Hospital

Mountainview Medical Center

Mountainview Medical Center in White Sulphur Springs, MT publishes cash prices for 258 common procedures listed here, from its own machine-readable price file updated Jul 13, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Montana median for 178 of 258 procedures and below it for 75. By typical cash price it ranks #22 of 29 Montana hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

16 W Main Street, White Sulphur Springs, MT 59645 Collected Nov 9, 2026 Source price file Check a bill from this hospital

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 Mountainview Medical Center in White Sulphur Springs, MT:

Apr 13, 2026 Warning notice
Jul 20, 2026 Corrective action plan requested

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found.

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
Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN W/WO CONTRAST	$2,233.56	$2,791.95	$2,233.56–$2,791.95	14% above	20%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W/WO CONTRAST	$2,233.56	$2,791.95	$2,233.56–$2,791.95	—	20%
Abdominal X-ray, 2 views CPT 74019 XR ABDOMEN COMPLETE 2 VIEWS	$245.28	$306.60	$245.28–$306.60	9% below	20%
Abdominal X-ray, 2 views inpatient CPT 74019 XR ABDOMEN COMPLETE 2 VIEWS	$245.28	$306.60	$245.28–$306.60	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L XTREMITY ART 2 LEVELS	$777.84	$972.30	$777.84–$972.30	162% above	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 UPR/L XTREMITY ART 2 LEVELS	$777.84	$972.30	$777.84–$972.30	—	20%
CT angiography (CTA) of the head CPT 70496 CTA HEAD W/WO CONTRAST	$2,157.12	$2,696.40	$2,157.12–$2,696.40	1% above	20%
CT angiography (CTA) of the head inpatient CPT 70496 CTA HEAD W/WO CONTRAST	$2,157.12	$2,696.40	$2,157.12–$2,696.40	—	20%
CT angiography (CTA) of the neck CPT 70498 CTA NECK W/WO CONTRAST	$2,146.20	$2,682.75	$2,146.20–$2,682.75	at median	20%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA NECK W/WO CONTRAST	$2,146.20	$2,682.75	$2,146.20–$2,682.75	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST W/ CONTRAST	$2,212.56	$2,765.70	$2,212.56–$2,765.70	at median	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST W/WO CONTRAST	$2,228.52	$2,785.65	$2,228.52–$2,785.65	1% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST W/ CONTRAST	$2,212.56	$2,765.70	$2,212.56–$2,765.70	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST W/WO CONTRAST	$2,228.52	$2,785.65	$2,228.52–$2,785.65	—	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD/PELVIS W/O CONTRAST	$2,418.36	$3,022.95	$2,418.36–$3,022.95	13% above	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD/PELVIS W/O CONTRAST	$2,418.36	$3,022.95	$2,418.36–$3,022.95	—	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PELVIS W/ CONTRAST	$2,835.84	$3,544.80	$2,835.84–$3,544.80	at median	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PELVIS W/ CONTRAST	$2,835.84	$3,544.80	$2,835.84–$3,544.80	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD/PELVIS W/WO CONTRAST	$3,281.04	$4,101.30	$3,281.04–$4,101.30	6% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD/PELVIS W/WO CONTRAST	$3,281.04	$4,101.30	$3,281.04–$4,101.30	—	20%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/ CONTRAST	$1,927.80	$2,409.75	$1,927.80–$2,409.75	6% above	20%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/ CONTRAST	$1,927.80	$2,409.75	$1,927.80–$2,409.75	—	20%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$1,485.12	$1,856.40	$1,485.12–$1,856.40	9% above	20%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST	$1,485.12	$1,856.40	$1,485.12–$1,856.40	—	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O CONTRAST	$1,401.12	$1,751.40	$1,401.12–$1,751.40	17% above	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O CONTRAST	$1,401.12	$1,751.40	$1,401.12–$1,751.40	—	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST	$1,086.12	$1,357.65	$1,086.12–$1,357.65	8% below	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONTRAST	$1,086.12	$1,357.65	$1,086.12–$1,357.65	—	20%
CT scan of the head with contrast CPT 70460 CT HEAD W/ CONTRAST	$1,197.00	$1,496.25	$1,197.00–$1,496.25	17% below	20%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W/ CONTRAST	$1,197.00	$1,496.25	$1,197.00–$1,496.25	—	20%
