Hospital Kalispell, MT

Logan Health - Whitefish

Logan Health - Whitefish in Whitefish, MT publishes cash prices for 225 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Montana median for 165 of 219 procedures and above it for 46. By typical cash price it ranks #4 of 23 Montana hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

1600 Hospital Way, Whitefish, MT 59937 Collected Sep 29, 2026 Source price file (406) 863-3550

Critical access hospital (rural, 25 beds or fewer) Emergency department CMS star rating 3 of 5 CCN 271336 · CMS hospital register NPI 1396710851

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Ankle X-ray, complete, 3 or more views both sides CPT 73610 ANKLE 3V, COMPLETE BILAT	$211.09	$324.75	—	—	35%
Ankle X-ray, complete, 3 or more views CPT 73610 ANKLE, MIN 3 VIEWS	$179.24	$275.75	—	2% below	35%
Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 ANKLE 3V, COMPLETE BILAT	$211.09	$324.75	—	—	35%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 ANKLE, MIN 3 VIEWS	$179.24	$275.75	—	—	35%
Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGRAM - IMAGING EXAM	$203.45	$313.00	—	43% below	35%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGRAM - IMAGING EXAM	$203.45	$313.00	—	—	35%
Bone scan, whole body (nuclear medicine) CPT 78306 BONE SCAN, COMPLETE	$1,161.88	$1,787.50	—	2% below	35%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE SCAN, COMPLETE	$1,161.88	$1,787.50	—	—	35%
Breast ultrasound, complete, one breast both sides CPT 76641 US BREAST COMPLETE BILATERAL	$226.85	$349.00	—	—	35%
Breast ultrasound, complete, one breast CPT 76641 ULTRASOUND BREAST COMPLETE	$53.95	$83.00	—	74% below	35%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMPLETE UNILATERAL	$151.29	$232.75	—	26% below	35%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 US BREAST COMPLETE BILATERAL	$226.85	$349.00	—	—	35%
Breast ultrasound, complete, one breast inpatient CPT 76641 ULTRASOUND BREAST COMPLETE	$53.95	$83.00	—	—	35%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMPLETE UNILATERAL	$151.29	$232.75	—	—	35%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 US BREAST LIMITED BILATERAL	$210.44	$323.75	—	—	35%
Breast ultrasound, limited (one breast or one area) CPT 76642 ULTRASOUND BREAST LIMITED	$50.70	$78.00	—	78% below	35%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED UNILATERAL	$195.98	$301.50	—	15% below	35%
Breast ultrasound, limited (one breast or one area) inpatient both sides CPT 76642 US BREAST LIMITED BILATERAL	$210.44	$323.75	—	—	35%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 ULTRASOUND BREAST LIMITED	$50.70	$78.00	—	—	35%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED UNILATERAL	$195.98	$301.50	—	—	35%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST INCLUDING RECONS	$1,683.34	$2,589.75	—	19% below	35%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST INCLUDING RECONS	$1,683.34	$2,589.75	—	—	35%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT ANGIO HRT W/3D IMAGE	$174.20	$268.00	—	62% below	35%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT ANGIO HRT W/3D IMAGE	$174.20	$268.00	—	—	35%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HRT W/O DYE W/CA TEST	$43.55	$67.00	—	82% below	35%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT HRT W/O DYE W/CA TEST	$43.55	$67.00	—	—	35%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD&PELVIS W/O CONTRAST	$1,361.42	$2,094.50	—	33% below	35%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD&PELVIS W/O CONTRAST	$1,361.42	$2,094.50	—	—	35%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PELV W/CON: TRAUMA	$2,385.66	$3,670.25	—	14% below	35%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD&PELVIS WITH CONTRAST	$2,386.31	$3,671.25	—	14% below	35%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PELV W/CON: TRAUMA	$2,385.66	$3,670.25	—	—	35%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD&PELVIS WITH CONTRAST	$2,386.31	$3,671.25	—	—	35%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD&PELVIS W&W/O CONTRAST	$2,245.91	$3,455.25	—	28% below	35%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD&PELVIS W&W/O CONTRAST	$2,245.91	$3,455.25	—	—	35%
CT scan of the abdomen with contrast CPT 74160 CT ABD W/	$1,224.60	$1,884.00	—	26% below	35%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABD W/	$1,224.60	$1,884.00	—	—	35%
CT scan of the abdomen without contrast CPT 74150 CT ABD W/O CONTRAST - LIMITED	$910.00	$1,400.00	—	29% below	35%
CT scan of the abdomen without contrast CPT 74150 CT ABD W/O	$955.66	$1,470.25	—	26% below	35%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABD W/O CONTRAST - LIMITED	$910.00	$1,400.00	—	—	35%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABD W/O	$955.66	$1,470.25	—	—	35%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS, LMTD SCREENING W/O	$581.42	$894.50	—	46% below	35%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SINUS, LMTD SCREENING W/O	$581.42	$894.50	—	—	35%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O	$704.92	$1,084.50	—	40% below	35%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O: TRAUMA	$704.92	$1,084.50	—	40% below	35%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O	$704.92	$1,084.50	—	—	35%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O: TRAUMA	$704.92	$1,084.50	—	—	35%
CT scan of the head with contrast CPT 70460 CT HEAD W/	$898.62	$1,382.50	—	33% below	35%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W/	$898.62	$1,382.50	—	—	35%
CT scan of the head without and with contrast CPT 70470 CT HEAD W/O AND W/	$993.52	$1,528.50	—	45% below	35%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W/O AND W/	$993.52	$1,528.50	—	—	35%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O	$862.55	$1,327.00	—	38% below	35%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O	$862.55	$1,327.00	—	—	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE W/O	$1,079.16	$1,660.25	—	22% below	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERV SPINE W/O: TRAUMA	$1,079.16	$1,660.25	—	22% below	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CHEST ABD/PELVIS WO	$1,159.11	$1,783.25	—	17% below	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT TRAUMA W/WO CONTRAST	$1,159.11	$1,783.25	—	17% below	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CHEST/ABD WITH	$1,159.11	$1,783.25	—	17% below	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CHEST/ABD W/O	$1,159.11	$1,783.25	—	17% below	35%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE W/O	$1,079.16	$1,660.25	—	—	35%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERV SPINE W/O: TRAUMA	$1,079.16	$1,660.25	—	—	35%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CHEST ABD/PELVIS WO	$1,159.11	$1,783.25	—	—	35%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CHEST/ABD WITH	$1,159.11	$1,783.25	—	—	35%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT TRAUMA W/WO CONTRAST	$1,159.11	$1,783.25	—	—	35%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CHEST/ABD W/O	$1,159.11	$1,783.25	—	—	35%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS (SI) JOINT W/CON	$945.26	$1,454.25	—	34% below	35%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS (SI) JOINT W/CON	$945.26	$1,454.25	—	—	35%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 EXTRACRANIAL STUDY, BILAT	$370.50	$570.00	—	—	35%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 CAROTID, BILATERAL COMPLETE	$390.98	$601.50	—	—	35%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 EXTRACRANIAL STUDY, BILAT	$370.50	$570.00	—	—	35%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 CAROTID, BILATERAL COMPLETE	$390.98	$601.50	—	—	35%
Chest X-ray, 2 views CPT 71046 CHEST X-RAY: 2 VIEWS	$171.76	$264.25	—	10% below	35%
Chest X-ray, 2 views inpatient CPT 71046 CHEST X-RAY: 2 VIEWS	$171.76	$264.25	—	—	35%
Chest X-ray, single view CPT 71045 CHEST X-RAY: SINGLE VIEW	$161.20	$248.00	—	10% below	35%
