Hospital

Logan Health - Cut Bank

Logan Health - Cut Bank in Cut Bank, MT publishes cash prices for 286 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 167 of 286 procedures and above it for 85. By typical cash price it ranks #8 of 23 Montana hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

802 2Nd St Se, Cut Bank, MT 59427 Collected Sep 29, 2026 Source price file (406) 873-2251

Critical access hospital (rural, 25 beds or fewer) No emergency department CCN 271337 · CMS hospital register NPI 1831143080

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 4 actions for a hospital named Logan Health - Cut Bank in Cut Bank, MT:

Jul 6, 2023 Met requirements
Aug 21, 2024 Warning notice
Nov 26, 2024 Case closed
Jun 2, 2026 Met requirements

Met requirements: CMS reviewed the hospital and found it met the requirements, so no further action was taken. Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Case closed: CMS closed the case after the hospital addressed the problems.

A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 XR Exam	$416.98	$641.50	—	129% above	35%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 XR Exam	$416.98	$641.50	—	—	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US Vas Lab Exam	$276.25	$425.00	—	2% below	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US Vas Lab Exam	$276.25	$425.00	—	—	35%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Fluoro Exam	$277.71	$427.25	—	22% below	35%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR Fluoro Exam	$277.71	$427.25	—	—	35%
Breast ultrasound, complete, one breast CPT 76641 US Breast Complete R - Report	$53.95	$83.00	—	74% below	35%
Breast ultrasound, complete, one breast CPT 76641 US Breast Complete L and R - Report	$53.95	$83.00	—	74% below	35%
Breast ultrasound, complete, one breast CPT 76641 US Breast Complete L - Report	$53.95	$83.00	—	74% below	35%
Breast ultrasound, complete, one breast CPT 76641 US Breast Complete L and R 2nd component	$236.76	$364.25	—	16% above	35%
Breast ultrasound, complete, one breast CPT 76641 US Exam	$236.76	$364.25	—	16% above	35%
Breast ultrasound, complete, one breast inpatient CPT 76641 US Breast Complete L and R - Report	$53.95	$83.00	—	—	35%
Breast ultrasound, complete, one breast inpatient CPT 76641 US Breast Complete L - Report	$53.95	$83.00	—	—	35%
Breast ultrasound, complete, one breast inpatient CPT 76641 US Breast Complete R - Report	$53.95	$83.00	—	—	35%
Breast ultrasound, complete, one breast inpatient CPT 76641 US Exam	$236.76	$364.25	—	—	35%
Breast ultrasound, complete, one breast inpatient CPT 76641 US Breast Complete L and R 2nd component	$236.76	$364.25	—	—	35%
Breast ultrasound, limited (one breast or one area) CPT 76642 US Breast L and R 2nd component	$50.70	$78.00	—	78% below	35%
Breast ultrasound, limited (one breast or one area) CPT 76642 US Breast L - Report	$50.70	$78.00	—	78% below	35%
Breast ultrasound, limited (one breast or one area) CPT 76642 US Breast R - Report	$50.70	$78.00	—	78% below	35%
Breast ultrasound, limited (one breast or one area) CPT 76642 US Breast L and R - Report	$101.40	$156.00	—	56% below	35%
Breast ultrasound, limited (one breast or one area) CPT 76642 US Exam	$203.61	$313.25	—	12% below	35%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US Breast L - Report	$50.70	$78.00	—	—	35%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US Breast R - Report	$50.70	$78.00	—	—	35%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US Breast L and R 2nd component	$50.70	$78.00	—	—	35%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US Breast L and R - Report	$101.40	$156.00	—	—	35%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US Exam	$203.61	$313.25	—	—	35%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Exam	$1,625.49	$2,500.75	—	22% below	35%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Exam	$1,625.49	$2,500.75	—	—	35%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT Cardiac and Coronary Art w/ Ca Score - Report	$174.20	$268.00	—	62% below	35%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT Cardiac and Coronary Art - Report	$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 Cardiac and Coronary Art - Report	$174.20	$268.00	—	—	35%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT Cardiac and Coronary Art w/ Ca Score - Report	$174.20	$268.00	—	—	35%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Cardiac Calcium Score - Report	$43.55	$67.00	—	82% below	35%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT Cardiac Calcium Score - Report	$43.55	$67.00	—	—	35%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Exam	$1,705.11	$2,623.25	—	16% below	35%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abd and Pelvis wo Contrast	$1,705.11	$2,623.25	—	16% below	35%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abd and Pelvis wo Contrast	$1,705.11	$2,623.25	—	—	35%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Exam	$1,705.11	$2,623.25	—	—	35%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abd and Pelvis w/ Contrast	$2,471.79	$3,802.75	—	11% below	35%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Exam	$2,471.79	$3,802.75	—	11% below	35%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Exam	$2,471.79	$3,802.75	—	—	35%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abd and Pelvis w/ Contrast	$2,471.79	$3,802.75	—	—	35%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abd/Pelvis w/wo Contrast	$2,738.61	$4,213.25	—	12% below	35%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Exam	$2,738.61	$4,213.25	—	12% below	35%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abd/Pelvis w/wo Contrast	$2,738.61	$4,213.25	—	—	35%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Exam	$2,738.61	$4,213.25	—	—	35%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen w/ Contrast	$1,463.31	$2,251.25	—	12% below	35%
CT scan of the abdomen with contrast CPT 74160 CT Exam	$1,463.31	$2,251.25	—	12% below	35%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Exam	$1,463.31	$2,251.25	—	—	35%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen w/ Contrast	$1,463.31	$2,251.25	—	—	35%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen wo Contrast	$1,118.32	$1,720.50	—	13% below	35%
CT scan of the abdomen without contrast CPT 74150 CT Exam	$1,118.32	$1,720.50	—	13% below	35%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Exam	$1,118.32	$1,720.50	—	—	35%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen wo Contrast	$1,118.32	$1,720.50	—	—	35%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Exam	$870.19	$1,338.75	—	19% below	35%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Exam	$870.19	$1,338.75	—	—	35%
CT scan of the head or brain, no contrast dye CPT 70450 CT Exam	$1,129.05	$1,737.00	—	3% below	35%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Exam	$1,129.05	$1,737.00	—	—	35%
CT scan of the head with contrast CPT 70460 CT Exam	$1,337.05	$2,057.00	—	at median	35%
CT scan of the head with contrast inpatient CPT 70460 CT Exam	$1,337.05	$2,057.00	—	—	35%
CT scan of the head without and with contrast CPT 70470 CT Exam	$1,560.00	$2,400.00	—	14% below	35%
CT scan of the head without and with contrast inpatient CPT 70470 CT Exam	$1,560.00	$2,400.00	—	—	35%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Exam	$1,240.20	$1,908.00	—	11% below	35%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Exam	$1,240.20	$1,908.00	—	—	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT C Spine wo Contrast	$1,273.19	$1,958.75	—	8% below	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Exam	$1,273.19	$1,958.75	—	8% below	35%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Exam	$1,273.19	$1,958.75	—	—	35%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT C Spine wo Contrast	$1,273.19	$1,958.75	—	—	35%
CT scan of the pelvis, with contrast dye CPT 72193 CT Exam	$1,121.90	$1,726.00	—	22% below	35%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Contrast	$1,121.90	$1,726.00	—	22% below	35%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Exam	$1,121.90	$1,726.00	—	—	35%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Contrast	$1,121.90	$1,726.00	—	—	35%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US Exam	$616.85	$949.00	—	34% below	35%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US Exam	$616.85	$949.00	—	—	35%
Chest X-ray, 2 views CPT 71046 OR Exam	$198.90	$306.00	—	4% above	35%
Chest X-ray, 2 views CPT 71046 XR Exam	$198.90	$306.00	—	4% above	35%
Chest X-ray, 2 views CPT 71046 XR Chest PA and Lateral	$198.90	$306.00	—	4% above	35%
Chest X-ray, 2 views inpatient CPT 71046 XR Exam	$198.90	$306.00	—	—	35%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest PA and Lateral	$198.90	$306.00	—	—	35%
Chest X-ray, 2 views inpatient CPT 71046 OR Exam	$198.90	$306.00	—	—	35%
Chest X-ray, single view CPT 71045 XR MU Exam	$197.28	$303.50	—	10% above	35%
Chest X-ray, single view CPT 71045 XR Exam	$197.28	$303.50	—	10% above	35%
Chest X-ray, single view CPT 71045 OR Exam	$197.28	$303.50	—	10% above	35%
Chest X-ray, single view CPT 71045 XR Chest PA/AP Only	$197.28	$303.50	—	10% above	35%
Chest X-ray, single view inpatient CPT 71045 XR Chest PA/AP Only	$197.28	$303.50	—	—	35%
Chest X-ray, single view inpatient CPT 71045 OR Exam	$197.28	$303.50	—	—	35%
Chest X-ray, single view inpatient CPT 71045 XR MU Exam	$197.28	$303.50	—	—	35%
Chest X-ray, single view inpatient CPT 71045 XR Exam	$197.28	$303.50	—	—	35%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Exam	$343.04	$527.75	—	23% below	35%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Exam	$343.04	$527.75	—	—	35%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA Exam	$287.79	$442.75	—	12% below	35%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA Exam	$287.79	$442.75	—	—	35%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA Exam	$182.32	$280.50	—	27% above	35%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DXA Exam	$182.32	$280.50	—	—	35%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB Detailed Study - Report	$139.75	$215.00	—	35% below	35%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB Exam	$443.79	$682.75	—	108% above	35%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB Detailed Study - Report	$139.75	$215.00	—	—	35%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB Exam	$443.79	$682.75	—	—	35%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Exam	$1,138.48	$1,751.50	—	13% below	35%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Exam	$1,138.48	$1,751.50	—	—	35%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Exam	$1,438.94	$2,213.75	—	12% below	35%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Exam	$1,438.94	$2,213.75	—	—	35%
Diagnostic mammogram, both breasts both sides CPT 77066 MA Mammogram Diagnostic Bilateral - Report	$73.45	$113.00	—	—	35%
Diagnostic mammogram, both breasts both sides CPT 77066 MA Mammogram Post Loc Device Bilat - Report	$73.45	$113.00	—	—	35%
Diagnostic mammogram, both breasts CPT 77066 MA Exam	$315.74	$485.75	—	3% below	35%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA Mammogram Diagnostic Bilateral - Report	$73.45	$113.00	—	—	35%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA Mammogram Post Loc Device Bilat - Report	$73.45	$113.00	—	—	35%
Diagnostic mammogram, both breasts inpatient CPT 77066 MA Exam	$315.74	$485.75	—	—	35%
Diagnostic mammogram, one breast CPT 77065 MA Mammogram Diagnostic Uni w/ Tomo R - Report	$59.80	$92.00	—	73% below	35%
Diagnostic mammogram, one breast CPT 77065 MA Mammogram Diagnostic Uni w/ Tomo L - Report	$59.80	$92.00	—	73% below	35%
Diagnostic mammogram, one breast CPT 77065 MA Mammogram Post Loc Device Uni L - Report	$59.80	$92.00	—	73% below	35%
Diagnostic mammogram, one breast CPT 77065 MA Mammogram Post Loc Device Uni R - Report	$59.80	$92.00	—	73% below	35%
Diagnostic mammogram, one breast CPT 77065 MA Mammogram Addtl Views R - Report	$59.80	$92.00	—	73% below	35%
Diagnostic mammogram, one breast CPT 77065 MA Mammogram Addtl Views L - Report	$59.80	$92.00	—	73% below	35%
Diagnostic mammogram, one breast CPT 77065 MA Exam	$256.26	$394.25	—	18% above	35%
Diagnostic mammogram, one breast one side CPT 77065 MA Mammogram Diagnostic Unilateral L - Report	$59.80	$92.00	—	73% below	35%
Diagnostic mammogram, one breast one side CPT 77065 MA Mammogram Diagnostic Unilateral R - Report	$59.80	$92.00	—	73% below	35%
Diagnostic mammogram, one breast inpatient CPT 77065 MA Mammogram Addtl Views R - Report	$59.80	$92.00	—	—	35%
Diagnostic mammogram, one breast inpatient CPT 77065 MA Mammogram Post Loc Device Uni R - Report	$59.80	$92.00	—	—	35%
Diagnostic mammogram, one breast inpatient CPT 77065 MA Mammogram Addtl Views L - Report	$59.80	$92.00	—	—	35%
Diagnostic mammogram, one breast inpatient CPT 77065 MA Mammogram Diagnostic Uni w/ Tomo R - Report	$59.80	$92.00	—	—	35%
Diagnostic mammogram, one breast inpatient CPT 77065 MA Mammogram Diagnostic Uni w/ Tomo L - Report	$59.80	$92.00	—	—	35%
Diagnostic mammogram, one breast inpatient CPT 77065 MA Mammogram Post Loc Device Uni L - Report	$59.80	$92.00	—	—	35%
Diagnostic mammogram, one breast inpatient CPT 77065 MA Exam	$256.26	$394.25	—	—	35%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Mammogram Diagnostic Unilateral L - Report	$59.80	$92.00	—	—	35%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Mammogram Diagnostic Unilateral R - Report	$59.80	$92.00	—	—	35%
Duplex ultrasound of the leg arteries, both legs CPT 93925 US Exam	$861.58	$1,325.50	—	7% below	35%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US Exam	$861.58	$1,325.50	—	—	35%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Venous Doppler LE Bilat	$771.06	$1,186.25	—	—	35%
Duplex ultrasound of the leg veins, both legs CPT 93970 US Exam	$771.06	$1,186.25	—	at median	35%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Venous Doppler LE Bilat	$771.06	$1,186.25	—	—	35%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US Exam	$771.06	$1,186.25	—	—	35%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 EC Exam	$1,327.30	$2,042.00	—	11% below	35%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 EC Exam	$1,327.30	$2,042.00	—	—	35%
Knee X-ray, 3 views both sides CPT 73562 XR O Knee w/ Merchant View Bilat 2nd com	$374.56	$576.25	—	—	35%
Knee X-ray, 3 views CPT 73562 XR Exam	$374.56	$576.25	—	107% above	35%
Knee X-ray, 3 views inpatient both sides CPT 73562 XR O Knee w/ Merchant View Bilat 2nd com	$374.56	$576.25	—	—	35%
Knee X-ray, 3 views inpatient CPT 73562 XR Exam	$374.56	$576.25	—	—	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Exam	$431.92	$664.50	—	8% above	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Exam	$431.92	$664.50	—	—	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Lung Low Dose - Report	$79.30	$122.00	—	81% below	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Exam	$1,058.85	$1,629.00	—	153% above	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Lung Low Dose - Report	$79.30	$122.00	—	—	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Exam	$1,058.85	$1,629.00	—	—	35%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MR Joint Lower wo Contrast Limited R	$2,963.84	$4,559.75	—	71% above	35%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MR Joint Lower wo Contrast Limited L	$2,963.84	$4,559.75	—	71% above	35%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MR Exam	$2,963.84	$4,559.75	—	71% above	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR Joint Lower wo Contrast Limited R	$2,963.84	$4,559.75	—	—	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR Exam	$2,963.84	$4,559.75	—	—	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR Joint Lower wo Contrast Limited L	$2,963.84	$4,559.75	—	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MR Joint Lower w/wo Contrast Limited R	$2,348.29	$3,612.75	—	11% below	35%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MR Exam	$2,348.29	$3,612.75	—	11% below	35%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MR Joint Lower w/wo Contrast Limited L	$2,348.29	$3,612.75	—	11% below	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR Joint Lower w/wo Contrast Limited R	$2,348.29	$3,612.75	—	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR Exam	$2,348.29	$3,612.75	—	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR Joint Lower w/wo Contrast Limited L	$2,348.29	$3,612.75	—	—	35%
MRI of the abdomen without contrast CPT 74181 MR Abdomen wo Contrast	$1,725.10	$2,654.00	—	4% below	35%
MRI of the abdomen without contrast CPT 74181 MR Exam	$1,725.10	$2,654.00	—	4% below	35%
MRI of the abdomen without contrast CPT 74181 MR Abdomen wo Contrast Limited	$1,725.10	$2,654.00	—	4% below	35%
MRI of the abdomen without contrast inpatient CPT 74181 MR Exam	$1,725.10	$2,654.00	—	—	35%
MRI of the abdomen without contrast inpatient CPT 74181 MR Abdomen wo Contrast	$1,725.10	$2,654.00	—	—	35%
MRI of the abdomen without contrast inpatient CPT 74181 MR Abdomen wo Contrast Limited	$1,725.10	$2,654.00	—	—	35%
