Hospital Kalispell, MT

Logan Health Medical Center

Logan Health Medical Center in Kalispell, MT publishes cash prices for 335 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 268 of 331 procedures and above it for 61. By typical cash price it ranks #1 of 23 Montana hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

310 Sunnyview Lane, Kalispell, MT 59901 Collected Sep 29, 2026 Source price file (406) 752-5111

Acute care hospital Emergency department CMS star rating 3 of 5 CCN 270051 · CMS hospital register

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 2 actions for a hospital named Logan Health Medical Center in Kalispell, MT:

Feb 13, 2023 Warning notice
Oct 19, 2023 Case closed

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 both sides CPT 73610 ANKLE 3V, COMPLETE BILAT	$297.05	$457.00	—	—	35%
Ankle X-ray, complete, 3 or more views CPT 73610 X-RAY ANKLE MINIMUM OF 3 V	$36.40	$56.00	—	80% below	35%
Ankle X-ray, complete, 3 or more views CPT 73610 ANKLE, MIN 3 VIEWS	$175.34	$269.75	—	4% below	35%
Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 ANKLE 3V, COMPLETE BILAT	$297.05	$457.00	—	—	35%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 X-RAY ANKLE MINIMUM OF 3 V	$36.40	$56.00	—	—	35%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 ANKLE, MIN 3 VIEWS	$175.34	$269.75	—	—	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 NON-INVAS PHYSIO STDY OF EXTR	$108.55	$167.00	—	61% below	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ANKLE / BRACHIAL INDICES; BILA	$317.20	$488.00	—	13% above	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 NON-INVAS PHYSIO STDY OF EXTR	$108.55	$167.00	—	—	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 ANKLE / BRACHIAL INDICES; BILA	$317.20	$488.00	—	—	35%
Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGRAM - IMAGING EXAM	$368.71	$567.25	—	4% above	35%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGRAM - IMAGING EXAM	$368.71	$567.25	—	—	35%
Bone scan, whole body (nuclear medicine) CPT 78306 BONE SCAN, COMPLETE	$1,494.84	$2,299.75	—	26% above	35%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE SCAN, COMPLETE	$1,494.84	$2,299.75	—	—	35%
Breast ultrasound, complete, one breast both sides CPT 76641 US BREAST COMPLETE BILATERAL	$348.08	$535.50	—	—	35%
Breast ultrasound, complete, one breast CPT 76641 ULTRASOUND BREAST COMPLETE	$53.95	$83.00	—	74% below	35%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST UNILATERAL	$219.21	$337.25	—	7% above	35%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMPLETE UNILATERAL	$219.21	$337.25	—	7% above	35%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 US BREAST COMPLETE BILATERAL	$348.08	$535.50	—	—	35%
Breast ultrasound, complete, one breast inpatient CPT 76641 ULTRASOUND BREAST COMPLETE	$53.95	$83.00	—	—	35%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMPLETE UNILATERAL	$219.21	$337.25	—	—	35%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST UNILATERAL	$219.21	$337.25	—	—	35%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 US BREAST LIMITED BILATERAL	$245.86	$378.25	—	—	35%
Breast ultrasound, limited (one breast or one area) CPT 76642 ULTRASOUND BREAST LIMITED	$50.70	$78.00	—	78% below	35%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED UNILATERAL	$200.52	$308.50	—	13% below	35%
Breast ultrasound, limited (one breast or one area) inpatient both sides CPT 76642 US BREAST LIMITED BILATERAL	$245.86	$378.25	—	—	35%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 ULTRASOUND BREAST LIMITED	$50.70	$78.00	—	—	35%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED UNILATERAL	$200.52	$308.50	—	—	35%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST INCLUDING RECONS	$1,525.06	$2,346.25	—	27% below	35%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST INCLUDING RECONS	$1,525.06	$2,346.25	—	—	35%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT ANGIO HRT W/3D IMAGE	$174.20	$268.00	—	62% below	35%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT ANGIO HRT W/3D IMAGE	$174.20	$268.00	—	—	35%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HRT W/O DYE W/CA TEST	$43.55	$67.00	—	82% below	35%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HEART W/O CONTRAST-CALCIUM	$412.26	$634.25	—	72% above	35%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT HRT W/O DYE W/CA TEST	$43.55	$67.00	—	—	35%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT HEART W/O CONTRAST-CALCIUM	$412.26	$634.25	—	—	35%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD/PELV W/O: TRAUMA	$1,837.71	$2,827.25	—	9% below	35%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD&PELVIS W/O CONTRAST	$1,837.71	$2,827.25	—	9% below	35%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD/PELV W/O: TRAUMA	$1,837.71	$2,827.25	—	—	35%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD&PELVIS W/O CONTRAST	$1,837.71	$2,827.25	—	—	35%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD&PELVIS WITH CONTRAST	$2,113.31	$3,251.25	—	24% below	35%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PELV W/CON: TRAUMA	$2,113.31	$3,251.25	—	24% below	35%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD&PELVIS WITH CONTRAST	$2,113.31	$3,251.25	—	—	35%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PELV W/CON: TRAUMA	$2,113.31	$3,251.25	—	—	35%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD & PELV W/ & W/O CON-NM	$2,430.35	$3,739.00	—	22% below	35%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD&PELVIS W&W/O CONTRAST	$2,430.35	$3,739.00	—	22% below	35%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD & PELV W/ & W/O CON-NM	$2,430.35	$3,739.00	—	—	35%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD&PELVIS W&W/O CONTRAST	$2,430.35	$3,739.00	—	—	35%
CT scan of the abdomen with contrast CPT 74160 CT ABD W/	$955.18	$1,469.50	—	42% below	35%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABD W/	$955.18	$1,469.50	—	—	35%
CT scan of the abdomen without contrast CPT 74150 CT ABD W/O CONTRAST - LIMITED	$659.75	$1,015.00	—	49% below	35%
CT scan of the abdomen without contrast CPT 74150 CT ABD W/O	$830.54	$1,277.75	—	36% below	35%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABD W/O CONTRAST - LIMITED	$659.75	$1,015.00	—	—	35%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABD W/O	$830.54	$1,277.75	—	—	35%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O	$933.72	$1,436.50	—	20% below	35%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O: TRAUMA	$933.72	$1,436.50	—	20% below	35%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O: TRAUMA	$933.72	$1,436.50	—	—	35%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O	$933.72	$1,436.50	—	—	35%
CT scan of the head with contrast CPT 70460 CT HEAD W/	$1,073.64	$1,651.75	—	20% below	35%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W/	$1,073.64	$1,651.75	—	—	35%
CT scan of the head without and with contrast CPT 70470 CT HEAD W/O AND W/	$1,234.51	$1,899.25	—	32% below	35%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W/O AND W/	$1,234.51	$1,899.25	—	—	35%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O	$1,055.44	$1,623.75	—	24% below	35%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O	$1,055.44	$1,623.75	—	—	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE W/O	$1,125.15	$1,731.00	—	19% below	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERV SPINE W/O: TRAUMA	$1,125.15	$1,731.00	—	19% below	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CHEST/ABD W/O	$1,172.92	$1,804.50	—	16% below	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CHEST ABD/PELVIS WO	$1,172.92	$1,804.50	—	16% below	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CHEST/ABD WITH	$1,172.92	$1,804.50	—	16% below	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT TRAUMA W/WO CONTRAST	$1,172.92	$1,804.50	—	16% below	35%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE W/O	$1,125.15	$1,731.00	—	—	35%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERV SPINE W/O: TRAUMA	$1,125.15	$1,731.00	—	—	35%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT TRAUMA W/WO CONTRAST	$1,172.92	$1,804.50	—	—	35%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CHEST ABD/PELVIS WO	$1,172.92	$1,804.50	—	—	35%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CHEST/ABD W/O	$1,172.92	$1,804.50	—	—	35%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CHEST/ABD WITH	$1,172.92	$1,804.50	—	—	35%
CT scan of the pelvis, with contrast dye both sides CPT 72193 CT BILATERAL SI JOINT W/CON	$1,659.12	$2,552.50	—	—	35%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS LIMITED W/CONTRAST	$829.89	$1,276.75	—	42% below	35%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS (SI) JOINT W/CON	$1,044.71	$1,607.25	—	27% below	35%
CT scan of the pelvis, with contrast dye inpatient both sides CPT 72193 CT BILATERAL SI JOINT W/CON	$1,659.12	$2,552.50	—	—	35%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS LIMITED W/CONTRAST	$829.89	$1,276.75	—	—	35%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS (SI) JOINT W/CON	$1,044.71	$1,607.25	—	—	35%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 EXTRACRANIAL STUDY, BILAT	$237.25	$365.00	—	—	35%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 CAROTID, BILATERAL COMPLETE	$523.74	$805.75	—	—	35%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 EXTRACRANIAL STUDY, BILAT	$237.25	$365.00	—	—	35%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 CAROTID, BILATERAL COMPLETE	$523.74	$805.75	—	—	35%
Chest X-ray, 2 views CPT 71046 CHEST X-RAY: 2 VIEWS	$142.84	$219.75	—	25% below	35%
Chest X-ray, 2 views inpatient CPT 71046 CHEST X-RAY: 2 VIEWS	$142.84	$219.75	—	—	35%
Chest X-ray, single view CPT 71045 X-RAY EXAM CHEST 1 VIEW	$40.30	$62.00	—	78% below	35%
Chest X-ray, single view CPT 71045 CHEST X-RAY: SINGLE VIEW	$136.34	$209.75	—	24% below	35%
Chest X-ray, single view inpatient CPT 71045 X-RAY EXAM CHEST 1 VIEW	$40.30	$62.00	—	—	35%
Chest X-ray, single view inpatient CPT 71045 CHEST X-RAY: SINGLE VIEW	$136.34	$209.75	—	—	35%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 RETROPERITONEAL; COMPLETE	$431.76	$664.25	—	2% below	35%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 RETROPERITONEAL; COMPLETE	$431.76	$664.25	—	—	35%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA SCAN; (HIP/PELVIS/SPINE)	$172.74	$265.75	—	47% below	35%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA SCAN; (HIP/PELVIS/SPINE)	$172.74	$265.75	—	—	35%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA BONE DENSITY PERIPHERAL	$33.80	$52.00	—	76% below	35%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DEXA SCAN; (WRIST/RADIUS/HEEL)	$46.96	$72.25	—	67% below	35%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DXA BONE DENSITY PERIPHERAL	$33.80	$52.00	—	—	35%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DEXA SCAN; (WRIST/RADIUS/HEEL)	$46.96	$72.25	—	—	35%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 OB US DETAILED SNGL FETUS	$139.75	$215.00	—	35% below	35%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US-OB, > 14 WEEKS,COMPLETE	$311.68	$479.50	—	46% above	35%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 OB US DETAILED SNGL FETUS	$139.75	$215.00	—	—	35%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US-OB, > 14 WEEKS,COMPLETE	$311.68	$479.50	—	—	35%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O	$860.44	$1,323.75	—	35% below	35%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O: TRAUMA	$860.44	$1,323.75	—	35% below	35%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O	$860.44	$1,323.75	—	—	35%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O: TRAUMA	$860.44	$1,323.75	—	—	35%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/CON: TRAUMA	$1,250.28	$1,923.50	—	24% below	35%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST WITH CONTRAST	$1,250.28	$1,923.50	—	24% below	35%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST WITH CONTRAST	$1,250.28	$1,923.50	—	—	35%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/CON: TRAUMA	$1,250.28	$1,923.50	—	—	35%
Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO INCL CAD BI	$73.45	$113.00	—	—	35%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DX MAMMO INCL CAD BI	$73.45	$113.00	—	—	35%
Diagnostic mammogram, one breast CPT 77065 DX MAMMO INCL CAD UNI	$59.80	$92.00	—	73% below	35%
Diagnostic mammogram, one breast inpatient CPT 77065 DX MAMMO INCL CAD UNI	$59.80	$92.00	—	—	35%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 BILATERAL LOWER EXT ARTERIAL	$834.76	$1,284.25	—	—	35%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 BILATERAL LOWER EXT ARTERIAL	$834.76	$1,284.25	—	—	35%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VEIN MAPPING; EXTREMITY;BILAT	$1,097.69	$1,688.75	—	—	35%
Duplex ultrasound of the leg veins, both legs CPT 93970 EXTREMITY STUDY	$236.60	$364.00	—	69% below	35%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 VEIN MAPPING; EXTREMITY;BILAT	$1,097.69	$1,688.75	—	—	35%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 EXTREMITY STUDY	$236.60	$364.00	—	—	35%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE W/DOPPLER, COMPLETE	$195.65	$301.00	—	87% below	35%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 TTE W/DOPPLER, COMPLETE	$195.65	$301.00	—	—	35%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HIDA SCAN	$1,359.96	$2,092.25	—	27% above	35%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HIDA SCAN	$1,359.96	$2,092.25	—	—	35%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STDY, UNATTEND W/RSP EFF	$173.71	$267.25	—	43% below	35%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STDY, UNATTEND W/RSP EFF	$173.71	$267.25	—	—	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNO,SLEEP,4 ADD'L W/CPAP	$2,000.70	$3,078.00	—	6% above	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNO, SLEEP STAGING W/CP	$2,000.70	$3,078.00	—	6% above	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNO, SLEEP STAGING W/CP	$2,000.70	$3,078.00	—	—	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNO,SLEEP,4 ADD'L W/CPAP	$2,000.70	$3,078.00	—	—	35%
Knee X-ray, 3 views both sides CPT 73562 BILATERAL KNEE - 3 VIEWS	$295.59	$454.75	—	—	35%
Knee X-ray, 3 views CPT 73562 X-RAY EXAM OF KNEE 3 VIEWS	$40.95	$63.00	—	77% below	35%
Knee X-ray, 3 views inpatient both sides CPT 73562 BILATERAL KNEE - 3 VIEWS	$295.59	$454.75	—	—	35%
Knee X-ray, 3 views inpatient CPT 73562 X-RAY EXAM OF KNEE 3 VIEWS	$40.95	$63.00	—	—	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ULTRASOUND-ABD LIMITED	$408.36	$628.25	—	3% above	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD REAL TIME W/LIMTD IMAGE	$480.35	$739.00	—	21% above	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ULTRASOUND-ABD LIMITED	$408.36	$628.25	—	—	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD REAL TIME W/LIMTD IMAGE	$480.35	$739.00	—	—	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CANCER SCR C-	$79.30	$122.00	—	81% below	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CX SCRN W/O CON	$515.29	$792.75	—	23% above	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LUNG CANCER SCR C-	$79.30	$122.00	—	—	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LUNG CX SCRN W/O CON	$515.29	$792.75	—	—	35%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI BREAST W/ CON; BILAT	$2,362.59	$3,634.75	—	—	35%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI BREAST W/ & W/O CON; BILAT	$2,877.22	$4,426.50	—	—	35%
MRI of both breasts, without and then with contrast dye CPT 77049 MRI, BREAST W/ & W/O CON, BIL	$2,717.00	$4,180.00	—	44% above	35%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 MRI BREAST W/ CON; BILAT	$2,362.59	$3,634.75	—	—	35%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 MRI BREAST W/ & W/O CON; BILAT	$2,877.22	$4,426.50	—	—	35%
MRI of both breasts, without and then with contrast dye inpatient CPT 77049 MRI, BREAST W/ & W/O CON, BIL	$2,717.00	$4,180.00	—	—	35%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWER EXT/JOINT W/O	$1,113.78	$1,713.50	—	36% below	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOWER EXT/JOINT W/O	$1,113.78	$1,713.50	—	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOWER EXT/JOINT W/O & W	$2,062.78	$3,173.50	—	22% below	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOWER EXT/JOINT W/O & W	$2,062.78	$3,173.50	—	—	35%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O	$1,350.86	$2,078.25	—	25% below	35%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O	$1,350.86	$2,078.25	—	—	35%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/ & W/O	$2,175.71	$3,347.25	—	25% below	35%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/ & W/O	$2,175.71	$3,347.25	—	—	35%
MRI of the brain, no contrast dye CPT 70551 MRI HEAD W/O LIMITED	$1,159.44	$1,783.75	—	35% below	35%