Chest X-ray, single view inpatient CPT 71045 CHEST X-RAY: SINGLE VIEW	$161.20	$248.00	—	—	35%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 RETROPERITONEAL; COMPLETE	$501.31	$771.25	—	13% above	35%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 RETROPERITONEAL; COMPLETE	$501.31	$771.25	—	—	35%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA SCAN; (HIP/PELVIS/SPINE)	$207.19	$318.75	—	36% below	35%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA SCAN; (HIP/PELVIS/SPINE)	$207.19	$318.75	—	—	35%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DEXA SCAN; (WRIST/RADIUS/HEEL)	$92.30	$142.00	—	36% below	35%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DEXA SCAN; (WRIST/RADIUS/HEEL)	$92.30	$142.00	—	—	35%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 OB US DETAILED SNGL FETUS	$139.75	$215.00	—	35% below	35%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 OB US DETAILED SNGL FETUS	$139.75	$215.00	—	—	35%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O	$975.81	$1,501.25	—	26% below	35%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O	$975.81	$1,501.25	—	—	35%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST WITH CONTRAST	$1,235.16	$1,900.25	—	25% below	35%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/CON: TRAUMA	$1,235.16	$1,900.25	—	25% below	35%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/CON: TRAUMA	$1,235.16	$1,900.25	—	—	35%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST WITH CONTRAST	$1,235.16	$1,900.25	—	—	35%
Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO INCL CAD BI	$73.45	$113.00	—	—	35%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DX MAMMO INCL CAD BI	$73.45	$113.00	—	—	35%
Diagnostic mammogram, one breast CPT 77065 DX MAMMO INCL CAD UNI	$59.80	$92.00	—	73% below	35%
Diagnostic mammogram, one breast inpatient CPT 77065 DX MAMMO INCL CAD UNI	$59.80	$92.00	—	—	35%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 BILATERAL LOWER EXT ARTERIAL	$400.72	$616.50	—	—	35%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 BILATERAL LOWER EXT ARTERIAL	$400.72	$616.50	—	—	35%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VEIN MAPPING; EXTREMITY;BILAT	$693.06	$1,066.25	—	—	35%
Duplex ultrasound of the leg veins, both legs CPT 93970 EXTREMITY STUDY	$287.30	$442.00	—	63% below	35%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 VEIN MAPPING; EXTREMITY;BILAT	$693.06	$1,066.25	—	—	35%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 EXTREMITY STUDY	$287.30	$442.00	—	—	35%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HIDA SCAN	$955.50	$1,470.00	—	11% below	35%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HIDA SCAN	$955.50	$1,470.00	—	—	35%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY UNATT & RESP EFFT	$324.35	$499.00	—	6% above	35%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STUDY UNATT & RESP EFFT	$324.35	$499.00	—	—	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNO,SLEEP,4 ADD'L W/CPAP	$1,070.88	$1,647.50	—	43% below	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNO,SLEEP,4 ADD'L W/CPAP	$1,070.88	$1,647.50	—	—	35%
Knee X-ray, 3 views both sides CPT 73562 BILATERAL KNEE - 3 VIEWS	$338.49	$520.75	—	—	35%
Knee X-ray, 3 views inpatient both sides CPT 73562 BILATERAL KNEE - 3 VIEWS	$338.49	$520.75	—	—	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ULTRASOUND-ABD LIMITED	$331.34	$509.75	—	17% below	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ULTRASOUND-ABD LIMITED	$331.34	$509.75	—	—	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CANCER SCR C-	$79.30	$122.00	—	81% below	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CX SCRN W/O CON	$914.06	$1,406.25	—	118% above	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LUNG CANCER SCR C-	$79.30	$122.00	—	—	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LUNG CX SCRN W/O CON	$914.06	$1,406.25	—	—	35%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI LOWER EXT/JOINT W/O BILAT	$1,484.60	$2,284.00	—	—	35%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWER EXT/JOINT W/O	$1,184.30	$1,822.00	—	32% below	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI LOWER EXT/JOINT W/O BILAT	$1,484.60	$2,284.00	—	—	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOWER EXT/JOINT W/O	$1,184.30	$1,822.00	—	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOWER EXT/JOINT W/O & W	$2,193.42	$3,374.50	—	17% below	35%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOWER EXT/JNT W/O & W BIL	$2,767.86	$4,258.25	—	5% above	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOWER EXT/JOINT W/O & W	$2,193.42	$3,374.50	—	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOWER EXT/JNT W/O & W BIL	$2,767.86	$4,258.25	—	—	35%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O	$1,436.99	$2,210.75	—	20% below	35%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O	$1,436.99	$2,210.75	—	—	35%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/ & W/O	$2,313.68	$3,559.50	—	20% below	35%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/ & W/O	$2,313.68	$3,559.50	—	—	35%
MRI of the brain, no contrast dye CPT 70551 MRI CORD SURVEY WITH (C/T)	$1,345.18	$2,069.50	—	24% below	35%
MRI of the brain, no contrast dye CPT 70551 MRA RUNOFF WITH CONTRAST	$1,345.18	$2,069.50	—	24% below	35%
MRI of the brain, no contrast dye CPT 70551 MRI LOWER EXT/JOINT W/O BIL	$1,345.18	$2,069.50	—	24% below	35%
MRI of the brain, no contrast dye CPT 70551 MRI CORD SURVEY W/W/O (C/T/L)	$1,345.18	$2,069.50	—	24% below	35%
MRI of the brain, no contrast dye CPT 70551 MRI CORD SURVEY W/WO (C/T)	$1,345.18	$2,069.50	—	24% below	35%
MRI of the brain, no contrast dye CPT 70551 MRI CORD SURVEY W/O (C/T/L)	$1,345.18	$2,069.50	—	24% below	35%
MRI of the brain, no contrast dye CPT 70551 MRI CORD SURVEY W/O (C/T)	$1,345.18	$2,069.50	—	24% below	35%
MRI of the brain, no contrast dye CPT 70551 MRI COMPRESSION FX SURV (T/L)	$1,345.18	$2,069.50	—	24% below	35%
MRI of the brain, no contrast dye CPT 70551 MRI HEAD WWO & MRA W/O	$1,412.45	$2,173.00	—	20% below	35%
MRI of the brain, no contrast dye CPT 70551 MRI HEAD W/O	$1,552.04	$2,387.75	—	12% below	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI CORD SURVEY W/W/O (C/T/L)	$1,345.18	$2,069.50	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI COMPRESSION FX SURV (T/L)	$1,345.18	$2,069.50	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI CORD SURVEY W/O (C/T)	$1,345.18	$2,069.50	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRA RUNOFF WITH CONTRAST	$1,345.18	$2,069.50	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI CORD SURVEY W/O (C/T/L)	$1,345.18	$2,069.50	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI LOWER EXT/JOINT W/O BIL	$1,345.18	$2,069.50	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI CORD SURVEY W/WO (C/T)	$1,345.18	$2,069.50	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI CORD SURVEY WITH (C/T)	$1,345.18	$2,069.50	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI HEAD WWO & MRA W/O	$1,412.45	$2,173.00	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI HEAD W/O	$1,552.04	$2,387.75	—	—	35%
MRI of the brain, with and without contrast dye CPT 70553 MRI HEAD W & W/O	$2,554.82	$3,930.50	—	10% below	35%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI HEAD W & W/O	$2,554.82	$3,930.50	—	—	35%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O	$1,358.50	$2,090.00	—	22% below	35%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O	$1,358.50	$2,090.00	—	—	35%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W/ & W/O	$2,311.56	$3,556.25	—	13% below	35%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE W/ & W/O	$2,311.56	$3,556.25	—	—	35%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE W/O	$1,085.66	$1,670.25	—	38% below	35%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE W/O	$1,085.66	$1,670.25	—	—	35%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL SPINE W& W/O	$2,040.84	$3,139.75	—	24% below	35%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERVICAL SPINE W& W/O	$2,040.84	$3,139.75	—	—	35%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE W/O	$1,345.50	$2,070.00	—	24% below	35%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL SPINE W/O	$1,345.50	$2,070.00	—	—	35%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/ & W/O	$2,444.00	$3,760.00	—	12% below	35%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/ & W/O	$2,444.00	$3,760.00	—	—	35%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O	$1,544.24	$2,375.75	—	16% below	35%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O	$1,544.24	$2,375.75	—	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 MRI UPPER EXT/JOINT W/O BILAT	$1,809.60	$2,784.00	—	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UPPER EXT/JOINT W/O	$1,122.39	$1,726.75	—	28% below	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient both sides CPT 73221 MRI UPPER EXT/JOINT W/O BILAT	$1,809.60	$2,784.00	—	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UPPER