMB ADJT IM | $339.20 | $424.00 | $296.06–$424.00 | 13% above | 20% |
| Rabies vaccine, one dose CPT 90675 HC PF RABIES VACC IM VL 1ML | $476.80 | $596.00 | $332.63–$596.00 | 12% below | 20% |
| Rabies vaccine, one dose CPT 90675 PR RABIES VACCINE INTRAMUSCULAR | $476.80 | $596.00 | $332.63–$596.00 | 12% below | 20% |
| Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC IM SUSR | $477.60 | $597.00 | $332.63–$597.00 | 12% below | 20% |
| Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE | $144.80 | $181.00 | $126.70–$181.00 | at median | 20% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 HC PF ROTAVIRUS O VAC PENTA | $113.60 | $142.00 | $99.40–$142.00 | 6% below | 20% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE | $113.60 | $142.00 | $99.40–$142.00 | 6% below | 20% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTAVIRUS VAC LIVE PENTAVALENT PO SOLN | $113.60 | $142.00 | $99.40–$142.00 | 6% below | 20% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX | $228.80 | $286.00 | $199.28–$286.00 | 1% above | 20% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 HC PF ZOSTER VAC HZV RECOMBINANT SUBUNIT ADJUVANTED IM | $228.80 | $286.00 | $199.28–$286.00 | 1% above | 20% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR | $228.80 | $286.00 | $199.28–$286.00 | 1% above | 20% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LFU IM INJ | $42.40 | $53.00 | $37.10–$53.00 | 37% below | 20% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE | $42.40 | $53.00 | $37.10–$53.00 | 37% below | 20% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 HC PF TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE | $42.40 | $53.00 | $37.10–$53.00 | 37% below | 20% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 PR TDAP VACCINE 7 YRS/> IM | $54.40 | $68.00 | $36.59–$68.00 | 48% below | 20% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 HC PF TDAP VACCINE >7 YO IM | $54.40 | $68.00 | $36.59–$68.00 | 48% below | 20% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY | $55.20 | $69.00 | $36.59–$69.00 | 47% below | 20% |
| Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 PR TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM | $161.60 | $202.00 | $141.40–$202.00 | 7% above | 20% |
| Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 TYPHOID VI POLYSACCHARIDE VACC 25 MCG/0.5ML IM SOSY | $161.60 | $202.00 | $141.40–$202.00 | 7% above | 20% |
| Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 HC PF TYPHOID VACC VI CAP | $161.60 | $202.00 | $141.40–$202.00 | 7% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZ ADMIN1 SINGLE/COMB VAC/TOXOID | $77.60 | $97.00 | $19.60–$97.00 | 59% above | 20% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZADMINEACH ADDL | $47.20 | $59.00 | $13.91–$59.00 | 48% above | 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://bozemanhealth.org/wp-content/uploads/2026/02/474717998_deaconess-regional-medical-center_standardcharges.json