MRI of the brain, no contrast dye CPT 70551 MRI HEAD W/O	$1,459.41	$2,245.25	—	18% below	35%
MRI of the brain, no contrast dye CPT 70551 MRA RUNOFF WITH CONTRAST	$1,521.81	$2,341.25	—	14% below	35%
MRI of the brain, no contrast dye CPT 70551 MRI COMPRESSION FX SURV (T/L)	$1,521.81	$2,341.25	—	14% below	35%
MRI of the brain, no contrast dye CPT 70551 MRI CORD SURVEY W/O (C/T)	$1,521.81	$2,341.25	—	14% below	35%
MRI of the brain, no contrast dye CPT 70551 MRI CORD SURVEY WITH (C/T)	$1,521.81	$2,341.25	—	14% below	35%
MRI of the brain, no contrast dye CPT 70551 MRI CORD SURVEY W/O (C/T/L)	$1,521.81	$2,341.25	—	14% below	35%
MRI of the brain, no contrast dye CPT 70551 MRI CORD SURVEY W/WO (C/T)	$1,521.81	$2,341.25	—	14% below	35%
MRI of the brain, no contrast dye CPT 70551 MRI CORD SURVEY W/W/O (C/T/L)	$1,521.81	$2,341.25	—	14% below	35%
MRI of the brain, no contrast dye CPT 70551 MRI LOWER EXT/JOINT W/O BIL	$1,521.81	$2,341.25	—	14% below	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI HEAD W/O LIMITED	$1,159.44	$1,783.75	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI HEAD W/O	$1,459.41	$2,245.25	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI CORD SURVEY W/O (C/T/L)	$1,521.81	$2,341.25	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI CORD SURVEY W/WO (C/T)	$1,521.81	$2,341.25	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI CORD SURVEY W/O (C/T)	$1,521.81	$2,341.25	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI COMPRESSION FX SURV (T/L)	$1,521.81	$2,341.25	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI CORD SURVEY W/W/O (C/T/L)	$1,521.81	$2,341.25	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI CORD SURVEY WITH (C/T)	$1,521.81	$2,341.25	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI LOWER EXT/JOINT W/O BIL	$1,521.81	$2,341.25	—	—	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRA RUNOFF WITH CONTRAST	$1,521.81	$2,341.25	—	—	35%
MRI of the brain, with and without contrast dye CPT 70553 MRI HEAD W & W/O	$2,144.84	$3,299.75	—	24% below	35%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI HEAD W & W/O	$2,144.84	$3,299.75	—	—	35%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O LIMITED	$1,056.74	$1,625.75	—	39% below	35%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O	$1,332.82	$2,050.50	—	24% below	35%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O LIMITED	$1,056.74	$1,625.75	—	—	35%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O	$1,332.82	$2,050.50	—	—	35%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W/&WO LIMITED	$2,158.00	$3,320.00	—	19% below	35%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W/ & W/O	$2,222.51	$3,419.25	—	16% below	35%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE W/&WO LIMITED	$2,158.00	$3,320.00	—	—	35%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE W/ & W/O	$2,222.51	$3,419.25	—	—	35%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE W/O LIMITED	$1,060.80	$1,632.00	—	39% below	35%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE W/O	$1,335.59	$2,054.75	—	24% below	35%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE W/O LIMITED	$1,060.80	$1,632.00	—	—	35%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE W/O	$1,335.59	$2,054.75	—	—	35%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL W/& W/O LIMITED	$1,739.89	$2,676.75	—	35% below	35%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL SPINE W& W/O	$2,018.90	$3,106.00	—	25% below	35%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERVICAL W/& W/O LIMITED	$1,739.89	$2,676.75	—	—	35%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERVICAL SPINE W& W/O	$2,018.90	$3,106.00	—	—	35%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL W/O LIMITED	$1,002.62	$1,542.50	—	43% below	35%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE W/O	$1,197.79	$1,842.75	—	32% below	35%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL W/O LIMITED	$1,002.62	$1,542.50	—	—	35%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL SPINE W/O	$1,197.79	$1,842.75	—	—	35%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/ & W/O	$2,370.22	$3,646.50	—	15% below	35%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/ & W/O	$2,370.22	$3,646.50	—	—	35%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O	$1,532.86	$2,358.25	—	17% below	35%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O	$1,532.86	$2,358.25	—	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UPPER EXT/JOINT W/O	$1,127.75	$1,735.00	—	27% below	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UPPER EXT/JOINT W/O	$1,127.75	$1,735.00	—	—	35%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 MYCARDIAL PERFUSION SPECT	$3,211.16	$4,940.25	—	56% above	35%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 MYCARDIAL PERFUSION SPECT	$3,211.16	$4,940.25	—	—	35%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET; SKULLBASE MID THIGH W CT	$6,660.06	$10,246.25	—	22% above	35%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET; SKULLBASE MID THIGH W CT	$6,660.06	$10,246.25	—	—	35%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC (NONOBSTETRIC) S&I	$198.25	$305.00	—	34% below	35%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 PELVIS US, LIMITED	$241.15	$371.00	—	20% below	35%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC (NONOBSTETRIC) S&I	$198.25	$305.00	—	—	35%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 PELVIS US, LIMITED	$241.15	$371.00	—	—	35%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 PELVIS US, COMPLETE	$468.65	$721.00	—	3% below	35%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 PELVIS US, COMPLETE	$468.65	$721.00	—	—	35%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US >= 14 WKS SNGL FETUS	$72.80	$112.00	—	82% below	35%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB U/S >/= 14 WKS, SINGLE FET	$72.80	$112.00	—	82% below	35%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB ULTRASOUND > 14 WEEKS	$400.56	$616.25	—	4% below	35%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB U/S >/= 14 WKS, SINGLE FET	$72.80	$112.00	—	—	35%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US >= 14 WKS SNGL FETUS	$72.80	$112.00	—	—	35%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB ULTRASOUND > 14 WEEKS	$400.56	$616.25	—	—	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB U/S <14 WKS, SINGLE FETUS	$58.50	$90.00	—	85% below	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US < 14 WKS SINGLE FETUS	$72.80	$112.00	—	81% below	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB < 14 WEEKS	$322.08	$495.50	—	15% below	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB U/S <14 WKS, SINGLE FETUS	$58.50	$90.00	—	—	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB US < 14 WKS SINGLE FETUS	$72.80	$112.00	—	—	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB < 14 WEEKS	$322.08	$495.50	—	—	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB U/S, LIMITED, FETUS (S)	$41.60	$64.00	—	84% below	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB US LIMITED FETUS(S)	$48.75	$75.00	—	81% below	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US-OB LIMITED	$284.05	$437.00	—	8% above	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 OB U/S, LIMITED, FETUS (S)	$41.60	$64.00	—	—	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 OB US LIMITED FETUS(S)	$48.75	$75.00	—	—	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US-OB LIMITED	$284.05	$437.00	—	—	35%
Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO BI INCL CAD	$56.55	$87.00	—	—	35%
Screening mammogram, both breasts inpatient both sides CPT 77067 SCR MAMMO BI INCL CAD	$56.55	$87.00	—	—	35%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 X-SRAY SHOULDER COMP, BILAT	$295.59	$454.75	—	—	35%
Shoulder X-ray, complete, 2 or more views CPT 73030 X-RAY EXAM OF SHOULDER 2 VIEWS	$30.55	$47.00	—	84% below	35%
Shoulder X-ray, complete, 2 or more views CPT 73030 X-RAY SHOULDER COMPLETE 2+VIEW	$172.74	$265.75	—	10% below	35%
Shoulder X-ray, complete, 2 or more views inpatient both sides CPT 73030 X-SRAY SHOULDER COMP, BILAT	$295.59	$454.75	—	—	35%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 X-RAY EXAM OF SHOULDER 2 VIEWS	$30.55	$47.00	—	—	35%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 X-RAY SHOULDER COMPLETE 2+VIEW	$172.74	$265.75	—	—	35%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNO, SLEEP STAGING	$857.84	$1,319.75	—	51% below	35%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNO,SLEEP,4 ADD'L PARAME	$1,822.76	$2,804.25	—	5% above	35%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNO, SLEEP STAGING	$857.84	$1,319.75	—	—	35%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNO,SLEEP,4 ADD'L PARAME	$1,822.76	$2,804.25	—	—	35%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 STRESS TTE, COMPLETE	$215.80	$332.00	—	77% below	35%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 STRESS TTE, COMPLETE	$215.80	$332.00	—	—	35%
Swallow study (modified barium swallow, video X-ray) CPT 74230 VIDEO ESOPHAGRAM	$382.52	$588.50	—	2% below	35%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 VIDEO ESOPHAGRAM	$382.52	$588.50	—	—	35%
Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US NON-OB	$51.35	$79.00	—	85% below	35%
Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US	$299.65	$461.00	—	14% below	35%
Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL US NON-OB	$51.35	$79.00	—	—	35%
Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL US	$299.65	$461.00	—	—	35%
Transvaginal ultrasound during pregnancy CPT 76817 TRANSVAGINAL U/S, OB	$47.45	$73.00	—	87% below	35%
Transvaginal ultrasound during pregnancy CPT 76817 TRANSVAGINAL US OBSTETRIC	$55.90	$86.00	—	85% below	35%
Transvaginal ultrasound during pregnancy CPT 76817 OB-US TRANSVAG	$362.38	$557.50	—	1% below	35%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 TRANSVAGINAL U/S, OB	$47.45	$73.00	—	—	35%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 TRANSVAGINAL US OBSTETRIC	$55.90	$86.00	—	—	35%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 OB-US TRANSVAG	$362.38	$557.50	—	—	35%
Ultrasound of the abdomen, complete CPT 76700 ABDOMINAL US, COMPLETE	$498.39	$766.75	—	5% below	35%
Ultrasound of the abdomen, complete inpatient CPT 76700 ABDOMINAL US, COMPLETE	$498.39	$766.75	—	—	35%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTAL	$460.85	$709.00	—	1% below	35%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTAL	$460.85	$709.00	—	—	35%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US EXAM HEAD & NECK	$247.98	$381.50	—	42% below	35%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US EXAM HEAD & NECK	$247.98	$381.50	—	—	35%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UGI WITHOUT KUB	$433.55	$667.00	—	2% below	35%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UGI WITHOUT KUB	$433.55	$667.00	—	—	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 EXTREMITY STUDY	$144.95	$223.00	—	71% below	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 VEIN MAPPING; EXTREMITY; UNI	$509.28	$783.50	—	2% above	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 EXTREMITY STUDY	$144.95	$223.00	—	—	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 VEIN MAPPING; EXTREMITY; UNI	$509.28	$783.50	—	—	35%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 BILATERAL WRIST MIN 3 VIEWS	$231.24	$355.75	—	—	35%
Wrist X-ray, complete, 3 or more views CPT 73110 X-RAY EXAM OF WRIST, 3-4 VIEWS	$40.95	$63.00	—	80% below	35%
Wrist X-ray, complete, 3 or more views CPT 73110 WRIST, MIN 3 VIEWS	$182.32	$280.50	—	12% below	35%
Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 BILATERAL WRIST MIN 3 VIEWS	$231.24	$355.75	—	—	35%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 X-RAY EXAM OF WRIST, 3-4 VIEWS	$40.95	$63.00	—	—	35%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 WRIST, MIN 3 VIEWS	$182.32	$280.50	—	—	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HIP, MIN 2 VIEWS	$159.90	$246.00	—	17% below	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 X-RAY, HIP UNILAT, W/PELVIS, 2	$46.80	$72.00	—	76% below	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HIP, MIN 2 VIEWS	$159.90	$246.00	—	—	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 X-RAY, HIP UNILAT, W/PELVIS, 2	$46.80	$72.00	—	—	35%
X-ray of the abdomen, 1 view CPT 74018 X-RAY EXAM ABDOMEN 1 VIEW	$41.60	$64.00	—	76% below	35%
X-ray of the abdomen, 1 view CPT 74018 X-RAY ABDOMEN; 1 VIEW	$149.99	$230.75	—	12% below	35%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN, 1 VIEW	$149.99	$230.75	—	12% below	35%
X-ray of the abdomen, 1 view inpatient CPT 74018 X-RAY EXAM ABDOMEN 1 VIEW	$41.60	$64.00	—	—	35%
X-ray of the abdomen, 1 view inpatient CPT 74018 X-RAY ABDOMEN; 1 VIEW	$149.99	$230.75	—	—	35%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN, 1 VIEW	$149.99	$230.75	—	—	35%
X-ray of the ankle, 2 views both sides CPT 73600 ANKLE, 2 VIEW BILAT	$272.51	$419.25	—	—	35%
X-ray of the ankle, 2 views CPT 73600 X-RAY EXAM OF ANKLE 2 VIEWS	$33.15	$51.00	—	80% below	35%
X-ray of the ankle, 2 views CPT 73600 ANKLE, 2 VIEWS	$138.29	$212.75	—	15% below	35%
X-ray of the ankle, 2 views inpatient both sides CPT 73600 ANKLE, 2 VIEW BILAT	$272.51	$419.25	—	—	35%
X-ray of the ankle, 2 views inpatient CPT 73600 X-RAY EXAM OF ANKLE 2 VIEWS	$33.15	$51.00	—	—	35%
X-ray of the ankle, 2 views inpatient CPT 73600 ANKLE, 2 VIEWS	$138.29	$212.75	—	—	35%
X-ray of the finger(s), 2 or more views CPT 73140 HAND, DIGIT	$166.08	$255.50	—	1% above	35%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HAND, DIGIT	$166.08	$255.50	—	—	35%
X-ray of the foot, 2 views both sides CPT 73620 FOOT 2 VIEW; BILATERAL	$186.71	$287.25	—	—	35%
X-ray of the foot, 2 views CPT 73620 X-RAY EXAM OF FOOT 2 VIEWS	$28.60	$44.00	—	80% below	35%
X-ray of the foot, 2 views CPT 73620 FOOT, 1 VIEW	$93.28	$143.50	—	36% below	35%
X-ray of the foot, 2 views CPT 73620 FOOT, 2 VIEWS	$117.65	$181.00	—	19% below	35%
X-ray of the foot, 2 views inpatient both sides CPT 73620 FOOT 2 VIEW; BILATERAL	$186.71	$287.25	—	—	35%
X-ray of the foot, 2 views inpatient CPT 73620 X-RAY EXAM OF FOOT 2 VIEWS	$28.60	$44.00	—	—	35%
X-ray of the foot, 2 views inpatient CPT 73620 FOOT, 1 VIEW	$93.28	$143.50	—	—	35%
X-ray of the foot, 2 views inpatient CPT 73620 FOOT, 2 VIEWS	$117.65	$181.00	—	—	35%
X-ray of the foot, complete, 3 or more views CPT 73630 X-RAY FOOT MINIMUM 3 VIEWS	$33.80	$52.00	—	83% below	35%
X-ray of the foot, complete, 3 or more views CPT 73630 FOOT, MIN 3 VIEWS	$163.48	$251.50	—	17% below	35%
X-ray of the foot, complete, 3 or more views CPT 73630 FOOT, MIN 3 VIEW-BIALTERAL	$295.10	$454.00	—	50% above	35%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 X-RAY FOOT MINIMUM 3 VIEWS	$33.80	$52.00	—	—	35%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 FOOT, MIN 3 VIEWS	$163.48	$251.50	—	—	35%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 FOOT, MIN 3 VIEW-BIALTERAL	$295.10	$454.00	—	—	35%
X-ray of the hand, 3 or more views CPT 73130 X-RAY EXAM OF HAND, 3 VIEWS	$36.40	$56.00	—	82% below	35%
X-ray of the hand, 3 or more views CPT 73130 HAND, MIN 3 VIEWS	$168.68	$259.50	—	18% below	35%
X-ray of the hand, 3 or more views inpatient CPT 73130 X-RAY EXAM OF HAND, 3 VIEWS	$36.40	$56.00	—	—	35%
X-ray of the hand, 3 or more views inpatient CPT 73130 HAND, MIN 3 VIEWS	$168.68	$259.50	—	—	35%
X-ray of the knee, 1 or 2 views both sides CPT 73560 BILAT KNEES 1 OR 2 VIEW	$240.18	$369.50	—	—	35%
X-ray of the knee, 1 or 2 views CPT 73560 X-RAY OF KNEE 1 OR 2 VIEWS	$35.10	$54.00	—	79% below	35%
X-ray of the knee, 1 or 2 views CPT 73560 KNEE, 1 OR 2 VIEWS	$151.29	$232.75	—	12% below	35%
X-ray of the knee, 1 or 2 views inpatient both sides CPT 73560 BILAT KNEES 1 OR 2 VIEW	$240.18	$369.50	—	—	35%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 X-RAY OF KNEE 1 OR 2 VIEWS	$35.10	$54.00	—	—	35%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 KNEE, 1 OR 2 VIEWS	$151.29	$232.75	—	—	35%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-RAY OF LOWER SPINE, 2 OR 3 V	$37.05	$57.00	—	84% below	35%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 SPINE, LUMBAR 2 OR 3 VIEWS	$186.88	$287.50	—	18% below	35%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 X-RAY OF LOWER SPINE, 2 OR 3 V	$37.05	$57.00	—	—	35%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 SPINE, LUMBAR 2 OR 3 VIEWS	$186.88	$287.50	—	—	35%
X-ray of the lower back, 4 or more views CPT 72110 X-RAY LOWER SPINE, 4 OR MORE V	$52.00	$80.00	—	83% below	35%
X-ray of the lower back, 4 or more views CPT 72110 SPINE, LUMBAR MIN 4 VIEWS	$245.86	$378.25	—	19% below	35%
X-ray of the lower back, 4 or more views inpatient CPT 72110 X-RAY LOWER SPINE, 4 OR MORE V	$52.00	$80.00	—	—	35%