EXT/JOINT W/O	$1,122.39	$1,726.75	—	—	35%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 MYCARDIAL PERFUSION SPECT	$1,580.31	$2,431.25	—	23% below	35%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 MYCARDIAL PERFUSION SPECT	$1,580.31	$2,431.25	—	—	35%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 PELVIS US, LIMITED	$334.26	$514.25	—	11% above	35%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 PELVIS US, LIMITED	$334.26	$514.25	—	—	35%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 PELVIS US, COMPLETE	$551.20	$848.00	—	15% above	35%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 PELVIS US, COMPLETE	$551.20	$848.00	—	—	35%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US >= 14 WKS SNGL FETUS	$72.80	$112.00	—	82% below	35%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB ULTRASOUND > 14 WEEKS	$435.34	$669.75	—	5% above	35%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US >= 14 WKS SNGL FETUS	$72.80	$112.00	—	—	35%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB ULTRASOUND > 14 WEEKS	$435.34	$669.75	—	—	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US < 14 WKS SINGLE FETUS	$72.80	$112.00	—	81% below	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB < 14 WEEKS	$379.60	$584.00	—	at median	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB US < 14 WKS SINGLE FETUS	$72.80	$112.00	—	—	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB < 14 WEEKS	$379.60	$584.00	—	—	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB US LIMITED FETUS(S)	$48.75	$75.00	—	81% below	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US-OB LIMITED	$242.78	$373.50	—	7% below	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 OB US LIMITED FETUS(S)	$48.75	$75.00	—	—	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US-OB LIMITED	$242.78	$373.50	—	—	35%
Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO BI INCL CAD	$56.55	$87.00	—	—	35%
Screening mammogram, both breasts inpatient both sides CPT 77067 SCR MAMMO BI INCL CAD	$56.55	$87.00	—	—	35%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 X-SRAY SHOULDER COMP, BILAT	$333.29	$512.75	—	—	35%
Shoulder X-ray, complete, 2 or more views CPT 73030 X-RAY SHOULDER COMPLETE 2+VIEW	$207.19	$318.75	—	8% above	35%
Shoulder X-ray, complete, 2 or more views inpatient both sides CPT 73030 X-SRAY SHOULDER COMP, BILAT	$333.29	$512.75	—	—	35%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 X-RAY SHOULDER COMPLETE 2+VIEW	$207.19	$318.75	—	—	35%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNO,SLEEP,4 ADD'L PARAME	$1,011.56	$1,556.25	—	42% below	35%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNO,SLEEP,4 ADD'L PARAME	$1,011.56	$1,556.25	—	—	35%
Swallow study (modified barium swallow, video X-ray) CPT 74230 VIDEO ESOPHAGRAM	$310.05	$477.00	—	20% below	35%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 VIDEO ESOPHAGRAM	$310.05	$477.00	—	—	35%
Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US NON-OB	$51.35	$79.00	—	85% below	35%
Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US	$310.70	$478.00	—	11% below	35%
Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL US NON-OB	$51.35	$79.00	—	—	35%
Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL US	$310.70	$478.00	—	—	35%
Transvaginal ultrasound during pregnancy CPT 76817 TRANSVAGINAL US OBSTETRIC	$55.90	$86.00	—	85% below	35%
Transvaginal ultrasound during pregnancy CPT 76817 OB-US TRANSVAG	$369.85	$569.00	—	1% above	35%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 TRANSVAGINAL US OBSTETRIC	$55.90	$86.00	—	—	35%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 OB-US TRANSVAG	$369.85	$569.00	—	—	35%
Ultrasound of the abdomen, complete CPT 76700 ABDOMINAL US, COMPLETE	$599.62	$922.50	—	14% above	35%
Ultrasound of the abdomen, complete inpatient CPT 76700 ABDOMINAL US, COMPLETE	$599.62	$922.50	—	—	35%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTAL	$377.16	$580.25	—	19% below	35%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTAL	$377.16	$580.25	—	—	35%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UGI WITHOUT KUB	$274.62	$422.50	—	38% below	35%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UGI WITHOUT KUB	$274.62	$422.50	—	—	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 VEIN MAPPING; EXTREMITY; UNI	$430.95	$663.00	—	14% below	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 VEIN MAPPING; EXTREMITY; UNI	$430.95	$663.00	—	—	35%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 BILATERAL WRIST MIN 3 VIEWS	$233.68	$359.50	—	—	35%
Wrist X-ray, complete, 3 or more views CPT 73110 WRIST, MIN 3 VIEWS	$218.56	$336.25	—	6% above	35%
Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 BILATERAL WRIST MIN 3 VIEWS	$233.68	$359.50	—	—	35%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 WRIST, MIN 3 VIEWS	$218.56	$336.25	—	—	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HIP, MIN 2 VIEWS	$196.62	$302.50	—	2% above	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HIP, MIN 2 VIEWS	$196.62	$302.50	—	—	35%
X-ray of the abdomen, 1 view CPT 74018 X-RAY ABDOMEN; 1 VIEW	$168.84	$259.75	—	1% below	35%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN, 1 VIEW	$168.84	$259.75	—	1% below	35%
X-ray of the abdomen, 1 view inpatient CPT 74018 X-RAY ABDOMEN; 1 VIEW	$168.84	$259.75	—	—	35%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN, 1 VIEW	$168.84	$259.75	—	—	35%
X-ray of the ankle, 2 views CPT 73600 ANKLE, 2 VIEWS	$50.70	$78.00	—	69% below	35%
X-ray of the ankle, 2 views inpatient CPT 73600 ANKLE, 2 VIEWS	$50.70	$78.00	—	—	35%
X-ray of the finger(s), 2 or more views both sides CPT 73140 HAND, DIGIT BILAT	$199.71	$307.25	—	—	35%
X-ray of the finger(s), 2 or more views CPT 73140 HAND, DIGIT	$157.46	$242.25	—	4% below	35%
X-ray of the finger(s), 2 or more views inpatient both sides CPT 73140 HAND, DIGIT BILAT	$199.71	$307.25	—	—	35%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HAND, DIGIT	$157.46	$242.25	—	—	35%
X-ray of the foot, 2 views both sides CPT 73620 FOOT 2 VIEW; BILATERAL	$134.71	$207.25	—	—	35%
X-ray of the foot, 2 views CPT 73620 FOOT, 1 VIEW	$134.71	$207.25	—	7% below	35%
X-ray of the foot, 2 views CPT 73620 FOOT, 2 VIEWS	$141.54	$217.75	—	3% below	35%
X-ray of the foot, 2 views inpatient both sides CPT 73620 FOOT 2 VIEW; BILATERAL	$134.71	$207.25	—	—	35%
X-ray of the foot, 2 views inpatient CPT 73620 FOOT, 1 VIEW	$134.71	$207.25	—	—	35%
X-ray of the foot, 2 views inpatient CPT 73620 FOOT, 2 VIEWS	$141.54	$217.75	—	—	35%
X-ray of the foot, complete, 3 or more views CPT 73630 FOOT, MIN 3 VIEWS	$196.62	$302.50	—	at median	35%
X-ray of the foot, complete, 3 or more views CPT 73630 FOOT, MIN 3 VIEW-BIALTERAL	$320.61	$493.25	—	63% above	35%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 FOOT, MIN 3 VIEWS	$196.62	$302.50	—	—	35%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 FOOT, MIN 3 VIEW-BIALTERAL	$320.61	$493.25	—	—	35%
X-ray of the hand, 3 or more views both sides CPT 73130 HAND, BILATERAL MIN 3 VW-BILAT	$233.68	$359.50	—	—	35%
X-ray of the hand, 3 or more views CPT 73130 HAND, MIN 3 VIEWS	$202.80	$312.00	—	2% below	35%
X-ray of the hand, 3 or more views inpatient both sides CPT 73130 HAND, BILATERAL MIN 3 VW-BILAT	$233.68	$359.50	—	—	35%
X-ray of the hand, 3 or more views inpatient CPT 73130 HAND, MIN 3 VIEWS	$202.80	$312.00	—	—	35%
X-ray of the knee, 1 or 2 views both sides CPT 73560 BILAT KNEES 1 OR 2 VIEW	$275.92	$424.50	—	—	35%
X-ray of the knee, 1 or 2 views CPT 73560 KNEE, 1 OR 2 VIEWS	$173.88	$267.50	—	2% above	35%
X-ray of the knee, 1 or 2 views inpatient both sides CPT 73560 BILAT KNEES 1 OR 2 VIEW	$275.92	$424.50	—	—	35%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 KNEE, 1 OR 2 VIEWS	$173.88	$267.50	—	—	35%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 SPINE, LUMBAR 2 OR 3 VIEWS	$224.58	$345.50	—	1% below	35%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 SPINE, LUMBAR 2 OR 3 VIEWS	$224.58	$345.50	—	—	35%
X-ray of the lower back, 4 or more views CPT 72110 SPINE, LUMBAR MIN 4 VIEWS	$294.94	$453.75	—	3% below	35%