MRI of the abdomen, without and then with contrast dye CPT 74183 MR Abdomen w/wo Contrast	$2,524.11	$3,883.25	—	13% below	35%
MRI of the abdomen, without and then with contrast dye CPT 74183 MR Exam	$2,524.11	$3,883.25	—	13% below	35%
MRI of the abdomen, without and then with contrast dye CPT 74183 MR Abdomen w/wo Contrast Limited	$2,524.11	$3,883.25	—	13% below	35%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MR Abdomen w/wo Contrast	$2,524.11	$3,883.25	—	—	35%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MR Abdomen w/wo Contrast Limited	$2,524.11	$3,883.25	—	—	35%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MR Exam	$2,524.11	$3,883.25	—	—	35%
MRI of the brain, no contrast dye CPT 70551 MR Exam	$1,770.28	$2,723.50	—	at median	35%
MRI of the brain, no contrast dye CPT 70551 MR Brain wo Contrast Limited	$1,770.28	$2,723.50	—	at median	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MR Exam	$1,770.28	$2,723.50	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MR Brain wo Contrast Limited	$1,770.28	$2,723.50	—	—	35%
MRI of the brain, with and without contrast dye CPT 70553 MR Exam	$2,699.78	$4,153.50	—	5% below	35%
MRI of the brain, with and without contrast dye CPT 70553 MR Brain w/wo Contrast Limited	$2,699.78	$4,153.50	—	5% below	35%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Brain w/wo Contrast Limited	$2,699.78	$4,153.50	—	—	35%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Exam	$2,699.78	$4,153.50	—	—	35%
MRI of the lower back, no contrast dye CPT 72148 MR L Spine wo Contrast Limited	$527.31	$811.25	—	70% below	35%
MRI of the lower back, no contrast dye CPT 72148 MR Exam	$527.31	$811.25	—	70% below	35%
MRI of the lower back, no contrast dye inpatient CPT 72148 MR Exam	$527.31	$811.25	—	—	35%
MRI of the lower back, no contrast dye inpatient CPT 72148 MR L Spine wo Contrast Limited	$527.31	$811.25	—	—	35%
MRI of the lower back, without and then with contrast dye CPT 72158 MR Exam	$832.00	$1,280.00	—	69% below	35%
MRI of the lower back, without and then with contrast dye CPT 72158 MR L Spine w/wo Contrast Limited	$832.00	$1,280.00	—	69% below	35%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MR L Spine w/wo Contrast Limited	$832.00	$1,280.00	—	—	35%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MR Exam	$832.00	$1,280.00	—	—	35%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MR Exam	$1,741.68	$2,679.50	—	at median	35%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MR T Spine wo Contrast Limited	$1,741.68	$2,679.50	—	at median	35%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MR T Spine wo Contrast Limited	$1,741.68	$2,679.50	—	—	35%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MR Exam	$1,741.68	$2,679.50	—	—	35%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MR C Spine w/wo Contrast Limited	$2,306.04	$3,547.75	—	14% below	35%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MR Exam	$2,306.04	$3,547.75	—	14% below	35%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MR C Spine w/wo Contrast	$2,306.04	$3,547.75	—	14% below	35%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MR C Spine w/wo Contrast Limited	$2,306.04	$3,547.75	—	—	35%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MR Exam	$2,306.04	$3,547.75	—	—	35%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MR C Spine w/wo Contrast	$2,306.04	$3,547.75	—	—	35%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MR C Spine wo Contrast Limited	$1,712.26	$2,634.25	—	3% below	35%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MR Exam	$1,712.26	$2,634.25	—	3% below	35%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MR C Spine wo Contrast	$1,712.26	$2,634.25	—	3% below	35%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MR Exam	$1,712.26	$2,634.25	—	—	35%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MR C Spine wo Contrast	$1,712.26	$2,634.25	—	—	35%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MR C Spine wo Contrast Limited	$1,712.26	$2,634.25	—	—	35%
MRI of the pelvis without and with contrast CPT 72197 MR Pelvis w/wo Contrast Limited	$2,706.92	$4,164.50	—	2% below	35%
MRI of the pelvis without and with contrast CPT 72197 MR Pelvis w/wo Contrast	$2,706.92	$4,164.50	—	2% below	35%
MRI of the pelvis without and with contrast CPT 72197 MR Exam	$2,706.92	$4,164.50	—	2% below	35%
MRI of the pelvis without and with contrast inpatient CPT 72197 MR Pelvis w/wo Contrast Limited	$2,706.92	$4,164.50	—	—	35%
MRI of the pelvis without and with contrast inpatient CPT 72197 MR Pelvis w/wo Contrast	$2,706.92	$4,164.50	—	—	35%
MRI of the pelvis without and with contrast inpatient CPT 72197 MR Exam	$2,706.92	$4,164.50	—	—	35%
MRI of the pelvis, no contrast dye CPT 72195 MR Exam	$1,730.14	$2,661.75	—	6% below	35%
MRI of the pelvis, no contrast dye CPT 72195 MR Pelvis wo Contrast Limited	$1,730.14	$2,661.75	—	6% below	35%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MR Pelvis wo Contrast Limited	$1,730.14	$2,661.75	—	—	35%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MR Exam	$1,730.14	$2,661.75	—	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MR Joint Upper wo Contrast Limited L	$1,474.04	$2,267.75	—	5% below	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MR Joint Upper wo Contrast Limited R	$1,474.04	$2,267.75	—	5% below	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MR Exam	$1,474.04	$2,267.75	—	5% below	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MR Joint Upper wo Contrast Limited R	$1,474.04	$2,267.75	—	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MR Exam	$1,474.04	$2,267.75	—	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MR Joint Upper wo Contrast Limited L	$1,474.04	$2,267.75	—	—	35%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Ltd Pelvis Exam	$293.48	$451.50	—	3% below	35%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Exam	$293.48	$451.50	—	3% below	35%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US GYN Pelvis TransAbd Ltd	$293.48	$451.50	—	3% below	35%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Exam	$293.48	$451.50	—	—	35%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Ltd Pelvis Exam	$293.48	$451.50	—	—	35%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US GYN Pelvis TransAbd Ltd	$293.48	$451.50	—	—	35%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Exam	$398.12	$612.50	—	17% below	35%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Exam	$398.12	$612.50	—	—	35%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB Over 14 weeks - Report	$72.80	$112.00	—	82% below	35%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB Exam	$479.21	$737.25	—	15% above	35%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB Over 14 weeks - Report	$72.80	$112.00	—	—	35%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB Exam	$479.21	$737.25	—	—	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB First Trimester - Report	$72.80	$112.00	—	81% below	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB First Trimester	$380.25	$585.00	—	at median	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB Exam	$380.25	$585.00	—	at median	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB First Trimester - Report	$72.80	$112.00	—	—	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB Exam	$380.25	$585.00	—	—	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB First Trimester	$380.25	$585.00	—	—	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB Limited - Report	$48.75	$75.00	—	81% below	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB Limited	$338.65	$521.00	—	29% above	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB Exam	$338.65	$521.00	—	29% above	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB Limited - Report	$48.75	$75.00	—	—	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB Limited	$338.65	$521.00	—	—	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB Exam	$338.65	$521.00	—	—	35%
Screening mammogram, both breasts CPT 77067 MA Mammogram Screening - Report	$56.55	$87.00	—	78% below	35%
Screening mammogram, both breasts CPT 77067 MA Mammogram Screening Implants/Extended - Report	$56.55	$87.00	—	78% below	35%
Screening mammogram, both breasts CPT 77067 MA Exam	$238.39	$366.75	—	7% below	35%
Screening mammogram, both breasts one side CPT 77067 MA Mammogram Screen Uni RT - Report	$56.55	$87.00	—	78% below	35%
Screening mammogram, both breasts one side CPT 77067 MA Mammogram Screen Uni LT - Report	$56.55	$87.00	—	78% below	35%
Screening mammogram, both breasts inpatient CPT 77067 MA Mammogram Screening - Report	$56.55	$87.00	—	—	35%
Screening mammogram, both breasts inpatient CPT 77067 MA Mammogram Screening Implants/Extended - Report	$56.55	$87.00	—	—	35%
Screening mammogram, both breasts inpatient CPT 77067 MA Exam	$238.39	$366.75	—	—	35%
Screening mammogram, both breasts inpatient one side CPT 77067 MA Mammogram Screen Uni LT - Report	$56.55	$87.00	—	—	35%
Screening mammogram, both breasts inpatient one side CPT 77067 MA Mammogram Screen Uni RT - Report	$56.55	$87.00	—	—	35%
Shoulder X-ray, complete, 2 or more views CPT 73030 XR Exam	$423.31	$651.25	—	120% above	35%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 XR Exam	$423.31	$651.25	—	—	35%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR Fluoro Exam	$313.62	$482.50	—	19% below	35%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR Fluoro Exam	$313.62	$482.50	—	—	35%
Transvaginal pelvic ultrasound CPT 76830 US GYN Pelvis Complete - Report	$51.35	$79.00	—	85% below	35%
Transvaginal pelvic ultrasound CPT 76830 US GYN Pelvis Transvaginal - Report	$51.35	$79.00	—	85% below	35%
Transvaginal pelvic ultrasound CPT 76830 US GYN Pelvis Transvaginal	$416.00	$640.00	—	19% above	35%
Transvaginal pelvic ultrasound CPT 76830 US Exam	$416.00	$640.00	—	19% above	35%
Transvaginal pelvic ultrasound inpatient CPT 76830 US GYN Pelvis Complete - Report	$51.35	$79.00	—	—	35%
Transvaginal pelvic ultrasound inpatient CPT 76830 US GYN Pelvis Transvaginal - Report	$51.35	$79.00	—	—	35%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Exam	$416.00	$640.00	—	—	35%
Transvaginal pelvic ultrasound inpatient CPT 76830 US GYN Pelvis Transvaginal	$416.00	$640.00	—	—	35%
Transvaginal ultrasound during pregnancy CPT 76817 US OB Transvaginal - Report	$55.90	$86.00	—	85% below	35%
Transvaginal ultrasound during pregnancy CPT 76817 US OB Transvaginal	$317.85	$489.00	—	13% below	35%
Transvaginal ultrasound during pregnancy CPT 76817 US OB Exam	$317.85	$489.00	—	13% below	35%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB Transvaginal - Report	$55.90	$86.00	—	—	35%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB Exam	$317.85	$489.00	—	—	35%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB Transvaginal	$317.85	$489.00	—	—	35%
Ultrasound of the abdomen, complete CPT 76700 US Exam	$518.70	$798.00	—	1% below	35%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Exam	$518.70	$798.00	—	—	35%
Ultrasound of the scrotum and testicles CPT 76870 US Exam	$456.46	$702.25	—	2% below	35%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Exam	$456.46	$702.25	—	—	35%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Exam	$304.85	$469.00	—	29% below	35%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Exam	$304.85	$469.00	—	—	35%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Fluoro Exam	$452.72	$696.50	—	2% above	35%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Fluoro Exam	$452.72	$696.50	—	—	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US Venous Doppler LE L	$492.86	$758.25	—	2% below	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US Exam	$492.86	$758.25	—	2% below	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US Venous Doppler LE R	$492.86	$758.25	—	2% below	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US Venous Doppler LE L	$492.86	$758.25	—	—	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US Venous Doppler LE R	$492.86	$758.25	—	—	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US Exam	$492.86	$758.25	—	—	35%
Wrist X-ray, complete, 3 or more views CPT 73110 XR Exam	$316.55	$487.00	—	53% above	35%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 XR Exam	$316.55	$487.00	—	—	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 XR Hip Complete L - Report	$48.75	$75.00	—	75% below	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 XR Exam	$253.99	$390.75	—	32% above	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 XR Hip Complete L - Report	$48.75	$75.00	—	—	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 XR Exam	$253.99	$390.75	—	—	35%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen Flatplate	$165.10	$254.00	—	4% below	35%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen Flatplate TC	$165.10	$254.00	—	4% below	35%
X-ray of the abdomen, 1 view CPT 74018 OR Exam	$165.10	$254.00	—	4% below	35%
X-ray of the abdomen, 1 view CPT 74018 XR Exam	$165.10	$254.00	—	4% below	35%
X-ray of the abdomen, 1 view inpatient CPT 74018 OR Exam	$165.10	$254.00	—	—	35%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen Flatplate TC	$165.10	$254.00	—	—	35%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Exam	$165.10	$254.00	—	—	35%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen Flatplate	$165.10	$254.00	—	—	35%
X-ray of the ankle, 2 views CPT 73600 OR Exam	$191.75	$295.00	—	18% above	35%
X-ray of the ankle, 2 views CPT 73600 XR Exam	$191.75	$295.00	—	18% above	35%
X-ray of the ankle, 2 views inpatient CPT 73600 XR Exam	$191.75	$295.00	—	—	35%
X-ray of the ankle, 2 views inpatient CPT 73600 OR Exam	$191.75	$295.00	—	—	35%
X-ray of the finger(s), 2 or more views CPT 73140 OR Exam	$165.10	$254.00	—	1% above	35%
X-ray of the finger(s), 2 or more views CPT 73140 XR Exam	$165.10	$254.00	—	1% above	35%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 OR Exam	$165.10	$254.00	—	—	35%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 XR Exam	$165.10	$254.00	—	—	35%
X-ray of the foot, 2 views CPT 73620 XR Foot Limited R	$173.06	$266.25	—	19% above	35%
X-ray of the foot, 2 views CPT 73620 XR Exam	$173.06	$266.25	—	19% above	35%
X-ray of the foot, 2 views CPT 73620 OR Exam	$173.06	$266.25	—	19% above	35%
X-ray of the foot, 2 views inpatient CPT 73620 OR Exam	$173.06	$266.25	—	—	35%
X-ray of the foot, 2 views inpatient CPT 73620 XR Exam	$173.06	$266.25	—	—	35%
X-ray of the foot, 2 views inpatient CPT 73620 XR Foot Limited R	$173.06	$266.25	—	—	35%
X-ray of the foot, complete, 3 or more views CPT 73630 XR Exam	$515.12	$792.50	—	162% above	35%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 XR Exam	$515.12	$792.50	—	—	35%
X-ray of the hand, 3 or more views CPT 73130 XR Exam	$330.04	$507.75	—	60% above	35%
X-ray of the hand, 3 or more views inpatient CPT 73130 XR Exam	$330.04	$507.75	—	—	35%
X-ray of the knee, 1 or 2 views CPT 73560 XR Knee 1 or 2 Views R	$398.12	$612.50	—	133% above	35%
X-ray of the knee, 1 or 2 views CPT 73560 OR Exam	$398.12	$612.50	—	133% above	35%
X-ray of the knee, 1 or 2 views CPT 73560 XR Exam	$398.12	$612.50	—	133% above	35%
X-ray of the knee, 1 or 2 views CPT 73560 XR Knee 1 or 2 Views L	$398.12	$612.50	—	133% above	35%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 XR Knee 1 or 2 Views L	$398.12	$612.50	—	—	35%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 XR Knee 1 or 2 Views R	$398.12	$612.50	—	—	35%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 XR Exam	$398.12	$612.50	—	—	35%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 OR Exam	$398.12	$612.50	—	—	35%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Exam	$201.82	$310.50	—	11% below	35%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Exam	$201.82	$310.50	—	—	35%
X-ray of the lower back, 4 or more views CPT 72110 XR Exam	$353.76	$544.25	—	16% above	35%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Exam	$353.76	$544.25	—	—	35%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Exam	$219.70	$338.00	—	3% above	35%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR Exam	$219.70	$338.00	—	—	35%
X-ray of the nasal bones, 3 or more views CPT 70160 XR Exam	$178.10	$274.00	—	15% below	35%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Exam	$178.10	$274.00	—	—	35%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Exam	$210.28	$323.50	—	2% below	35%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Exam	$210.28	$323.50	—	—	35%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis AP	$198.74	$305.75	—	6% below	35%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Exam	$208.98	$321.50	—	1% below	35%
X-ray of the pelvis, 1 or 2 views CPT 72170 OR Exam	$208.98	$321.50	—	1% below	35%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis AP	$198.74	$305.75	—	—	35%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 OR Exam	$208.98	$321.50	—	—	35%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Exam	$208.98	$321.50	—	—	35%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Exam	$210.92	$324.50	—	10% below	35%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Exam	$210.92	$324.50	—	—	35%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine aminotransferase	$61.75	$95.00	—	30% above	35%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alanine aminotransferase	$61.75	$95.00	—	—	35%