X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE, LUMBAR MIN 4 VIEWS	$245.86	$378.25	—	—	35%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-RAY THORACIC SPINE, 2 VIEWS	$33.80	$52.00	—	84% below	35%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 SPINE, THORACIC 2 VIEWS	$180.54	$277.75	—	15% below	35%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 X-RAY THORACIC SPINE, 2 VIEWS	$33.80	$52.00	—	—	35%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 SPINE, THORACIC 2 VIEWS	$180.54	$277.75	—	—	35%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES, COMPLETE	$197.11	$303.25	—	5% below	35%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES, COMPLETE	$197.11	$303.25	—	—	35%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-RAY NECK SPINE, 2-3 VIEWS	$37.05	$57.00	—	83% below	35%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-RAY SPINE-CERVICAL- 2-3 VIEW	$169.32	$260.50	—	21% below	35%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 X-RAY NECK SPINE, 2-3 VIEWS	$37.05	$57.00	—	—	35%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 X-RAY SPINE-CERVICAL- 2-3 VIEW	$169.32	$260.50	—	—	35%
X-ray of the pelvis, 1 or 2 views CPT 72170 X-RAY PELVIS 1 OR 2 VIEWS	$35.75	$55.00	—	83% below	35%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS, 1 OR 2 VIEWS	$171.92	$264.50	—	18% below	35%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 X-RAY PELVIS 1 OR 2 VIEWS	$35.75	$55.00	—	—	35%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS, 1 OR 2 VIEWS	$171.92	$264.50	—	—	35%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM/COCCYX MIN 2 VIEWS	$202.31	$311.25	—	13% below	35%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM/COCCYX MIN 2 VIEWS	$202.31	$311.25	—	—	35%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINO (ALT) (SGPT)	$9.75	$15.00	—	79% below	35%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 CHEM-ALT (SGPT)	$32.01	$49.25	—	33% below	35%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALANINE AMINO (ALT) (SGPT)	$9.75	$15.00	—	—	35%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 CHEM-ALT (SGPT)	$32.01	$49.25	—	—	35%
AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE (AST) (SGOT)	$9.10	$14.00	—	80% below	35%
AST (aspartate aminotransferase) enzyme test CPT 84450 CHEM-AST (SGOT)	$34.94	$53.75	—	24% below	35%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSFERASE (AST) (SGOT)	$9.10	$14.00	—	—	35%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 CHEM-AST (SGOT)	$34.94	$53.75	—	—	35%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL	$81.90	$126.00	—	58% below	35%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL	$81.90	$126.00	—	—	35%
Allergy blood test, specific IgE, per allergen CPT 86003 REF- ALLERGEN, IGE	$6.99	$10.75	—	81% below	35%
Allergy blood test, specific IgE, per allergen CPT 86003 REF- NUT ALLERGEN, IGE	$6.99	$10.75	—	81% below	35%
Allergy blood test, specific IgE, per allergen CPT 86003 REF-ALLERGEN PANEL, IGE	$168.68	$259.50	—	355% above	35%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 REF- ALLERGEN, IGE	$6.99	$10.75	—	—	35%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 REF- NUT ALLERGEN, IGE	$6.99	$10.75	—	—	35%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 REF-ALLERGEN PANEL, IGE	$168.68	$259.50	—	—	35%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES	$21.45	$33.00	—	69% below	35%
Antinuclear antibody (ANA) blood test, screen CPT 86038 SER-ANA	$75.72	$116.50	—	9% above	35%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES	$21.45	$33.00	—	—	35%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 SER-ANA	$75.72	$116.50	—	—	35%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 CHEM-B NATRIURETIC PEPTIDE	$226.69	$348.75	—	10% above	35%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 CHEM-B NATRIURETIC PEPTIDE	$226.69	$348.75	—	—	35%
Basic metabolic panel (blood test) CPT 80048 METABOLIC PANEL TOT CA	$14.95	$23.00	—	83% below	35%
Basic metabolic panel (blood test) CPT 80048 CHEM-BASIC METABOLIC PANL	$53.14	$81.75	—	39% below	35%
Basic metabolic panel (blood test) inpatient CPT 80048 METABOLIC PANEL TOT CA	$14.95	$23.00	—	—	35%
Basic metabolic panel (blood test) inpatient CPT 80048 CHEM-BASIC METABOLIC PANL	$53.14	$81.75	—	—	35%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 PATH-G&M LEVEL IV 88305	$188.66	$290.25	—	30% above	35%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 REF-BONE MARROW BIOPSY	$342.71	$527.25	—	136% above	35%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 REF-BONE MARROW CLOT	$342.71	$527.25	—	136% above	35%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 REF - PARTICLE PREP	$342.71	$527.25	—	136% above	35%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 PATH-G&M LEVEL IV 88305	$188.66	$290.25	—	—	35%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 REF - PARTICLE PREP	$342.71	$527.25	—	—	35%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 REF-BONE MARROW BIOPSY	$342.71	$527.25	—	—	35%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 REF-BONE MARROW CLOT	$342.71	$527.25	—	—	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCT	$16.25	$25.00	—	9% below	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 LEGAL C EVID. COLL/BLD ALCOHOL	$18.36	$28.25	—	3% above	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE BLOOD DRAW-ED	$19.82	$30.50	—	11% above	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 MISC-COLLECT/VENIPUNCTURE	$21.78	$33.50	—	22% above	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 ROUTINE VENIPUNCT	$16.25	$25.00	—	—	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 LEGAL C EVID. COLL/BLD ALCOHOL	$18.36	$28.25	—	—	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE BLOOD DRAW-ED	$19.82	$30.50	—	—	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 MISC-COLLECT/VENIPUNCTURE	$21.78	$33.50	—	—	35%
Blood glucose (sugar) test CPT 82947 GLUCOSE; QUANTITATIVE BLOOD	$7.15	$11.00	—	80% below	35%
Blood glucose (sugar) test CPT 82947 CHEM-GLUCOSE	$17.55	$27.00	—	50% below	35%
Blood glucose (sugar) test CPT 82947 CHEM-GLUCOSE,QUANT	$45.50	$70.00	—	29% above	35%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE; QUANTITATIVE BLOOD	$7.15	$11.00	—	—	35%
Blood glucose (sugar) test inpatient CPT 82947 CHEM-GLUCOSE	$17.55	$27.00	—	—	35%
Blood glucose (sugar) test inpatient CPT 82947 CHEM-GLUCOSE,QUANT	$45.50	$70.00	—	—	35%
Blood lead test CPT 83655 ASSAY LEAD	$21.45	$33.00	—	64% below	35%
Blood lead test inpatient CPT 83655 ASSAY LEAD	$21.45	$33.00	—	—	35%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 GONADOTROPIN CHORIONIC QUAL	$13.65	$21.00	—	75% below	35%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 SER-HCG/QUAL/SERUM	$74.91	$115.25	—	36% above	35%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 GONADOTROPIN CHORIONIC QUAL	$13.65	$21.00	—	—	35%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 SER-HCG/QUAL/SERUM	$74.91	$115.25	—	—	35%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BB - REF ABO TESTING	$39.98	$61.50	—	53% below	35%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BB - REF ABO TESTING	$39.98	$61.50	—	—	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACT PROTEIN	$9.10	$14.00	—	81% below	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CRP-QUANTITATIVE	$65.16	$100.25	—	33% above	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 PNL CRP-QUANT	$89.38	$137.50	—	83% above	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 SER-CRP	$95.55	$147.00	—	95% above	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACT PROTEIN	$9.10	$14.00	—	—	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CRP-QUANTITATIVE	$65.16	$100.25	—	—	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 PNL CRP-QUANT	$89.38	$137.50	—	—	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 SER-CRP	$95.55	$147.00	—	—	35%
C. difficile toxin gene test (stool PCR) both sides CPT 87493 MLDX-C.DIFF 027-NAP1-BI, PROBE	$238.06	$366.25	—	—	35%
C. difficile toxin gene test (stool PCR) CPT 87493 MLDX-C.DIFF TOXIGENIC, PROBE.	$246.02	$378.50	—	40% above	35%
C. difficile toxin gene test (stool PCR) inpatient both sides CPT 87493 MLDX-C.DIFF 027-NAP1-BI, PROBE	$238.06	$366.25	—	—	35%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 MLDX-C.DIFF TOXIGENIC, PROBE.	$246.02	$378.50	—	—	35%
CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSY FOR TUM ANTIG CA12	$36.40	$56.00	—	67% below	35%
CA-125 blood test (ovarian cancer marker) CPT 86304 CHEM-CA 125	$98.64	$151.75	—	9% below	35%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 IMMUNOASSY FOR TUM ANTIG CA12	$36.40	$56.00	—	—	35%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CHEM-CA 125	$98.64	$151.75	—	—	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHYLMD TRACH AP TECHNI	$61.75	$95.00	—	32% below	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 MLDX-CHLAMYDIA TRACHOMATIS PCR	$161.04	$247.75	—	77% above	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 MLDX-PNL CHLAMYDIA TRACH PCR.	$169.81	$261.25	—	86% above	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHYLMD TRACH AP TECHNI	$61.75	$95.00	—	—	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 MLDX-CHLAMYDIA TRACHOMATIS PCR	$161.04	$247.75	—	—	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 MLDX-PNL CHLAMYDIA TRACH PCR.	$169.81	$261.25	—	—	35%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE	$23.40	$36.00	—	64% below	35%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 CHEM-LIPID PROFILE	$55.58	$85.50	—	16% below	35%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE	$23.40	$36.00	—	—	35%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 CHEM-LIPID PROFILE	$55.58	$85.50	—	—	35%
Complete blood count (CBC) with differential CPT 85025 COMPLETE BLOOD COUNT	$9.10	$14.00	—	86% below	35%
Complete blood count (CBC) with differential CPT 85025 HEME-PANEL CBC W/DIFF	$19.99	$30.75	—	70% below	35%
Complete blood count (CBC) with differential CPT 85025 HEME-CBC W/DIFF	$52.32	$80.50	—	22% below	35%
Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE BLOOD COUNT	$9.10	$14.00	—	—	35%
Complete blood count (CBC) with differential inpatient CPT 85025 HEME-PANEL CBC W/DIFF	$19.99	$30.75	—	—	35%
Complete blood count (CBC) with differential inpatient CPT 85025 HEME-CBC W/DIFF	$52.32	$80.50	—	—	35%
Complete blood count (CBC), no differential CPT 85027 CBC AUTO	$11.70	$18.00	—	73% below	35%
Complete blood count (CBC), no differential CPT 85027 HEM-PNL CBC W/OUT DIFF	$23.56	$36.25	—	45% below	35%
Complete blood count (CBC), no differential CPT 85027 HEME-CBC	$26.65	$41.00	—	38% below	35%
Complete blood count (CBC), no differential CPT 85027 HEME-CBC/AUTO HEMOGRAM	$40.62	$62.50	—	6% below	35%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC AUTO	$11.70	$18.00	—	—	35%
Complete blood count (CBC), no differential inpatient CPT 85027 HEM-PNL CBC W/OUT DIFF	$23.56	$36.25	—	—	35%
Complete blood count (CBC), no differential inpatient CPT 85027 HEME-CBC	$26.65	$41.00	—	—	35%
Complete blood count (CBC), no differential inpatient CPT 85027 HEME-CBC/AUTO HEMOGRAM	$40.62	$62.50	—	—	35%
Comprehensive metabolic panel (blood test) CPT 80053 COMPHENSIVE METABOLIC PANEL	$18.85	$29.00	—	82% below	35%
Comprehensive metabolic panel (blood test) CPT 80053 CHEM-COMP METABOLIC PANEL	$58.01	$89.25	—	46% below	35%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPHENSIVE METABOLIC PANEL	$18.85	$29.00	—	—	35%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 CHEM-COMP METABOLIC PANEL	$58.01	$89.25	—	—	35%
D-dimer blood test (blood clot marker) CPT 85379 CHEM-D-DIMER	$111.80	$172.00	—	8% above	35%
D-dimer blood test (blood clot marker) inpatient CPT 85379 CHEM-D-DIMER	$111.80	$172.00	—	—	35%
Estradiol blood test CPT 82670 ASSAY ESTRADIOL	$48.75	$75.00	—	60% below	35%
Estradiol blood test CPT 82670 CHEM-ESTRADIOL	$95.55	$147.00	—	21% below	35%
Estradiol blood test inpatient CPT 82670 ASSAY ESTRADIOL	$48.75	$75.00	—	—	35%
Estradiol blood test inpatient CPT 82670 CHEM-ESTRADIOL	$95.55	$147.00	—	—	35%
FSH (follicle-stimulating hormone) test CPT 83001 CHEM - FSH	$81.09	$124.75	—	28% below	35%
FSH (follicle-stimulating hormone) test CPT 83001 CHEM - PANEL FSH	$111.80	$172.00	—	at median	35%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 CHEM - FSH	$81.09	$124.75	—	—	35%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 CHEM - PANEL FSH	$111.80	$172.00	—	—	35%
Ferritin blood test (iron stores) CPT 82728 ASSAY FERRITIN	$24.05	$37.00	—	68% below	35%
Ferritin blood test (iron stores) CPT 82728 CHEM-FERRITIN	$70.36	$108.25	—	6% below	35%
Ferritin blood test (iron stores) inpatient CPT 82728 ASSAY FERRITIN	$24.05	$37.00	—	—	35%
Ferritin blood test (iron stores) inpatient CPT 82728 CHEM-FERRITIN	$70.36	$108.25	—	—	35%
Folate (folic acid) blood test CPT 82746 BLOOD FOLIC ACID SER	$26.00	$40.00	—	68% below	35%
Folate (folic acid) blood test CPT 82746 CHEM-FOLATE	$72.31	$111.25	—	11% below	35%
Folate (folic acid) blood test inpatient CPT 82746 BLOOD FOLIC ACID SER	$26.00	$40.00	—	—	35%
Folate (folic acid) blood test inpatient CPT 82746 CHEM-FOLATE	$72.31	$111.25	—	—	35%
Free T3 thyroid hormone test CPT 84481 CHEM-FREE T3	$66.46	$102.25	—	27% below	35%
Free T3 thyroid hormone test inpatient CPT 84481 CHEM-FREE T3	$66.46	$102.25	—	—	35%
Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE	$16.25	$25.00	—	77% below	35%
Free T4 (free thyroxine) thyroid blood test CPT 84439 REF-T4, FREE, DIRECT DIALYSIS	$24.54	$37.75	—	66% below	35%
Free T4 (free thyroxine) thyroid blood test CPT 84439 CHEM-FREE T4	$67.44	$103.75	—	6% below	35%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 ASSAY OF FREE THYROXINE	$16.25	$25.00	—	—	35%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 REF-T4, FREE, DIRECT DIALYSIS	$24.54	$37.75	—	—	35%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 CHEM-FREE T4	$67.44	$103.75	—	—	35%
Free testosterone test CPT 84402 ASSAY TESTOSTERONE FREE	$44.85	$69.00	—	63% below	35%
Free testosterone test inpatient CPT 84402 ASSAY TESTOSTERONE FREE	$44.85	$69.00	—	—	35%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL	$72.80	$112.00	—	73% below	35%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL	$72.80	$112.00	—	—	35%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE; POST GLUCOSE DOSE	$8.45	$13.00	—	85% below	35%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 CHEM-POST GLUCOSE DOSE	$53.14	$81.75	—	6% below	35%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE; POST GLUCOSE DOSE	$8.45	$13.00	—	—	35%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 CHEM-POST GLUCOSE DOSE	$53.14	$81.75	—	—	35%
Glucose tolerance test, 3 samples CPT 82951 CHEM-GLUCOSE TOLERANCE	$76.21	$117.25	—	6% below	35%
Glucose tolerance test, 3 samples CPT 82951 CHEM-LACTOSE TOLERANCE	$98.31	$151.25	—	21% above	35%
Glucose tolerance test, 3 samples inpatient CPT 82951 CHEM-GLUCOSE TOLERANCE	$76.21	$117.25	—	—	35%
Glucose tolerance test, 3 samples inpatient CPT 82951 CHEM-LACTOSE TOLERANCE	$98.31	$151.25	—	—	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE AMP PROBE TECH	$61.75	$95.00	—	38% below	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 MLDX-NEISSERIA GONORRHOEAE PCR	$130.32	$200.50	—	30% above	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 MLDX-PNL-NEISSERIA GONOR PCR.	$139.10	$214.00	—	39% above	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N.GONORRHOEAE AMP PROBE TECH	$61.75	$95.00	—	—	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 MLDX-NEISSERIA GONORRHOEAE PCR	$130.32	$200.50	—	—	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 MLDX-PNL-NEISSERIA GONOR PCR.	$139.10	$214.00	—	—	35%
H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI	$25.35	$39.00	—	79% below	35%
H. pylori antibody blood test CPT 86677 CHEM-H.PYLORI,IGG	$183.95	$283.00	—	53% above	35%
H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI	$25.35	$39.00	—	—	35%
H. pylori antibody blood test inpatient CPT 86677 CHEM-H.PYLORI,IGG	$183.95	$283.00	—	—	35%
HIV-1 and HIV-2 antibody test CPT 86703 HIV-1 AND HIV-2 ONE RESULT	$24.05	$37.00	—	68% below	35%
HIV-1 and HIV-2 antibody test CPT 86703 CHEM-PANEL HIV 1,2	$62.56	$96.25	—	16% below	35%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV-1 AND HIV-2 ONE RESULT	$24.05	$37.00	—	—	35%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 CHEM-PANEL HIV 1,2	$62.56	$96.25	—	—	35%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 REF-HIV-1/-2 AG/AB DIAGNOSTIC	$24.70	$38.00	—	62% below	35%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 REF-HIV-1/-2 AG/AB DIAGNOSTIC	$24.70	$38.00	—	—	35%
HPV test for high-risk types, one combined (pooled) result CPT 87624 MLDX-HPV DNA HIGH RISK	$178.10	$274.00	—	23% above	35%