X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE, LUMBAR MIN 4 VIEWS	$294.94	$453.75	—	—	35%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 SPINE, THORACIC 2 VIEWS	$171.76	$264.25	—	19% below	35%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 SPINE, THORACIC 2 VIEWS	$171.76	$264.25	—	—	35%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES, COMPLETE	$314.44	$483.75	—	51% above	35%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES, COMPLETE	$314.44	$483.75	—	—	35%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-RAY SPINE-CERVICAL- 2-3 VIEW	$203.45	$313.00	—	5% below	35%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 X-RAY SPINE-CERVICAL- 2-3 VIEW	$203.45	$313.00	—	—	35%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS, 1 OR 2 VIEWS	$196.62	$302.50	—	7% below	35%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS, 1 OR 2 VIEWS	$196.62	$302.50	—	—	35%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM/COCCYX MIN 2 VIEWS	$314.44	$483.75	—	35% above	35%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM/COCCYX MIN 2 VIEWS	$314.44	$483.75	—	—	35%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL	$134.55	$207.00	—	31% below	35%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL	$134.55	$207.00	—	—	35%
Allergy blood test, specific IgE, per allergen CPT 86003 REF- ALLERGEN, IGE	$6.82	$10.50	—	82% below	35%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 REF- ALLERGEN, IGE	$6.82	$10.50	—	—	35%
Basic metabolic panel (blood test) CPT 80048 METABOLIC PANEL TOT CA	$37.21	$57.25	—	57% below	35%
Basic metabolic panel (blood test) inpatient CPT 80048 METABOLIC PANEL TOT CA	$37.21	$57.25	—	—	35%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 PATH-G&M LEVEL IV 88305	$146.58	$225.50	—	1% above	35%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 REF-BONE MARROW CLOT	$307.78	$473.50	—	112% above	35%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 REF - PARTICLE PREP	$307.78	$473.50	—	112% above	35%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 REF-BONE MARROW BIOPSY	$307.78	$473.50	—	112% above	35%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 PATH-G&M LEVEL IV 88305	$146.58	$225.50	—	—	35%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 REF - PARTICLE PREP	$307.78	$473.50	—	—	35%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 REF-BONE MARROW CLOT	$307.78	$473.50	—	—	35%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 REF-BONE MARROW BIOPSY	$307.78	$473.50	—	—	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 LEGAL C EVID. COLL/BLD ALCOHOL	$13.65	$21.00	—	23% below	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE BLOOD DRAW-ED	$14.14	$21.75	—	20% below	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 LEGAL C EVID. COLL/BLD ALCOHOL	$13.65	$21.00	—	—	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE BLOOD DRAW-ED	$14.14	$21.75	—	—	35%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE	$39.32	$60.50	—	40% below	35%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE	$39.32	$60.50	—	—	35%
Comprehensive metabolic panel (blood test) CPT 80053 COMPHENSIVE METABOLIC PANEL	$45.18	$69.50	—	58% below	35%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPHENSIVE METABOLIC PANEL	$45.18	$69.50	—	—	35%
Free T4 (free thyroxine) thyroid blood test CPT 84439 REF-T4, FREE, DIRECT DIALYSIS	$22.26	$34.25	—	69% below	35%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 REF-T4, FREE, DIRECT DIALYSIS	$22.26	$34.25	—	—	35%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL	$115.86	$178.25	—	57% below	35%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL	$115.86	$178.25	—	—	35%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCO-HEMOGLOBIN TEST A1C	$24.38	$37.50	—	50% below	35%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCO-HEMOGLOBIN TEST A1C	$24.38	$37.50	—	—	35%
High-sensitivity CRP (hs-CRP) test CPT 86141 REF-HIGH SENSITIVE CRP	$14.30	$22.00	—	81% below	35%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 REF-HIGH SENSITIVE CRP	$14.30	$22.00	—	—	35%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$46.48	$71.50	—	55% below	35%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$46.48	$71.50	—	—	35%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$40.14	$61.75	—	38% below	35%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$40.14	$61.75	—	—	35%
Magnesium blood test CPT 83735 REF-LITHOLINK MAGNESIUM, UR	$15.76	$24.25	—	74% below	35%
Magnesium blood test inpatient CPT 83735 REF-LITHOLINK MAGNESIUM, UR	$15.76	$24.25	—	—	35%
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODIES; SCREEN	$40.14	$61.75	—	30% below	35%
Mono test (heterophile antibody, Monospot) CPT 86308 SER-MONO TEST	$40.30	$62.00	—	30% below	35%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODIES; SCREEN	$40.14	$61.75	—	—	35%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 SER-MONO TEST	$40.30	$62.00	—	—	35%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTO-PAP/LB IMAGED/ROUT 88175	$94.09	$144.75	—	48% above	35%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTO-PAP/LB IMAGED/ROUT 88175	$94.09	$144.75	—	—	35%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TM	$25.02	$38.50	—	6% above	35%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TM	$25.02	$38.50	—	—	35%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 URINE DRUG SCREEN	$26.65	$41.00	—	50% below	35%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 URINE DRUG SCREEN	$26.65	$41.00	—	—	35%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREPTOCOCCUS RAPID STREP	$42.90	$66.00	—	11% below	35%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREPTOCOCCUS RAPID STREP	$42.90	$66.00	—	—	35%
Rheumatoid factor (RF) test CPT 86431 REF-RHEUMATOID FACTOR	$43.88	$67.50	—	7% below	35%
Rheumatoid factor (RF) test inpatient CPT 86431 REF-RHEUMATOID FACTOR	$43.88	$67.50	—	—	35%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HEMOCCULT	$25.84	$39.75	—	21% below	35%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HEMOCCULT	$25.84	$39.75	—	—	35%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 ASSAY TEST FOR BLOOD FECAL	$30.88	$47.50	—	39% below	35%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 REF-FECAL OCCULT BLOOD, MAYO	$107.58	$165.50	—	112% above	35%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 ASSAY TEST FOR BLOOD FECAL	$30.88	$47.50	—	—	35%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 REF-FECAL OCCULT BLOOD, MAYO	$107.58	$165.50	—	—	35%
Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY TESTOSTERONE TOT	$83.69	$128.75	—	13% below	35%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 ASSAY TESTOSTERONE TOT	$83.69	$128.75	—	—	35%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 STATE TSH SCREEN	$21.12	$32.50	—	73% below	35%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 STATE TSH SCREEN	$21.12	$32.50	—	—	35%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE	$21.45	$33.00	—	51% below	35%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/SCOPE	$21.45	$33.00	—	—	35%
Urinalysis with microscope exam, manual CPT 81000 URINALYSIS MICRO & DIP	$13.00	$20.00	—	24% below	35%
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS MICRO & DIP	$13.00	$20.00	—	—	35%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS DIPSTICK/TABLET	$15.11	$23.25	—	44% below	35%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS, DIPSTICK/TABLET	$17.22	$26.50	—	37% below	35%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS DIPSTICK/TABLET	$15.11	$23.25	—	—	35%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS, DIPSTICK/TABLET	$17.22	$26.50	—	—	35%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO W/O SCOPE	$15.11	$23.25	—	at median	35%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS NONAUTO W/O SCOPE	$15.11	$23.25	—	—	35%
Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST	$17.88	$27.50	—	49% below	35%
Urine pregnancy test, read by color change CPT 81025 POC-HCG URINE	$20.31	$31.25	—	42% below	35%
Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY TEST	$17.88	$27.50	—	—	35%
Urine pregnancy test, read by color change inpatient CPT 81025 POC-HCG URINE	$20.31	$31.25	—	—	35%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 APPENDECTOMY;RUPTURED	$1,320.31	$2,031.25	—	30% below	35%
Appendectomy for a ruptured appendix with abscess or peritonitis inpatient CPT 44960 APPENDECTOMY;RUPTURED	$1,320.31	$2,031.25	—	—	35%
Appendectomy, open surgery CPT 44950 APPENDECTOMY	$981.82	$1,510.50	—	28% below	35%