CT scan of the head without and with contrast CPT 70470 CT HEAD W/WO CONTRAST	$1,498.56	$1,873.20	$1,498.56–$1,873.20	17% below	20%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W/WO CONTRAST	$1,498.56	$1,873.20	$1,498.56–$1,873.20	—	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT L-SPINE W/O CONTRAST	$1,170.96	$1,463.70	$1,170.96–$1,463.70	18% below	20%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT L-SPINE W/O CONTRAST	$1,170.96	$1,463.70	$1,170.96–$1,463.70	—	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT C-SPINE W/O CONTRAST	$1,599.36	$1,999.20	$1,599.36–$1,999.20	13% above	20%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT C-SPINE W/O CONTRAST	$1,599.36	$1,999.20	$1,599.36–$1,999.20	—	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST	$1,365.84	$1,707.30	$1,365.84–$1,707.30	15% below	20%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ CONTRAST	$1,365.84	$1,707.30	$1,365.84–$1,707.30	—	20%
Chest CT scan without and with contrast CPT 71270 CT THORAX W/WO CONTRAST	$2,228.52	$2,785.65	$2,228.52–$2,785.65	12% above	20%
Chest CT scan without and with contrast inpatient CPT 71270 CT THORAX W/WO CONTRAST	$2,228.52	$2,785.65	$2,228.52–$2,785.65	—	20%
Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEWS	$208.32	$260.40	$208.32–$260.40	6% below	20%
Chest X-ray, 2 views CPT 71046 XR CHEST SPECIAL VIEWS	$208.32	$260.40	$208.32–$260.40	6% below	20%
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEWS	$208.32	$260.40	$208.32–$260.40	—	20%
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST SPECIAL VIEWS	$208.32	$260.40	$208.32–$260.40	—	20%
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW	$176.40	$220.50	$176.40–$220.50	5% below	20%
Chest X-ray, single view inpatient CPT 71045 XR CHEST 1 VIEW	$176.40	$220.50	$176.40–$220.50	—	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 XR DXA BONE DENSITY AXIAL	$315.84	$394.80	$315.84–$394.80	2% below	20%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 XR DXA BONE DENSITY AXIAL	$315.84	$394.80	$315.84–$394.80	—	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 XR DXA BONE DENSITY PERIPHERAL	$150.36	$187.95	$150.36–$187.95	2% above	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 XR DXA BONE DENSITY PERIPHERAL	$150.36	$187.95	$150.36–$187.95	—	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX W/O CONTRAST	$1,484.28	$1,855.35	$1,484.28–$1,855.35	7% above	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX W/O CONTRAST	$1,484.28	$1,855.35	$1,484.28–$1,855.35	—	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX W/ CONTRAST	$1,908.48	$2,385.60	$1,908.48–$2,385.60	15% above	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX W/ CONTRAST	$1,908.48	$2,385.60	$1,908.48–$2,385.60	—	20%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORB/SELLA/IAC W/O CONTRAST	$1,092.00	$1,365.00	$1,092.00–$1,365.00	16% below	20%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORB/SELLA/IAC W/O CONTRAST	$1,092.00	$1,365.00	$1,092.00–$1,365.00	—	20%
Facial bones X-ray, complete, 3 or more views CPT 70150 XR FACIAL (3+) COMPLETE	$283.08	$353.85	$283.08–$353.85	13% below	20%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XR FACIAL (3+) COMPLETE	$283.08	$353.85	$283.08–$353.85	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMINAL REAL TIME W/IMAGE LIMITED	$674.40	$843.00	$674.40–$843.00	65% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMINAL REAL TIME W/IMAGE LIMITED	$674.40	$843.00	$674.40–$843.00	—	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 LDCT FOR LUNG CA SCREENING	$283.92	$354.90	$283.92–$354.90	61% below	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 LDCT FOR LUNG CA SCREENING	$283.92	$354.90	$283.92–$354.90	—	20%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR C-SPINE 4+ VIEWS COMPLETE	$336.00	$420.00	$336.00–$420.00	3% above	20%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XR C-SPINE 4+ VIEWS COMPLETE	$336.00	$420.00	$336.00–$420.00	—	20%
Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISSUE NECK W/ CONTRAST	$1,773.24	$2,216.55	$1,773.24–$2,216.55	1% above	20%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT SOFT TISSUE NECK W/ CONTRAST	$1,773.24	$2,216.55	$1,773.24–$2,216.55	—	20%
Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISSUE NECK W/O CONTRAST	$1,405.32	$1,756.65	$1,405.32–$1,756.65	15% above	20%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISSUE NECK W/O CONTRAST	$1,405.32	$1,756.65	$1,405.32–$1,756.65	—	20%
Neck soft tissue X-ray CPT 70360 XR NECK SOFT TISSUE	$199.08	$248.85	$199.08–$248.85	2% above	20%
Neck soft tissue X-ray inpatient CPT 70360 XR NECK SOFT TISSUE	$199.08	$248.85	$199.08–$248.85	—	20%
Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O CONTRAST	$1,087.80	$1,359.75	$1,087.80–$1,359.75	22% below	20%
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O CONTRAST	$1,087.80	$1,359.75	$1,087.80–$1,359.75	—	20%
Sinus X-ray, complete, 3 or more views CPT 70220 XR SINUS/PARANASAL COMPLETE	$263.76	$329.70	$263.76–$329.70	3% above	20%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 XR SINUS/PARANASAL COMPLETE	$263.76	$329.70	$263.76–$329.70	—	20%
Skull X-ray, fewer than 4 views CPT 70250 XR SKULL 1-3 VIEWS	$237.72	$297.15	$237.72–$297.15	at median	20%
Skull X-ray, fewer than 4 views inpatient CPT 70250 XR SKULL 1-3 VIEWS	$237.72	$297.15	$237.72–$297.15	—	20%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT T-SPINE W/O CONTRAST	$1,593.48	$1,991.85	$1,593.48–$1,991.85	12% above	20%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT T-SPINE W/O CONTRAST	$1,593.48	$1,991.85	$1,593.48–$1,991.85	—	20%
X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN 1 VIEW	$185.64	$232.05	$185.64–$232.05	3% above	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABDOMEN 1 VIEW	$185.64	$232.05	$185.64–$232.05	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR L-SPINE 2 VIEWS	$258.72	$323.40	$258.72–$323.40	2% above	20%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR L-SPINE 2 VIEWS	$258.72	$323.40	$258.72–$323.40	—	20%
X-ray of the lower back, 4 or more views CPT 72110 XR L-SPINE (4+) COMPLETE	$351.96	$439.95	$351.96–$439.95	5% above	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR L-SPINE (4+) COMPLETE	$351.96	$439.95	$351.96–$439.95	—	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR T-SPINE 2 VIEWS	$309.12	$386.40	$309.12–$386.40	38% above	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR T-SPINE 2 VIEWS	$309.12	$386.40	$309.12–$386.40	—	20%
X-ray of the nasal bones, 3 or more views CPT 70160 XR NASAL (3+) COMPLETE	$225.12	$281.40	$225.12–$281.40	7% above	20%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR NASAL (3+) COMPLETE	$225.12	$281.40	$225.12–$281.40	—	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR C-SPINE 2-3 VIEWS	$236.04	$295.05	$236.04–$295.05	10% above	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR C-SPINE 2-3 VIEWS	$236.04	$295.05	$236.04–$295.05	—	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS 1-2 VIEWS	$281.40	$351.75	$281.40–$351.75	29% above	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR PELVIS 1-2 VIEWS	$281.40	$351.75	$281.40–$351.75	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR SACRUM AND COCCYX	$292.32	$365.40	$292.32–$365.40	25% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR SACRUM AND COCCYX	$292.32	$365.40	$292.32–$365.40	—	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
ACTH blood test CPT 82024 ACTH-ADRENOCORTICOTROPHIC HORMONE	$213.76	$267.20	$213.76–$267.20	5% below	20%
ACTH blood test inpatient CPT 82024 ACTH-ADRENOCORTICOTROPHIC HORMONE	$213.76	$267.20	$213.76–$267.20	—	20%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT	$59.27	$74.09	$59.27–$74.09	14% above	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT	$59.27	$74.09	$59.27–$74.09	—	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST	$57.48	$71.85	$57.48–$71.85	14% above	20%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST	$57.48	$71.85	$57.48–$71.85	—	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL	$423.94	$529.92	$423.94–$529.92	104% above	20%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL	$423.94	$529.92	$423.94–$529.92	—	20%
Albumin blood test CPT 82040 ALBUMIN SERUM	$53.90	$67.37	$53.90–$67.37	75% above	20%
Albumin blood test inpatient CPT 82040 ALBUMIN SERUM	$53.90	$67.37	$53.90–$67.37	—	20%
Aldosterone blood test CPT 82088 ALDOSTERONE	$176.05	$220.06	$176.05–$220.06	11% below	20%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE	$176.05	$220.06	$176.05–$220.06	—	20%
Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE SERUM	$57.48	$71.85	$57.48–$71.85	at median	20%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE SERUM	$57.48	$71.85	$57.48–$71.85	—	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT	$28.00	$35.00	$28.00–$35.00	41% below	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT	$28.00	$35.00	$28.00–$35.00	—	20%
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-FETO PROTEIN SERUM	$143.70	$179.62	$143.70–$179.62	24% above	20%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-FETO PROTEIN SERUM	$143.70	$179.62	$143.70–$179.62	—	20%
Ammonia blood test CPT 82140 AMMONIA	$233.52	$291.90	$233.52–$291.90	88% above	20%
Ammonia blood test inpatient CPT 82140 AMMONIA	$233.52	$291.90	$233.52–$291.90	—	20%
Amylase blood test CPT 82150 AMYLASE	$100.60	$125.75	$100.60–$125.75	76% above	20%
Amylase blood test inpatient CPT 82150 AMYLASE	$100.60	$125.75	$100.60–$125.75	—	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY	$136.53	$170.66	$136.53–$170.66	41% above	20%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP ANTIBODY	$136.53	$170.66	$136.53–$170.66	—	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA	$140.12	$175.15	$140.12–$175.15	88% above	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA	$140.12	$175.15	$140.12–$175.15	—	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP	$294.59	$368.24	$294.59–$368.24	30% above	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-PRO BNP	$387.97	$484.96	$387.97–$484.96	71% above	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP	$294.59	$368.24	$294.59–$368.24	—	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT-PRO BNP	$387.97	$484.96	$387.97–$484.96	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE MISC OTHER SPECIMEN	$140.12	$175.15	$140.12–$175.15	86% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 THROAT CULTURE	$140.12	$175.15	$140.12–$175.15	86% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE MISC OTHER SPECIMEN	$140.12	$175.15	$140.12–$175.15	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 THROAT CULTURE	$140.12	$175.15	$140.12–$175.15	—	20%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$140.12	$175.15	$140.12–$175.15	49% above	20%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$140.12	$175.15	$140.12–$175.15	—	20%
Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL	$79.03	$98.79	$79.03–$98.79	59% above	20%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL	$79.03	$98.79	$79.03–$98.79	—	20%
Blood culture for bacteria CPT 87040 BLOOD CULTURE	$183.22	$229.03	$183.22–$229.03	21% above	20%
Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE	$183.22	$229.03	$183.22–$229.03	—	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 DRAW FEE	$30.54	$38.18	$30.54–$38.18	61% above	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 DRAW FEE	$30.54	$38.18	$30.54–$38.18	—	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE	$71.86	$89.82	$71.86–$89.82	83% above	20%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE	$71.86	$89.82	$71.86–$89.82	—	20%
Blood lead test CPT 83655 LEAD LEVEL SERUM	$66.47	$83.09	$66.47–$83.09	13% above	20%
Blood lead test inpatient CPT 83655 LEAD LEVEL SERUM	$66.47	$83.09	$66.47–$83.09	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG QUALITATIVE	$120.35	$150.44	$120.35–$150.44	69% above	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG QUALITATIVE	$120.35	$150.44	$120.35–$150.44	—	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO	$93.40	$116.75	$93.40–$116.75	30% above	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING ABO	$116.77	$145.96	$116.77–$145.96	62% above	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO	$93.40	$116.75	$93.40–$116.75	—	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING ABO	$116.77	$145.96	$116.77–$145.96	—	20%
Blood urea nitrogen (BUN) test CPT 84520 BUN	$52.10	$65.12	$52.10–$65.12	9% above	20%
Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN	$52.10	$65.12	$52.10–$65.12	—	20%
C-peptide blood test CPT 84681 C-PEPTIDE	$127.54	$159.42	$127.54–$159.42	14% below	20%
C-peptide blood test inpatient CPT 84681 C-PEPTIDE	$127.54	$159.42	$127.54–$159.42	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$84.43	$105.54	$84.43–$105.54	28% above	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$84.43	$105.54	$84.43–$105.54	—	20%