HPV test for high-risk types, one combined (pooled) result CPT 87624 MLDX-HPV DNA TISSUE HIGH RISK	$192.24	$295.75	—	33% above	35%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 MLDX-HPV DNA HIGH RISK	$178.10	$274.00	—	—	35%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 MLDX-HPV DNA TISSUE HIGH RISK	$192.24	$295.75	—	—	35%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 CHEM GLYCOLATED HGB (A1C)	$28.11	$43.25	—	43% below	35%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 CHEM GLYCOLATED HGB (A1C)	$28.11	$43.25	—	—	35%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SUR AB	$76.86	$118.25	—	6% below	35%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SUR AB	$76.86	$118.25	—	—	35%
Hepatitis B surface antigen (HBsAg) test CPT 87340 CHEM-OBP HEPATITIS B SUR AG	$40.30	$62.00	—	44% below	35%
Hepatitis B surface antigen (HBsAg) test CPT 87340 CHEM-HEPATITIS B SUR AG	$71.18	$109.50	—	1% below	35%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 CHEM-OBP HEPATITIS B SUR AG	$40.30	$62.00	—	—	35%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 CHEM-HEPATITIS B SUR AG	$71.18	$109.50	—	—	35%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY TEST	$25.35	$39.00	—	76% below	35%
Hepatitis C antibody blood test (screening) CPT 86803 PANEL - HCV	$64.51	$99.25	—	39% below	35%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB	$98.64	$151.75	—	6% below	35%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY TEST	$25.35	$39.00	—	—	35%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 PANEL - HCV	$64.51	$99.25	—	—	35%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C AB	$98.64	$151.75	—	—	35%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2	$33.80	$52.00	—	65% below	35%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX TYPE 2	$33.80	$52.00	—	—	35%
High-sensitivity CRP (hs-CRP) test CPT 86141 REF-HIGH SENSITIVE CRP	$15.76	$24.25	—	80% below	35%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACT PROTEIN HIGH SENSITIV	$22.75	$35.00	—	70% below	35%
High-sensitivity CRP (hs-CRP) test CPT 86141 CRP-HIGH SENSITIVE	$72.96	$112.25	—	5% below	35%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 REF-HIGH SENSITIVE CRP	$15.76	$24.25	—	—	35%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACT PROTEIN HIGH SENSITIV	$22.75	$35.00	—	—	35%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP-HIGH SENSITIVE	$72.96	$112.25	—	—	35%
Insulin blood test CPT 83525 ASSAY INSULIN	$20.15	$31.00	—	77% below	35%
Insulin blood test inpatient CPT 83525 ASSAY INSULIN	$20.15	$31.00	—	—	35%
Iron blood test (serum iron) CPT 83540 ASSAY IRON	$7.80	$12.00	—	85% below	35%
Iron blood test (serum iron) CPT 83540 CHEM-IRON	$58.99	$90.75	—	11% above	35%
Iron blood test (serum iron) inpatient CPT 83540 ASSAY IRON	$7.80	$12.00	—	—	35%
Iron blood test (serum iron) inpatient CPT 83540 CHEM-IRON	$58.99	$90.75	—	—	35%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING TEST	$9.75	$15.00	—	81% below	35%
Iron-binding capacity (TIBC) test CPT 83550 CHEM-IRON BINDING CAP	$62.24	$95.75	—	20% above	35%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING TEST	$9.75	$15.00	—	—	35%
Iron-binding capacity (TIBC) test inpatient CPT 83550 CHEM-IRON BINDING CAP	$62.24	$95.75	—	—	35%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$15.60	$24.00	—	85% below	35%
Kidney function blood test panel CPT 80069 CHEM - RENAL FUNCTION PANEL	$55.09	$84.75	—	47% below	35%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$15.60	$24.00	—	—	35%
Kidney function blood test panel inpatient CPT 80069 CHEM - RENAL FUNCTION PANEL	$55.09	$84.75	—	—	35%
LH (luteinizing hormone) test CPT 83002 CHEM-LH	$73.29	$112.75	—	31% below	35%
LH (luteinizing hormone) test inpatient CPT 83002 CHEM-LH	$73.29	$112.75	—	—	35%
Lipase blood test (pancreas enzyme) CPT 83690 ASSAY LIPASE	$11.70	$18.00	—	84% below	35%
Lipase blood test (pancreas enzyme) CPT 83690 CHEM-LIPASE	$62.56	$96.25	—	15% below	35%
Lipase blood test (pancreas enzyme) CPT 83690 CHEM-LIPASE BODY FLUID	$84.01	$129.25	—	14% above	35%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 ASSAY LIPASE	$11.70	$18.00	—	—	35%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 CHEM-LIPASE	$62.56	$96.25	—	—	35%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 CHEM-LIPASE BODY FLUID	$84.01	$129.25	—	—	35%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$14.30	$22.00	—	78% below	35%
Liver function blood test panel CPT 80076 CHEM-LIVER FUNCTION PANEL	$55.58	$85.50	—	14% below	35%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$14.30	$22.00	—	—	35%
Liver function blood test panel inpatient CPT 80076 CHEM-LIVER FUNCTION PANEL	$55.58	$85.50	—	—	35%
Lyme disease antibody test CPT 86618 REF-LYME DISEASE ANTIBODY	$223.44	$343.75	—	112% above	35%
Lyme disease antibody test inpatient CPT 86618 REF-LYME DISEASE ANTIBODY	$223.44	$343.75	—	—	35%
Magnesium blood test CPT 83735 ASSAY MAGNESIUM	$11.70	$18.00	—	81% below	35%
Magnesium blood test CPT 83735 REF-LITHOLINK MAGNESIUM, UR	$17.39	$26.75	—	72% below	35%
Magnesium blood test CPT 83735 CHEM-MAGNESIUM	$35.75	$55.00	—	42% below	35%
Magnesium blood test CPT 83735 REF- LABCORP MAGNESIUM, RBC	$47.45	$73.00	—	23% below	35%
Magnesium blood test inpatient CPT 83735 ASSAY MAGNESIUM	$11.70	$18.00	—	—	35%
Magnesium blood test inpatient CPT 83735 REF-LITHOLINK MAGNESIUM, UR	$17.39	$26.75	—	—	35%
Magnesium blood test inpatient CPT 83735 CHEM-MAGNESIUM	$35.75	$55.00	—	—	35%
Magnesium blood test inpatient CPT 83735 REF- LABCORP MAGNESIUM, RBC	$47.45	$73.00	—	—	35%
Measles (rubeola) antibody test CPT 86765 SER-RUBEOLA AB IGG	$88.56	$136.25	—	113% above	35%
Measles (rubeola) antibody test inpatient CPT 86765 SER-RUBEOLA AB IGG	$88.56	$136.25	—	—	35%
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODIES; SCREEN	$7.80	$12.00	—	86% below	35%
Mono test (heterophile antibody, Monospot) CPT 86308 SER-MONO TEST	$70.36	$108.25	—	22% above	35%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODIES; SCREEN	$7.80	$12.00	—	—	35%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 SER-MONO TEST	$70.36	$108.25	—	—	35%
PSA (prostate-specific antigen) blood test, free CPT 84154 ASSAY PSA FREE	$32.50	$50.00	—	62% below	35%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 ASSAY PSA FREE	$32.50	$50.00	—	—	35%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA	$32.50	$50.00	—	69% below	35%
PSA (prostate-specific antigen) blood test, total CPT 84153 CHEM-PSA DIAGNOSTIC	$98.31	$151.25	—	6% below	35%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA	$32.50	$50.00	—	—	35%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 CHEM-PSA DIAGNOSTIC	$98.31	$151.25	—	—	35%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTO-PAP/LB IMAGED/ROUT 88175	$110.01	$169.25	—	73% above	35%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTO-PAP/LB IMAGED/DIAG 88175	$110.01	$169.25	—	73% above	35%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTO-PAP/LB IMAGED/HR 88175	$110.01	$169.25	—	73% above	35%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTO-PAP/LB IMAGED/ROUT 88175	$110.01	$169.25	—	—	35%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTO-PAP/LB IMAGED/HR 88175	$110.01	$169.25	—	—	35%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTO-PAP/LB IMAGED/DIAG 88175	$110.01	$169.25	—	—	35%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH C/V MANL PHYS SUPERV	$35.10	$54.00	—	44% below	35%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTO-PAP/AUTOCYTE/DIAG 88142	$110.01	$169.25	—	77% above	35%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTOPATH C/V MANL PHYS SUPERV	$35.10	$54.00	—	—	35%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTO-PAP/AUTOCYTE/DIAG 88142	$110.01	$169.25	—	—	35%
Parathyroid hormone (PTH) blood test CPT 83970 ASSAY PARATHORMONE	$72.15	$111.00	—	63% below	35%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID HORMONE	$185.58	$285.50	—	6% below	35%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 ASSAY PARATHORMONE	$72.15	$111.00	—	—	35%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHYROID HORMONE	$185.58	$285.50	—	—	35%
Partial thromboplastin time (PTT) clotting test CPT 85730 REF-ALUPP PTT	$7.96	$12.25	—	82% below	35%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PART	$11.05	$17.00	—	75% below	35%
Partial thromboplastin time (PTT) clotting test CPT 85730 CHEM-PTT	$48.59	$74.75	—	10% above	35%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 REF-ALUPP PTT	$7.96	$12.25	—	—	35%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PART	$11.05	$17.00	—	—	35%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 CHEM-PTT	$48.59	$74.75	—	—	35%
Progesterone blood test CPT 84144 ASSAY PROGESTERONE	$36.40	$56.00	—	70% below	35%
Progesterone blood test CPT 84144 CHEM - PROGESTERONE	$90.51	$139.25	—	24% below	35%
Progesterone blood test inpatient CPT 84144 ASSAY PROGESTERONE	$36.40	$56.00	—	—	35%
Progesterone blood test inpatient CPT 84144 CHEM - PROGESTERONE	$90.51	$139.25	—	—	35%
Prolactin blood test CPT 84146 CHEM-PROLACTIN	$73.29	$112.75	—	34% below	35%
Prolactin blood test inpatient CPT 84146 CHEM-PROLACTIN	$73.29	$112.75	—	—	35%
Prothrombin time (PT/INR) clotting test CPT 85610 REF-ALUPP PT	$5.85	$9.00	—	75% below	35%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TM	$7.15	$11.00	—	70% below	35%
Prothrombin time (PT/INR) clotting test CPT 85610 REF-PNL PT/INR	$11.70	$18.00	—	50% below	35%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME HOSP	$28.76	$44.25	—	22% above	35%
Prothrombin time (PT/INR) clotting test CPT 85610 CHEM-PROTHROMBIN TIME	$32.50	$50.00	—	38% above	35%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 REF-ALUPP PT	$5.85	$9.00	—	—	35%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TM	$7.15	$11.00	—	—	35%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 REF-PNL PT/INR	$11.70	$18.00	—	—	35%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME HOSP	$28.76	$44.25	—	—	35%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CHEM-PROTHROMBIN TIME	$32.50	$50.00	—	—	35%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 URINE DRUG SCREEN	$25.35	$39.00	—	52% below	35%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 URINE DRUG SCREEN	$25.35	$39.00	—	—	35%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA ASSAY W/OPTIC	$21.45	$33.00	—	61% below	35%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA ASSAY W/OPTIC	$21.45	$33.00	—	—	35%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREPTOCOCCUS RAPID STREP	$21.45	$33.00	—	55% below	35%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREPTOCOCCUS RAPID STREP	$21.45	$33.00	—	—	35%
Rheumatoid factor (RF) test CPT 86431 REF-RHEUMATOID FACTOR	$11.05	$17.00	—	76% below	35%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANTITATIVE	$22.75	$35.00	—	52% below	35%
Rheumatoid factor (RF) test CPT 86431 CHEM-PNL RHEUM FACTOR QUANT	$73.61	$113.25	—	57% above	35%
Rheumatoid factor (RF) test CPT 86431 CHEM-RHEUMATOID FACTOR QUANT	$75.72	$116.50	—	61% above	35%
Rheumatoid factor (RF) test inpatient CPT 86431 REF-RHEUMATOID FACTOR	$11.05	$17.00	—	—	35%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANTITATIVE	$22.75	$35.00	—	—	35%
Rheumatoid factor (RF) test inpatient CPT 86431 CHEM-PNL RHEUM FACTOR QUANT	$73.61	$113.25	—	—	35%
Rheumatoid factor (RF) test inpatient CPT 86431 CHEM-RHEUMATOID FACTOR QUANT	$75.72	$116.50	—	—	35%
Rubella antibody test (immunity check) CPT 86762 CHEM-OBP RUBELLA SCREEN	$51.51	$79.25	—	2% below	35%
Rubella antibody test (immunity check) CPT 86762 CHEM-RUBELLA SCREEN	$73.12	$112.50	—	39% above	35%
Rubella antibody test (immunity check) inpatient CPT 86762 CHEM-OBP RUBELLA SCREEN	$51.51	$79.25	—	—	35%
Rubella antibody test (immunity check) inpatient CPT 86762 CHEM-RUBELLA SCREEN	$73.12	$112.50	—	—	35%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 RBC SED RATE AUTOMATED	$5.20	$8.00	—	88% below	35%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HEME-SED RATE	$30.22	$46.50	—	31% below	35%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 RBC SED RATE AUTOMATED	$5.20	$8.00	—	—	35%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HEME-SED RATE	$30.22	$46.50	—	—	35%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 HEME-SEMEN ANAL/COMPLETE	$231.24	$355.75	—	46% above	35%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 HEME-SEMEN ANAL/COMPLETE	$231.24	$355.75	—	—	35%
Stool ova and parasites exam CPT 87177 REF - OVA AND PARASITES SMEARS	$12.84	$19.75	—	79% below	35%
Stool ova and parasites exam CPT 87177 MICRO-STOOL/O&P/DIRECT	$104.32	$160.50	—	68% above	35%
Stool ova and parasites exam inpatient CPT 87177 REF - OVA AND PARASITES SMEARS	$12.84	$19.75	—	—	35%
Stool ova and parasites exam inpatient CPT 87177 MICRO-STOOL/O&P/DIRECT	$104.32	$160.50	—	—	35%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HEMOCCULT	$5.85	$9.00	—	82% below	35%
Stool test for hidden blood (guaiac FOBT) CPT 82270 MICRO-OCCULT BLOOD/SCR	$59.96	$92.25	—	84% above	35%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HEMOCCULT	$5.85	$9.00	—	—	35%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 MICRO-OCCULT BLOOD/SCR	$59.96	$92.25	—	—	35%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 ASSAY TEST FOR BLOOD FECAL	$27.95	$43.00	—	45% below	35%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 MLD-FIT COLORECTAL BLD DIAG	$47.45	$73.00	—	6% below	35%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 REF-FECAL OCCULT BLOOD, MAYO	$108.39	$166.75	—	114% above	35%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 ASSAY TEST FOR BLOOD FECAL	$27.95	$43.00	—	—	35%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 MLD-FIT COLORECTAL BLD DIAG	$47.45	$73.00	—	—	35%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 REF-FECAL OCCULT BLOOD, MAYO	$108.39	$166.75	—	—	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST QUALITATIVE	$7.80	$12.00	—	81% below	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 REF-RPR SCRN W/ RFLX TO TITER	$38.35	$59.00	—	8% below	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SER-RPR	$66.46	$102.25	—	60% above	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST QUALITATIVE	$7.80	$12.00	—	—	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 REF-RPR SCRN W/ RFLX TO TITER	$38.35	$59.00	—	—	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SER-RPR	$66.46	$102.25	—	—	35%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL IMMUN MEASURE	$108.55	$167.00	—	39% below	35%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST CELL IMMUN MEASURE	$108.55	$167.00	—	—	35%
Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY TESTOSTERONE TOT	$45.50	$70.00	—	53% below	35%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 ASSAY TESTOSTERONE TOT	$45.50	$70.00	—	—	35%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 STATE TSH SCREEN	$21.12	$32.50	—	73% below	35%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYRD STIM HORMONE	$29.90	$46.00	—	62% below	35%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 PANEL-TSH	$58.99	$90.75	—	24% below	35%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 CHEM-TSH	$73.29	$112.75	—	6% below	35%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 STATE TSH SCREEN	$21.12	$32.50	—	—	35%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ASSAY THYRD STIM HORMONE	$29.90	$46.00	—	—	35%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 PANEL-TSH	$58.99	$90.75	—	—	35%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 CHEM-TSH	$73.29	$112.75	—	—	35%
Uric acid blood test CPT 84550 ASSAY BLOOD/URIC ACID	$8.45	$13.00	—	69% below	35%
Uric acid blood test CPT 84550 CHEM-URIC ACID	$19.66	$30.25	—	28% below	35%
Uric acid blood test inpatient CPT 84550 ASSAY BLOOD/URIC ACID	$8.45	$13.00	—	—	35%
Uric acid blood test inpatient CPT 84550 CHEM-URIC ACID	$19.66	$30.25	—	—	35%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE	$5.85	$9.00	—	87% below	35%
Urinalysis with microscope exam, automated CPT 81001 HEME-URINALYSIS MICROSCOPIC	$41.11	$63.25	—	6% below	35%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/SCOPE	$5.85	$9.00	—	—	35%
Urinalysis with microscope exam, automated inpatient CPT 81001 HEME-URINALYSIS MICROSCOPIC	$41.11	$63.25	—	—	35%
Urinalysis with microscope exam, manual CPT 81000 URINALYSIS MICRO & DIP	$5.85	$9.00	—	66% below	35%
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS MICRO & DIP	$5.85	$9.00	—	—	35%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS DIPSTICK/TABLET	$4.55	$7.00	—	83% below	35%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS, DIPSTICK/TABLET	$7.64	$11.75	—	72% below	35%
Urinalysis without microscope exam, automated CPT 81003 HEME-SPEC GRAV/URINE	$21.78	$33.50	—	20% below	35%
Urinalysis without microscope exam, automated CPT 81003 HEME-URINE CHEM-STRIP	$22.59	$34.75	—	17% below	35%
Urinalysis without microscope exam, automated CPT 81003 HEME - URINALYSIS REFLEX	$23.56	$36.25	—	13% below	35%