Appendectomy, open surgery inpatient CPT 44950 APPENDECTOMY	$981.82	$1,510.50	—	—	35%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 BX BREAST 1ST LESION STRTCTC	$877.50	$1,350.00	—	13% below	35%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 BX BREAST 1ST LESION STRTCTC	$877.50	$1,350.00	—	—	35%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TREATMENT OF ANKLE FRACTURE	$401.21	$617.25	—	10% below	35%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 TREATMENT OF ANKLE FRACTURE	$401.21	$617.25	—	—	35%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION W CONS SEDATION	$803.56	$1,236.25	—	30% above	35%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION W CONS SEDATION	$803.56	$1,236.25	—	—	35%
Circumcision, surgical, older than a newborn CPT 54160 CIRCUMCISION NEONATE	$312.00	$480.00	—	at median	35%
Circumcision, surgical, older than a newborn inpatient CPT 54160 CIRCUMCISION NEONATE	$312.00	$480.00	—	—	35%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 TREAT FX RADIUS AND ULNA	$466.86	$718.25	—	7% above	35%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 TREAT FX RADIUS AND ULNA	$466.86	$718.25	—	—	35%
Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONSCOPY	$455.65	$701.00	—	44% below	35%
Colonoscopy, diagnostic inpatient CPT 45378 DIAGNOSTIC COLONSCOPY	$455.65	$701.00	—	—	35%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALG LESION	$179.72	$276.50	—	11% above	35%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCT PREMALG LESION	$179.72	$276.50	—	—	35%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX	$60.29	$92.75	—	54% above	35%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EAR WAX	$60.29	$92.75	—	—	35%
Earwax removal with instruments, one ear CPT 69210 REMOVE EARWAX	$144.14	$221.75	—	90% above	35%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE EARWAX	$144.14	$221.75	—	—	35%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERT F JNT L/S 1 LEV	$273.00	$420.00	—	29% below	35%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ PARAVERT F JNT L/S 1 LEV	$273.00	$420.00	—	—	35%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 RPR AA HERNIA 1ST 3-10CM RDC	$943.80	$1,452.00	—	at median	35%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 RPR AA HERNIA 1ST 3-10CM RDC	$943.80	$1,452.00	—	—	35%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 RPR AA HERNIA >10 CM RDC	$1,265.88	$1,947.50	—	20% below	35%
First repair of a front abdominal hernia larger than 10 cm inpatient CPT 49595 RPR AA HERNIA >10 CM RDC	$1,265.88	$1,947.50	—	—	35%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 RPR OF ANT ABD HERNIA <3CM	$565.18	$869.50	—	at median	35%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 RPR OF ANT ABD HERNIA <3CM	$565.18	$869.50	—	—	35%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY	$288.76	$444.25	—	19% below	35%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY	$288.76	$444.25	—	—	35%
Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY	$1,034.31	$1,591.25	—	35% below	35%
Gallbladder removal, laparoscopic inpatient CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY	$1,034.31	$1,591.25	—	—	35%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAPARO: CHOLECYSTECTOMY W/GRAP	$1,204.61	$1,853.25	—	39% below	35%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 LAPARO: CHOLECYSTECTOMY W/GRAP	$1,204.61	$1,853.25	—	—	35%
Gallbladder removal, open surgery through a larger incision CPT 47600 REM GALLBLADDER	$1,583.72	$2,436.50	—	31% below	35%
Gallbladder removal, open surgery through a larger incision inpatient CPT 47600 REM GALLBLADDER	$1,583.72	$2,436.50	—	—	35%
Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHOID(S)	$445.41	$685.25	—	2% below	35%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 LIGATION OF HEMORRHOID(S)	$445.41	$685.25	—	—	35%
Hemorrhoidectomy (internal and external), one area CPT 46255 REMOVE INT/EXT HEMORROID 1 GRP	$773.50	$1,190.00	—	10% below	35%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 REMOVE INT/EXT HEMORROID 1 GRP	$773.50	$1,190.00	—	—	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATHETER FOR HYSTEROGRAPHY	$358.80	$552.00	—	22% above	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATH INSERT FOR HYSTEROGRAPHY	$377.81	$581.25	—	28% above	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATH INTRO CONTRAST/SALINE	$378.95	$583.00	—	28% above	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 CATHETER FOR HYSTEROGRAPHY	$358.80	$552.00	—	—	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 CATH INSERT FOR HYSTEROGRAPHY	$377.81	$581.25	—	—	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 CATH INTRO CONTRAST/SALINE	$378.95	$583.00	—	—	35%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE SKIN ABSCESS	$193.38	$297.50	—	6% below	35%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE SKIN ABSCESS	$193.38	$297.50	—	—	35%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 REPAIR I/HERNIA INIT REDUC >5Y	$760.66	$1,170.25	—	48% below	35%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 REPAIR I/HERNIA INIT REDUC >5Y	$760.66	$1,170.25	—	—	35%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT	$313.30	$482.00	—	160% above	35%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH/LIGAMENT	$313.30	$482.00	—	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJECT JOINT/BURSA WO US	$91.98	$141.50	—	53% below	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASP&INJ MJR JT/BRSA W/O US	$98.15	$151.00	—	50% below	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJECT JOINT/BURSA WO US	$91.98	$141.50	—	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASP&INJ MJR JT/BRSA W/O US	$98.15	$151.00	—	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASP&INJ INTERM JT/BRSA W/O US	$82.55	$127.00	—	41% below	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTES,INTMED JNT W/O US	$332.15	$511.00	—	138% above	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASP&INJ INTERM JT/BRSA W/O US	$82.55	$127.00	—	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTES,INTMED JNT W/O US	$332.15	$511.00	—	—	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASP&INJ SM JT/BRSA W/O US	$79.30	$122.00	—	22% below	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS,SML JNT W/O US	$332.15	$511.00	—	228% above	35%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ASP&INJ SM JT/BRSA W/O US	$79.30	$122.00	—	—	35%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS,SML JNT W/O US	$332.15	$511.00	—	—	35%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAP SURG APPENDECTOMY	$1,013.19	$1,558.75	—	24% below	35%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 LAP SURG APPENDECTOMY	$1,013.19	$1,558.75	—	—	35%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAP ING HERNIA REPAIR INT	$695.99	$1,070.75	—	29% below	35%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 LAP ING HERNIA REPAIR INT	$695.99	$1,070.75	—	—	35%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAP RECUR ING HERNIA REPAIR	$936.98	$1,441.50	—	35% below	35%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 LAP RECUR ING HERNIA REPAIR	$936.98	$1,441.50	—	—	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 UP TO 2.5CM-INTERMEDIATE	$433.88	$667.50	—	16% above	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 UP TO 2.5CM-INTERMEDIATE	$433.88	$667.50	—	—	35%
Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC	$408.20	$628.00	—	16% below	35%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX INTERLAMINAR LMBR/SAC	$408.20	$628.00	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NJX AA&/STRD TFRM EPI L/S 1	$381.55	$587.00	—	8% below	35%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 NJX AA&/STRD TFRM EPI L/S 1	$381.55	$587.00	—	—	35%
Mastectomy (total removal of the breast) CPT 19303 MASTECTOMY SIMPLE COMPLETE	$1,889.55	$2,907.00	—	21% below	35%
Mastectomy (total removal of the breast) inpatient CPT 19303 MASTECTOMY SIMPLE COMPLETE	$1,889.55	$2,907.00	—	—	35%
Miscarriage treatment with D&C, first trimester CPT 59820 CARE OF MISCARRIAGE	$1,641.90	$2,526.00	—	1% below	35%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 CARE OF MISCARRIAGE	$1,641.90	$2,526.00	—	—	35%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5 CM SS	$192.08	$295.50	—	at median	35%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC TR-EXT B9+MARG 0.5 CM SS	$192.08	$295.50	—	—	35%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC FACE-MM B9+MARG 0.5 CM SS	$206.38	$317.50	—	30% below	35%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC FACE-MM B9+MARG 0.5 CM SS	$206.38	$317.50	—	—	35%
Occipital nerve block (injection for headaches) CPT 64405 N BLOCK INJ OCCIPITAL	$448.34	$689.75	—	106% above	35%