C. difficile toxin gene test (stool PCR) CPT 87493 REFLEX INF AGENT DETECTION BY NUCLEIC	$294.59	$368.24	$294.59–$368.24	75% above	20%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 REFLEX INF AGENT DETECTION BY NUCLEIC	$294.59	$368.24	$294.59–$368.24	—	20%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9	$119.40	$149.25	$119.40–$149.25	10% below	20%
CA 19-9 blood test (tumor marker) CPT 86301 CANCER ANTIGEN CA19-9	$154.50	$193.12	$154.50–$193.12	17% above	20%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9	$119.40	$149.25	$119.40–$149.25	—	20%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CANCER ANTIGEN CA19-9	$154.50	$193.12	$154.50–$193.12	—	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 CANCER ANTIGEN 125	$185.02	$231.27	$185.02–$231.27	48% above	20%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CANCER ANTIGEN 125	$185.02	$231.27	$185.02–$231.27	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COV2-19 MMC PCR	$117.15	$146.44	$117.15–$146.44	3% below	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COV2-19 MMC PCR	$117.15	$146.44	$117.15–$146.44	—	20%
Calcium blood test, total CPT 82310 CALCIUM TOTAL	$59.27	$74.09	$59.27–$74.09	70% above	20%
Calcium blood test, total inpatient CPT 82310 CALCIUM TOTAL	$59.27	$74.09	$59.27–$74.09	—	20%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA	$186.82	$233.52	$186.82–$233.52	75% above	20%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA	$186.82	$233.52	$186.82–$233.52	—	20%
Chickenpox (varicella) immunity blood test CPT 86787 IGM VARICELLA ANTIBODY	$116.77	$145.96	$116.77–$145.96	136% above	20%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER AB IGG	$116.77	$145.96	$116.77–$145.96	136% above	20%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER AB IGG	$116.77	$145.96	$116.77–$145.96	—	20%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 IGM VARICELLA ANTIBODY	$116.77	$145.96	$116.77–$145.96	—	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE	$154.50	$193.12	$154.50–$193.12	85% above	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE	$154.50	$193.12	$154.50–$193.12	—	20%
Complete blood count (CBC) with differential CPT 85025 .CBC AUTO DIFF	$107.78	$134.73	$107.78–$134.73	36% above	20%
Complete blood count (CBC) with differential inpatient CPT 85025 .CBC AUTO DIFF	$107.78	$134.73	$107.78–$134.73	—	20%
Complete blood count (CBC), no differential CPT 85027 .CBC MANUAL DIFF	$88.02	$110.03	$88.02–$110.03	75% above	20%
Complete blood count (CBC), no differential inpatient CPT 85027 .CBC MANUAL DIFF	$88.02	$110.03	$88.02–$110.03	—	20%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$183.22	$229.03	$183.22–$229.03	41% above	20%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL	$183.22	$229.03	$183.22–$229.03	—	20%
Cortisol blood test, total CPT 82533 CORTISOL TOTAL	$177.85	$222.31	$177.85–$222.31	59% above	20%
Cortisol blood test, total inpatient CPT 82533 CORTISOL TOTAL	$177.85	$222.31	$177.85–$222.31	—	20%
Creatine kinase (CK) blood test, total CPT 82550 CPK TOTAL	$71.86	$89.82	$71.86–$89.82	28% above	20%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CPK TOTAL	$71.86	$89.82	$71.86–$89.82	—	20%
Creatinine blood test CPT 82565 CREATININE BLOOD	$62.87	$78.59	$62.87–$78.59	46% above	20%
Creatinine blood test inpatient CPT 82565 CREATININE BLOOD	$62.87	$78.59	$62.87–$78.59	—	20%
Cytomegalovirus (CMV) antibody test CPT 86644 CYTOMEGALOVIRUS	$111.37	$139.21	$111.37–$139.21	7% above	20%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CYTOMEGALOVIRUS	$111.37	$139.21	$111.37–$139.21	—	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE	$131.13	$163.91	$131.13–$163.91	14% below	20%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE	$131.13	$163.91	$131.13–$163.91	—	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 TOXICOLOGY SCREEN	$328.72	$410.90	$328.72–$410.90	75% above	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 TOXICOLOGY SCREEN	$328.72	$410.90	$328.72–$410.90	—	20%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTES	$129.34	$161.67	$129.34–$161.67	76% above	20%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTES	$129.34	$161.67	$129.34–$161.67	—	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN BARRR CAPSID VCA	$93.60	$117.00	$93.60–$117.00	1% below	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN BARR VIRAL CAPSID	$113.17	$141.46	$113.17–$141.46	20% above	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN-BARR CAPSID VCA	$113.86	$142.33	$113.86–$142.33	21% above	20%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN BARRR CAPSID VCA	$93.60	$117.00	$93.60–$117.00	—	20%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN BARR VIRAL CAPSID	$113.17	$141.46	$113.17–$141.46	—	20%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN-BARR CAPSID VCA	$113.86	$142.33	$113.86–$142.33	—	20%