AST (aspartate aminotransferase) enzyme test CPT 84450 Aspartate aminotransferase	$59.96	$92.25	—	30% above	35%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Aspartate aminotransferase	$59.96	$92.25	—	—	35%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Acute Panel (KSP)	$180.38	$277.50	—	8% below	35%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis Acute Panel (KSP)	$180.38	$277.50	—	—	35%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen House Dust Mites-DP (Mayo DP)	$47.45	$73.00	—	28% above	35%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Dog Dander (Mayo DOGD)	$47.45	$73.00	—	28% above	35%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Cat Epithelium (Mayo CAT)	$47.45	$73.00	—	28% above	35%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen House Dust Mites-DF (Mayo DF)	$47.45	$73.00	—	28% above	35%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Cat Epithelium (Mayo CAT)	$47.45	$73.00	—	—	35%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Dog Dander (Mayo DOGD)	$47.45	$73.00	—	—	35%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen House Dust Mites-DP (Mayo DP)	$47.45	$73.00	—	—	35%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen House Dust Mites-DF (Mayo DF)	$47.45	$73.00	—	—	35%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Anti-CCP Ab	$94.41	$145.25	—	at median	35%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP Ab, IgG, S (Mayo CCP)	$94.41	$145.25	—	at median	35%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP Ab, IgG, S (Mayo CCP)	$94.41	$145.25	—	—	35%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Anti-CCP Ab	$94.41	$145.25	—	—	35%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Ab, S	$80.44	$123.75	—	16% above	35%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Ab, S (Mayo ANA2)	$80.44	$123.75	—	16% above	35%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Ab, S (Mayo ANA2)	$80.44	$123.75	—	—	35%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Ab, S	$80.44	$123.75	—	—	35%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-Type Natriuretic Peptide	$295.91	$455.25	—	44% above	35%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT- proBNP Regional	$295.91	$455.25	—	44% above	35%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT- proBNP Regional	$295.91	$455.25	—	—	35%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-Type Natriuretic Peptide	$295.91	$455.25	—	—	35%
Basic metabolic panel (blood test) CPT 80048 Chem 8	$94.25	$145.00	—	8% above	35%
Basic metabolic panel (blood test) CPT 80048 Charge Chem 8	$94.25	$145.00	—	8% above	35%
Basic metabolic panel (blood test) inpatient CPT 80048 Charge Chem 8	$94.25	$145.00	—	—	35%
Basic metabolic panel (blood test) inpatient CPT 80048 Chem 8	$94.25	$145.00	—	—	35%
Blood culture for bacteria CPT 87040 Culture Blood Line	$120.09	$184.75	—	13% below	35%
Blood culture for bacteria CPT 87040 Culture Blood Routine Peripheral	$120.09	$184.75	—	13% below	35%
Blood culture for bacteria inpatient CPT 87040 Culture Blood Line	$120.09	$184.75	—	—	35%
Blood culture for bacteria inpatient CPT 87040 Culture Blood Routine Peripheral	$120.09	$184.75	—	—	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Draw Fee: Paternity CBK	$17.22	$26.50	—	3% below	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Draw Fee: CRD	$25.51	$39.25	—	43% above	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw	$25.51	$39.25	—	43% above	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Draw Fee: SHY	$25.51	$39.25	—	43% above	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Draw Fee: CHR	$25.51	$39.25	—	43% above	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Draw Fee: CBK	$25.51	$39.25	—	43% above	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Draw Fee: Paternity CBK	$17.22	$26.50	—	—	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Draw Fee: CRD	$25.51	$39.25	—	—	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Draw Fee: CBK	$25.51	$39.25	—	—	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Draw Fee: CHR	$25.51	$39.25	—	—	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Draw Fee: SHY	$25.51	$39.25	—	—	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw	$25.51	$39.25	—	—	35%
Blood glucose (sugar) test CPT 82947 Glucose, Blood	$49.89	$76.75	—	42% above	35%
Blood glucose (sugar) test inpatient CPT 82947 Glucose, Blood	$49.89	$76.75	—	—	35%
Blood lead test CPT 83655 Lead, Bld	$58.82	$90.50	—	at median	35%
Blood lead test CPT 83655 Lead, Ur	$63.54	$97.75	—	8% above	35%
Blood lead test CPT 83655 Lead, Capillary, w/Demographics, B (Mayo PBDC)	$70.85	$109.00	—	20% above	35%
Blood lead test CPT 83655 Lead, Venous, Bl w/ Demographics (Mayo PBDV)	$70.85	$109.00	—	20% above	35%
Blood lead test CPT 83655 Lead, Blood	$70.85	$109.00	—	20% above	35%
Blood lead test inpatient CPT 83655 Lead, Bld	$58.82	$90.50	—	—	35%
Blood lead test inpatient CPT 83655 Lead, Ur	$63.54	$97.75	—	—	35%
Blood lead test inpatient CPT 83655 Lead, Blood	$70.85	$109.00	—	—	35%
Blood lead test inpatient CPT 83655 Lead, Capillary, w/Demographics, B (Mayo PBDC)	$70.85	$109.00	—	—	35%
Blood lead test inpatient CPT 83655 Lead, Venous, Bl w/ Demographics (Mayo PBDV)	$70.85	$109.00	—	—	35%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Pregnancy, Blood	$79.79	$122.75	—	45% above	35%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Pregnancy, Blood	$79.79	$122.75	—	—	35%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/Rh Interpretation	$113.75	$175.00	—	35% above	35%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO/Rh Interpretation	$113.75	$175.00	—	—	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$85.96	$132.25	—	76% above	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein	$85.96	$132.25	—	—	35%
CA 19-9 blood test (tumor marker) CPT 86301 Carbohydrate Antigen 19-9 (Mayo CA19)	$126.42	$194.50	—	at median	35%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 Carbohydrate Antigen 19-9 (Mayo CA19)	$126.42	$194.50	—	—	35%
CA-125 blood test (ovarian cancer marker) CPT 86304 Ca 125	$105.14	$161.75	—	3% below	35%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Ca 125	$105.14	$161.75	—	—	35%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS CoV-2 PCR (COVID-19)	$102.38	$157.50	—	14% below	35%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS CoV-2 PCR (COVID-19)	$102.38	$157.50	—	—	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia DNA Probe Amp	$180.54	$277.75	—	98% above	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia DNA Probe Amp	$180.54	$277.75	—	—	35%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel, Lipo	$65.81	$101.25	—	at median	35%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel, Regional	$145.92	$224.50	—	122% above	35%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel, Lipo	$65.81	$101.25	—	—	35%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel, Regional	$145.92	$224.50	—	—	35%
Complete blood count (CBC) with differential CPT 85025 CBC, Diff	$78.98	$121.50	—	18% above	35%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC, Diff	$78.98	$121.50	—	—	35%
Complete blood count (CBC), no differential CPT 85027 CBC no Diff	$43.06	$66.25	—	at median	35%
Complete blood count (CBC), no differential CPT 85027 Charge CBC	$43.06	$66.25	—	at median	35%
Complete blood count (CBC), no differential inpatient CPT 85027 Charge CBC	$43.06	$66.25	—	—	35%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC no Diff	$43.06	$66.25	—	—	35%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel	$130.32	$200.50	—	22% above	35%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel	$130.32	$200.50	—	—	35%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer, P (Mayo AATHR)	$28.76	$44.25	—	72% below	35%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer	$151.29	$232.75	—	45% above	35%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer, P (Mayo AATHR)	$28.76	$44.25	—	—	35%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer	$151.29	$232.75	—	—	35%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone Sulfate (Mayo DHES1)	$151.78	$233.50	—	at median	35%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Dehydroepiandrosterone Sulfate (Mayo DHES1)	$151.78	$233.50	—	—	35%
Estradiol blood test CPT 82670 Estradiol, Blood	$101.72	$156.50	—	16% below	35%
Estradiol blood test CPT 82670 Estradiol, Enhanced	$109.52	$168.50	—	10% below	35%
Estradiol blood test inpatient CPT 82670 Estradiol, Blood	$101.72	$156.50	—	—	35%
Estradiol blood test inpatient CPT 82670 Estradiol, Enhanced	$109.52	$168.50	—	—	35%
FSH (follicle-stimulating hormone) test CPT 83001 FSH	$86.12	$132.50	—	23% below	35%
FSH (follicle-stimulating hormone) test CPT 83001 FSH, Blood	$86.12	$132.50	—	23% below	35%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH, Blood	$86.12	$132.50	—	—	35%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH	$86.12	$132.50	—	—	35%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin (Mayo CALPR)	$195.49	$300.75	—	13% below	35%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin (Mayo CALPR)	$195.49	$300.75	—	—	35%
Ferritin blood test (iron stores) CPT 82728 Ferritin, Plasma	$74.91	$115.25	—	at median	35%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin, Plasma	$74.91	$115.25	—	—	35%
Folate (folic acid) blood test CPT 82746 Folate level	$77.02	$118.50	—	5% below	35%
Folate (folic acid) blood test CPT 82746 Folate Level	$77.02	$118.50	—	5% below	35%
Folate (folic acid) blood test inpatient CPT 82746 Folate level	$77.02	$118.50	—	—	35%
Folate (folic acid) blood test inpatient CPT 82746 Folate Level	$77.02	$118.50	—	—	35%
Free T3 thyroid hormone test CPT 84481 T3 Free	$70.85	$109.00	—	23% below	35%
Free T3 thyroid hormone test inpatient CPT 84481 T3 Free	$70.85	$109.00	—	—	35%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 Free	$71.66	$110.25	—	at median	35%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 Free	$71.66	$110.25	—	—	35%
Free testosterone test CPT 84402 Testosterone, Free	$32.99	$50.75	—	73% below	35%
Free testosterone test CPT 84402 Testosterone Free (Mayo TTFB)	$91.32	$140.50	—	24% below	35%
Free testosterone test inpatient CPT 84402 Testosterone, Free	$32.99	$50.75	—	—	35%
Free testosterone test inpatient CPT 84402 Testosterone Free (Mayo TTFB)	$91.32	$140.50	—	—	35%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose Prenatal, 1 Hr PP	$56.55	$87.00	—	at median	35%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose Prenatal, 1 Hr PP	$56.55	$87.00	—	—	35%
Glucose tolerance test, 3 samples CPT 82951 ZZ Glucose, Fasting (GTT)	$81.25	$125.00	—	at median	35%
Glucose tolerance test, 3 samples inpatient CPT 82951 ZZ Glucose, Fasting (GTT)	$81.25	$125.00	—	—	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neis DNA Probe Amp	$148.20	$228.00	—	48% above	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neis DNA Probe Amp	$148.20	$228.00	—	—	35%
H. pylori stool antigen test CPT 87338 H Pylori Antigen Feces, Regional	$85.48	$131.50	—	at median	35%
H. pylori stool antigen test inpatient CPT 87338 H Pylori Antigen Feces, Regional	$85.48	$131.50	—	—	35%
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1-2	$66.46	$102.25	—	10% below	35%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1-2	$66.46	$102.25	—	—	35%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV Confirmation (State)	$29.25	$45.00	—	55% below	35%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV Ag/Ab Combo, Regional	$92.62	$142.50	—	41% above	35%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV Confirmation (State)	$29.25	$45.00	—	—	35%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV Ag/Ab Combo, Regional	$92.62	$142.50	—	—	35%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 POC-RE Hemoglobin A1c	$66.79	$102.75	—	36% above	35%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c	$83.04	$127.75	—	69% above	35%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 POC-RE Hemoglobin A1c	$66.79	$102.75	—	—	35%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c	$83.04	$127.75	—	—	35%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Antibody	$81.74	$125.75	—	at median	35%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Antibody	$81.74	$125.75	—	—	35%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B surface antigen	$75.89	$116.75	—	5% above	35%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B surface antigen	$75.89	$116.75	—	—	35%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Antibody	$105.14	$161.75	—	at median	35%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Antibody	$105.14	$161.75	—	—	35%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCV RNA Detect/Quant RFX Geno, S (Mayo HCVQG)	$74.75	$115.00	—	69% below	35%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C RNA (RT-PCR) (Mayo HCVQN)	$123.66	$190.25	—	49% below	35%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCV RNA Detect/Quant RFX Geno, S (Mayo HCVQG)	$74.75	$115.00	—	—	35%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C RNA (RT-PCR) (Mayo HCVQN)	$123.66	$190.25	—	—	35%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex 1 IgG	$91.16	$140.25	—	8% above	35%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes Simplex 1 IgG	$91.16	$140.25	—	—	35%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex 2 IgG	$96.52	$148.50	—	at median	35%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Herpes Simplex 2 IgG	$96.52	$148.50	—	—	35%
High-sensitivity CRP (hs-CRP) test CPT 86141 High Sensitive CRP	$77.51	$119.25	—	1% above	35%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 High Sensitive CRP	$77.51	$119.25	—	—	35%
Homocysteine blood test CPT 83090 Homocysteine, Plasma, Regional (Mayo HCYSP)	$134.22	$206.50	—	at median	35%
Homocysteine blood test inpatient CPT 83090 Homocysteine, Plasma, Regional (Mayo HCYSP)	$134.22	$206.50	—	—	35%
Insulin blood test CPT 83525 Insulin, Serum (Mayo INS)	$40.62	$62.50	—	53% below	35%
Insulin blood test CPT 83525 Insulin, Total (Mayo)	$40.62	$62.50	—	53% below	35%
Insulin blood test inpatient CPT 83525 Insulin, Serum (Mayo INS)	$40.62	$62.50	—	—	35%
Insulin blood test inpatient CPT 83525 Insulin, Total (Mayo)	$40.62	$62.50	—	—	35%
Iron blood test (serum iron) CPT 83540 Iron, Blood	$62.89	$96.75	—	18% above	35%
Iron blood test (serum iron) CPT 83540 Iron Panel with measured TIBC	$62.89	$96.75	—	18% above	35%
Iron blood test (serum iron) inpatient CPT 83540 Iron, Blood	$62.89	$96.75	—	—	35%
Iron blood test (serum iron) inpatient CPT 83540 Iron Panel with measured TIBC	$62.89	$96.75	—	—	35%
Iron-binding capacity (TIBC) test CPT 83550 TIBC	$66.14	$101.75	—	28% above	35%
Iron-binding capacity (TIBC) test inpatient CPT 83550 TIBC	$66.14	$101.75	—	—	35%
Kidney function blood test panel CPT 80069 Renal Panel	$111.48	$171.50	—	7% above	35%
Kidney function blood test panel inpatient CPT 80069 Renal Panel	$111.48	$171.50	—	—	35%
LH (luteinizing hormone) test CPT 83002 Luteinizing hormone	$78.00	$120.00	—	26% below	35%
LH (luteinizing hormone) test CPT 83002 LH	$78.00	$120.00	—	26% below	35%
LH (luteinizing hormone) test inpatient CPT 83002 LH	$78.00	$120.00	—	—	35%
LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing hormone	$78.00	$120.00	—	—	35%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase, Blood	$87.10	$134.00	—	18% above	35%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase, Blood	$87.10	$134.00	—	—	35%
Liver function blood test panel CPT 80076 Liver Panel	$59.15	$91.00	—	8% below	35%
Liver function blood test panel inpatient CPT 80076 Liver Panel	$59.15	$91.00	—	—	35%
Lyme disease antibody test CPT 86618 Lyme Ab Serum	$67.60	$104.00	—	36% below	35%
Lyme disease antibody test inpatient CPT 86618 Lyme Ab Serum	$67.60	$104.00	—	—	35%
Magnesium blood test CPT 83735 Magnesium, Serum	$66.14	$101.75	—	8% above	35%
Magnesium blood test inpatient CPT 83735 Magnesium, Serum	$66.14	$101.75	—	—	35%
Measles (rubeola) antibody test CPT 86765 Rubeola IgG Ab	$12.68	$19.50	—	70% below	35%
Measles (rubeola) antibody test CPT 86765 Rubeola, IgG Ab (Mayo ROPG)	$20.15	$31.00	—	52% below	35%
Measles (rubeola) antibody test CPT 86765 Rubeola Abs IgM (Mayo ROM)	$92.30	$142.00	—	122% above	35%
Measles (rubeola) antibody test inpatient CPT 86765 Rubeola IgG Ab	$12.68	$19.50	—	—	35%
Measles (rubeola) antibody test inpatient CPT 86765 Rubeola, IgG Ab (Mayo ROPG)	$20.15	$31.00	—	—	35%
Measles (rubeola) antibody test inpatient CPT 86765 Rubeola Abs IgM (Mayo ROM)	$92.30	$142.00	—	—	35%
Mono test (heterophile antibody, Monospot) CPT 86308 Mono Test	$74.91	$115.25	—	30% above	35%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mono Test	$74.91	$115.25	—	—	35%
PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen	$104.65	$161.00	—	at median	35%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, Ultrasensitive (Mayo PSAU)	$223.92	$344.50	—	114% above	35%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen	$104.65	$161.00	—	—	35%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, Ultrasensitive (Mayo PSAU)	$223.92	$344.50	—	—	35%
Parathyroid hormone (PTH) blood test CPT 83970 PTH Intact, LH	$197.60	$304.00	—	at median	35%
Parathyroid hormone (PTH) blood test CPT 83970 PTH Intact, Regional	$197.60	$304.00	—	at median	35%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH Intact, LH	$197.60	$304.00	—	—	35%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH Intact, Regional	$197.60	$304.00	—	—	35%
Partial thromboplastin time (PTT) clotting test CPT 85730 APTSC (Mayo ALUPP)	$8.61	$13.25	—	80% below	35%
Partial thromboplastin time (PTT) clotting test CPT 85730 Activated Partial Thrombopl Time, P (Mayo AATHR)	$17.22	$26.50	—	61% below	35%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$85.96	$132.25	—	95% above	35%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 APTSC (Mayo ALUPP)	$8.61	$13.25	—	—	35%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Activated Partial Thrombopl Time, P (Mayo AATHR)	$17.22	$26.50	—	—	35%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$85.96	$132.25	—	—	35%
Progesterone blood test CPT 84144 Progesterone Level	$96.36	$148.25	—	19% below	35%
Progesterone blood test inpatient CPT 84144 Progesterone Level	$96.36	$148.25	—	—	35%
Prolactin blood test CPT 84146 Macroprolactin, S (Mayo MCRPL)	$54.76	$84.25	—	51% below	35%
Prolactin blood test CPT 84146 Prolactin Unprecipitated (Mayo)	$54.76	$84.25	—	51% below	35%
Prolactin blood test CPT 84146 Prolactin Level	$78.00	$120.00	—	30% below	35%
Prolactin blood test inpatient CPT 84146 Prolactin Unprecipitated (Mayo)	$54.76	$84.25	—	—	35%
Prolactin blood test inpatient CPT 84146 Macroprolactin, S (Mayo MCRPL)	$54.76	$84.25	—	—	35%
Prolactin blood test inpatient CPT 84146 Prolactin Level	$78.00	$120.00	—	—	35%
Prothrombin time (PT/INR) clotting test CPT 85610 Lupus Anticoag Panel (Mayo ALUPP)	$6.18	$9.50	—	74% below	35%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time (PT) P (Mayo AATHR)	$12.51	$19.25	—	47% below	35%
Prothrombin time (PT/INR) clotting test CPT 85610 Protime	$48.10	$74.00	—	105% above	35%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Lupus Anticoag Panel (Mayo ALUPP)	$6.18	$9.50	—	—	35%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time (PT) P (Mayo AATHR)	$12.51	$19.25	—	—	35%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Protime	$48.10	$74.00	—	—	35%
Rapid flu test (influenza antigen) CPT 87804 POC-RE Influenza B	$53.30	$82.00	—	2% below	35%
Rapid flu test (influenza antigen) CPT 87804 Influ A Rapid Test	$56.06	$86.25	—	3% above	35%
Rapid flu test (influenza antigen) CPT 87804 POC-RE Influenza A and B	$56.06	$86.25	—	3% above	35%
Rapid flu test (influenza antigen) CPT 87804 Influ B, Rapid Test	$56.06	$86.25	—	3% above	35%
Rapid flu test (influenza antigen) inpatient CPT 87804 POC-RE Influenza B	$53.30	$82.00	—	—	35%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influ A Rapid Test	$56.06	$86.25	—	—	35%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influ B, Rapid Test	$56.06	$86.25	—	—	35%
Rapid flu test (influenza antigen) inpatient CPT 87804 POC-RE Influenza A and B	$56.06	$86.25	—	—	35%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Strep Screen	$45.34	$69.75	—	6% below	35%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 POC-RE Rapid Strep	$47.78	$73.50	—	at median	35%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Strep Screen	$45.34	$69.75	—	—	35%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 POC-RE Rapid Strep	$47.78	$73.50	—	—	35%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor	$80.44	$123.75	—	71% above	35%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor	$80.44	$123.75	—	—	35%
Rubella antibody test (immunity check) CPT 86762 Rubella, IgG	$13.00	$20.00	—	75% below	35%
Rubella antibody test (immunity check) CPT 86762 Rubella Antibody (KSP)	$77.68	$119.50	—	47% above	35%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella, IgG	$13.00	$20.00	—	—	35%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Antibody (KSP)	$77.68	$119.50	—	—	35%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 ESR, Mini iSed	$43.55	$67.00	—	at median	35%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 ESR, Mini iSed	$43.55	$67.00	—	—	35%
Stool ova and parasites exam CPT 87177 Ova and Parasite, Microscopy, F (Mayo OPE)	$13.81	$21.25	—	78% below	35%
Stool ova and parasites exam inpatient CPT 87177 Ova and Parasite, Microscopy, F (Mayo OPE)	$13.81	$21.25	—	—	35%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Bld, Stool, Screening	$63.54	$97.75	—	95% above	35%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Bld, Stool, Screening	$63.54	$97.75	—	—	35%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 iFOBT	$50.70	$78.00	—	at median	35%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Fecal Occult Blood (Mayo FOBT) Regional	$128.38	$197.50	—	153% above	35%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 iFOBT	$50.70	$78.00	—	—	35%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Fecal Occult Blood (Mayo FOBT) Regional	$128.38	$197.50	—	—	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR Screen w/ Reflex to Titer,S, Regional (Mayo RPRT1)	$40.95	$63.00	—	1% below	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 xxRPR w/ Rfx TP-PA, S Regional (Mayo RPRT3)	$40.95	$63.00	—	1% below	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis Screen Confirmation State	$86.78	$133.50	—	109% above	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR Screen w/ Reflex to Titer,S, Regional (Mayo RPRT1)	$40.95	$63.00	—	—	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 xxRPR w/ Rfx TP-PA, S Regional (Mayo RPRT3)	$40.95	$63.00	—	—	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Syphilis Screen Confirmation State	$86.78	$133.50	—	—	35%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QuantiFERON TB Gold, Bld (KSP)	$272.68	$419.50	—	54% above	35%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QuantiFERON TB Gold, Bld (KSP)	$272.68	$419.50	—	—	35%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total, MS, S (Mayo TTST)	$33.31	$51.25	—	66% below	35%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total	$33.31	$51.25	—	66% below	35%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total, Bio and Free (Mayo TTFB)	$92.46	$142.25	—	4% below	35%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Total	$33.31	$51.25	—	—	35%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Total, MS, S (Mayo TTST)	$33.31	$51.25	—	—	35%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total, Bio and Free (Mayo TTFB)	$92.46	$142.25	—	—	35%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroperoxidase Ab (Mayo TPO) Regional	$91.16	$140.25	—	at median	35%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroperoxidase Ab (Mayo TPO) Regional	$91.16	$140.25	—	—	35%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH (Cascade)	$78.00	$120.00	—	at median	35%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid stimulating hormone	$78.00	$120.00	—	at median	35%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid stimulating hormone	$78.00	$120.00	—	—	35%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH (Cascade)	$78.00	$120.00	—	—	35%
Trichomonas test (NAAT) CPT 87661 Vaginosis Panel, LH - Trich vaginalis	$55.09	$84.75	—	at median	35%
Trichomonas test (NAAT) inpatient CPT 87661 Vaginosis Panel, LH - Trich vaginalis	$55.09	$84.75	—	—	35%
Uric acid blood test CPT 84550 Uric Acid, Blood	$20.96	$32.25	—	23% below	35%
Uric acid blood test inpatient CPT 84550 Uric Acid, Blood	$20.96	$32.25	—	—	35%
Urinalysis with microscope exam, automated CPT 81001 Charge UA Complete	$43.88	$67.50	—	at median	35%
Urinalysis with microscope exam, automated CPT 81001 UA Complete Reflex Culture	$43.88	$67.50	—	at median	35%
Urinalysis with microscope exam, automated CPT 81001 UA Complete no culture	$43.88	$67.50	—	at median	35%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA Complete no culture	$43.88	$67.50	—	—	35%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA Complete Reflex Culture	$43.88	$67.50	—	—	35%
Urinalysis with microscope exam, automated inpatient CPT 81001 Charge UA Complete	$43.88	$67.50	—	—	35%
Urinalysis without microscope exam, automated CPT 81003 Urine, Blood	$27.14	$41.75	—	at median	35%
Urinalysis without microscope exam, automated CPT 81003 UA Routine no culture	$31.04	$47.75	—	14% above	35%
Urinalysis without microscope exam, automated CPT 81003 POC-RE Urine Dipstick, Automated	$31.04	$47.75	—	14% above	35%
Urinalysis without microscope exam, automated CPT 81003 UA Routine Reflex Culture	$31.04	$47.75	—	14% above	35%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urine, Blood	$27.14	$41.75	—	—	35%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA Routine no culture	$31.04	$47.75	—	—	35%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA Routine Reflex Culture	$31.04	$47.75	—	—	35%
Urinalysis without microscope exam, automated inpatient CPT 81003 POC-RE Urine Dipstick, Automated	$31.04	$47.75	—	—	35%
Urine culture for bacteria, with colony count CPT 87086 Culture Urine and Colony Count	$99.61	$153.25	—	17% above	35%
Urine culture for bacteria, with colony count inpatient CPT 87086 Culture Urine and Colony Count	$99.61	$153.25	—	—	35%
Urine pregnancy test, read by color change CPT 81025 POC-RE Urine Pregnancy Test	$64.02	$98.50	—	84% above	35%
Urine pregnancy test, read by color change CPT 81025 Pregnancy, Urine	$72.96	$112.25	—	110% above	35%
Urine pregnancy test, read by color change inpatient CPT 81025 POC-RE Urine Pregnancy Test	$64.02	$98.50	—	—	35%
Urine pregnancy test, read by color change inpatient CPT 81025 Pregnancy, Urine	$72.96	$112.25	—	—	35%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12, Blood	$74.91	$115.25	—	7% below	35%
Vitamin B12 (cobalamin) blood test CPT 82607 B12, Vitamin	$74.91	$115.25	—	7% below	35%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 B12, Vitamin	$74.91	$115.25	—	—	35%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12, Blood	$74.91	$115.25	—	—	35%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25-OH	$137.15	$211.00	—	31% above	35%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25-OH	$137.15	$211.00	—	—	35%
Zinc blood test CPT 84630 Zinc, Serum (Mayo ZN_S)	$152.75	$235.00	—	85% above	35%
Zinc blood test inpatient CPT 84630 Zinc, Serum (Mayo ZN_S)	$152.75	$235.00	—	—	35%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BHCG, Beta HCG, Quant	$100.91	$155.25	—	1% below	35%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BHCG, Beta HCG, Quant	$100.91	$155.25	—	—	35%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 MA Stereotactic Breast Biopsy L - Report	$877.50	$1,350.00	—	13% below	35%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 MA Stereotactic Breast Biopsy R - Report	$877.50	$1,350.00	—	13% below	35%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 MA Stereotactic Breast Biopsy R - Report	$877.50	$1,350.00	—	—	35%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 MA Stereotactic Breast Biopsy L - Report	$877.50	$1,350.00	—	—	35%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786 ED PROF TREAT OF ANKLE FX-HOSPITAL	$670.31	$1,031.25	—	50% above	35%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786 Cltx Dstl Fibular Fx Lat Malls W/O Mnpj	$670.31	$1,031.25	—	50% above	35%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 27786 Cltx Dstl Fibular Fx Lat Malls W/O Mnpj	$670.31	$1,031.25	—	—	35%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 27786 ED PROF TREAT OF ANKLE FX-HOSPITAL	$670.31	$1,031.25	—	—	35%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 28470P Closed Tx Metatarsal Fracture W/O Manipulation	$496.92	$764.50	—	47% above	35%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 ED 28470 PROF TREAT METATARSAL FX- HOSPITAL	$496.92	$764.50	—	47% above	35%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 ED 28470 PROF TREAT METATARSAL FX- HOSPITAL	$496.92	$764.50	—	—	35%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 28470P Closed Tx Metatarsal Fracture W/O Manipulation	$496.92	$764.50	—	—	35%
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 Cardioversion Elective Arrhyt Xtrnl	$511.88	$787.50	—	17% below	35%
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 ED PROF CARDIOVERSION ELECTIVE ARRHYT XTRNL	$511.88	$787.50	—	17% below	35%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC Exam	$806.98	$1,241.50	—	31% above	35%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion (OP Charge)	$806.98	$1,241.50	—	31% above	35%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion	$806.98	$1,241.50	—	31% above	35%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 92960 ED PROF CARDIOVERSION ELECTIVE ARRHYT XTRNL	$511.88	$787.50	—	—	35%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 92960 Cardioversion Elective Arrhyt Xtrnl	$511.88	$787.50	—	—	35%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC Exam	$806.98	$1,241.50	—	—	35%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion	$806.98	$1,241.50	—	—	35%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion (OP Charge)	$806.98	$1,241.50	—	—	35%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 54161 Circumcision >28 Days	$195.98	$301.50	—	54% below	35%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 54161 TR Circumcision >28 Day	$3,498.46	$5,382.25	—	720% above	35%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 54161 Circumcision >28 Days	$195.98	$301.50	—	—	35%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 54161 TR Circumcision >28 Day	$3,498.46	$5,382.25	—	—	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 54150P Circumcision W/Clamp/Oth Dev W/Block	$172.09	$264.75	—	8% below	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision Charged	$180.86	$278.25	—	3% below	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 54150 Circumcision W/Clamp TR	$180.86	$278.25	—	3% below	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 54150P Circumcision W/Clamp/Oth Dev W/Block	$172.09	$264.75	—	—	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Circumcision Charged	$180.86	$278.25	—	—	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 54150 Circumcision W/Clamp TR	$180.86	$278.25	—	—	35%
Circumcision, surgical, older than a newborn CPT 54160 54160 Circumcision Neonate	$165.10	$254.00	—	47% below	35%
Circumcision, surgical, older than a newborn CPT 54160 54160P Circumcision Neonate	$172.09	$264.75	—	45% below	35%
Circumcision, surgical, older than a newborn inpatient CPT 54160 54160 Circumcision Neonate	$165.10	$254.00	—	—	35%
Circumcision, surgical, older than a newborn inpatient CPT 54160 54160P Circumcision Neonate	$172.09	$264.75	—	—	35%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 Cltx Dstl Radial Fx/Epiphysl Sep W/O Mnpj	$364.49	$560.75	—	17% below	35%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 25600 Cltx Dstl Radial Fx/Epiphysl Sep W/O Mnpj	$364.49	$560.75	—	—	35%
Colonoscopy with polyp removal CPT 45385 45385 Colsc Flx Prox Splenic Flxr Rmvl Les Snare Tq	$976.79	$1,502.75	—	4% below	35%
Colonoscopy with polyp removal CPT 45385 45385 ENDO Colonoscopy W/ Snare Biopsy	$2,878.52	$4,428.50	—	184% above	35%
Colonoscopy with polyp removal inpatient CPT 45385 45385 Colsc Flx Prox Splenic Flxr Rmvl Les Snare Tq	$976.79	$1,502.75	—	—	35%
Colonoscopy with polyp removal inpatient CPT 45385 45385 ENDO Colonoscopy W/ Snare Biopsy	$2,878.52	$4,428.50	—	—	35%
Colonoscopy with tissue sample CPT 45380 45380 Scope Of Colon With Biopsy	$842.24	$1,295.75	—	at median	35%
Colonoscopy with tissue sample CPT 45380 45380 ENDO Colonscopy W/ Biopsy	$2,878.52	$4,428.50	—	242% above	35%
Colonoscopy with tissue sample inpatient CPT 45380 45380 Scope Of Colon With Biopsy	$842.24	$1,295.75	—	—	35%
Colonoscopy with tissue sample inpatient CPT 45380 45380 ENDO Colonscopy W/ Biopsy	$2,878.52	$4,428.50	—	—	35%
Colonoscopy, diagnostic CPT 45378 45378 Scope Of Colon For Diagnosis	$711.26	$1,094.25	—	13% below	35%
Colonoscopy, diagnostic CPT 45378 45378 Colonoscopy Flx Dx W/Collj Spec When Pfrmd	$2,314.49	$3,560.75	—	183% above	35%
Colonoscopy, diagnostic CPT 45378 G0105 Colorectal Scrn; Hi Risk Ind	$2,391.19	$3,678.75	—	192% above	35%
Colonoscopy, diagnostic CPT 45378 G0121 Colon Ca Scrn Not Hi Rsk Ind	$2,878.52	$4,428.50	—	252% above	35%
Colonoscopy, diagnostic inpatient CPT 45378 45378 Scope Of Colon For Diagnosis	$711.26	$1,094.25	—	—	35%
Colonoscopy, diagnostic inpatient CPT 45378 45378 Colonoscopy Flx Dx W/Collj Spec When Pfrmd	$2,314.49	$3,560.75	—	—	35%
Colonoscopy, diagnostic inpatient CPT 45378 G0105 Colorectal Scrn; Hi Risk Ind	$2,391.19	$3,678.75	—	—	35%