Occipital nerve block (injection for headaches) inpatient CPT 64405 N BLOCK INJ OCCIPITAL	$448.34	$689.75	—	—	35%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGE GUID	$466.54	$717.75	—	1% below	35%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING	$471.90	$726.00	—	at median	35%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGE GUID	$466.54	$717.75	—	—	35%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGING	$471.90	$726.00	—	—	35%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION NAIL MATRIX-PERM	$656.34	$1,009.75	—	112% above	35%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION NAIL MATRIX-PERM	$656.34	$1,009.75	—	—	35%
Prostate biopsy both sides CPT 55700 ASPIRATION; BREAST BILATERAL	$487.66	$750.25	—	—	35%
Prostate biopsy both sides CPT 55700 US EXTREMITY;LIMITED BILATERAL	$512.04	$787.75	—	—	35%
Prostate biopsy CPT 55700 BIOPSY OF PROSTATE	$382.20	$588.00	—	41% below	35%
Prostate biopsy CPT 55700 US PELVIS WTRANSVAG WDOPP	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 US OB W BIOPROFILE WOSTRESS	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 OB US<14 WKS W/TRANSVAG	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 RENAL US WITH DOPPLER	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 ART/VENOUS FLOW; US LIMITED	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 ASPIRATION; BREAST	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 ART/VENOUS FLOW; US	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 US HYSTEROSONOGRAPHY	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 US PLACE PROSTATE MARKER	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 US BIOPSY; PROSTATE	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 OB US>14 WKS W FETAL UMBARTERY	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 PELVIS US WITH TRANSVAG	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 PELIVS US WITH DOPPLER	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 US AMNIOCENTESIS	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 US SCROTUM WITH DOPPLER	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 OB>14WKS W/TRANSVAG	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 RENAL ARTER US	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 OB US F/U TWINS	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 OB US <14WKS TWINS	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 US NEEDLE PLCMNT PRE-PX	$487.66	$750.25	—	25% below	35%
Prostate biopsy CPT 55700 BIOPSY;NEEDLE LYMPH NODE US	$487.66	$750.25	—	25% below	35%
Prostate biopsy inpatient both sides CPT 55700 ASPIRATION; BREAST BILATERAL	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient both sides CPT 55700 US EXTREMITY;LIMITED BILATERAL	$512.04	$787.75	—	—	35%
Prostate biopsy inpatient CPT 55700 BIOPSY OF PROSTATE	$382.20	$588.00	—	—	35%
Prostate biopsy inpatient CPT 55700 US BIOPSY; PROSTATE	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 US AMNIOCENTESIS	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 OB>14WKS W/TRANSVAG	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 US OB W BIOPROFILE WOSTRESS	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 OB US>14 WKS W FETAL UMBARTERY	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 PELVIS US WITH TRANSVAG	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 PELIVS US WITH DOPPLER	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 US SCROTUM WITH DOPPLER	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 RENAL ARTER US	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 US PELVIS WTRANSVAG WDOPP	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 OB US F/U TWINS	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 OB US <14WKS TWINS	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 OB US<14 WKS W/TRANSVAG	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 RENAL US WITH DOPPLER	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 ART/VENOUS FLOW; US LIMITED	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 ART/VENOUS FLOW; US	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 US HYSTEROSONOGRAPHY	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 US PLACE PROSTATE MARKER	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 US NEEDLE PLCMNT PRE-PX	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 BIOPSY;NEEDLE LYMPH NODE US	$487.66	$750.25	—	—	35%
Prostate biopsy inpatient CPT 55700 ASPIRATION; BREAST	$487.66	$750.25	—	—	35%
Removal of a breast lump, open surgery CPT 19120 REM BREAST LESION 1 OR MORE	$901.55	$1,387.00	—	12% below	35%
Removal of a breast lump, open surgery inpatient CPT 19120 REM BREAST LESION 1 OR MORE	$901.55	$1,387.00	—	—	35%
Removal of a foreign object under the skin, simple CPT 10120 SQ FB REMOVL/W INCIS/SIMP	$311.35	$479.00	—	33% above	35%
Removal of a foreign object under the skin, simple inpatient CPT 10120 SQ FB REMOVL/W INCIS/SIMP	$311.35	$479.00	—	—	35%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colorectal scrn; hi risk ind	$455.65	$701.00	—	23% below	35%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 Colorectal scrn; hi risk ind	$455.65	$701.00	—	—	35%
Short arm cast (elbow to hand) CPT 29075 APPLICATION OF FOREARM CAST	$305.99	$470.75	—	90% above	35%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION OF FOREARM CAST	$305.99	$470.75	—	—	35%
Short arm splint (forearm and hand) CPT 29125 SPLINT APPLICATION - SHORT ARM	$227.50	$350.00	—	90% above	35%
Short arm splint (forearm and hand) inpatient CPT 29125 SPLINT APPLICATION - SHORT ARM	$227.50	$350.00	—	—	35%
Short leg cast (below the knee) CPT 29405 CAST-SHORT LEG	$245.86	$378.25	—	46% above	35%
Short leg cast (below the knee) inpatient CPT 29405 CAST-SHORT LEG	$245.86	$378.25	—	—	35%
Short leg splint (calf to foot) CPT 29515 SPLINT APPLICATION - SHORT LEG	$227.50	$350.00	—	65% above	35%
Short leg splint (calf to foot) inpatient CPT 29515 SPLINT APPLICATION - SHORT LEG	$227.50	$350.00	—	—	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 UP TO 2.5 CM - SIMPLE	$254.31	$391.25	—	6% above	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 UP TO 2.5 CM - SIMPLE	$254.31	$391.25	—	—	35%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION	$177.45	$273.00	—	40% below	35%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION	$177.45	$273.00	—	—	35%
Skin tag removal, up to 15 tags CPT 11200 REM SKIN TAGS < 15	$149.18	$229.50	—	10% above	35%
Skin tag removal, up to 15 tags CPT 11200 REMVL SKIN TAGS<15, ANY AREA	$184.44	$283.75	—	35% above	35%
Skin tag removal, up to 15 tags inpatient CPT 11200 REM SKIN TAGS < 15	$149.18	$229.50	—	—	35%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMVL SKIN TAGS<15, ANY AREA	$184.44	$283.75	—	—	35%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE, DIAGNOSTIC	$702.32	$1,080.50	—	195% above	35%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE, DIAGNOSTIC	$702.32	$1,080.50	—	—	35%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 2.6 TO 7.5 CM - SIMPLE	$285.19	$438.75	—	21% above	35%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 2.6 TO 7.5 CM - SIMPLE	$285.19	$438.75	—	—	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 UP TO 2.5 CM - SIMPLE	$359.78	$553.50	—	25% above	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 UP TO 2.5 CM - SIMPLE	$359.78	$553.50	—	—	35%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES	$194.84	$299.75	—	at median	35%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGNTL BX SKIN SINGLE LES	$194.84	$299.75	—	—	35%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING	$499.85	$769.00	—	at median	35%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS; WITH GUIDANCE	$792.02	$1,218.50	—	58% above	35%
Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLEURA W/ IMAGING	$499.85	$769.00	—	—	35%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS; WITH GUIDANCE	$792.02	$1,218.50	—	—	35%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$83.20	$128.00	—	26% below	35%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT,1 TO 2 MUSCL	$275.11	$423.25	—	144% above	35%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$83.20	$128.00	—	—	35%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT,1 TO 2 MUSCL	$275.11	$423.25	—	—	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion both sides CPT 19083 BREAST BIOPSY;US BILATERAL	$2,157.35	$3,319.00	—	—	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST 1ST LESION US IMAG	$878.80	$1,352.00	—	at median	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BREAST BIOPSY; ULTRASOUND (US)	$1,438.12	$2,212.50	—	64% above	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient both sides CPT 19083 BREAST BIOPSY;US BILATERAL	$2,157.35	$3,319.00	—	—	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BREAST 1ST LESION US IMAG	$878.80	$1,352.00	—	—	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BREAST BIOPSY; ULTRASOUND (US)	$1,438.12	$2,212.50	—	—	35%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD REMOVE LESION SNARE	$711.59	$1,094.75	—	16% below	35%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 EGD REMOVE LESION SNARE	$711.59	$1,094.75	—	—	35%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 VASECTOMY UNILAT/BILAT	$2,992.60	$4,604.00	—	—	35%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 VASECTOMY UNILAT/BILAT	$2,992.60	$4,604.00	—	—	35%