Urinalysis without microscope exam, automated CPT 81003 HEME - BLOOD/URINE	$25.51	$39.25	—	6% below	35%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS DIPSTICK/TABLET	$4.55	$7.00	—	—	35%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS, DIPSTICK/TABLET	$7.64	$11.75	—	—	35%
Urinalysis without microscope exam, automated inpatient CPT 81003 HEME-SPEC GRAV/URINE	$21.78	$33.50	—	—	35%
Urinalysis without microscope exam, automated inpatient CPT 81003 HEME-URINE CHEM-STRIP	$22.59	$34.75	—	—	35%
Urinalysis without microscope exam, automated inpatient CPT 81003 HEME - URINALYSIS REFLEX	$23.56	$36.25	—	—	35%
Urinalysis without microscope exam, automated inpatient CPT 81003 HEME - BLOOD/URINE	$25.51	$39.25	—	—	35%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO W/O SCOPE	$4.55	$7.00	—	70% below	35%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS NONAUTO W/O SCOPE	$4.55	$7.00	—	—	35%
Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE COLONY COUNT	$14.30	$22.00	—	83% below	35%
Urine culture for bacteria, with colony count CPT 87086 MICRO-CULTURE/URINE	$85.15	$131.00	—	at median	35%
Urine culture for bacteria, with colony count inpatient CPT 87086 URINE CULTURE COLONY COUNT	$14.30	$22.00	—	—	35%
Urine culture for bacteria, with colony count inpatient CPT 87086 MICRO-CULTURE/URINE	$85.15	$131.00	—	—	35%
Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST	$7.15	$11.00	—	79% below	35%
Urine pregnancy test, read by color change CPT 81025 POC-HCG URINE	$60.12	$92.50	—	73% above	35%
Urine pregnancy test, read by color change CPT 81025 SER-HCG/QUAL/URINE	$68.58	$105.50	—	98% above	35%
Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY TEST	$7.15	$11.00	—	—	35%
Urine pregnancy test, read by color change inpatient CPT 81025 POC-HCG URINE	$60.12	$92.50	—	—	35%
Urine pregnancy test, read by color change inpatient CPT 81025 SER-HCG/QUAL/URINE	$68.58	$105.50	—	—	35%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12	$26.65	$41.00	—	67% below	35%
Vitamin B12 (cobalamin) blood test CPT 82607 CHEM-VITAMIN B12	$70.36	$108.25	—	13% below	35%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12	$26.65	$41.00	—	—	35%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 CHEM-VITAMIN B12	$70.36	$108.25	—	—	35%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY	$52.00	$80.00	—	50% below	35%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 CHEM-VITAMIN D 25 HYDROXY	$128.86	$198.25	—	23% above	35%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 HYDROXY	$52.00	$80.00	—	—	35%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 CHEM-VITAMIN D 25 HYDROXY	$128.86	$198.25	—	—	35%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN CHORIONIC QUANT	$26.65	$41.00	—	74% below	35%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 POC-HCG QUANT	$94.74	$145.75	—	7% below	35%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHEM-HCG/QUANTITATIVE	$94.74	$145.75	—	7% below	35%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 GONADOTROPIN CHORIONIC QUANT	$26.65	$41.00	—	—	35%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 CHEM-HCG/QUANTITATIVE	$94.74	$145.75	—	—	35%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 POC-HCG QUANT	$94.74	$145.75	—	—	35%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 NECK SPINE FUSE&REMOV BEL C2	$11,437.72	$17,596.50	—	114% above	35%
Anterior cervical discectomy and fusion (ACDF), one level inpatient CPT 22551 NECK SPINE FUSE&REMOV BEL C2	$11,437.72	$17,596.50	—	—	35%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 ARTHRS AIDED ACL RPR/AGMNT/RCN	$6,403.96	$9,852.25	—	149% above	35%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 ARTHRS AIDED ACL RPR/AGMNT/RCN	$6,403.96	$9,852.25	—	—	35%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 ARTHRS SHLDR ROTATOR CUFF RPR	$5,006.95	$7,703.00	—	73% above	35%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 ARTHRS SHLDR ROTATOR CUFF RPR	$5,006.95	$7,703.00	—	—	35%
Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC MIGRAINE	$129.35	$199.00	—	60% below	35%
Botox injections for chronic migraine inpatient CPT 64615 CHEMODENERV MUSC MIGRAINE	$129.35	$199.00	—	—	35%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 BX BREAST 1ST LESION STRTCTC	$877.50	$1,350.00	—	13% below	35%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 BX BREAST 1ST LESION STRTCTC	$877.50	$1,350.00	—	—	35%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLTX DSTL FIB FX LAT MALLS W/O	$196.79	$302.75	—	56% below	35%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TREATMENT OF ANKLE FRACTURE	$267.80	$412.00	—	40% below	35%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLSD TXT OF DISTAL FIBULAR	$430.46	$662.25	—	4% below	35%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLTX DSTL FIB FX LAT MALLS W/O	$196.79	$302.75	—	—	35%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 TREATMENT OF ANKLE FRACTURE	$267.80	$412.00	—	—	35%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLSD TXT OF DISTAL FIBULAR	$430.46	$662.25	—	—	35%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TREAT METATARSAL FRACTURE	$185.25	$285.00	—	45% below	35%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 TREAT METATARSAL FRACTURE	$185.25	$285.00	—	—	35%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 CORRJ HALLUX VALG W/DIST METAR	$2,685.96	$4,132.25	—	35% above	35%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 CORRJ HALLUX VALG W/DIST METAR	$2,685.96	$4,132.25	—	—	35%
Bunion correction with removal of part of the big toe joint CPT 28292 CORRJ HALLUX VALG W/SES W/RES	$773.50	$1,190.00	—	34% below	35%
Bunion correction with removal of part of the big toe joint CPT 28292 CORR HALLUX VALG W/RESC PROX P	$2,685.96	$4,132.25	—	129% above	35%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 CORRJ HALLUX VALG W/SES W/RES	$773.50	$1,190.00	—	—	35%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 CORR HALLUX VALG W/RESC PROX P	$2,685.96	$4,132.25	—	—	35%
Cardiac catheterization with coronary angiogram CPT 93458 LT HC W/WO LV&ANGIO (93458)	$12,751.86	$19,618.25	—	6% above	35%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 LT HC W/WO LV&ANGIO (93458)	$12,751.86	$19,618.25	—	—	35%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION W CONS SEDATION	$1,229.80	$1,892.00	—	100% above	35%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION W CONS SEDATION	$1,229.80	$1,892.00	—	—	35%
Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL,LOCAL NO ANESTH	$1,931.31	$2,971.25	—	51% above	35%
Carpal tunnel release, open surgery inpatient CPT 64721 CARPAL TUNNEL,LOCAL NO ANESTH	$1,931.31	$2,971.25	—	—	35%
Cataract surgery with lens implant CPT 66984 REMOVE CATARACT/INSERT LENSE	$1,788.15	$2,751.00	—	2% below	35%
Cataract surgery with lens implant inpatient CPT 66984 REMOVE CATARACT/INSERT LENSE	$1,788.15	$2,751.00	—	—	35%
Catheter ablation for atrial fibrillation CPT 93656 TX ATRIAL FIB PULM VEIN	$32,116.99	$49,410.75	—	at median	35%
Catheter ablation for atrial fibrillation inpatient CPT 93656 TX ATRIAL FIB PULM VEIN	$32,116.99	$49,410.75	—	—	35%
Cervical biopsy CPT 57500 BIOPSY OF CERVIX	$145.60	$224.00	—	45% below	35%
Cervical biopsy CPT 57500 BPSY OF CERVIX	$172.58	$265.50	—	35% below	35%
Cervical biopsy inpatient CPT 57500 BIOPSY OF CERVIX	$145.60	$224.00	—	—	35%
Cervical biopsy inpatient CPT 57500 BPSY OF CERVIX	$172.58	$265.50	—	—	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/REGIONAL BLOCK	$160.55	$247.00	—	14% below	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION, W/REGIONAL BLOCK	$4,206.64	$6,471.75	—	2160% above	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION W/REGIONAL BLOCK	$160.55	$247.00	—	—	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION, W/REGIONAL BLOCK	$4,206.64	$6,471.75	—	—	35%
Circumcision, surgical, older than a newborn CPT 54160 CIRCUMCISION NEONATE	$227.50	$350.00	—	27% below	35%
Circumcision, surgical, older than a newborn inpatient CPT 54160 CIRCUMCISION NEONATE	$227.50	$350.00	—	—	35%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 TREAT FRACTURE RADIUS & ULNA	$273.00	$420.00	—	38% below	35%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLSD TXT OF DISTAL RADIAL F	$445.41	$685.25	—	2% above	35%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 TREAT FRACTURE RADIUS & ULNA	$273.00	$420.00	—	—	35%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLSD TXT OF DISTAL RADIAL F	$445.41	$685.25	—	—	35%
Colonoscopy with polyp removal CPT 45385 LESION REMOVAL COLONOSCOPY	$2,310.91	$3,555.25	—	128% above	35%
Colonoscopy with polyp removal inpatient CPT 45385 LESION REMOVAL COLONOSCOPY	$2,310.91	$3,555.25	—	—	35%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY	$2,310.91	$3,555.25	—	174% above	35%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY AND BIOPSY	$2,310.91	$3,555.25	—	—	35%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY;SCREEN;HIGH RISK	$1,072.99	$1,650.75	—	31% above	35%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY;SCREEN;HIGH RISK	$1,072.99	$1,650.75	—	—	35%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 COLP CERVIX W/LOOP ELEC BIOPS	$319.15	$491.00	—	44% below	35%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 COLP CERVIX W/LOOP ELEC BIOPS	$319.15	$491.00	—	—	35%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BX/CURETT OF CERVIX W/SCOPE	$138.45	$213.00	—	52% below	35%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 BX/CURETT OF CERVIX W/SCOPE	$138.45	$213.00	—	—	35%
Complex cataract surgery with lens implant CPT 66982 CATARACT SURGERY, COMPLEX	$1,913.44	$2,943.75	—	9% below	35%
Complex cataract surgery with lens implant inpatient CPT 66982 CATARACT SURGERY, COMPLEX	$1,913.44	$2,943.75	—	—	35%
Coronary stent placement, one artery CPT 92928 INSERTION NON DRUG EL STENT	$16,918.04	$26,027.75	—	225% above	35%
Coronary stent placement, one artery inpatient CPT 92928 INSERTION NON DRUG EL STENT	$16,918.04	$26,027.75	—	—	35%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOSCOPY	$222.95	$343.00	—	47% below	35%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY	$1,162.20	$1,788.00	—	179% above	35%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOSCOPY	$222.95	$343.00	—	—	35%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOURETHROSCOPY	$1,162.20	$1,788.00	—	—	35%
D&C (dilation and curettage), not related to pregnancy CPT 58120 D & C DIAG AND/OR THER (NONOB)	$242.45	$373.00	—	64% below	35%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 D & C DIAG AND/OR THER (NONOB)	$242.45	$373.00	—	—	35%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALG LESION	$59.80	$92.00	—	63% below	35%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCT PREMALG LESION	$59.80	$92.00	—	—	35%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 TYMPANOSTOMY LOCAL/TOPICAL ANE	$229.45	$353.00	—	40% below	35%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 TYMPANOSTOMY LOCAL/TOPICAL ANE	$229.45	$353.00	—	—	35%
Earwax removal by irrigation (rinsing), one ear CPT 69209 RMVL IMPACTED CERUM, LAV, UN	$17.88	$27.50	—	54% below	35%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX	$174.04	$267.75	—	345% above	35%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 RMVL IMPACTED CERUM, LAV, UN	$17.88	$27.50	—	—	35%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EAR WAX	$174.04	$267.75	—	—	35%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED CERUMEN	$46.80	$72.00	—	38% below	35%
Earwax removal with instruments, one ear CPT 69210 IMP CERUMEN RMVL ONE OR BOT	$66.95	$103.00	—	12% below	35%
Earwax removal with instruments, one ear CPT 69210 REMOVE EARWAX	$208.81	$321.25	—	175% above	35%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPACTED CERUMEN	$46.80	$72.00	—	—	35%
Earwax removal with instruments, one ear inpatient CPT 69210 IMP CERUMEN RMVL ONE OR BOT	$66.95	$103.00	—	—	35%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE EARWAX	$208.81	$321.25	—	—	35%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF UTERUS LINING	$194.19	$298.75	—	1% below	35%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 BIOPSY OF UTERUS LINING	$194.19	$298.75	—	—	35%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX INTERLAMINAR CRV/THRC W GU	$299.65	$461.00	—	59% below	35%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJ INTERLAMINAR:CRV/TH, W/IM	$1,279.69	$1,968.75	—	74% above	35%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 NJX INTERLAMINAR CRV/THRC W GU	$299.65	$461.00	—	—	35%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 INJ INTERLAMINAR:CRV/TH, W/IM	$1,279.69	$1,968.75	—	—	35%
Eye injection into the vitreous (intravitreal injection) CPT 67028 INTRAVIT INJ PHAR AGNT	$550.71	$847.25	—	51% above	35%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 INTRAVIT INJ PHAR AGNT	$550.71	$847.25	—	—	35%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERT F JNT L/S 1 LEV	$273.00	$420.00	—	29% below	35%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERTEBRAL FACET,SNGLVL	$1,308.45	$2,013.00	—	241% above	35%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 FACET/PARS LUMBAR/SACRAL 1ST L	$1,988.84	$3,059.75	—	419% above	35%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ PARAVERT F JNT L/S 1 LEV	$273.00	$420.00	—	—	35%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ PARAVERTEBRAL FACET,SNGLVL	$1,308.45	$2,013.00	—	—	35%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 FACET/PARS LUMBAR/SACRAL 1ST L	$1,988.84	$3,059.75	—	—	35%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY	$1,494.51	$2,299.25	—	321% above	35%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY	$1,494.51	$2,299.25	—	—	35%
Hammertoe correction surgery CPT 28285 CORRECTION HAMMERTOE	$542.75	$835.00	—	52% below	35%
Hammertoe correction surgery CPT 28285 REPAIR OF HAMMERTOE	$1,877.69	$2,888.75	—	67% above	35%
Hammertoe correction surgery inpatient CPT 28285 CORRECTION HAMMERTOE	$542.75	$835.00	—	—	35%
Hammertoe correction surgery inpatient CPT 28285 REPAIR OF HAMMERTOE	$1,877.69	$2,888.75	—	—	35%
Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHOID(S)	$269.75	$415.00	—	40% below	35%
Hemorrhoid banding (rubber band ligation) CPT 46221 HEMORRHOIDECTOMY SIMPLE LIG	$365.62	$562.50	—	19% below	35%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 LIGATION OF HEMORRHOID(S)	$269.75	$415.00	—	—	35%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HEMORRHOIDECTOMY SIMPLE LIG	$365.62	$562.50	—	—	35%