Colonoscopy, diagnostic inpatient CPT 45378 G0121 Colon Ca Scrn Not Hi Rsk Ind	$2,878.52	$4,428.50	—	—	35%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 57454 Colposcopy Cervix Bx Cervix&Endocrv Curtg	$321.59	$494.75	—	12% above	35%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 57454 Colposcopy Cervix Bx Cervix&Endocrv Curtg	$321.59	$494.75	—	—	35%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 17000 Treatment Room II	$64.68	$99.50	—	60% below	35%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 17000 Destruction Premalignant Lesion 1st Lesion	$185.74	$285.75	—	14% above	35%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 17000 Destruction Premalignant Lesion 1St	$185.74	$285.75	—	14% above	35%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 17000 Treatment Room II	$64.68	$99.50	—	—	35%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 17000 Destruction Premalignant Lesion 1st Lesion	$185.74	$285.75	—	—	35%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 17000 Destruction Premalignant Lesion 1St	$185.74	$285.75	—	—	35%
Earwax removal by irrigation (rinsing), one ear CPT 69209 69209P Rmvl Impacted Cerumen w/o Instrumentation	$89.54	$137.75	—	129% above	35%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 69209 Remove Impacted Ear Wax Unilateral	$89.54	$137.75	—	129% above	35%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 69209 ED Prof Rmvl Impacted Cerumen Spx Unilateral	$89.54	$137.75	—	129% above	35%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 69209 REMOVE CERUMEN IMPACTED IRRIG/LAVAGE UNILAT	$94.90	$146.00	—	143% above	35%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 69209P Rmvl Impacted Cerumen w/o Instrumentation	$89.54	$137.75	—	—	35%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 69209 ED Prof Rmvl Impacted Cerumen Spx Unilateral	$89.54	$137.75	—	—	35%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 69209 Remove Impacted Ear Wax Unilateral	$89.54	$137.75	—	—	35%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 69209 REMOVE CERUMEN IMPACTED IRRIG/LAVAGE UNILAT	$94.90	$146.00	—	—	35%
Earwax removal with instruments, one ear CPT 69210 69210 ED PROF REM IMPACTED CERUMEN-HOSPITAL	$89.54	$137.75	—	18% above	35%
Earwax removal with instruments, one ear one side CPT 69210 69210 Rmvl Impacted Cerumen Spx Unilateral	$89.54	$137.75	—	18% above	35%
Earwax removal with instruments, one ear inpatient CPT 69210 69210 ED PROF REM IMPACTED CERUMEN-HOSPITAL	$89.54	$137.75	—	—	35%
Earwax removal with instruments, one ear inpatient one side CPT 69210 69210 Rmvl Impacted Cerumen Spx Unilateral	$89.54	$137.75	—	—	35%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 XR Facet Joint Inj Lumb/Sacr Uni - Report	$273.00	$420.00	—	29% below	35%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 CT Facet Joint Inj Lumb/Sacr Uni Rad - Report	$273.00	$420.00	—	29% below	35%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 CT Facet Joint Inj Lumb/Sacr Uni Rad - Report	$273.00	$420.00	—	—	35%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 XR Facet Joint Inj Lumb/Sacr Uni - Report	$273.00	$420.00	—	—	35%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 45330P Scope Of Sigmoid Colon Only For Diagnosis	$483.92	$744.50	—	36% above	35%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 45330P Scope Of Sigmoid Colon Only For Diagnosis	$483.92	$744.50	—	—	35%
Hemorrhoid banding (rubber band ligation) CPT 46221 46221P Hemorrhoidectomy Internal Rubber Band Ligations	$452.72	$696.50	—	at median	35%
Hemorrhoid banding (rubber band ligation) CPT 46221 46221 TR Hemorrhoidectomy Internal Rubber Band Ligations	$1,557.24	$2,395.75	—	244% above	35%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 46221P Hemorrhoidectomy Internal Rubber Band Ligations	$452.72	$696.50	—	—	35%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 46221 TR Hemorrhoidectomy Internal Rubber Band Ligations	$1,557.24	$2,395.75	—	—	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 XR Inject HSG	$358.80	$552.00	—	22% above	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 US Inject Hysterosonogram	$358.80	$552.00	—	22% above	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 US Inject Hystero w/ ABBI	$358.80	$552.00	—	22% above	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 US Inject Hystero w/ ABBI	$358.80	$552.00	—	—	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 US Inject Hysterosonogram	$358.80	$552.00	—	—	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 XR Inject HSG	$358.80	$552.00	—	—	35%
IUD insertion (the device itself billed separately) CPT 58300 58300 Treatment Room II	$64.68	$99.50	—	62% below	35%
IUD insertion (the device itself billed separately) CPT 58300 58300 Insj Intrauterine Dev	$209.62	$322.50	—	24% above	35%
IUD insertion (the device itself billed separately) CPT 58300 58300P Insj Intrauterine Dev	$209.62	$322.50	—	24% above	35%
IUD insertion (the device itself billed separately) inpatient CPT 58300 58300 Treatment Room II	$64.68	$99.50	—	—	35%
IUD insertion (the device itself billed separately) inpatient CPT 58300 58300P Insj Intrauterine Dev	$209.62	$322.50	—	—	35%
IUD insertion (the device itself billed separately) inpatient CPT 58300 58300 Insj Intrauterine Dev	$209.62	$322.50	—	—	35%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 I&D ABS SIMPLE	$64.68	$99.50	—	69% below	35%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 ED PROF - I&D ABS SIMPLE-HOSPITAL SRVC	$249.11	$383.25	—	21% above	35%
Incision and drainage of a simple or single skin abscess CPT 10060 10060P Incision and Drainage Abcess Simple/Single	$249.11	$383.25	—	21% above	35%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 ED PROC I&D ABS SIMPLE-HOSPITAL SRVC	$308.10	$474.00	—	50% above	35%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060 I&D ABS SIMPLE	$64.68	$99.50	—	—	35%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060P Incision and Drainage Abcess Simple/Single	$249.11	$383.25	—	—	35%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060 ED PROF - I&D ABS SIMPLE-HOSPITAL SRVC	$249.11	$383.25	—	—	35%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060 ED PROC I&D ABS SIMPLE-HOSPITAL SRVC	$308.10	$474.00	—	—	35%
Injection into a tendon sheath or ligament (for example trigger finger) both sides CPT 20550 US Inj Tendon/Ligament Aponeurosis Bilat	$226.04	$347.75	—	—	35%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 INJ SGL TENDON SHTH OR LIGAMENT	$64.68	$99.50	—	46% below	35%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Injection 1 Tendon Sheath/Ligament Aponeurosis	$214.99	$330.75	—	78% above	35%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550P Injection 1 Tendon Sheath/Ligament Aponeurosis	$214.99	$330.75	—	78% above	35%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 US Inject Tendon/Ligament Aponeurosis	$226.04	$347.75	—	87% above	35%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient both sides CPT 20550 US Inj Tendon/Ligament Aponeurosis Bilat	$226.04	$347.75	—	—	35%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 20550 INJ SGL TENDON SHTH OR LIGAMENT	$64.68	$99.50	—	—	35%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 20550 Injection 1 Tendon Sheath/Ligament Aponeurosis	$214.99	$330.75	—	—	35%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 20550P Injection 1 Tendon Sheath/Ligament Aponeurosis	$214.99	$330.75	—	—	35%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 US Inject Tendon/Ligament Aponeurosis	$226.04	$347.75	—	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound both sides CPT 20610 XR Inject Joint Major Bilateral	$155.19	$238.75	—	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 Arthrocentesis Aspir/Injection Major Jt/Bursa TR	$64.68	$99.50	—	67% below	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 CT Inject Joint Major	$98.15	$151.00	—	50% below	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610P Arthrocentesis Aspir&/Inj Major Jt/Bursa W/O Us	$147.55	$227.00	—	25% below	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 Arthrocentesis Aspir&/Injection Major Jt/Bursa	$147.55	$227.00	—	25% below	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 XR Inject Joint Major	$155.19	$238.75	—	21% below	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 ED PROC ARTHROCENTSIS MAJOR-HOSPITAL	$221.81	$341.25	—	13% above	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610-50 Drain/Inj Joint/Bursa W/O US	$332.64	$511.75	—	70% above	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient both sides CPT 20610 XR Inject Joint Major Bilateral	$155.19	$238.75	—	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610 Arthrocentesis Aspir/Injection Major Jt/Bursa TR	$64.68	$99.50	—	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 CT Inject Joint Major	$98.15	$151.00	—	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610P Arthrocentesis Aspir&/Inj Major Jt/Bursa W/O Us	$147.55	$227.00	—	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610 Arthrocentesis Aspir&/Injection Major Jt/Bursa	$147.55	$227.00	—	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 XR Inject Joint Major	$155.19	$238.75	—	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610 ED PROC ARTHROCENTSIS MAJOR-HOSPITAL	$221.81	$341.25	—	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610-50 Drain/Inj Joint/Bursa W/O US	$332.64	$511.75	—	—	35%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 11981 Treatment Room II	$64.68	$99.50	—	74% below	35%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 11981 Insj Non-Biodegradable Drug Delivery Implant	$232.86	$358.25	—	5% below	35%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 11981 Treatment Room II	$64.68	$99.50	—	—	35%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 11981 Insj Non-Biodegradable Drug Delivery Implant	$232.86	$358.25	—	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) both sides CPT 20605 XR Inject Joint Intermediate Bilateral	$192.40	$296.00	—	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 CT Inject Joint Intermediate	$82.55	$127.00	—	41% below	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 ED PROF ARTHROCENTESIS MED JOINT	$182.98	$281.50	—	31% above	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 Arthrocentesis Aspir&/Injection Interm Jt/Bursa	$182.98	$281.50	—	31% above	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 ED PROC ARTHROCENTESIS INTERM HOSPITAL	$192.40	$296.00	—	38% above	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 XR Inject Joint Intermediate	$192.40	$296.00	—	38% above	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient both sides CPT 20605 XR Inject Joint Intermediate Bilateral	$192.40	$296.00	—	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 CT Inject Joint Intermediate	$82.55	$127.00	—	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605 ED PROF ARTHROCENTESIS MED JOINT	$182.98	$281.50	—	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605 Arthrocentesis Aspir&/Injection Interm Jt/Bursa	$182.98	$281.50	—	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 XR Inject Joint Intermediate	$192.40	$296.00	—	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605 ED PROC ARTHROCENTESIS INTERM HOSPITAL	$192.40	$296.00	—	—	35%
Joint injection or drainage, small joint (fingers, toes) both sides CPT 20600 XR Inject Joint Small Bilateral	$105.62	$162.50	—	—	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 CT Inject Joint Small	$79.30	$122.00	—	22% below	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 ARTHROCENT JT SMALL	$100.42	$154.50	—	1% below	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 ED PROF ARTHROCENTESIS SM JOINT	$100.42	$154.50	—	1% below	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 Arthrocentesis Aspir&/Injection Small Jt/Bursa	$100.42	$154.50	—	1% below	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ED ASPIRATION JOINT SMALL FINGERS TOES	$105.62	$162.50	—	4% above	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 XR Inject Joint Small	$105.62	$162.50	—	4% above	35%
Joint injection or drainage, small joint (fingers, toes) inpatient both sides CPT 20600 XR Inject Joint Small Bilateral	$105.62	$162.50	—	—	35%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 CT Inject Joint Small	$79.30	$122.00	—	—	35%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 20600 Arthrocentesis Aspir&/Injection Small Jt/Bursa	$100.42	$154.50	—	—	35%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 20600 ED PROF ARTHROCENTESIS SM JOINT	$100.42	$154.50	—	—	35%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 20600 ARTHROCENT JT SMALL	$100.42	$154.50	—	—	35%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ED ASPIRATION JOINT SMALL FINGERS TOES	$105.62	$162.50	—	—	35%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 XR Inject Joint Small	$105.62	$162.50	—	—	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 Treatment Room II	$64.68	$99.50	—	83% below	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 ED PROF INT LAC <2.6CM BD - HOSPITAL	$365.14	$561.75	—	3% below	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 Scalp/Neck/Ax/Genit/Trunk/Ext <2.5cm	$365.14	$561.75	—	3% below	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 12031 Treatment Room II	$64.68	$99.50	—	—	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 12031 ED PROF INT LAC <2.6CM BD - HOSPITAL	$365.14	$561.75	—	—	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 12031 Scalp/Neck/Ax/Genit/Trunk/Ext <2.5cm	$365.14	$561.75	—	—	35%
Lower-back epidural injection, with imaging guidance CPT 62323 XR Intrathecal Med Inj Non-Rad - Report	$408.20	$628.00	—	16% below	35%
Lower-back epidural injection, with imaging guidance CPT 62323 XR Intrathecal Med Inj by Rad - Report	$408.20	$628.00	—	16% below	35%
Lower-back epidural injection, with imaging guidance CPT 62323 XR Epidural Lumbar Spine Inj - Report	$408.20	$628.00	—	16% below	35%
Lower-back epidural injection, with imaging guidance CPT 62323 CT Epidural Inj Lumbar Spine - Report	$408.20	$628.00	—	16% below	35%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 XR Intrathecal Med Inj Non-Rad - Report	$408.20	$628.00	—	—	35%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 CT Epidural Inj Lumbar Spine - Report	$408.20	$628.00	—	—	35%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 XR Epidural Lumbar Spine Inj - Report	$408.20	$628.00	—	—	35%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 XR Intrathecal Med Inj by Rad - Report	$408.20	$628.00	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 CT Transforaminal ESI Lumbar Bilateral - Report	$381.55	$587.00	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 CT Nerve Root Block L/S by Rad Bilat - Report	$381.55	$587.00	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 CT Nerve Root Block L Spine by Rad - Report	$381.55	$587.00	—	8% below	35%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 CT Transforaminal ESI Lumbar - Report	$381.55	$587.00	—	8% below	35%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 XR Transforam/Epi L/S Anesth	$381.55	$587.00	—	8% below	35%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 XR Selective Nerve Root Blk Lumb/Sac Uni - Report	$381.55	$587.00	—	8% below	35%
Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 CT Transforaminal ESI Lumbar Bilateral - Report	$381.55	$587.00	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 CT Nerve Root Block L/S by Rad Bilat - Report	$381.55	$587.00	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 XR Transforam/Epi L/S Anesth	$381.55	$587.00	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 XR Selective Nerve Root Blk Lumb/Sac Uni - Report	$381.55	$587.00	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 CT Nerve Root Block L Spine by Rad - Report	$381.55	$587.00	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 CT Transforaminal ESI Lumbar - Report	$381.55	$587.00	—	—	35%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400 Exc B9 Lesion Mrgn Xcp Sk Tg T/A/L 0.5 cm/<	$64.68	$99.50	—	66% below	35%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400P Exc B9 Les Mrgn Xcp Sk Tg T/A/L 0.5 Cm/<	$307.12	$472.50	—	60% above	35%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400 Exc B9 Les Mrgn Xcp Sk Tg T/A/L 0.5 Cm/<	$307.12	$472.50	—	60% above	35%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 11400 Exc B9 Lesion Mrgn Xcp Sk Tg T/A/L 0.5 cm/<	$64.68	$99.50	—	—	35%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 11400P Exc B9 Les Mrgn Xcp Sk Tg T/A/L 0.5 Cm/<	$307.12	$472.50	—	—	35%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 11400 Exc B9 Les Mrgn Xcp Sk Tg T/A/L 0.5 Cm/<	$307.12	$472.50	—	—	35%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 11440 Exc B9 Les Mrgn Xcp Sk Tag F/E/E/N/L/M 0.5Cm/<	$249.92	$384.50	—	15% below	35%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 11440 Exc B9 Les Mrgn Xcp Sk Tg F/E/E/N/L/M 0.5Cm/<	$249.92	$384.50	—	15% below	35%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 11440 Exc B9 Les Mrgn Xcp Sk Tg F/E/E/N/L/M 0.5Cm/<	$249.92	$384.50	—	—	35%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 11440 Exc B9 Les Mrgn Xcp Sk Tag F/E/E/N/L/M 0.5Cm/<	$249.92	$384.50	—	—	35%