Wart removal, up to 14 warts CPT 17110 DESTRUCT B9 LESION 1-14	$203.94	$313.75	—	18% above	35%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT B9 LESION 1-14	$203.94	$313.75	—	—	35%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SUBQ TISS 20 SQ CM OR	$183.95	$283.00	—	at median	35%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 NO BURN DEBRID/SKIN, SQ	$353.76	$544.25	—	92% above	35%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE SUBQ TISS 20 SQ CM OR	$183.95	$283.00	—	—	35%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 NO BURN DEBRID/SKIN, SQ	$353.76	$544.25	—	—	35%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION, BLD OR BLD CMPT	$313.30	$482.00	—	58% below	35%
Blood transfusion (giving blood or blood components) CPT 36430 BB-BLOOD ADMINISTRATION FEE	$337.68	$519.50	—	55% below	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION, BLD OR BLD CMPT	$313.30	$482.00	—	—	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BB-BLOOD ADMINISTRATION FEE	$337.68	$519.50	—	—	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT	$123.50	$190.00	—	25% above	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT	$123.50	$190.00	—	—	35%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1 HR	$387.72	$596.50	—	18% below	35%
Chemotherapy IV infusion, first hour CPT 96413 IV INFUS, BIO/CHEMO, UP TO 1HR	$429.49	$660.75	—	9% below	35%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV INFUSION 1 HR	$387.72	$596.50	—	—	35%
Chemotherapy IV infusion, first hour inpatient CPT 96413 IV INFUS, BIO/CHEMO, UP TO 1HR	$429.49	$660.75	—	—	35%
Critical care, first 30 to 74 minutes CPT 99291 CRIT CARE E/M, 1ST 30-74 MIN	$418.76	$644.25	—	28% below	35%
Critical care, first 30 to 74 minutes CPT 99291 ER FACILITY-CRITICAL 30-74 MIN	$1,344.20	$2,068.00	—	132% above	35%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRIT CARE E/M, 1ST 30-74 MIN	$418.76	$644.25	—	—	35%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ER FACILITY-CRITICAL 30-74 MIN	$1,344.20	$2,068.00	—	—	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TECH LAB STATS	$87.26	$134.25	—	39% below	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TECH LAB STATS	$87.26	$134.25	—	—	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENCY DEPT - LEVEL 1	$35.42	$54.50	—	68% below	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 EMERGENCY DEPT - LEVEL 1	$35.42	$54.50	—	—	35%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPT LEVEL 2	$67.44	$103.75	—	51% below	35%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENCY DEPT LEVEL 2	$67.44	$103.75	—	—	35%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPT - LEVEL 3	$100.91	$155.25	—	48% below	35%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY DEPT - LEVEL 3	$100.91	$155.25	—	—	35%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPT - LEVEL 4	$183.95	$283.00	—	48% below	35%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY DEPT - LEVEL 4	$183.95	$283.00	—	—	35%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPT - LEVEL 5	$267.64	$411.75	—	48% below	35%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY DEPT - LEVEL 5	$267.64	$411.75	—	—	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS ECHO WITH CONTRAST	$286.00	$440.00	—	40% below	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 ECHO TTE W/BUBBLE, LIMITED	$286.00	$440.00	—	40% below	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 CONGENITAL CARDIAC ECHO COMPLT	$286.00	$440.00	—	40% below	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 CONGENITAL CARDIAC ECHO, LMTD	$286.00	$440.00	—	40% below	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 CONGENITAL ECHO COMPLT W/CONST	$286.00	$440.00	—	40% below	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 TRANSTHORACIC ECHO W/ CONTRAST	$286.00	$440.00	—	40% below	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 ECHO TTE WITH BUBBLE	$286.00	$440.00	—	40% below	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 TRANSTHORACIC ECHO COMPLETE	$286.00	$440.00	—	40% below	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 TRANSTHORACIC ECHO LIMITED	$286.00	$440.00	—	40% below	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 TRANSESOPHAGEAL ECHO/OR WCOLOR	$286.00	$440.00	—	40% below	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS ECHO W/DOPPLER&COLORFLO	$286.00	$440.00	—	40% below	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 TRANSTHORACIC ECHO LMTD W CONS	$286.00	$440.00	—	40% below	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 ECHO TEE COMPLETE W/CONTRAST	$286.00	$440.00	—	40% below	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 ECHO TEE WITH BUBBLE	$286.00	$440.00	—	40% below	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 TREADMILL/PHARMOCOLOGIC STRESS	$734.34	$1,129.75	—	55% above	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 TRANSTHORACIC ECHO COMPLETE	$286.00	$440.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 ECHO TEE COMPLETE W/CONTRAST	$286.00	$440.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CONGENITAL ECHO COMPLT W/CONST	$286.00	$440.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CONGENITAL CARDIAC ECHO COMPLT	$286.00	$440.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 ECHO TTE W/BUBBLE, LIMITED	$286.00	$440.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 STRESS ECHO WITH CONTRAST	$286.00	$440.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 TRANSTHORACIC ECHO LIMITED	$286.00	$440.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 TRANSTHORACIC ECHO LMTD W CONS	$286.00	$440.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 TRANSESOPHAGEAL ECHO/OR WCOLOR	$286.00	$440.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 STRESS ECHO W/DOPPLER&COLORFLO	$286.00	$440.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 ECHO TEE WITH BUBBLE	$286.00	$440.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 TRANSTHORACIC ECHO W/ CONTRAST	$286.00	$440.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 ECHO TTE WITH BUBBLE	$286.00	$440.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CONGENITAL CARDIAC ECHO, LMTD	$286.00	$440.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 TREADMILL/PHARMOCOLOGIC STRESS	$734.34	$1,129.75	—	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUS HYDRAT INIT, 31 MIN-	$228.15	$351.00	—	2% below	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION INFUSION 1ST HOUR	$257.40	$396.00	—	11% above	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION 1ST HR	$272.19	$418.75	—	17% above	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUS HYDRAT INIT, 31 MIN-	$228.15	$351.00	—	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION INFUSION 1ST HOUR	$257.40	$396.00	—	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION 1ST HR	$272.19	$418.75	—	—	35%
IV infusion of a medicine, first hour CPT 96365 IV INFUS, UP TO 1 HR	$101.56	$156.25	—	60% below	35%
IV infusion of a medicine, first hour CPT 96365 THERAPEUTIC IV INFUSION 1ST HR	$272.19	$418.75	—	8% above	35%
IV infusion of a medicine, first hour CPT 96365 IV INFUS, THERAPEUTIC, 1ST HR	$285.84	$439.75	—	13% above	35%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUS, UP TO 1 HR	$101.56	$156.25	—	—	35%