Hemorrhoidectomy (internal and external), one area CPT 46255 REMOVE INT/EXT HEMORROID 1 GRP	$510.25	$785.00	—	41% below	35%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 REMOVE INT/EXT HEMORROID 1 GRP	$510.25	$785.00	—	—	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATHETER FOR HYSTEROGRAPHY	$193.05	$297.00	—	35% below	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATH INTRO CONTRAST/SALINE	$366.92	$564.50	—	24% above	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATH INSERT FOR HYSTEROGRAPHY	$367.25	$565.00	—	24% above	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 CATHETER FOR HYSTEROGRAPHY	$193.05	$297.00	—	—	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 CATH INTRO CONTRAST/SALINE	$366.92	$564.50	—	—	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 CATH INSERT FOR HYSTEROGRAPHY	$367.25	$565.00	—	—	35%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE SKIN ABSCESS	$107.90	$166.00	—	48% below	35%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS, SIMPLE	$158.76	$244.25	—	23% below	35%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS,SMPL	$296.24	$455.75	—	44% above	35%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE SKIN ABSCESS	$107.90	$166.00	—	—	35%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS, SIMPLE	$158.76	$244.25	—	—	35%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE OF SKIN ABSCESS,SMPL	$296.24	$455.75	—	—	35%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 REPAIR I/HERNIA INIT REDUC>5YR	$4,023.34	$6,189.75	—	173% above	35%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 REPAIR I/HERNIA INIT REDUC>5YR	$4,023.34	$6,189.75	—	—	35%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT	$51.35	$79.00	—	57% below	35%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 TRIGGER PT INJ(S)	$79.79	$122.75	—	34% below	35%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON/LIGAMENT	$364.49	$560.75	—	202% above	35%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ SINGL TENDON/LIGAMENT/CYST	$636.02	$978.50	—	427% above	35%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH/LIGAMENT	$51.35	$79.00	—	—	35%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 TRIGGER PT INJ(S)	$79.79	$122.75	—	—	35%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON/LIGAMENT	$364.49	$560.75	—	—	35%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ SINGL TENDON/LIGAMENT/CYST	$636.02	$978.50	—	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJECT JOINT/BURSA WO US	$56.55	$87.00	—	71% below	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENT, ASPIR OR INJEC	$81.74	$125.75	—	58% below	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASP&INJ MJR JT/BRSA W/O US	$98.15	$151.00	—	50% below	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJECT, JOINT/BURSA	$967.85	$1,489.00	—	395% above	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJECT JOINT/BURSA WO US	$56.55	$87.00	—	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENT, ASPIR OR INJEC	$81.74	$125.75	—	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASP&INJ MJR JT/BRSA W/O US	$98.15	$151.00	—	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJECT, JOINT/BURSA	$967.85	$1,489.00	—	—	35%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSRT NON-BIODEGRAD DELIV IM	$150.80	$232.00	—	38% below	35%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSRT NON-BIODEGRAD DELIV IM	$150.80	$232.00	—	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Drain/Inject Bursa	$48.75	$75.00	—	65% below	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENT, ASPIR OR INJEC	$75.40	$116.00	—	46% below	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASP&INJ INTERM JT/BRSA W/O US	$82.55	$127.00	—	41% below	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTES,INTMED JNT W/O US	$334.59	$514.75	—	140% above	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTES, INTMED JNT WO US	$344.01	$529.25	—	147% above	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASPR/INJ INTMED JNT WO US-BILA	$517.72	$796.50	—	271% above	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Drain/Inject Bursa	$48.75	$75.00	—	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENT, ASPIR OR INJEC	$75.40	$116.00	—	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASP&INJ INTERM JT/BRSA W/O US	$82.55	$127.00	—	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTES,INTMED JNT W/O US	$334.59	$514.75	—	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTES, INTMED JNT WO US	$344.01	$529.25	—	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASPR/INJ INTMED JNT WO US-BILA	$517.72	$796.50	—	—	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJECT JOINT/BURSA	$46.80	$72.00	—	54% below	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASP&INJ SM JT/BRSA W/O US	$79.30	$122.00	—	22% below	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHOCENTESIS, SML JNT W/O US	$296.24	$455.75	—	192% above	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS,SML JNT W/O US	$344.01	$529.25	—	239% above	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENT, ASPIR OR INJEC	$344.01	$529.25	—	239% above	35%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJECT JOINT/BURSA	$46.80	$72.00	—	—	35%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ASP&INJ SM JT/BRSA W/O US	$79.30	$122.00	—	—	35%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHOCENTESIS, SML JNT W/O US	$296.24	$455.75	—	—	35%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS,SML JNT W/O US	$344.01	$529.25	—	—	35%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENT, ASPIR OR INJEC	$344.01	$529.25	—	—	35%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 ARTHRS KNEE W/MENISCUS RPR MED	$2,710.18	$4,169.50	—	51% above	35%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 ARTHRS KNEE W/MENISCUS RPR MED	$2,710.18	$4,169.50	—	—	35%
Knee arthroscopy with meniscus trim CPT 29881 ARTHRS KNEE W/MENISCECT MED/LA	$2,710.18	$4,169.50	—	91% above	35%
Knee arthroscopy with meniscus trim inpatient CPT 29881 ARTHRS KNEE W/MENISCECT MED/LA	$2,710.18	$4,169.50	—	—	35%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 ARTHRS KNEE DEBR/SHAVING ARTCL	$2,710.18	$4,169.50	—	102% above	35%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 ARTHRS KNEE DEBR/SHAVING ARTCL	$2,710.18	$4,169.50	—	—	35%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 AFTER CATARACT LASER SURGERY	$357.82	$550.50	—	50% below	35%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 AFTER CATARACT LASER SURGERY	$357.82	$550.50	—	—	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/<	$189.64	$291.75	—	49% below	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 RPR INT S/A/T/EXT 2.5 CM OR L	$255.45	$393.00	—	32% below	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 RPR, INTRMD, UP TO 2.5 CM	$320.12	$492.50	—	15% below	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 UP TO 2.5CM-INTERMEDIATE	$467.02	$718.50	—	24% above	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/<	$189.64	$291.75	—	—	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 RPR INT S/A/T/EXT 2.5 CM OR L	$255.45	$393.00	—	—	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 RPR, INTRMD, UP TO 2.5 CM	$320.12	$492.50	—	—	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 UP TO 2.5CM-INTERMEDIATE	$467.02	$718.50	—	—	35%
Left heart catheterization, diagnostic one side CPT 93452 LEFT HEART CATH (93452)	$5,487.46	$8,442.25	—	41% below	35%
Left heart catheterization, diagnostic inpatient one side CPT 93452 LEFT HEART CATH (93452)	$5,487.46	$8,442.25	—	—	35%
Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAR W GU	$300.95	$463.00	—	38% below	35%
Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC	$408.20	$628.00	—	16% below	35%
Lower-back epidural injection, with imaging guidance CPT 62323 INJ INTERLAMINAR:LMB/SAC W/IM	$617.34	$949.75	—	27% above	35%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX INTERLAMINAR LMBR/SAR W GU	$300.95	$463.00	—	—	35%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX INTERLAMINAR LMBR/SAC	$408.20	$628.00	—	—	35%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ INTERLAMINAR:LMB/SAC W/IM	$617.34	$949.75	—	—	35%
Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAR W/O	$167.05	$257.00	—	42% below	35%
Lower-back epidural injection, without imaging guidance CPT 62322 INJ INTERLAMINAR:LMB/SACW/O IM	$1,275.30	$1,962.00	—	340% above	35%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTERLAMINAR LMBR/SAR W/O	$167.05	$257.00	—	—	35%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJ INTERLAMINAR:LMB/SACW/O IM	$1,275.30	$1,962.00	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 SNRB LUMB/SAC BILAT	$3,628.95	$5,583.00	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NJX AA&/STRD TFRM EPI L/S 1	$381.55	$587.00	—	8% below	35%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ FOREAMEN EPIDURAL I/S	$1,341.28	$2,063.50	—	223% above	35%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 SELECT NERVE ROOT BLCK LUMB/SR	$2,284.75	$3,515.00	—	450% above	35%
Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 SNRB LUMB/SAC BILAT	$3,628.95	$5,583.00	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 NJX AA&/STRD TFRM EPI L/S 1	$381.55	$587.00	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ FOREAMEN EPIDURAL I/S	$1,341.28	$2,063.50	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 SELECT NERVE ROOT BLCK LUMB/SR	$2,284.75	$3,515.00	—	—	35%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 LOW BACK DISK SURG	$5,006.95	$7,703.00	—	67% above	35%
Lumbar discectomy or laminotomy to free a nerve root, one level inpatient CPT 63030 LOW BACK DISK SURG	$5,006.95	$7,703.00	—	—	35%
Lumbar laminectomy (spinal decompression), one level CPT 63047 RMV SPINE LAMINA 1 LMBR	$5,159.38	$7,937.50	—	51% above	35%
Lumbar laminectomy (spinal decompression), one level inpatient CPT 63047 RMV SPINE LAMINA 1 LMBR	$5,159.38	$7,937.50	—	—	35%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5 CM SS	$127.40	$196.00	—	34% below	35%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXCIS, BENIGN LES 0.5 CM OR L	$167.21	$257.25	—	13% below	35%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5 CM	$1,070.88	$1,647.50	—	458% above	35%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC TR-EXT B9+MARG 0.5 CM SS	$127.40	$196.00	—	—	35%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXCIS, BENIGN LES 0.5 CM OR L	$167.21	$257.25	—	—	35%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC TR-EXT B9+MARG 0.5 CM	$1,070.88	$1,647.50	—	—	35%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC FACE-MM B9+MARG 0.5 CM SS	$132.60	$204.00	—	55% below	35%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC FACE-MM B9+MARG 0.5 CM SS	$132.60	$204.00	—	—	35%
Nail removal (partial or complete), one nail CPT 11730 REM NAIL PLATE	$122.85	$189.00	—	20% below	35%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULS, SIMPLE; SINGLE	$133.90	$206.00	—	12% below	35%
Nail removal (partial or complete), one nail CPT 11730 REMVL OF NAIL PLATE	$186.06	$286.25	—	22% above	35%
Nail removal (partial or complete), one nail inpatient CPT 11730 REM NAIL PLATE	$122.85	$189.00	—	—	35%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULS, SIMPLE; SINGLE	$133.90	$206.00	—	—	35%
Nail removal (partial or complete), one nail inpatient CPT 11730 REMVL OF NAIL PLATE	$186.06	$286.25	—	—	35%
Occipital nerve block (injection for headaches) CPT 64405 N BLOCK INJ OCCIPITAL	$84.50	$130.00	—	61% below	35%
Occipital nerve block (injection for headaches) CPT 64405 INJ, ANESTHETIC AGENT, OCCIPI	$137.64	$211.75	—	37% below	35%
Occipital nerve block (injection for headaches) CPT 64405 INJ ANESTHETIC;OCCIPITAL NERVE	$362.70	$558.00	—	67% above	35%
Occipital nerve block (injection for headaches) inpatient CPT 64405 N BLOCK INJ OCCIPITAL	$84.50	$130.00	—	—	35%
Occipital nerve block (injection for headaches) inpatient CPT 64405 INJ, ANESTHETIC AGENT, OCCIPI	$137.64	$211.75	—	—	35%
Occipital nerve block (injection for headaches) inpatient CPT 64405 INJ ANESTHETIC;OCCIPITAL NERVE	$362.70	$558.00	—	—	35%
Pacemaker implant (dual chamber) CPT 33208 INSERT PACER LEAD/GEN A&V PERM	$21,673.11	$33,343.25	—	25% above	35%
Pacemaker implant (dual chamber) inpatient CPT 33208 INSERT PACER LEAD/GEN A&V PERM	$21,673.11	$33,343.25	—	—	35%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING	$2,270.29	$3,492.75	—	381% above	35%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGING	$2,270.29	$3,492.75	—	—	35%
Partial knee replacement (one compartment) CPT 27446 REVISION OF KNEE JNT	$8,802.14	$13,541.75	—	188% above	35%
Partial knee replacement (one compartment) inpatient CPT 27446 REVISION OF KNEE JNT	$8,802.14	$13,541.75	—	—	35%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCIS OF NAIL AND NAIL MATRIX	$252.20	$388.00	—	19% below	35%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMVL OF NAIL BED	$390.65	$601.00	—	26% above	35%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION NAIL MATRIX-PERM	$716.79	$1,102.75	—	132% above	35%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCIS OF NAIL AND NAIL MATRIX	$252.20	$388.00	—	—	35%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMVL OF NAIL BED	$390.65	$601.00	—	—	35%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION NAIL MATRIX-PERM	$716.79	$1,102.75	—	—	35%
Prostate biopsy both sides CPT 55700 ASPIRATION; BREAST BILATERAL	$548.11	$843.25	—	—	35%
Prostate biopsy CPT 55700 BIOPSY OF PROSTATE ANY APPROAC	$278.20	$428.00	—	57% below	35%
Prostate biopsy CPT 55700 BIOPSY OF PROSTATE	$382.20	$588.00	—	41% below	35%
Prostate biopsy CPT 55700 OB US F/U TWINS	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 OB>14WKS W/TRANSVAG	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 RENAL US WITH DOPPLER	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 US OB W BIOPROFILE WOSTRESS	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 OB US<14 WKS W/TRANSVAG	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 OB US <14WKS TWINS	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 US PELVIS WTRANSVAG WDOPP	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 RENAL ARTER US	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 US SCROTUM WITH DOPPLER	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 OB US>14 WKS W FETAL UMBARTERY	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 PELVIS US WITH TRANSVAG	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 PELIVS US WITH DOPPLER	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 US NEEDLE PLCMNT PRE-PX	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 BIOPSY;NEEDLE LYMPH NODE US	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 US BIOPSY; PROSTATE	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 US PLACE PROSTATE MARKER	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 US HYSTEROSONOGRAPHY	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 ART/VENOUS FLOW; US	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 ASPIRATION; BREAST	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 US AMNIOCENTESIS	$548.11	$843.25	—	16% below	35%
Prostate biopsy CPT 55700 ART/VENOUS FLOW; US LIMITED	$548.11	$843.25	—	16% below	35%
Prostate biopsy inpatient both sides CPT 55700 ASPIRATION; BREAST BILATERAL	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 BIOPSY OF PROSTATE ANY APPROAC	$278.20	$428.00	—	—	35%
Prostate biopsy inpatient CPT 55700 BIOPSY OF PROSTATE	$382.20	$588.00	—	—	35%
Prostate biopsy inpatient CPT 55700 PELIVS US WITH DOPPLER	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 US OB W BIOPROFILE WOSTRESS	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 US SCROTUM WITH DOPPLER	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 RENAL ARTER US	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 US PELVIS WTRANSVAG WDOPP	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 PELVIS US WITH TRANSVAG	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 OB US>14 WKS W FETAL UMBARTERY	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 OB US<14 WKS W/TRANSVAG	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 RENAL US WITH DOPPLER	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 OB>14WKS W/TRANSVAG	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 OB US <14WKS TWINS	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 ART/VENOUS FLOW; US LIMITED	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 OB US F/U TWINS	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 ART/VENOUS FLOW; US	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 US AMNIOCENTESIS	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 ASPIRATION; BREAST	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 US HYSTEROSONOGRAPHY	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 US PLACE PROSTATE MARKER	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 US BIOPSY; PROSTATE	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 BIOPSY;NEEDLE LYMPH NODE US	$548.11	$843.25	—	—	35%
Prostate biopsy inpatient CPT 55700 US NEEDLE PLCMNT PRE-PX	$548.11	$843.25	—	—	35%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTROY LUMB/SAC FACET JNT	$1,430.49	$2,200.75	—	11% above	35%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DESTROY LUMB/SAC FACET JNT	$1,430.49	$2,200.75	—	—	35%
Removal of a breast lump, open surgery CPT 19120 REM BREAST LESION 1 OR MORE	$444.60	$684.00	—	56% below	35%
Removal of a breast lump, open surgery inpatient CPT 19120 REM BREAST LESION 1 OR MORE	$444.60	$684.00	—	—	35%
Removal of a foreign object under the skin, simple CPT 10120 REM FOREIGN BODY	$153.40	$236.00	—	35% below	35%
Removal of a foreign object under the skin, simple CPT 10120 INCIS & RMVL FB, SU	$205.56	$316.25	—	12% below	35%
Removal of a foreign object under the skin, simple CPT 10120 SQ FB REMOVL/W INCIS/SIMP	$561.76	$864.25	—	139% above	35%
Removal of a foreign object under the skin, simple inpatient CPT 10120 REM FOREIGN BODY	$153.40	$236.00	—	—	35%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCIS & RMVL FB, SU	$205.56	$316.25	—	—	35%
Removal of a foreign object under the skin, simple inpatient CPT 10120 SQ FB REMOVL/W INCIS/SIMP	$561.76	$864.25	—	—	35%
Removal of one lobe of the thyroid (lobectomy) CPT 60220 TOTAL THYROID LOBECTOMY W/WO U	$550.55	$847.00	—	73% below	35%
Removal of one lobe of the thyroid (lobectomy) inpatient CPT 60220 TOTAL THYROID LOBECTOMY W/WO U	$550.55	$847.00	—	—	35%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colorectal scrn; hi risk ind	$364.16	$560.25	—	38% below	35%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 Colorectal scrn; hi risk ind	$364.16	$560.25	—	—	35%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 LITHOTRIPSY OF KIDNEY STONE	$690.95	$1,063.00	—	60% below	35%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 LITHOTRIPSY OF KIDNEY STONE	$690.95	$1,063.00	—	—	35%
Short arm cast (elbow to hand) CPT 29075 APPLY FOREARM CAST	$85.15	$131.00	—	47% below	35%
Short arm cast (elbow to hand) CPT 29075 CAST, SHORT ARM	$118.62	$182.50	—	26% below	35%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLY FOREARM CAST	$85.15	$131.00	—	—	35%
Short arm cast (elbow to hand) inpatient CPT 29075 CAST, SHORT ARM	$118.62	$182.50	—	—	35%
Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT	$68.25	$105.00	—	43% below	35%