Nail removal (partial or complete), one nail CPT 11730 11730 Avuls Nail Plt Part/Compl Simple 1	$64.68	$99.50	—	58% below	35%
Nail removal (partial or complete), one nail CPT 11730 11730 Avulsion Nail Plate Partial/Complete Simple 1	$223.28	$343.50	—	46% above	35%
Nail removal (partial or complete), one nail CPT 11730 11730 ED PROF NAIL AVUL/EXCIS-HOSPITAL	$223.28	$343.50	—	46% above	35%
Nail removal (partial or complete), one nail CPT 11730 11730 ED PROC NAIL AVUL/EXCIS- HOSPITAL	$339.46	$522.25	—	122% above	35%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730 Avuls Nail Plt Part/Compl Simple 1	$64.68	$99.50	—	—	35%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730 ED PROF NAIL AVUL/EXCIS-HOSPITAL	$223.28	$343.50	—	—	35%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730 Avulsion Nail Plate Partial/Complete Simple 1	$223.28	$343.50	—	—	35%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730 ED PROC NAIL AVUL/EXCIS- HOSPITAL	$339.46	$522.25	—	—	35%
Paracentesis with imaging guidance CPT 49083 CT Abdominal Paracentesis - Report	$471.90	$726.00	—	at median	35%
Paracentesis with imaging guidance CPT 49083 US Paracentesis - Report	$471.90	$726.00	—	at median	35%
Paracentesis with imaging guidance CPT 49083 CT Exam	$748.96	$1,152.25	—	59% above	35%
Paracentesis with imaging guidance CPT 49083 US Exam	$748.96	$1,152.25	—	59% above	35%
Paracentesis with imaging guidance CPT 49083 49083 ED ABD PARACENTESIS W/IMAGING	$1,601.28	$2,463.50	—	239% above	35%
Paracentesis with imaging guidance inpatient CPT 49083 US Paracentesis - Report	$471.90	$726.00	—	—	35%
Paracentesis with imaging guidance inpatient CPT 49083 CT Abdominal Paracentesis - Report	$471.90	$726.00	—	—	35%
Paracentesis with imaging guidance inpatient CPT 49083 CT Exam	$748.96	$1,152.25	—	—	35%
Paracentesis with imaging guidance inpatient CPT 49083 US Exam	$748.96	$1,152.25	—	—	35%
Paracentesis with imaging guidance inpatient CPT 49083 49083 ED ABD PARACENTESIS W/IMAGING	$1,601.28	$2,463.50	—	—	35%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 Treatment Room II	$64.68	$99.50	—	79% below	35%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 ED PROF REM OF NAILBED - HOSPITAL	$252.20	$388.00	—	19% below	35%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 Excision Nail Matrix Permanent Removal	$435.50	$670.00	—	41% above	35%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 11750 Treatment Room II	$64.68	$99.50	—	—	35%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 11750 ED PROF REM OF NAILBED - HOSPITAL	$252.20	$388.00	—	—	35%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 11750 Excision Nail Matrix Permanent Removal	$435.50	$670.00	—	—	35%
Removal of a foreign object under the skin, simple CPT 10120 10120 Rem Skin Foreign Body Smpl PBB, Regional	$64.68	$99.50	—	72% below	35%
Removal of a foreign object under the skin, simple CPT 10120 10120 Incision&Removal Foreign Body Subq Tiss Smpl	$253.99	$390.75	—	8% above	35%
Removal of a foreign object under the skin, simple CPT 10120 10120 Inc & Removal Foreign Body Subq Tiss Smpl	$253.99	$390.75	—	8% above	35%
Removal of a foreign object under the skin, simple CPT 10120 10120 ED PROF - REMVE FB SIMPLE-HOSPITAL	$253.99	$390.75	—	8% above	35%
Removal of a foreign object under the skin, simple CPT 10120 10120 ED PROC REMVE FB SIMPLE-HOSPITAL	$682.50	$1,050.00	—	191% above	35%
Removal of a foreign object under the skin, simple inpatient CPT 10120 10120 Rem Skin Foreign Body Smpl PBB, Regional	$64.68	$99.50	—	—	35%
Removal of a foreign object under the skin, simple inpatient CPT 10120 10120 ED PROF - REMVE FB SIMPLE-HOSPITAL	$253.99	$390.75	—	—	35%
Removal of a foreign object under the skin, simple inpatient CPT 10120 10120 Inc & Removal Foreign Body Subq Tiss Smpl	$253.99	$390.75	—	—	35%
Removal of a foreign object under the skin, simple inpatient CPT 10120 10120 Incision&Removal Foreign Body Subq Tiss Smpl	$253.99	$390.75	—	—	35%
Removal of a foreign object under the skin, simple inpatient CPT 10120 10120 ED PROC REMVE FB SIMPLE-HOSPITAL	$682.50	$1,050.00	—	—	35%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 G0121 Colorec Scrn Colonscpy Md	$658.61	$1,013.25	—	at median	35%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 G0121 Colon Ca Scrn Not Hi Rsk Ind	$2,878.52	$4,428.50	—	337% above	35%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 G0121 Colorec Scrn Colonscpy Md	$658.61	$1,013.25	—	—	35%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 G0121 Colon Ca Scrn Not Hi Rsk Ind	$2,878.52	$4,428.50	—	—	35%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 G0105 Colorect Scrn Highrisk Me	$532.35	$819.00	—	10% below	35%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 G0105 Colorectal Scrn; Hi Risk Ind	$2,391.19	$3,678.75	—	306% above	35%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 G0105 Colorect Scrn Highrisk Me	$532.35	$819.00	—	—	35%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 G0105 Colorectal Scrn; Hi Risk Ind	$2,391.19	$3,678.75	—	—	35%
Short arm cast (elbow to hand) CPT 29075 29075 ED PROF SHORT ARM CAST	$144.14	$221.75	—	10% below	35%
Short arm cast (elbow to hand) inpatient CPT 29075 29075 ED PROF SHORT ARM CAST	$144.14	$221.75	—	—	35%
Short arm splint (forearm and hand) CPT 29125 29125 Application Short Arm Splint Forearm-Hand Static DMHC	$64.68	$99.50	—	46% below	35%
Short arm splint (forearm and hand) CPT 29125 29125 ED PROF APPLY SHORT ARM SPLINT	$139.26	$214.25	—	16% above	35%
Short arm splint (forearm and hand) CPT 29125 29125 Application Short Arm Splint Forearm-Hand Static	$139.26	$214.25	—	16% above	35%
Short arm splint (forearm and hand) CPT 29125 29125 ED PROC APPLY SHORT ARM SPLINT	$142.19	$218.75	—	19% above	35%
Short arm splint (forearm and hand) inpatient CPT 29125 29125 Application Short Arm Splint Forearm-Hand Static DMHC	$64.68	$99.50	—	—	35%
Short arm splint (forearm and hand) inpatient CPT 29125 29125 Application Short Arm Splint Forearm-Hand Static	$139.26	$214.25	—	—	35%
Short arm splint (forearm and hand) inpatient CPT 29125 29125 ED PROF APPLY SHORT ARM SPLINT	$139.26	$214.25	—	—	35%
Short arm splint (forearm and hand) inpatient CPT 29125 29125 ED PROC APPLY SHORT ARM SPLINT	$142.19	$218.75	—	—	35%
Short leg splint (calf to foot) CPT 29515 29515 ED PROF APPLICATION SHORT LEG SPLINT	$148.20	$228.00	—	8% above	35%
Short leg splint (calf to foot) CPT 29515 29515 ED PROC APPLICATION SHORT LEG SPLINT	$150.64	$231.75	—	9% above	35%
Short leg splint (calf to foot) inpatient CPT 29515 29515 ED PROF APPLICATION SHORT LEG SPLINT	$148.20	$228.00	—	—	35%
Short leg splint (calf to foot) inpatient CPT 29515 29515 ED PROC APPLICATION SHORT LEG SPLINT	$150.64	$231.75	—	—	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< RP	$64.68	$99.50	—	73% below	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 Scalp/Neck/Ax/Genit/Trunk/Ext <2.5cm	$216.45	$333.00	—	10% below	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 ED PROF SIM LAC <2.6CM BD - HOSPITAL	$216.45	$333.00	—	10% below	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 ED PROC SIM LAC <2.6CM BD- HOSPITAL	$237.90	$366.00	—	1% below	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< RP	$64.68	$99.50	—	—	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001 Scalp/Neck/Ax/Genit/Trunk/Ext <2.5cm	$216.45	$333.00	—	—	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001 ED PROF SIM LAC <2.6CM BD - HOSPITAL	$216.45	$333.00	—	—	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001 ED PROC SIM LAC <2.6CM BD- HOSPITAL	$237.90	$366.00	—	—	35%
Skin biopsy, punch, one lesion CPT 11104 11104 Punch bx skin single lesion_	$301.11	$463.25	—	2% above	35%
Skin biopsy, punch, one lesion CPT 11104 11104 PUNCH BX SKIN SINGLE LESION	$682.50	$1,050.00	—	132% above	35%
Skin biopsy, punch, one lesion inpatient CPT 11104 11104 Punch bx skin single lesion_	$301.11	$463.25	—	—	35%
Skin biopsy, punch, one lesion inpatient CPT 11104 11104 PUNCH BX SKIN SINGLE LESION	$682.50	$1,050.00	—	—	35%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 11600 Excision Mal Lesion Trunk/Arm/Leg 0.5 Cm/<	$329.06	$506.25	—	6% above	35%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 11600 Excis Mal Lesion Trunk/Arm/Leg 0.5 Cm/<	$479.21	$737.25	—	55% above	35%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 11600 Excision Mal Lesion Trunk/Arm/Leg 0.5 Cm/<	$329.06	$506.25	—	—	35%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 11600 Excis Mal Lesion Trunk/Arm/Leg 0.5 Cm/<	$479.21	$737.25	—	—	35%
Skin tag removal, up to 15 tags CPT 11200 11200 Treatment Room II	$64.68	$99.50	—	53% below	35%
Skin tag removal, up to 15 tags CPT 11200 11200 Removal Sk Tgs Mlt Fibrq Tags Any Area Up&W/15<	$133.90	$206.00	—	2% below	35%
Skin tag removal, up to 15 tags CPT 11200 11200 Removal of Skin Tags, Multiple Fibrocutaneous Tags Up To 15	$133.90	$206.00	—	2% below	35%
Skin tag removal, up to 15 tags inpatient CPT 11200 11200 Treatment Room II	$64.68	$99.50	—	—	35%
Skin tag removal, up to 15 tags inpatient CPT 11200 11200 Removal Sk Tgs Mlt Fibrq Tags Any Area Up&W/15<	$133.90	$206.00	—	—	35%
Skin tag removal, up to 15 tags inpatient CPT 11200 11200 Removal of Skin Tags, Multiple Fibrocutaneous Tags Up To 15	$133.90	$206.00	—	—	35%
Spinal tap (lumbar puncture), diagnostic CPT 62270 XR Lumbar Puncture Diagnostic	$207.35	$319.00	—	13% below	35%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 XR Lumbar Puncture Diagnostic	$207.35	$319.00	—	—	35%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM	$64.68	$99.50	—	73% below	35%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 ED PROC SIM LAC 2.6-7.5CM BD- HOSPITAL	$240.34	$369.75	—	2% above	35%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 ED PROF SIM LAC 2.6-7.5CM BD - HOSPITAL	$272.35	$419.00	—	15% above	35%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 Scalp/Neck/Ax/Genit/Trunk/Ext 2.6-7.5cm	$272.35	$419.00	—	15% 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 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM	$64.68	$99.50	—	—	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 12002 ED PROC SIM LAC 2.6-7.5CM BD- HOSPITAL	$240.34	$369.75	—	—	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 12002 Scalp/Neck/Ax/Genit/Trunk/Ext 2.6-7.5cm	$272.35	$419.00	—	—	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 12002 ED PROF SIM LAC 2.6-7.5CM BD - HOSPITAL	$272.35	$419.00	—	—	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 ED PROF SM LAC <2.6CM FCE - HOSPITAL	$263.58	$405.50	—	8% below	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 Face/Ears/Eyelids/Nose/Lips/MM <2.5cm	$263.58	$405.50	—	8% below	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 ED PROC SM LAC <2.6CM FCE- HOSPITAL	$372.78	$573.50	—	29% above	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 12011 Face/Ears/Eyelids/Nose/Lips/MM <2.5cm	$263.58	$405.50	—	—	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 12011 ED PROF SM LAC <2.6CM FCE - HOSPITAL	$263.58	$405.50	—	—	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 12011 ED PROC SM LAC <2.6CM FCE- HOSPITAL	$372.78	$573.50	—	—	35%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Tangential Biopsy Skin Single Lesion	$271.54	$417.75	—	39% above	35%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 ED PROF Tangntl BX Skin Single Les	$282.59	$434.75	—	45% above	35%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Tangntl bx skin single les_	$282.59	$434.75	—	45% above	35%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 11102 Tangential Biopsy Skin Single Lesion	$271.54	$417.75	—	—	35%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 11102 Tangntl bx skin single les_	$282.59	$434.75	—	—	35%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 11102 ED PROF Tangntl BX Skin Single Les	$282.59	$434.75	—	—	35%
Thoracentesis with imaging guidance both sides CPT 32555 US Thoracentesis Bilateral - Report	$499.85	$769.00	—	—	35%
Thoracentesis with imaging guidance CPT 32555 US Thoracentesis - Report	$499.85	$769.00	—	at median	35%
Thoracentesis with imaging guidance CPT 32555 CT Thoracentesis - Report	$499.85	$769.00	—	at median	35%
Thoracentesis with imaging guidance CPT 32555 CT Exam	$990.76	$1,524.25	—	98% above	35%
Thoracentesis with imaging guidance CPT 32555 US Exam	$990.76	$1,524.25	—	98% above	35%
Thoracentesis with imaging guidance inpatient both sides CPT 32555 US Thoracentesis Bilateral - Report	$499.85	$769.00	—	—	35%
Thoracentesis with imaging guidance inpatient CPT 32555 CT Thoracentesis - Report	$499.85	$769.00	—	—	35%
Thoracentesis with imaging guidance inpatient CPT 32555 US Thoracentesis - Report	$499.85	$769.00	—	—	35%
Thoracentesis with imaging guidance inpatient CPT 32555 US Exam	$990.76	$1,524.25	—	—	35%
Thoracentesis with imaging guidance inpatient CPT 32555 CT Exam	$990.76	$1,524.25	—	—	35%
Trigger point injections, 1 or 2 muscles CPT 20552 20552 ED PROF INJ TRIGGER POINT 1 OR 2-HOSP	$101.72	$156.50	—	10% below	35%
Trigger point injections, 1 or 2 muscles CPT 20552 20552 Injection Single/Mlt Trigger Point 1/2 Muscles	$101.72	$156.50	—	10% below	35%
Trigger point injections, 1 or 2 muscles CPT 20552 XR Inject Trigger Points 1 or 2 Muscles	$106.92	$164.50	—	5% below	35%
Trigger point injections, 1 or 2 muscles CPT 20552 US Inject Trigger Points 1 or 2 Muscles	$106.92	$164.50	—	5% below	35%
Trigger point injections, 1 or 2 muscles CPT 20552 CT Inject Trigger Points 1 or 2 Muscles	$106.92	$164.50	—	5% below	35%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552 ED PROF INJ TRIGGER POINT 1 OR 2-HOSP	$101.72	$156.50	—	—	35%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552 Injection Single/Mlt Trigger Point 1/2 Muscles	$101.72	$156.50	—	—	35%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 CT Inject Trigger Points 1 or 2 Muscles	$106.92	$164.50	—	—	35%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 XR Inject Trigger Points 1 or 2 Muscles	$106.92	$164.50	—	—	35%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 US Inject Trigger Points 1 or 2 Muscles	$106.92	$164.50	—	—	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 US Breast Biopsy L - Report	$878.80	$1,352.00	—	at median	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 US Breast Biopsy R - Report	$878.80	$1,352.00	—	at median	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 US Breast Biopsy R - Report	$878.80	$1,352.00	—	—	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 US Breast Biopsy L - Report	$878.80	$1,352.00	—	—	35%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 43249 ENDO EGD w/Ballon Dilation	$1,563.74	$2,405.75	—	149% above	35%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 43249 Upr Gi Ndsc Balo Dilat Esoph < 30 Mm Diam	$2,931.34	$4,509.75	—	366% above	35%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 43249 ENDO EGD w/Ballon Dilation	$1,563.74	$2,405.75	—	—	35%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 43249 Upr Gi Ndsc Balo Dilat Esoph < 30 Mm Diam	$2,931.34	$4,509.75	—	—	35%
Upper endoscopy (EGD) with biopsy CPT 43239 43239P Upper Stomach-Intestine Scope For Biopsy	$598.00	$920.00	—	15% below	35%
Upper endoscopy (EGD) with biopsy CPT 43239 43239 Egd Transoral Biopsy Single/Multiple	$1,563.74	$2,405.75	—	121% above	35%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 43239P Upper Stomach-Intestine Scope For Biopsy	$598.00	$920.00	—	—	35%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 43239 Egd Transoral Biopsy Single/Multiple	$1,563.74	$2,405.75	—	—	35%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 43251 Upr Gi Ndsc Rmvl Tum Polyp/Oth Les Snare Tq	$337.84	$519.75	—	60% below	35%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 43251 ENDO EGD w/Polyp Removal By Snare	$1,838.36	$2,828.25	—	116% above	35%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 43251 Upr Gi Ndsc Rmvl Tum Polyp/Oth Les Snare Tq	$337.84	$519.75	—	—	35%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 43251 ENDO EGD w/Polyp Removal By Snare	$1,838.36	$2,828.25	—	—	35%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 43248 Upr Gi Ndsc Insj Gd Wire Dilat Esoph > Gd Wire	$1,082.58	$1,665.50	—	64% above	35%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 43248 ENDO EGD w/Inser Of Guide Wire & Dilita	$1,597.54	$2,457.75	—	143% above	35%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 43248 Upr Gi Ndsc Insj Gd Wire Dilat Esoph > Gd Wire	$1,082.58	$1,665.50	—	—	35%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 43248 ENDO EGD w/Inser Of Guide Wire & Dilita	$1,597.54	$2,457.75	—	—	35%
Upper endoscopy (EGD), diagnostic CPT 43235 43235P Upper Stomach-Intestine Scope For Diagnosis	$405.44	$623.75	—	25% below	35%
Upper endoscopy (EGD), diagnostic CPT 43235 43235 ENDO EGD w/wo Collection	$1,543.75	$2,375.00	—	186% above	35%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 43235P Upper Stomach-Intestine Scope For Diagnosis	$405.44	$623.75	—	—	35%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 43235 ENDO EGD w/wo Collection	$1,543.75	$2,375.00	—	—	35%