Estradiol blood test CPT 82670 ESTRADIOL TTL	$204.78	$255.97	$204.78–$255.97	37% above	20%
Estradiol blood test inpatient CPT 82670 ESTRADIOL TTL	$204.78	$255.97	$204.78–$255.97	—	20%
FSH (follicle-stimulating hormone) test CPT 83001 FSH-FOLLICLE STIMULATING HORMONE	$159.88	$199.85	$159.88–$199.85	28% above	20%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH-FOLLICLE STIMULATING HORMONE	$159.88	$199.85	$159.88–$199.85	—	20%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN, FECAL	$228.14	$285.18	$228.14–$285.18	12% below	20%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN, FECAL	$228.14	$285.18	$228.14–$285.18	—	20%
Ferritin blood test (iron stores) CPT 82728 FERRITIN (SERUM)	$202.98	$253.73	$202.98–$253.73	119% above	20%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN (SERUM)	$202.98	$253.73	$202.98–$253.73	—	20%
Fibrinogen blood test CPT 85384 FIBRINOGEN ACTIVITY	$134.73	$168.41	$134.73–$168.41	45% above	20%
Fibrinogen blood test CPT 85384 FIBRINOGEN PLASMA	$195.15	$243.94	$195.15–$243.94	110% above	20%
Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN ACTIVITY	$134.73	$168.41	$134.73–$168.41	—	20%
Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN PLASMA	$195.15	$243.94	$195.15–$243.94	—	20%
Folate (folic acid) blood test CPT 82746 FOLATE	$199.39	$249.24	$199.39–$249.24	119% above	20%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE	$199.39	$249.24	$199.39–$249.24	—	20%
Free T3 thyroid hormone test CPT 84481 FREE T3	$199.39	$249.24	$199.39–$249.24	80% above	20%
Free T3 thyroid hormone test inpatient CPT 84481 FREE T3	$199.39	$249.24	$199.39–$249.24	—	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4	$120.35	$150.44	$120.35–$150.44	60% above	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4	$120.35	$150.44	$120.35–$150.44	—	20%
Free testosterone test CPT 84402 TESTOSTERONE FREE	$136.53	$170.66	$136.53–$170.66	2% above	20%
Free testosterone test CPT 84402 TESTOSTERONE, FREE	$136.53	$170.66	$136.53–$170.66	2% above	20%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE	$136.53	$170.66	$136.53–$170.66	—	20%
Free testosterone test inpatient CPT 84402 TESTOSTERONE, FREE	$136.53	$170.66	$136.53–$170.66	—	20%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT GLUTAMYLTRANSFERASE	$80.84	$101.05	$80.84–$101.05	91% above	20%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT GLUTAMYLTRANSFERASE	$80.84	$101.05	$80.84–$101.05	—	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL	$472.43	$590.54	$472.43–$590.54	71% above	20%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL	$472.43	$590.54	$472.43–$590.54	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 2HR PP	$71.86	$89.82	$71.86–$89.82	17% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE 2HR PP	$71.86	$89.82	$71.86–$89.82	—	20%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 3 SPECIMENS	$174.25	$217.81	$174.25–$217.81	66% above	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE 3 SPECIMENS	$174.25	$217.81	$174.25–$217.81	—	20%
H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI	$138.32	$172.90	$138.32–$172.90	8% above	20%
H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI	$138.32	$172.90	$138.32–$172.90	—	20%
H. pylori stool antigen test CPT 87338 HELICOBACTOR PYLORI ANTIGEN F	$129.34	$161.67	$129.34–$161.67	51% above	20%
H. pylori stool antigen test inpatient CPT 87338 HELICOBACTOR PYLORI ANTIGEN F	$129.34	$161.67	$129.34–$161.67	—	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA	$431.11	$538.89	$431.11–$538.89	17% above	20%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA	$431.11	$538.89	$431.11–$538.89	—	20%