Short arm splint (forearm and hand) CPT 29125 SPLINT, SHORT ARM	$87.91	$135.25	—	27% below	35%
Short arm splint (forearm and hand) CPT 29125 SPLINT APPLICATION - SHORT ARM	$242.94	$373.75	—	103% above	35%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLY FOREARM SPLINT	$68.25	$105.00	—	—	35%
Short arm splint (forearm and hand) inpatient CPT 29125 SPLINT, SHORT ARM	$87.91	$135.25	—	—	35%
Short arm splint (forearm and hand) inpatient CPT 29125 SPLINT APPLICATION - SHORT ARM	$242.94	$373.75	—	—	35%
Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST	$78.00	$120.00	—	54% below	35%
Short leg cast (below the knee) CPT 29405 CAST, SHORT LEG	$111.80	$172.00	—	33% below	35%
Short leg cast (below the knee) CPT 29405 CAST-SHORT LEG	$290.88	$447.50	—	73% above	35%
Short leg cast (below the knee) inpatient CPT 29405 APPLY SHORT LEG CAST	$78.00	$120.00	—	—	35%
Short leg cast (below the knee) inpatient CPT 29405 CAST, SHORT LEG	$111.80	$172.00	—	—	35%
Short leg cast (below the knee) inpatient CPT 29405 CAST-SHORT LEG	$290.88	$447.50	—	—	35%
Short leg splint (calf to foot) CPT 29515 APPLY LOWER LEG SPLINT	$71.50	$110.00	—	48% below	35%
Short leg splint (calf to foot) CPT 29515 SPLINT, SHORT LEG	$97.99	$150.75	—	29% below	35%
Short leg splint (calf to foot) CPT 29515 SPLINT APPLICATION - SHORT LEG	$274.30	$422.00	—	99% above	35%
Short leg splint (calf to foot) inpatient CPT 29515 APPLY LOWER LEG SPLINT	$71.50	$110.00	—	—	35%
Short leg splint (calf to foot) inpatient CPT 29515 SPLINT, SHORT LEG	$97.99	$150.75	—	—	35%
Short leg splint (calf to foot) inpatient CPT 29515 SPLINT APPLICATION - SHORT LEG	$274.30	$422.00	—	—	35%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 ARTHRS SHLDR DIS CLAVICULECTOM	$3,690.86	$5,678.25	—	157% above	35%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 ARTHRS SHLDR DIS CLAVICULECTOM	$3,690.86	$5,678.25	—	—	35%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 ARTHRS SHLDR W/COR LIGMNT REL	$2,303.28	$3,543.50	—	86% above	35%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 ARTHRS SHLDR W/COR LIGMNT REL	$2,303.28	$3,543.50	—	—	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 LAC RPR-SIMPLE 2.5 CM OR	$100.75	$155.00	—	58% below	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR, SIMPLE, UP TO 2.5 CM	$120.41	$185.25	—	50% below	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/<	$134.55	$207.00	—	44% below	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 UP TO 2.5 CM - SIMPLE	$365.14	$561.75	—	52% above	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 LAC RPR-SIMPLE 2.5 CM OR	$100.75	$155.00	—	—	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR, SIMPLE, UP TO 2.5 CM	$120.41	$185.25	—	—	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/<	$134.55	$207.00	—	—	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 UP TO 2.5 CM - SIMPLE	$365.14	$561.75	—	—	35%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION	$378.95	$583.00	—	29% above	35%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION	$378.95	$583.00	—	—	35%
Skin tag removal, up to 15 tags CPT 11200 REM SKIN TAGS < 15	$79.95	$123.00	—	41% below	35%
Skin tag removal, up to 15 tags CPT 11200 RMVL SKIN TAGS, MULTIPLE, UP	$119.11	$183.25	—	13% below	35%
Skin tag removal, up to 15 tags CPT 11200 REMVL SKIN TAGS<15, ANY AREA	$386.91	$595.25	—	184% above	35%
Skin tag removal, up to 15 tags inpatient CPT 11200 REM SKIN TAGS < 15	$79.95	$123.00	—	—	35%
Skin tag removal, up to 15 tags inpatient CPT 11200 RMVL SKIN TAGS, MULTIPLE, UP	$119.11	$183.25	—	—	35%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMVL SKIN TAGS<15, ANY AREA	$386.91	$595.25	—	—	35%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL FLUID TAP DIAGNOSTIC	$165.10	$254.00	—	31% below	35%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCT, LUMBAR, DIAG	$216.94	$333.75	—	9% below	35%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE, DIAGNOSTIC	$789.26	$1,214.25	—	232% above	35%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL FLUID TAP DIAGNOSTIC	$165.10	$254.00	—	—	35%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCT, LUMBAR, DIAG	$216.94	$333.75	—	—	35%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE, DIAGNOSTIC	$789.26	$1,214.25	—	—	35%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM	$107.41	$165.25	—	55% 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 RPR S/N/AX/GEN/TRNK 2.6 - 7.5	$118.95	$183.00	—	50% 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 RPR, SIMPLE, 2.6 CM - 7.5 CM	$146.74	$225.75	—	38% 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 2.6 TO 7.5 CM - SIMPLE	$413.08	$635.50	—	75% 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 RPR S/N/AX/GEN/TRNK2.6-7.5CM	$107.41	$165.25	—	—	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 RPR S/N/AX/GEN/TRNK 2.6 - 7.5	$118.95	$183.00	—	—	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 RPR, SIMPLE, 2.6 CM - 7.5 CM	$146.74	$225.75	—	—	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 2.6 TO 7.5 CM - SIMPLE	$413.08	$635.50	—	—	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR F/E/E/N/L/M 2.5 CM OR LESS	$122.20	$188.00	—	58% below	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR, SIMPLE, UP TO 2.5 CM	$147.71	$227.25	—	49% below	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 UP TO 2.5 CM - SIMPLE	$365.14	$561.75	—	27% above	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 RPR F/E/E/N/L/M 2.5 CM OR LESS	$122.20	$188.00	—	—	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 RPR, SIMPLE, UP TO 2.5 CM	$147.71	$227.25	—	—	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 UP TO 2.5 CM - SIMPLE	$365.14	$561.75	—	—	35%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES	$378.95	$583.00	—	95% above	35%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGNTL BX SKIN SINGLE LES	$378.95	$583.00	—	—	35%
Thoracentesis with imaging guidance both sides CPT 32555 THORACENTESIS; W/ IMG; BILAT	$2,634.12	$4,052.50	—	—	35%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/IMAGING	$394.22	$606.50	—	21% below	35%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING	$499.85	$769.00	—	at median	35%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS W/ GUIDANCE	$1,214.04	$1,867.75	—	143% above	35%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS; WITH GUIDANCE	$1,658.80	$2,552.00	—	232% above	35%
Thoracentesis with imaging guidance inpatient both sides CPT 32555 THORACENTESIS; W/ IMG; BILAT	$2,634.12	$4,052.50	—	—	35%
Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLEURA W/IMAGING	$394.22	$606.50	—	—	35%
Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLEURA W/ IMAGING	$499.85	$769.00	—	—	35%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS W/ GUIDANCE	$1,214.04	$1,867.75	—	—	35%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS; WITH GUIDANCE	$1,658.80	$2,552.00	—	—	35%
Total knee replacement CPT 27447 TOTAL KNEE ARTHROPLASTY	$14,269.61	$21,953.25	—	214% above	35%
Total knee replacement inpatient CPT 27447 TOTAL KNEE ARTHROPLASTY	$14,269.61	$21,953.25	—	—	35%
Total shoulder replacement CPT 23472 ARTHROPLASTY GLENOHUMRL JNT, T	$9,298.58	$14,305.50	—	103% above	35%
Total shoulder replacement inpatient CPT 23472 ARTHROPLASTY GLENOHUMRL JNT, T	$9,298.58	$14,305.50	—	—	35%
Trigger finger release surgery CPT 26055 INCISE FINGER TENDON SHEATH	$624.65	$961.00	—	11% below	35%
Trigger finger release surgery inpatient CPT 26055 INCISE FINGER TENDON SHEATH	$624.65	$961.00	—	—	35%
Trigger point injections, 1 or 2 muscles CPT 20552 ST TISS INFILTRN 1 0R 2 MU	$55.25	$85.00	—	51% below	35%
Trigger point injections, 1 or 2 muscles CPT 20552 TRIGGER PT INJ(S); MUSCLE	$75.08	$115.50	—	33% below	35%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$83.20	$128.00	—	26% below	35%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT,1 TO 2 MUSCL	$404.95	$623.00	—	259% above	35%
Trigger point injections, 1 or 2 muscles CPT 20552 TRIGGER POINT INJECTION	$905.78	$1,393.50	—	703% above	35%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 ST TISS INFILTRN 1 0R 2 MU	$55.25	$85.00	—	—	35%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 TRIGGER PT INJ(S); MUSCLE	$75.08	$115.50	—	—	35%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$83.20	$128.00	—	—	35%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT,1 TO 2 MUSCL	$404.95	$623.00	—	—	35%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 TRIGGER POINT INJECTION	$905.78	$1,393.50	—	—	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion both sides CPT 19083 BREAST BIOPSY;US BILATERAL	$2,066.35	$3,179.00	—	—	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST 1ST LESION US IMAG	$878.80	$1,352.00	—	at median	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BREAST BIOPSY; ULTRASOUND (US)	$1,834.79	$2,822.75	—	109% above	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BREAST BIOPSY; ULTRASOUND; BIL	$3,666.49	$5,640.75	—	317% above	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient both sides CPT 19083 BREAST BIOPSY;US BILATERAL	$2,066.35	$3,179.00	—	—	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BREAST 1ST LESION US IMAG	$878.80	$1,352.00	—	—	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BREAST BIOPSY; ULTRASOUND (US)	$1,834.79	$2,822.75	—	—	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BREAST BIOPSY; ULTRASOUND; BIL	$3,666.49	$5,640.75	—	—	35%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPH ENDOSCOPY, DILATION	$1,333.31	$2,051.25	—	112% above	35%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPH ENDOSCOPY, DILATION <30	$2,603.25	$4,005.00	—	314% above	35%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 ESOPH ENDOSCOPY, DILATION	$1,333.31	$2,051.25	—	—	35%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 ESOPH ENDOSCOPY, DILATION <30	$2,603.25	$4,005.00	—	—	35%
Upper endoscopy (EGD) with biopsy CPT 43239 UPPER GI ENDOSCOPY, BIOPSY	$1,783.76	$2,744.25	—	152% above	35%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 UPPER GI ENDOSCOPY, BIOPSY	$1,783.76	$2,744.25	—	—	35%
Upper endoscopy (EGD) with injection into the lining CPT 43236 UPPER GI SCOPE W/SUBMUC INJ	$1,783.76	$2,744.25	—	190% above	35%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 UPPER GI SCOPE W/SUBMUC INJ	$1,783.76	$2,744.25	—	—	35%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD; REMOVE LESION SNARE	$2,603.25	$4,005.00	—	205% above	35%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 EGD; REMOVE LESION SNARE	$2,603.25	$4,005.00	—	—	35%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 EGD; GUIDE WIRE INSERTION	$1,783.76	$2,744.25	—	171% above	35%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 EGD; GUIDE WIRE INSERTION	$1,783.76	$2,744.25	—	—	35%
Upper endoscopy (EGD), diagnostic CPT 43235 UPPER GI ENDOSCOPY, DIAGNOSIS	$1,054.30	$1,622.00	—	95% above	35%
Upper endoscopy (EGD), diagnostic CPT 43235 UPPER GI ENDOSCOPY, DIAGNOSTIC	$1,551.06	$2,386.25	—	187% above	35%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 UPPER GI ENDOSCOPY, DIAGNOSIS	$1,054.30	$1,622.00	—	—	35%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 UPPER GI ENDOSCOPY, DIAGNOSTIC	$1,551.06	$2,386.25	—	—	35%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 VASECTOMY UNILAT/BILAT	$2,155.08	$3,315.50	—	—	35%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 VASECTOMY	$416.65	$641.00	—	32% below	35%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 VASECTOMY UNILAT/BILAT	$2,155.08	$3,315.50	—	—	35%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 VASECTOMY	$416.65	$641.00	—	—	35%
Vein ablation, radiofrequency, first vein CPT 36475 ENDOVENOUS ABLAT VEIN EXTREM	$1,905.80	$2,932.00	—	19% below	35%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 ENDOVENOUS ABLAT VEIN EXTREM	$1,905.80	$2,932.00	—	—	35%
Wart removal, up to 14 warts CPT 17110 DSTR BEN LESIONS UP TO 14	$115.70	$178.00	—	33% below	35%
Wart removal, up to 14 warts CPT 17110 DESTRUCT FLAT WARTS - UP TO 1	$149.66	$230.25	—	13% below	35%
Wart removal, up to 14 warts inpatient CPT 17110 DSTR BEN LESIONS UP TO 14	$115.70	$178.00	—	—	35%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT FLAT WARTS - UP TO 1	$149.66	$230.25	—	—	35%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SUBQ TISS 20 SQ CM OR	$137.15	$211.00	—	25% below	35%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE, SKIN AND SUB Q TISS	$157.79	$242.75	—	14% below	35%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TIS 20 SQ CM/<	$337.68	$519.50	—	84% above	35%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 NO BURN DEBRID/SKIN, SQ	$629.20	$968.00	—	242% above	35%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE SUBQ TISS 20 SQ CM OR	$137.15	$211.00	—	—	35%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE, SKIN AND SUB Q TISS	$157.79	$242.75	—	—	35%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEB SUBQ TIS 20 SQ CM/<	$337.68	$519.50	—	—	35%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 NO BURN DEBRID/SKIN, SQ	$629.20	$968.00	—	—	35%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 OPTX DSTL RADL X-ARTIC FX/EPIP	$5,006.95	$7,703.00	—	176% above	35%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 OPTX DSTL RADL X-ARTIC FX/EPIP	$5,006.95	$7,703.00	—	—	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 BB-BLOOD ADMINISTRATION FEE	$773.34	$1,189.75	—	4% above	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BB-BLOOD ADMINISTRATION FEE	$773.34	$1,189.75	—	—	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT	$83.20	$128.00	—	16% below	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT	$83.20	$128.00	—	—	35%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUS, UP TO 1 HR	$206.70	$318.00	—	56% below	35%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV INFUS, UP TO 1 HR	$206.70	$318.00	—	—	35%
Critical care, first 30 to 74 minutes CPT 99291 CRIT CARE E/M, 1ST 30-74 MIN	$357.50	$550.00	—	38% below	35%
Critical care, first 30 to 74 minutes CPT 99291 ER FACILITY-CRITICAL 30-74 MIN	$3,407.46	$5,242.25	—	487% above	35%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRIT CARE E/M, 1ST 30-74 MIN	$357.50	$550.00	—	—	35%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ER FACILITY-CRITICAL 30-74 MIN	$3,407.46	$5,242.25	—	—	35%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE AND DROWSY	$475.48	$731.50	—	40% below	35%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE&DROWSY;UP TO 40 MIN	$730.11	$1,123.25	—	8% below	35%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE AND DROWSY	$475.48	$731.50	—	—	35%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE&DROWSY;UP TO 40 MIN	$730.11	$1,123.25	—	—	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TECH LAB STATS	$179.08	$275.50	—	25% above	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TECH LAB STATS	$179.08	$275.50	—	—	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED VISIT, MINOR SEVERIT	$28.76	$44.25	—	74% below	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER. FACILITY-LEVEL 1 RESOURCES	$62.24	$95.75	—	44% below	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ED VISIT, MINOR SEVERIT	$28.76	$44.25	—	—	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER. FACILITY-LEVEL 1 RESOURCES	$62.24	$95.75	—	—	35%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED VISIT, LOW SEVERITY	$55.90	$86.00	—	59% below	35%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER. FACILITY-LEVEL 2 RESOURCES	$223.76	$344.25	—	63% above	35%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ED VISIT, LOW SEVERITY	$55.90	$86.00	—	—	35%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER. FACILITY-LEVEL 2 RESOURCES	$223.76	$344.25	—	—	35%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED VISIT, MODERATE SEVE	$83.69	$128.75	—	57% below	35%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 LEGAL B EVID. COLL/SUSPECT SA	$251.71	$387.25	—	29% above	35%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER. FACILITY-LEVEL 3 RESOURCES	$388.05	$597.00	—	100% above	35%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ED VISIT, MODERATE SEVE	$83.69	$128.75	—	—	35%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 LEGAL B EVID. COLL/SUSPECT SA	$251.71	$387.25	—	—	35%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER. FACILITY-LEVEL 3 RESOURCES	$388.05	$597.00	—	—	35%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED VISIT, HIGH SEVERITY	$158.76	$244.25	—	55% below	35%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 LEGAL A EVID. COLL/SEX ASSULT	$710.61	$1,093.25	—	101% above	35%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER. FACILITY-LEVEL 4 RESOURCES	$721.82	$1,110.50	—	104% above	35%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ED VISIT, HIGH SEVERITY	$158.76	$244.25	—	—	35%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 LEGAL A EVID. COLL/SEX ASSULT	$710.61	$1,093.25	—	—	35%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER. FACILITY-LEVEL 4 RESOURCES	$721.82	$1,110.50	—	—	35%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED VISIT, COMPREHENSIVE	$234.16	$360.25	—	55% below	35%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER. FACILITY-LEVEL 5 RESOURCES	$1,524.25	$2,345.00	—	193% above	35%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ED VISIT, COMPREHENSIVE	$234.16	$360.25	—	—	35%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER. FACILITY-LEVEL 5 RESOURCES	$1,524.25	$2,345.00	—	—	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 ECHO TTE WITH BUBBLE	$619.45	$953.00	—	30% above	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 CONGENITAL ECHO COMPLT W/CONST	$619.45	$953.00	—	30% above	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 TRANSTHORACIC ECHO W/ CONTRAST	$619.45	$953.00	—	30% above	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 ECHO TEE WITH BUBBLE	$619.45	$953.00	—	30% above	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS ECHO WITH CONTRAST	$619.45	$953.00	—	30% above	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS ECHO W/DOPPLER&COLORFLO	$619.45	$953.00	—	30% above	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 TRANSESOPHAGEAL ECHO/OR WCOLOR	$619.45	$953.00	—	30% above	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 TRANSTHORACIC ECHO LIMITED	$619.45	$953.00	—	30% above	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 TRANSTHORACIC ECHO LMTD W CONS	$619.45	$953.00	—	30% above	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 ECHO TEE COMPLETE W/CONTRAST	$619.45	$953.00	—	30% above	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 TRANSTHORACIC ECHO COMPLETE	$619.45	$953.00	—	30% above	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 CONGENITAL CARDIAC ECHO, LMTD	$619.45	$953.00	—	30% above	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 CONGENITAL CARDIAC ECHO COMPLT	$619.45	$953.00	—	30% above	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 ECHO TTE W/BUBBLE, LIMITED	$619.45	$953.00	—	30% above	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 TREADMILL/PHARMOCOLOGIC STRESS	$747.99	$1,150.75	—	57% above	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 TRANSESOPHAGEAL ECHO/OR WCOLOR	$619.45	$953.