Wart removal, up to 14 warts CPT 17110 17110 Destruction Benign Lesions Up To 14	$156.98	$241.50	—	9% below	35%
Wart removal, up to 14 warts CPT 17110 17110 Destruction of Benign Lesion Up To 14 Lesions(Warts)	$156.98	$241.50	—	9% below	35%
Wart removal, up to 14 warts inpatient CPT 17110 17110 Destruction Benign Lesions Up To 14	$156.98	$241.50	—	—	35%
Wart removal, up to 14 warts inpatient CPT 17110 17110 Destruction of Benign Lesion Up To 14 Lesions(Warts)	$156.98	$241.50	—	—	35%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debride Subq Tissue <=20 cm PBB, Regional	$64.68	$99.50	—	65% below	35%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 ED PROF DEBRIDE SKIN AND SUB Q TISSUE	$512.69	$788.75	—	179% above	35%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Debridement, SubQ Tissue <20 sq cm	$512.69	$788.75	—	179% above	35%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debride Subq Tissue <=20 cm PBB, Regional	$64.68	$99.50	—	—	35%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 11042 ED PROF DEBRIDE SKIN AND SUB Q TISSUE	$512.69	$788.75	—	—	35%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 11042 Debridement, SubQ Tissue <20 sq cm	$512.69	$788.75	—	—	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 36430 Transfusion Admin	$746.69	$1,148.75	—	at median	35%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Administration Charge	$746.69	$1,148.75	—	at median	35%
Blood transfusion (giving blood or blood components) CPT 36430 TWN Blood Transfusion	$746.69	$1,148.75	—	at median	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TWN Blood Transfusion	$746.69	$1,148.75	—	—	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Administration Charge	$746.69	$1,148.75	—	—	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 Transfusion Admin	$746.69	$1,148.75	—	—	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 Aerosol Inhalation Treatment	$20.48	$31.50	—	79% below	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 ED PROC INHALATION TREATMENT	$166.72	$256.50	—	68% above	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 Aerosol Inhalation Treatment	$20.48	$31.50	—	—	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 ED PROC INHALATION TREATMENT	$166.72	$256.50	—	—	35%
Critical care, first 30 to 74 minutes CPT 99291 99291 ED PROF CRITICAL CARE FIRST 30-74 MIN	$654.55	$1,007.00	—	13% above	35%
Critical care, first 30 to 74 minutes CPT 99291 TWN Critical Care 1st 30-74 Min	$1,745.90	$2,686.00	—	201% above	35%
Critical care, first 30 to 74 minutes CPT 99291 99291 ED PROC CRITICAL CARE 1ST HR- HOSPITAL	$1,745.90	$2,686.00	—	201% above	35%
Critical care, first 30 to 74 minutes inpatient CPT 99291 99291 ED PROF CRITICAL CARE FIRST 30-74 MIN	$654.55	$1,007.00	—	—	35%
Critical care, first 30 to 74 minutes inpatient CPT 99291 99291 ED PROC CRITICAL CARE 1ST HR- HOSPITAL	$1,745.90	$2,686.00	—	—	35%
Critical care, first 30 to 74 minutes inpatient CPT 99291 TWN Critical Care 1st 30-74 Min	$1,745.90	$2,686.00	—	—	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EK Exam	$139.91	$215.25	—	2% below	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EK Exam	$139.91	$215.25	—	—	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP	$136.34	$209.75	—	22% above	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 99281 EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP	$136.34	$209.75	—	—	35%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 ED PROF EMERGENCY DEPT VISIT STRAIGHTFORWARD MDM	$124.96	$192.25	—	9% below	35%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM	$232.54	$357.75	—	70% above	35%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 99282 ED PROF EMERGENCY DEPT VISIT STRAIGHTFORWARD MDM	$124.96	$192.25	—	—	35%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 99282 EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM	$232.54	$357.75	—	—	35%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 ED PROF EMERGENCY DEPARTMENT VISIT LOW MDM	$206.21	$317.25	—	6% above	35%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 EMERGENCY DEPARTMENT VISIT LOW MDM	$407.55	$627.00	—	110% above	35%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 99283 ED PROF EMERGENCY DEPARTMENT VISIT LOW MDM	$206.21	$317.25	—	—	35%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 99283 EMERGENCY DEPARTMENT VISIT LOW MDM	$407.55	$627.00	—	—	35%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 ED PROF EMERGENCY DEPARTMENT VISIT MODERATE MDM	$362.54	$557.75	—	2% above	35%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 EMERGENCY DEPARTMENT VISIT MODERATE MDM	$697.29	$1,072.75	—	97% above	35%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 99284 ED PROF EMERGENCY DEPARTMENT VISIT MODERATE MDM	$362.54	$557.75	—	—	35%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 99284 EMERGENCY DEPARTMENT VISIT MODERATE MDM	$697.29	$1,072.75	—	—	35%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 ED PROF Emergency department visit high level MDM	$528.29	$812.75	—	2% above	35%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 Emergency department visit high level MDM	$1,299.19	$1,998.75	—	150% above	35%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 99285 ED PROF Emergency department visit high level MDM	$528.29	$812.75	—	—	35%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 99285 Emergency department visit high level MDM	$1,299.19	$1,998.75	—	—	35%
Family therapy with the patient, 50 minutes CPT 90847 90847-95 Telehealth Fam Psyctx W/Pt Present	$174.04	$267.75	—	4% above	35%
Family therapy with the patient, 50 minutes CPT 90847 90847 Fam Psyctx W/Pt Present	$174.04	$267.75	—	4% above	35%
Family therapy with the patient, 50 minutes inpatient CPT 90847 90847-95 Telehealth Fam Psyctx W/Pt Present	$174.04	$267.75	—	—	35%
Family therapy with the patient, 50 minutes inpatient CPT 90847 90847 Fam Psyctx W/Pt Present	$174.04	$267.75	—	—	35%
Family therapy without the patient, 50 minutes CPT 90846 90846 Fam Psyctx W/O Pt Present	$226.04	$347.75	—	19% above	35%
Family therapy without the patient, 50 minutes CPT 90846 90846-95 Telehealth Fam Psyctx W/O Pt Present	$226.04	$347.75	—	19% above	35%
Family therapy without the patient, 50 minutes inpatient CPT 90846 90846-95 Telehealth Fam Psyctx W/O Pt Present	$226.04	$347.75	—	—	35%
Family therapy without the patient, 50 minutes inpatient CPT 90846 90846 Fam Psyctx W/O Pt Present	$226.04	$347.75	—	—	35%
Group psychotherapy session CPT 90853 90853 Grp Psyctx	$63.05	$97.00	—	12% below	35%
Group psychotherapy session CPT 90853 90853-95 Telehealth Grp Psyctx	$63.05	$97.00	—	12% below	35%
Group psychotherapy session inpatient CPT 90853 90853-95 Telehealth Grp Psyctx	$63.05	$97.00	—	—	35%
Group psychotherapy session inpatient CPT 90853 90853 Grp Psyctx	$63.05	$97.00	—	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Hydration Initial 96360	$253.34	$389.75	—	9% above	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 - Admin IVI, Hydration, Initial 31 Min to 1 Hr	$253.34	$389.75	—	9% above	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 IV Hydration Initial	$253.34	$389.75	—	9% above	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 IV Hydration Initial	$253.34	$389.75	—	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Hydration Initial 96360	$253.34	$389.75	—	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 - Admin IVI, Hydration, Initial 31 Min to 1 Hr	$253.34	$389.75	—	—	35%
IV infusion of a medicine, first hour CPT 96365 96365 IV Infusion Initial	$204.42	$314.50	—	19% below	35%
IV infusion of a medicine, first hour CPT 96365 96365 Admin IVI,For Therapy; Initial, Up to 1Hr Non-Chemo	$204.42	$314.50	—	19% below	35%
IV infusion of a medicine, first hour CPT 96365 IV Infusion Initial 96365	$204.42	$314.50	—	19% below	35%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 IV Infusion Initial	$204.42	$314.50	—	—	35%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Infusion Initial 96365	$204.42	$314.50	—	—	35%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 Admin IVI,For Therapy; Initial, Up to 1Hr Non-Chemo	$204.42	$314.50	—	—	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 SQ/IM Injection	$52.49	$80.75	—	16% below	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 ED PROC INJECTION SQ/IM	$52.49	$80.75	—	16% below	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 SQ/IM Injection Treatment	$52.49	$80.75	—	16% below	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 - Admin SQ/IM Non-Chemo Injection	$52.49	$80.75	—	16% below	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Admin SQ/IM POM	$52.49	$80.75	—	16% below	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ Injection Charge	$52.49	$80.75	—	16% below	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 ED PROC INJECTION SQ/IM	$52.49	$80.75	—	—	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 SQ/IM Injection Treatment	$52.49	$80.75	—	—	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 Admin SQ/IM POM	$52.49	$80.75	—	—	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SQ Injection Charge	$52.49	$80.75	—	—	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 SQ/IM Injection	$52.49	$80.75	—	—	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 - Admin SQ/IM Non-Chemo Injection	$52.49	$80.75	—	—	35%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 90791 Psych Diagnostic Evaluation	$156.32	$240.50	—	31% below	35%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 90791-95 Telehealth Psych Diagnostic Eval	$156.32	$240.50	—	31% below	35%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 90791 Psych Diagnostic Evaluation	$156.32	$240.50	—	—	35%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 90791-95 Telehealth Psych Diagnostic Eval	$156.32	$240.50	—	—	35%
Neuromuscular re-education, 15 minutes CPT 97112 REHAB 97112 GO Neuromuscular Rehab Each 15 Min	$76.86	$118.25	—	2% above	35%
Neuromuscular re-education, 15 minutes CPT 97112 OT Neuromuscular Reeducation Assistant Units	$76.86	$118.25	—	2% above	35%
Neuromuscular re-education, 15 minutes CPT 97112 OT Neuromuscular Reeducation Units	$76.86	$118.25	—	2% above	35%
Neuromuscular re-education, 15 minutes CPT 97112 REHAB 97112 GP Neuromuscular Rehab Each 15 Min	$76.86	$118.25	—	2% above	35%
Neuromuscular re-education, 15 minutes CPT 97112 PT Neuromuscular Reeducation Units	$76.86	$118.25	—	2% above	35%
Neuromuscular re-education, 15 minutes CPT 97112 PT Neuromuscular Reeducation Assistant Units	$76.86	$118.25	—	2% above	35%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT Neuromuscular Reeducation Units	$76.86	$118.25	—	—	35%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT Neuromuscular Reeducation Units	$76.86	$118.25	—	—	35%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT Neuromuscular Reeducation Assistant Units	$76.86	$118.25	—	—	35%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT Neuromuscular Reeducation Assistant Units	$76.86	$118.25	—	—	35%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 REHAB 97112 GP Neuromuscular Rehab Each 15 Min	$76.86	$118.25	—	—	35%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 REHAB 97112 GO Neuromuscular Rehab Each 15 Min	$76.86	$118.25	—	—	35%
New patient office visit, about 30 minutes CPT 99203 Telehealth Home Visit 99203	$148.85	$229.00	—	11% below	35%
New patient office visit, about 30 minutes CPT 99203 99203 OFFICE/OP NEW LOW MDM 30 MINUTES	$156.32	$240.50	—	7% below	35%
New patient office visit, about 30 minutes CPT 99203 99203P OFFICE/OP NEW LOW MDM 30-44 MINUTES	$156.32	$240.50	—	7% below	35%
New patient office visit, about 30 minutes inpatient CPT 99203 Telehealth Home Visit 99203	$148.85	$229.00	—	—	35%
New patient office visit, about 30 minutes inpatient CPT 99203 99203P OFFICE/OP NEW LOW MDM 30-44 MINUTES	$156.32	$240.50	—	—	35%
New patient office visit, about 30 minutes inpatient CPT 99203 99203 OFFICE/OP NEW LOW MDM 30 MINUTES	$156.32	$240.50	—	—	35%
New patient office visit, about 45 minutes CPT 99204 Telehealth Home Visit 99204	$226.20	$348.00	—	11% below	35%
New patient office visit, about 45 minutes CPT 99204 99204 OFFICE/OP NEW MODERATE MDM 45 MINUTES	$237.58	$365.50	—	6% below	35%
New patient office visit, about 45 minutes CPT 99204 99204 OFFICE OUTPATIENT NEW 45 MINUTES	$237.58	$365.50	—	6% below	35%
New patient office visit, about 45 minutes inpatient CPT 99204 Telehealth Home Visit 99204	$226.20	$348.00	—	—	35%
New patient office visit, about 45 minutes inpatient CPT 99204 99204 OFFICE OUTPATIENT NEW 45 MINUTES	$237.58	$365.50	—	—	35%
New patient office visit, about 45 minutes inpatient CPT 99204 99204 OFFICE/OP NEW MODERATE MDM 45 MINUTES	$237.58	$365.50	—	—	35%
New patient office visit, about 60 minutes CPT 99205 Telehealth Home Visit 99205	$279.50	$430.00	—	9% below	35%
New patient office visit, about 60 minutes CPT 99205 99205P OFFICE/OP NEW HIGH MDM 60-74 MINUTES	$293.48	$451.50	—	4% below	35%
New patient office visit, about 60 minutes CPT 99205 99205 OFFICE/OP NEW HIGH MDM 60 MINUTES	$293.48	$451.50	—	4% below	35%
New patient office visit, about 60 minutes inpatient CPT 99205 Telehealth Home Visit 99205	$279.50	$430.00	—	—	35%
New patient office visit, about 60 minutes inpatient CPT 99205 99205P OFFICE/OP NEW HIGH MDM 60-74 MINUTES	$293.48	$451.50	—	—	35%
New patient office visit, about 60 minutes inpatient CPT 99205 99205 OFFICE/OP NEW HIGH MDM 60 MINUTES	$293.48	$451.50	—	—	35%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Telehealth Home Visit 99202	$113.10	$174.00	—	17% below	35%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202P OFFICE/OP NEW SF MDM 15-29 MINUTES	$118.79	$182.75	—	13% below	35%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 OFFICE/OP NEW SF MDM 15 MINUTES	$118.79	$182.75	—	13% below	35%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Telehealth Home Visit 99202	$113.10	$174.00	—	—	35%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 99202P OFFICE/OP NEW SF MDM 15-29 MINUTES	$118.79	$182.75	—	—	35%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 99202 OFFICE/OP NEW SF MDM 15 MINUTES	$118.79	$182.75	—	—	35%
Occupational therapy evaluation, low complexity CPT 97165 REHAB 97165 GO OT Evaluation Low Complexity	$168.02	$258.50	—	1% below	35%
Occupational therapy evaluation, low complexity CPT 97165 OT Evaluation Units, Low Complexity	$168.02	$258.50	—	1% below	35%
Occupational therapy evaluation, low complexity inpatient CPT 97165 REHAB 97165 GO OT Evaluation Low Complexity	$168.02	$258.50	—	—	35%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT Evaluation Units, Low Complexity	$168.02	$258.50	—	—	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT Evaluation Units, High Complexity	$155.19	$238.75	—	17% below	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 REHAB 97163 GP PT Evaluation High Complexity	$155.19	$238.75	—	17% below	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 REHAB 97163 GP PT Evaluation High Complexity	$155.19	$238.75	—	—	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT Evaluation Units, High Complexity	$155.19	$238.75	—	—	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 REHAB 97161 GP PT Evaluation Low Complexity	$155.19	$238.75	—	6% below	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT Evaluation Units, Low Complexity	$155.19	$238.75	—	6% below	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT Evaluation Units, Low Complexity	$155.19	$238.75	—	—	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 REHAB 97161 GP PT Evaluation Low Complexity	$155.19	$238.75	—	—	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 REHAB 97162 GP PT Evaluation Moderate Complexity	$155.19	$238.75	—	7% below	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT Evaluation Units, Moderate Complexity	$155.19	$238.75	—	7% below	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT Evaluation Units, Moderate Complexity	$155.19	$238.75	—	—	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 REHAB 97162 GP PT Evaluation Moderate Complexity	$155.19	$238.75	—	—	35%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Manual Therapy Units	$64.68	$99.50	—	6% below	35%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Manual Therapy Assistant Units	$64.68	$99.50	—	6% below	35%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Manual Therapy Units	$64.68	$99.50	—	6% below	35%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Manual Therapy Assistant Units	$64.68	$99.50	—	6% below	35%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 REHAB 97140 GP Manual Therapy Each 15 Min	$64.68	$99.50	—	6% below	35%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 REHAB 97140 GO Manual Therapy Each 15 Min	$64.68	$99.50	—	6% below	35%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT Manual Therapy Assistant Units	$64.68	$99.50	—	—	35%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 REHAB 97140 GP Manual Therapy Each 15 Min	$64.68	$99.50	—	—	35%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT Manual Therapy Units	$64.68	$99.50	—	—	35%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 REHAB 97140 GO Manual Therapy Each 15 Min	$64.68	$99.50	—	—	35%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT Manual Therapy Units	$64.68	$99.50	—	—	35%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT Manual Therapy Assistant Units	$64.68	$99.50	—	—	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise Units	$74.75	$115.00	—	at median	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 REHAB 97110 GO Therapeutic Exercise Each 15 Min	$74.75	$115.00	—	at median	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 REHAB 97110 GP Therapeutic Exercise Each 15 Min	$74.75	$115.00	—	at median	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise Assistant Units	$74.75	$115.00	—	at median	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise Assistant Units	$74.75	$115.00	—	at median	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise Units	$74.75	$115.00	—	at median	35%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise Assistant Units	$74.75	$115.00	—	—	35%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 REHAB 97110 GO Therapeutic Exercise Each 15 Min	$74.75	$115.00	—	—	35%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise Units	$74.75	$115.00	—	—	35%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise Assistant Units	$74.75	$115.00	—	—	35%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 REHAB 97110 GP Therapeutic Exercise Each 15 Min	$74.75	$115.00	—	—	35%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise Units	$74.75	$115.00	—	—	35%