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1, 2	$125.75	$157.19	$125.75–$157.19	51% above	20%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1, 2	$125.75	$157.19	$125.75–$157.19	—	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV, HIGH RISK	$195.79	$244.74	$195.79–$244.74	31% above	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV, HIGH RISK	$195.79	$244.74	$195.79–$244.74	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HGBA1C	$105.98	$132.48	$105.98–$132.48	59% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HGBA1C	$105.98	$132.48	$105.98–$132.48	—	20%
Hemoglobin blood test CPT 85018 HEMOGLOBIN	$41.32	$51.65	$41.32–$51.65	44% above	20%
Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN	$41.32	$51.65	$41.32–$51.65	—	20%
Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B COR AB (IGG & IGM)	$104.19	$130.24	$104.19–$130.24	15% above	20%
Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B COR AB (IGG & IGM)	$104.19	$130.24	$104.19–$130.24	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B S AB TITER	$114.96	$143.70	$114.96–$143.70	41% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE AB	$114.96	$143.70	$114.96–$143.70	41% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEP B S AB TITER	$114.96	$143.70	$114.96–$143.70	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE AB	$114.96	$143.70	$114.96–$143.70	—	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG	$109.57	$136.96	$109.57–$136.96	44% above	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE AG	$109.57	$136.96	$109.57–$136.96	—	20%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY	$136.53	$170.66	$136.53–$170.66	19% above	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY	$136.53	$170.66	$136.53–$170.66	—	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C VIRAL LOAD	$353.87	$442.34	$353.87–$442.34	30% below	20%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 HEP C VIRAL RNA/AT/RT/PCR	$353.87	$442.34	$353.87–$442.34	30% below	20%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C VIRAL LOAD	$353.87	$442.34	$353.87–$442.34	—	20%
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 HEP C VIRAL RNA/AT/RT/PCR	$353.87	$442.34	$353.87–$442.34	—	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HS	$89.92	$112.40	$89.92–$112.40	16% above	20%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HS	$89.92	$112.40	$89.92–$112.40	—	20%
Homocysteine blood test CPT 83090 HOMOCYSTEINE	$154.50	$193.12	$154.50–$193.12	15% above	20%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE	$154.50	$193.12	$154.50–$193.12	—	20%
Insulin blood test CPT 83525 INSULIN (SERUM)	$129.34	$161.67	$129.34–$161.67	48% above	20%
Insulin blood test inpatient CPT 83525 INSULIN (SERUM)	$129.34	$161.67	$129.34–$161.67	—	20%
Iron blood test (serum iron) CPT 83540 IRON	$79.03	$98.79	$79.03–$98.79	26% above	20%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$79.03	$98.79	$79.03–$98.79	—	20%
Iron-binding capacity (TIBC) test CPT 83550 UNBOUND IRON BINDING CAPACITY (UIB	$95.20	$119.00	$95.20–$119.00	44% above	20%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY	$95.20	$119.00	$95.20–$119.00	44% above	20%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY	$95.20	$119.00	$95.20–$119.00	—	20%
Iron-binding capacity (TIBC) test inpatient CPT 83550 UNBOUND IRON BINDING CAPACITY (UIB	$95.20	$119.00	$95.20–$119.00	—	20%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$195.79	$244.74	$195.79–$244.74	76% above	20%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$195.79	$244.74	$195.79–$244.74	—	20%
LH (luteinizing hormone) test CPT 83002 LH LUTEINIZING HORMONE	$158.08	$197.60	$158.08–$197.60	38% above	20%
LH (luteinizing hormone) test inpatient CPT 83002 LH LUTEINIZING HORMONE	$158.08	$197.60	$158.08–$197.60	—	20%
Lactate (lactic acid) blood test CPT 83605 LACTIC ACID	$141.92	$177.40	$141.92–$177.40	3% above	20%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID	$141.92	$177.40	$141.92–$177.40	—	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH LACTATE DEHYDROGENASE	$107.78	$134.73	$107.78–$134.73	128% above	20%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH LACTATE DEHYDROGENASE	$107.78	$134.73	$107.78–$134.73	—	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$113.17	$141.46	$113.17–$141.46	30% above	20%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$113.17	$141.46	$113.17–$141.46	—	20%
Liver function blood test panel CPT 80076 HEPATIC PANEL	$143.70	$179.62	$143.70–$179.62	86% above	20%