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 ECHO TEE COMPLETE W/CONTRAST	$619.45	$953.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 TRANSTHORACIC ECHO LMTD W CONS	$619.45	$953.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 TRANSTHORACIC ECHO W/ CONTRAST	$619.45	$953.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CONGENITAL ECHO COMPLT W/CONST	$619.45	$953.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 ECHO TTE WITH BUBBLE	$619.45	$953.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 ECHO TEE WITH BUBBLE	$619.45	$953.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 STRESS ECHO WITH CONTRAST	$619.45	$953.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 STRESS ECHO W/DOPPLER&COLORFLO	$619.45	$953.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 TRANSTHORACIC ECHO LIMITED	$619.45	$953.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 TRANSTHORACIC ECHO COMPLETE	$619.45	$953.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CONGENITAL CARDIAC ECHO, LMTD	$619.45	$953.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CONGENITAL CARDIAC ECHO COMPLT	$619.45	$953.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 ECHO TTE W/BUBBLE, LIMITED	$619.45	$953.00	—	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 TREADMILL/PHARMOCOLOGIC STRESS	$747.99	$1,150.75	—	—	35%
Family therapy with the patient, 50 minutes CPT 90847 FAM PSYCHOTHERAPY W/PT PRES	$94.90	$146.00	—	43% below	35%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FAM PSYCHOTHERAPY W/PT PRES	$94.90	$146.00	—	—	35%
Family therapy without the patient, 50 minutes CPT 90846 FAM PSYCHOTHERAPY W/O PT PR	$91.65	$141.00	—	52% below	35%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAM PSYCHOTHERAPY W/O PT PR	$91.65	$141.00	—	—	35%
Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY	$23.40	$36.00	—	67% below	35%
Group psychotherapy session CPT 90853 TELEHEALTH GRP PSYC OT FAM	$39.98	$61.50	—	44% below	35%
Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY	$23.40	$36.00	—	—	35%
Group psychotherapy session inpatient CPT 90853 TELEHEALTH GRP PSYC OT FAM	$39.98	$61.50	—	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUS HYDRAT INIT, 31 MIN-	$55.90	$86.00	—	76% below	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION 1ST HR	$355.39	$546.75	—	53% above	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUS HYDRAT INIT, 31 MIN-	$55.90	$86.00	—	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION 1ST HR	$355.39	$546.75	—	—	35%
IV infusion of a medicine, first hour CPT 96365 IV INFUS, UP TO 1 HR	$105.30	$162.00	—	58% below	35%
IV infusion of a medicine, first hour CPT 96365 THERAPEUTIC INFUSION 1ST HR	$357.34	$549.75	—	41% above	35%
IV infusion of a medicine, first hour CPT 96365 THERAPEUTIC IV INFUSION 1ST HR	$385.78	$593.50	—	52% above	35%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUS, UP TO 1 HR	$105.30	$162.00	—	—	35%
IV infusion of a medicine, first hour inpatient CPT 96365 THERAPEUTIC INFUSION 1ST HR	$357.34	$549.75	—	—	35%
IV infusion of a medicine, first hour inpatient CPT 96365 THERAPEUTIC IV INFUSION 1ST HR	$385.78	$593.50	—	—	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ, SC/IM	$24.70	$38.00	—	60% below	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ, SC/IM	$24.70	$38.00	—	—	35%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAGNOSTIC EVALUATION	$118.30	$182.00	—	48% below	35%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 TELEHEALTH DIAGNOSTIC EXAM	$195.32	$300.50	—	14% below	35%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DX INTERVIEW EXAM	$207.84	$319.75	—	8% below	35%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCH DIAGNOSTIC EVALUATION	$118.30	$182.00	—	—	35%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 TELEHEALTH DIAGNOSTIC EXAM	$195.32	$300.50	—	—	35%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCH DX INTERVIEW EXAM	$207.84	$319.75	—	—	35%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 NERVE COND STUDIES, 7-8 STUDI	$127.40	$196.00	—	48% below	35%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 NERVE COND STUDIES, 7-8 STUDI	$127.40	$196.00	—	—	35%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REEDUCATION	$52.00	$80.00	—	31% below	35%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR RE-EDUCATION 15	$61.75	$95.00	—	18% below	35%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR REEDUCATION	$52.00	$80.00	—	—	35%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR RE-EDUCATION 15	$61.75	$95.00	—	—	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INITIAL NUTRITION 15 MIN	$33.64	$51.75	—	26% below	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 INIT 1:1 NUTR THER EA 60MIN	$54.60	$84.00	—	20% above	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 INIT 1:1 NUTR THER EA 45MIN	$54.60	$84.00	—	20% above	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 INIT 1:1 NUTR THER EA 30MIN	$54.60	$84.00	—	20% above	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 INIT 1:1 NUTR THER EA 15MIN	$54.60	$84.00	—	20% above	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INITIAL NUTRITION 90 MIN	$353.28	$543.50	—	679% above	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT INITIAL NUTRITION 15 MIN	$33.64	$51.75	—	—	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 INIT 1:1 NUTR THER EA 15MIN	$54.60	$84.00	—	—	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 INIT 1:1 NUTR THER EA 60MIN	$54.60	$84.00	—	—	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 INIT 1:1 NUTR THER EA 45MIN	$54.60	$84.00	—	—	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 INIT 1:1 NUTR THER EA 30MIN	$54.60	$84.00	—	—	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT INITIAL NUTRITION 90 MIN	$353.28	$543.50	—	—	35%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEX 30 MIN	$134.55	$207.00	—	21% below	35%
Occupational therapy evaluation, low complexity CPT 97165 OT EVALUATION;LOW COMPLEX	$146.09	$224.75	—	14% below	35%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW COMPLEX 30 MIN	$134.55	$207.00	—	—	35%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVALUATION;LOW COMPLEX	$146.09	$224.75	—	—	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEX	$104.00	$160.00	—	44% below	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVALUATION;HIGH COMPLEX	$146.09	$224.75	—	22% below	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEX	$104.00	$160.00	—	—	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVALUATION;HIGH COMPLEX	$146.09	$224.75	—	—	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVALUATION; LOW COMPLEX	$146.09	$224.75	—	12% below	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVALUATION; LOW COMPLEX	$146.09	$224.75	—	—	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVALUATION;MODERATE COMPLEX	$146.09	$224.75	—	12% below	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVALUATION;MODERATE COMPLEX	$146.09	$224.75	—	—	35%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MNL THERAPY, 1/> REG; 15 MIN	$41.60	$64.00	—	40% below	35%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY TECHNIQUE	$63.21	$97.25	—	8% below	35%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY TECHNIQUES;15MI	$63.21	$97.25	—	8% below	35%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MNL THERAPY, 1/> REG; 15 MIN	$41.60	$64.00	—	—	35%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY TECHNIQUES;15MI	$63.21	$97.25	—	—	35%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY TECHNIQUE	$63.21	$97.25	—	—	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES; 15 MINS	$45.50	$70.00	—	39% below	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE	$66.14	$101.75	—	11% below	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE 1:1	$66.14	$101.75	—	11% below	35%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISES; 15 MINS	$45.50	$70.00	—	—	35%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE 1:1	$66.14	$101.75	—	—	35%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE	$66.14	$101.75	—	—	35%
Psychiatric evaluation with medical services CPT 90792 PSYCH DIAGNOSTIC EVAL W/MED SR	$131.30	$202.00	—	56% below	35%
Psychiatric evaluation with medical services inpatient CPT 90792 PSYCH DIAGNOSTIC EVAL W/MED SR	$131.30	$202.00	—	—	35%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 PSYCL TEST EVAL PHYS/QHP 1ST	$97.50	$150.00	—	40% below	35%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 PSYCL TEST EVAL PHYS/QHP 1ST	$97.50	$150.00	—	—	35%
Psychotherapy for crisis, first 60 minutes CPT 90839 PSYTX CRISIS INT 60 MIN	$83.20	$128.00	—	61% below	35%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 PSYTX CRISIS INT 60 MIN	$83.20	$128.00	—	—	35%
Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHERAPY, PT &/OR FAM	$57.20	$88.00	—	49% below	35%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTHERAPY, PT &/OR FAM	$57.20	$88.00	—	—	35%
Psychotherapy session, 45 minutes CPT 90834 PSYCHOTHER, PT &/OR FAM	$76.05	$117.00	—	47% below	35%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTHER, PT &/OR FAM	$76.05	$117.00	—	—	35%
Psychotherapy session, 60 minutes CPT 90837 PSYCHOTHERAPY, PT &/OR FAM	$113.75	$175.00	—	40% below	35%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYCHOTHERAPY, PT &/OR FAM	$113.75	$175.00	—	—	35%
Speech and language evaluation CPT 92523 SPEECH EVAL;SOUND PROD W COMPR	$354.09	$544.75	—	1% below	35%
Speech and language evaluation inpatient CPT 92523 SPEECH EVAL;SOUND PROD W COMPR	$354.09	$544.75	—	—	35%
Speech therapy session, individual CPT 92507 SPEECH TREATMENT	$149.18	$229.50	—	9% below	35%
Speech therapy session, individual inpatient CPT 92507 SPEECH TREATMENT	$149.18	$229.50	—	—	35%
Spirometry (breathing test) CPT 94010 BREATHING CAPACITY TEST	$39.65	$61.00	—	74% below	35%
Spirometry (breathing test) inpatient CPT 94010 BREATHING CAPACITY TEST	$39.65	$61.00	—	—	35%
Spirometry before and after a bronchodilator CPT 94060 EVALUATION OF WHEEZING	$68.25	$105.00	—	74% below	35%
Spirometry before and after a bronchodilator inpatient CPT 94060 EVALUATION OF WHEEZING	$68.25	$105.00	—	—	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES	$59.15	$91.00	—	22% below	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC FUNCTIONAL ACTIVIT	$66.14	$101.75	—	13% below	35%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITIES	$59.15	$91.00	—	—	35%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC FUNCTIONAL ACTIVIT	$66.14	$101.75	—	—	35%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY 0-2 HRS	$140.40	$216.00	—	9% below	35%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY 0-2 HRS	$140.40	$216.00	—	—	35%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SARCOV2 VAC 50MCG/0.5ML IM INJ	$121.55	$187.00	—	14% below	35%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 SARCOV2 VAC 50MCG/0.5ML IM INJ	$121.55	$187.00	—	—	35%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 SARSCOV2 VAC 30MCG/0.3ML IM	$112.45	$173.00	—	19% below	35%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 SARSCOV2 VAC 30MCG/0.3ML IM	$112.45	$173.00	—	—	35%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VAC LIVE SUBQ	$88.40	$136.00	—	59% below	35%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VAC LIVE SUBQ	$88.40	$136.00	—	—	35%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACCINE, 3 YRS AND UP	$24.70	$38.00	—	11% above	35%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACCINE, 3 YRS AND UP	$24.70	$38.00	—	—	35%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE ADULT, IM	$53.30	$82.00	—	44% below	35%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE ADULT, IM	$53.30	$82.00	—	—	35%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VACCINE, SPLIT ANT	$94.90	$146.00	—	25% above	35%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENZA VACCINE, SPLIT ANT	$94.90	$146.00	—	—	35%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL CONJ VAC TETRAVA	$139.10	$214.00	—	15% below	35%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL CONJ VAC TETRAVA	$139.10	$214.00	—	—	35%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MenB 2 Dose Schedule	$300.95	$463.00	—	8% above	35%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MenB 2 Dose Schedule	$300.95	$463.00	—	—	35%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PCV20 VACCINE IM	$233.35	$359.00	—	26% below	35%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PCV20 VACCINE IM	$233.35	$359.00	—	—	35%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VACCINE, 2 YR+	$109.85	$169.00	—	20% below	35%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VACCINE, 2 YR+	$109.85	$169.00	—	—	35%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 AREXVY RSV VACC 0.5ML	$262.60	$404.00	—	13% below	35%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 AREXVY RSV VACC 0.5ML	$262.60	$404.00	—	—	35%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM	$241.15	$371.00	—	45% below	35%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE IM	$241.15	$371.00	—	—	35%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 TYPHOID VACCINE, IM	$73.45	$113.00	—	28% below	35%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 TYPHOID VACCINE, IM	$73.45	$113.00	—	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION VACCINE ADMIN 1ST	$51.68	$79.50	—	24% above	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUN VACC ADMIN 1ST-INPT OBST	$62.89	$96.75	—	51% above	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZE/SINGLE OR COMBINATION	$62.89	$96.75	—	51% above	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION VACCINE ADMIN 1ST	$51.68	$79.50	—	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUN VACC ADMIN 1ST-INPT OBST	$62.89	$96.75	—	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZE/SINGLE OR COMBINATION	$62.89	$96.75	—	—	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATIONS, 2+	$16.90	$26.00	—	44% below	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION VACCINE ADMIN 2ND	$59.64	$91.75	—	96% above	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUN VACC ADMIN 2ND-INPT OBST	$59.64	$91.75	—	96% above	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATIONS, 2+	$16.90	$26.00	—	—	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION VACCINE ADMIN 2ND	$59.64	$91.75	—	—	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUN VACC ADMIN 2ND-INPT OBST	$59.64	$91.75	—	—	35%

Source file: https://HospitalPriceDisclosure.com/Download.aspx?pi=nlnNge8MhLiec440RvxqVQ*-*