Preventive checkup, new patient aged 18–39 CPT 99385 99385 - New Pt.Well Office Visit Age 18-39 99385	$213.04	$327.75	—	3% above	35%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 99385 - New Pt.Well Office Visit Age 18-39 99385	$213.04	$327.75	—	—	35%
Preventive checkup, new patient aged 40–64 CPT 99386 99386 - New Pt. Well Office Visit Age 40-64	$230.75	$355.00	—	at median	35%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 99386 - New Pt. Well Office Visit Age 40-64	$230.75	$355.00	—	—	35%
Preventive checkup, new patient aged 65 or older CPT 99387 99387 - New Pt. Well Office Visit Age 65 & Over	$227.34	$349.75	—	10% below	35%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 99387 - New Pt. Well Office Visit Age 65 & Over	$227.34	$349.75	—	—	35%
Preventive checkup, returning patient aged 18–39 CPT 99395 99395 - Est Pt. Well Office Visit Age 18-39	$178.26	$274.25	—	at median	35%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 99395 - Est Pt. Well Office Visit Age 18-39	$178.26	$274.25	—	—	35%
Preventive checkup, returning patient aged 40–64 CPT 99396 99396 - Est Pt. Well Office Visit Age 40-64	$201.34	$309.75	—	5% above	35%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 99396 - Est Pt. Well Office Visit Age 40-64	$201.34	$309.75	—	—	35%
Preventive checkup, returning patient aged 65 or older CPT 99397 99397 - Est Pt. Well Office Visit Age 65 & Over	$214.99	$330.75	—	6% above	35%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 99397 - Est Pt. Well Office Visit Age 65 & Over	$214.99	$330.75	—	—	35%
Psychotherapy for crisis, first 60 minutes CPT 90839 90839-95 Telehealth Psychotherapy for Crisis Initial 60 min	$232.05	$357.00	—	7% above	35%
Psychotherapy for crisis, first 60 minutes CPT 90839 90839 Psychotherapy For Crisis Initial 60 Minutes	$232.05	$357.00	—	7% above	35%
Psychotherapy for crisis, first 60 minutes CPT 90839 90839 PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES RP	$232.05	$357.00	—	7% above	35%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 90839 PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES RP	$232.05	$357.00	—	—	35%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 90839-95 Telehealth Psychotherapy for Crisis Initial 60 min	$232.05	$357.00	—	—	35%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 90839 Psychotherapy For Crisis Initial 60 Minutes	$232.05	$357.00	—	—	35%
Psychotherapy session, 30 minutes CPT 90832 90832 Psych Tx Pt&/Family 30 Min	$104.49	$160.75	—	6% below	35%
Psychotherapy session, 30 minutes CPT 90832 90832-95 Telehealth Psych Tx Pt&/Family 30 min	$104.49	$160.75	—	6% below	35%
Psychotherapy session, 30 minutes inpatient CPT 90832 90832 Psych Tx Pt&/Family 30 Min	$104.49	$160.75	—	—	35%
Psychotherapy session, 30 minutes inpatient CPT 90832 90832-95 Telehealth Psych Tx Pt&/Family 30 min	$104.49	$160.75	—	—	35%
Psychotherapy session, 45 minutes CPT 90834 90834-95 Telehealth Psych Tx Pt&/Family 45 min	$151.61	$233.25	—	5% above	35%
Psychotherapy session, 45 minutes CPT 90834 90834 Psych Tx Pt&/Family 45 Min	$151.61	$233.25	—	5% above	35%
Psychotherapy session, 45 minutes inpatient CPT 90834 90834 Psych Tx Pt&/Family 45 Min	$151.61	$233.25	—	—	35%
Psychotherapy session, 45 minutes inpatient CPT 90834 90834-95 Telehealth Psych Tx Pt&/Family 45 min	$151.61	$233.25	—	—	35%
Psychotherapy session, 60 minutes CPT 90837 90837-95 Telehealth Psych Tx Pt&/Family 60 min	$197.92	$304.50	—	5% above	35%
Psychotherapy session, 60 minutes CPT 90837 90837 Psych Tx Pt&/Family 60 Min	$197.92	$304.50	—	5% above	35%
Psychotherapy session, 60 minutes inpatient CPT 90837 90837 Psych Tx Pt&/Family 60 Min	$197.92	$304.50	—	—	35%
Psychotherapy session, 60 minutes inpatient CPT 90837 90837-95 Telehealth Psych Tx Pt&/Family 60 min	$197.92	$304.50	—	—	35%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 OFFICE/OP EST HIGH MDM 40 MIN	$205.56	$316.25	—	11% below	35%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215P OFFICE/OP EST HIGH MDM 40-54 MIN	$205.56	$316.25	—	11% below	35%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Telehealth Home Visit 99215	$822.25	$1,265.00	—	254% above	35%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 OFFICE/OP EST HIGH MDM 40 MIN	$205.56	$316.25	—	—	35%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215P OFFICE/OP EST HIGH MDM 40-54 MIN	$205.56	$316.25	—	—	35%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Telehealth Home Visit 99215	$822.25	$1,265.00	—	—	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Treatment Room III	$87.92	$135.26	—	30% below	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213P OFFICE/OP EST SF MDM 20-29 MIN	$144.95	$223.00	—	15% above	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Telehealth Home Visit 99213	$144.95	$223.00	—	15% above	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 OFFICE/OP EST SF MDM 20 MIN	$144.95	$223.00	—	15% above	35%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 Treatment Room III	$87.92	$135.26	—	—	35%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 OFFICE/OP EST SF MDM 20 MIN	$144.95	$223.00	—	—	35%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213P OFFICE/OP EST SF MDM 20-29 MIN	$144.95	$223.00	—	—	35%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Telehealth Home Visit 99213	$144.95	$223.00	—	—	35%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 OFFICE/OP EST MOD MDM 30 MIN	$154.38	$237.50	—	5% below	35%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214P OFFICE/OP EST MOD MDM 30-39 MIN	$154.38	$237.50	—	5% below	35%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Telehealth Home Visit 99214	$154.38	$237.50	—	5% below	35%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Telehealth Home Visit 99214	$154.38	$237.50	—	—	35%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 OFFICE/OP EST MOD MDM 30 MIN	$154.38	$237.50	—	—	35%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214P OFFICE/OP EST MOD MDM 30-39 MIN	$154.38	$237.50	—	—	35%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 - Est Pt. Problem Focus	$81.90	$126.00	—	5% below	35%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212P Office Outpt Est 10 Min	$81.90	$126.00	—	5% below	35%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Treatment Room II	$87.92	$135.26	—	2% above	35%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Telehealth Home Visit 99212	$327.60	$504.00	—	279% above	35%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 - Est Pt. Problem Focus	$81.90	$126.00	—	—	35%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212P Office Outpt Est 10 Min	$81.90	$126.00	—	—	35%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 Treatment Room II	$87.92	$135.26	—	—	35%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Telehealth Home Visit 99212	$327.60	$504.00	—	—	35%
Specialist consultation, low complexity or 30+ minutes CPT 99243 99243P Outpatient Consultations Moderate Complexity	$206.21	$317.25	—	21% below	35%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 99243P Outpatient Consultations Moderate Complexity	$206.21	$317.25	—	—	35%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 99244P OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES	$410.96	$632.25	—	7% above	35%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES	$410.96	$632.25	—	7% above	35%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES	$410.96	$632.25	—	—	35%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 99244P OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES	$410.96	$632.25	—	—	35%
Speech and language evaluation CPT 92523 TELEHEALTH SLP Eval Lang Compreh,Express Unit	$518.05	$797.00	—	45% above	35%
Speech and language evaluation inpatient CPT 92523 TELEHEALTH SLP Eval Lang Compreh,Express Unit	$518.05	$797.00	—	—	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Therapeutic Activities Assistant Units	$76.21	$117.25	—	at median	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 REHAB 97530 GP Therapeutic Activities Each 15 Min	$76.21	$117.25	—	at median	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Therapeutic Activities Units	$76.21	$117.25	—	at median	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 REHAB 97530 GO Therapeutic Activities Each 15 Min	$76.21	$117.25	—	at median	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT Therapeutic Activity Units	$76.21	$117.25	—	at median	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT Therapeutic Activity Assistant Units	$76.21	$117.25	—	at median	35%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT Therapeutic Activities Units	$76.21	$117.25	—	—	35%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 REHAB 97530 GP Therapeutic Activities Each 15 Min	$76.21	$117.25	—	—	35%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT Therapeutic Activity Units	$76.21	$117.25	—	—	35%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT Therapeutic Activities Assistant Units	$76.21	$117.25	—	—	35%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT Therapeutic Activity Assistant Units	$76.21	$117.25	—	—	35%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 REHAB 97530 GO Therapeutic Activities Each 15 Min	$76.21	$117.25	—	—	35%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy, Ther	$105.62	$162.50	—	32% below	35%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 99195 Phlebotomy Therapeutic TR	$118.46	$182.25	—	23% below	35%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Phlebotomy, Ther	$105.62	$162.50	—	—	35%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 99195 Phlebotomy Therapeutic TR	$118.46	$182.25	—	—	35%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 varicella virus vaccine live vial	$215.34	$331.29	—	at median	35%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 varicella virus vaccine live vial	$215.34	$331.29	—	—	35%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 human papillomavirus vaccine 9-valent susp 0.5mL	$350.30	$538.93	—	6% above	35%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 human papillomavirus vaccine 9-valent susp 0.5mL	$350.30	$538.93	—	—	35%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 influenza vacc (Fluzone HD) high-dose PF, 65 years & over 0.5mL	$43.34	$66.67	—	43% below	35%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 influenza vacc (Fluzone HD) high-dose PF, 65 years & over 0.5mL	$43.34	$66.67	—	—	35%
MMR vaccine (measles, mumps and rubella), live CPT 90707 measles-mumps-rubella vaccine	$112.41	$172.94	—	3% below	35%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 measles-mumps-rubella vaccine	$112.41	$172.94	—	—	35%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 meningococcal group B (Bexsero) vaccine recombinant 0.5mL	$208.86	$321.32	—	25% below	35%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 meningococcal group B (Bexsero) vaccine recombinant 0.5mL	$208.86	$321.32	—	—	35%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcal 20-valent conjugate vaccine 0.5mL	$315.55	$485.46	—	at median	35%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumococcal 20-valent conjugate vaccine 0.5mL	$315.55	$485.46	—	—	35%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 nirsevimab (cvx 306) alip PF 50mg/0.5mL inj	$1,741.06	$2,678.56	—	43% above	35%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 nirsevimab (cvx 306) alip PF 50mg/0.5mL inj	$1,741.06	$2,678.56	—	—	35%
Rabies vaccine, one dose CPT 90675 rabies vacc, chick embryo, 2.5 Unit(s)/1mL (G/K)	$414.40	$637.54	—	5% below	35%
Rabies vaccine, one dose CPT 90675 rabies vaccine, human diploid cell 2.5 Unit(s)/1mL (G/K)	$528.42	$812.96	—	21% above	35%
Rabies vaccine, one dose inpatient CPT 90675 rabies vacc, chick embryo, 2.5 Unit(s)/1mL (G/K)	$414.40	$637.54	—	—	35%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, human diploid cell 2.5 Unit(s)/1mL (G/K)	$528.42	$812.96	—	—	35%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 tetanus-diphtheria (Tenivac) 5-2LFU/ 0.5mL 7 years and over	$45.32	$69.72	—	28% below	35%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 tetanus-diphtheria (Tenivac) 5-2LFU/ 0.5mL 7 years and over	$45.32	$69.72	—	—	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphtheria/pertussis, acel/ adult (Adacel)	$58.45	$89.92	—	43% below	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus/diphtheria/pertussis, acel/ adult (Adacel)	$58.45	$89.92	—	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 PED Total Quantity 90471 - SL	$13.86	$21.32	—	67% below	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471-SL Imadm Prq Id Subq/Im Njxs 1 Vacc VFC	$13.86	$21.32	—	67% below	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Administration Fee-Pneumococcal	$22.10	$34.00	—	47% below	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 Admin Vaccine Initial IM/SQ	$22.10	$34.00	—	47% below	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Administration Fee-Influenza	$22.10	$34.00	—	47% below	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Administration Fee - Hep B	$22.10	$34.00	—	47% below	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 PED Total Quantity 90471	$22.10	$34.00	—	47% below	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471-SL Imadm Prq Id Subq/Im Njxs 1 Vacc VFC	$13.86	$21.32	—	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 PED Total Quantity 90471 - SL	$13.86	$21.32	—	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Administration Fee-Pneumococcal	$22.10	$34.00	—	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 PED Total Quantity 90471	$22.10	$34.00	—	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 Admin Vaccine Initial IM/SQ	$22.10	$34.00	—	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Administration Fee-Influenza	$22.10	$34.00	—	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Administration Fee - Hep B	$22.10	$34.00	—	—	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472-SL Imadm Prq Id Subq/Im Njxs Ea Vacc	$13.86	$21.32	—	54% below	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 PED Total Quantity 90472 - SL	$13.86	$21.32	—	54% below	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 PED Total Quantity 90472	$19.50	$30.00	—	36% below	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Administration Second Immunization	$20.64	$31.75	—	32% below	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Administration - Hep B Addnl Inj	$20.64	$31.75	—	32% below	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Admin Fee - Flu Second Admin	$20.64	$31.75	—	32% below	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 Admin Vaccine Ea Addnl IM/SQ	$46.48	$71.50	—	53% above	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 PED Total Quantity 90472 - SL	$13.86	$21.32	—	—	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472-SL Imadm Prq Id Subq/Im Njxs Ea Vacc	$13.86	$21.32	—	—	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 PED Total Quantity 90472	$19.50	$30.00	—	—	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Administration - Hep B Addnl Inj	$20.64	$31.75	—	—	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Administration Second Immunization	$20.64	$31.75	—	—	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Admin Fee - Flu Second Admin	$20.64	$31.75	—	—	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472 Admin Vaccine Ea Addnl IM/SQ	$46.48	$71.50	—	—	35%

Source file: https://HospitalPriceDisclosure.com/Download.aspx?pi=hHEPHhBKSCnwV0CWZsIVig*-*