IV infusion of a medicine, first hour inpatient CPT 96365 THERAPEUTIC IV INFUSION 1ST HR	$272.19	$418.75	—	—	35%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUS, THERAPEUTIC, 1ST HR	$285.84	$439.75	—	—	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DX INJ, SUB Q OR I	$39.65	$61.00	—	36% below	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ, SC/IM	$93.28	$143.50	—	50% above	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION,SQ OR IM, EA	$93.28	$143.50	—	50% above	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DX INJ, SUB Q OR I	$39.65	$61.00	—	—	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ, SC/IM	$93.28	$143.50	—	—	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION,SQ OR IM, EA	$93.28	$143.50	—	—	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INITIAL NUTRITION 15 MIN	$41.11	$63.25	—	9% below	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT INITIAL NUTRITION 15 MIN	$41.11	$63.25	—	—	35%
Occupational therapy evaluation, low complexity CPT 97165 OT EVALUATION;LOW COMPLEX	$128.05	$197.00	—	25% below	35%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVALUATION;LOW COMPLEX	$128.05	$197.00	—	—	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEX	$109.04	$167.75	—	42% below	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVALUATION;HIGH COMPLEX	$143.49	$220.75	—	23% below	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEX	$109.04	$167.75	—	—	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVALUATION;HIGH COMPLEX	$143.49	$220.75	—	—	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVALUATION; LOW COMPLEX	$150.64	$231.75	—	9% below	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVALUATION; LOW COMPLEX	$150.64	$231.75	—	—	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVALUATION;MODERATE COMPLEX	$150.64	$231.75	—	9% below	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVALUATION;MODERATE COMPLEX	$150.64	$231.75	—	—	35%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MNL THERAPY, 1/> REG; 15 MIN	$45.82	$70.50	—	33% below	35%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MNL THERAPY, 1/> REG; 15 MIN	$45.82	$70.50	—	—	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES; 15 MINS	$49.40	$76.00	—	34% below	35%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISES; 15 MINS	$49.40	$76.00	—	—	35%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 ESTABLISHED PT LEVEL V	$325.32	$500.50	—	40% above	35%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 ESTABLISHED PT LEVEL V	$325.32	$500.50	—	—	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTABLISHED PT LEVEL III	$138.61	$213.25	—	10% above	35%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 ESTABLISHED PT LEVEL III	$138.61	$213.25	—	—	35%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTABLISHED PT LEVEL IV	$200.04	$307.75	—	23% above	35%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 ESTABLISHED PT LEVEL IV	$200.04	$307.75	—	—	35%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTABLISHED PT LEVEL II	$108.71	$167.25	—	26% above	35%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 ESTABLISHED PT LEVEL II	$108.71	$167.25	—	—	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES	$45.82	$70.50	—	40% below	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC FUNCTIONAL ACTIVIT	$67.76	$104.25	—	11% below	35%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITIES	$45.82	$70.50	—	—	35%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC FUNCTIONAL ACTIVIT	$67.76	$104.25	—	—	35%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY	$123.01	$189.25	—	20% below	35%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY	$123.01	$189.25	—	—	35%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SARCOV2 VAC 50MCG/0.5ML IM INJ	$127.40	$196.00	—	10% below	35%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 SARCOV2 VAC 50MCG/0.5ML IM INJ	$127.40	$196.00	—	—	35%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 SARSCOV2 VAC 30MCG/0.3ML IM	$112.45	$173.00	—	19% below	35%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 SARSCOV2 VAC 30MCG/0.3ML IM	$112.45	$173.00	—	—	35%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VAC LIVE SUBQ	$92.62	$142.50	—	57% below	35%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VAC LIVE SUBQ	$92.62	$142.50	—	—	35%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACCINE, 3 YRS AND UP	$26.00	$40.00	—	17% above	35%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACCINE, 3 YRS AND UP	$26.00	$40.00	—	—	35%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV VACCINE 9 VALENT IM	$281.94	$433.75	—	15% below	35%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV VACCINE 9 VALENT IM	$281.94	$433.75	—	—	35%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEP A/HEP B VACC ADULT IM	$99.45	$153.00	—	35% below	35%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HEP A/HEP B VACC ADULT IM	$99.45	$153.00	—	—	35%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE ADULT, IM	$68.90	$106.00	—	28% below	35%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE ADULT, IM	$68.90	$106.00	—	—	35%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B VACCINE ADULT DOSAGE IN	$64.84	$99.75	—	31% below	35%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B VACCINE ADULT DOSAGE IN	$64.84	$99.75	—	—	35%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VACCINE, SPLIT ANT	$96.20	$148.00	—	27% above	35%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENZA VACCINE, SPLIT ANT	$96.20	$148.00	—	—	35%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR VIRUS VACCINE	$90.68	$139.50	—	22% below	35%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES,MUMPS&RUBELLA VACC/PF	$133.90	$206.00	—	15% above	35%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR VIRUS VACCINE	$90.68	$139.50	—	—	35%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES,MUMPS&RUBELLA VACC/PF	$133.90	$206.00	—	—	35%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL CONJ VAC TETRAVA	$115.21	$177.25	—	29% below	35%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL CONJ VAC TETRAVA	$115.21	$177.25	—	—	35%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MenB 2 Dose Schedule	$315.25	$485.00	—	13% above	35%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MenB 2 Dose Schedule	$315.25	$485.00	—	—	35%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PCV20 VACCINE IM	$244.56	$376.25	—	23% below	35%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PCV20 VACCINE IM	$244.56	$376.25	—	—	35%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VACCINE, 2 YR+	$115.21	$177.25	—	16% below	35%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VACCINE, 2 YR+	$115.21	$177.25	—	—	35%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 AREXVY RSV VACC 0.5ML	$228.80	$352.00	—	24% below	35%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 AREXVY RSV VACC 0.5ML	$228.80	$352.00	—	—	35%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM	$252.69	$388.75	—	42% below	35%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE IM	$252.69	$388.75	—	—	35%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACCINE, 7 YRS OR OLDER, IM	$24.54	$37.75	—	61% below	35%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS/DIPHTHERIA TOX 0.5ML	$45.50	$70.00	—	28% below	35%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD VACCINE, 7 YRS OR OLDER, IM	$24.54	$37.75	—	—	35%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS/DIPHTHERIA TOX 0.5ML	$45.50	$70.00	—	—	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACCINE, 7 YR+ , IM	$40.95	$63.00	—	60% below	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP VACCINE, 7 YR+ , IM	$40.95	$63.00	—	—	35%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 TYPHOID VACCINE, IM	$77.02	$118.50	—	24% below	35%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 TYPHOID VACCINE, IM	$77.02	$118.50	—	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZE/SINGLE OR COMBINATION	$45.82	$70.50	—	10% above	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN 1 VACCINE	$47.12	$72.50	—	13% above	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZE/SINGLE OR COMBINATION	$45.82	$70.50	—	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN 1 VACCINE	$47.12	$72.50	—	—	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATIONS, 2+	$17.71	$27.25	—	42% below	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN 2 OR MORE	$42.41	$65.25	—	40% above	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION VACCINE ADMIN 2ND	$43.39	$66.75	—	43% above	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATIONS, 2+	$17.71	$27.25	—	—	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN 2 OR MORE	$42.41	$65.25	—	—	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION VACCINE ADMIN 2ND	$43.39	$66.75	—	—	35%

Source file: https://HospitalPriceDisclosure.com/Download.aspx?pi=FdPNqgcn*_*TDE47QlrE*__*fuQ*-*