Liver function blood test panel inpatient CPT 80076 HEPATIC PANEL	$143.70	$179.62	$143.70–$179.62	—	20%
Lyme disease antibody test CPT 86618 LYME ANTIBODY	$113.17	$141.46	$113.17–$141.46	9% below	20%
Lyme disease antibody test inpatient CPT 86618 LYME ANTIBODY	$113.17	$141.46	$113.17–$141.46	—	20%
Magnesium blood test CPT 83735 MAGNESIUM SERUM	$91.62	$114.52	$91.62–$114.52	41% above	20%
Magnesium blood test CPT 83735 MAGNESIUM (URINE)	$91.62	$114.52	$91.62–$114.52	41% above	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM (URINE)	$91.62	$114.52	$91.62–$114.52	—	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM SERUM	$91.62	$114.52	$91.62–$114.52	—	20%
Measles (rubeola) antibody test CPT 86765 MEASLES (RUBIOLA) IGM	$66.40	$83.00	$66.40–$83.00	6% above	20%
Measles (rubeola) antibody test CPT 86765 MEASLES (RUBIOLA) AB IGG	$93.40	$116.75	$93.40–$116.75	49% above	20%
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES (RUBIOLA) IGM	$66.40	$83.00	$66.40–$83.00	—	20%
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES (RUBIOLA) AB IGG	$93.40	$116.75	$93.40–$116.75	—	20%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO SPOT	$84.43	$105.54	$84.43–$105.54	29% above	20%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO SPOT	$84.43	$105.54	$84.43–$105.54	—	20%
Mumps immunity blood test CPT 86735 MUMPS VIRUS AB, IGG	$93.40	$116.75	$93.40–$116.75	82% above	20%
Mumps immunity blood test inpatient CPT 86735 MUMPS VIRUS AB, IGG	$93.40	$116.75	$93.40–$116.75	—	20%
Obstetric blood test panel CPT 80055 OBSTETRIC PANEL	$287.42	$359.27	$287.42–$359.27	4% below	20%
Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL	$287.42	$359.27	$287.42–$359.27	—	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 FREE PSA	$158.08	$197.60	$158.08–$197.60	38% above	20%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 FREE PSA	$158.08	$197.60	$158.08–$197.60	—	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (PROSTATE SPECIFIC ANTIG TOTAL	$226.34	$282.93	$226.34–$282.93	102% above	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 ULTRA SENSITIVE PSA	$226.34	$282.93	$226.34–$282.93	102% above	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA (PROSTATE SPECIFIC ANTIG TOTAL	$226.34	$282.93	$226.34–$282.93	—	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 ULTRA SENSITIVE PSA	$226.34	$282.93	$226.34–$282.93	—	20%
Pap test (liquid-based, automated screening with review) CPT 88175 PAP LB AUTO + MANUAL SCREEN	$154.50	$193.12	$154.50–$193.12	94% above	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 PAP LB AUTO + MANUAL SCREEN	$154.50	$193.12	$154.50–$193.12	—	20%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP THIN PREP	$138.32	$172.90	$138.32–$172.90	122% above	20%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 PAP THIN PREP	$138.32	$172.90	$138.32–$172.90	—	20%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID HORMONE	$291.01	$363.76	$291.01–$363.76	41% above	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHYROID HORMONE	$291.01	$363.76	$291.01–$363.76	—	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$95.20	$119.00	$95.20–$119.00	64% above	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$95.20	$119.00	$95.20–$119.00	—	20%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS SERUM	$62.87	$78.59	$62.87–$78.59	19% above	20%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS SERUM	$62.87	$78.59	$62.87–$78.59	—	20%
Potassium blood test CPT 84132 POTASSIUM SERUM	$61.07	$76.34	$61.07–$76.34	27% above	20%
Potassium blood test inpatient CPT 84132 POTASSIUM SERUM	$61.07	$76.34	$61.07–$76.34	—	20%
Progesterone blood test CPT 84144 PROGESTERONE	$154.50	$193.12	$154.50–$193.12	16% above	20%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$154.50	$193.12	$154.50–$193.12	—	20%
Prolactin blood test CPT 84146 PROLACTIN	$174.25	$217.81	$174.25–$217.81	45% above	20%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$174.25	$217.81	$174.25–$217.81	—	20%
Prothrombin time (PT/INR) clotting test CPT 85610 LUPUS ANTICOAGULANT PANEL	$64.67	$80.84	$64.67–$80.84	96% above	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME (PT)	$64.67	$80.84	$64.67–$80.84	96% above	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 LUPUS ANTICOAGULANT PANEL	$64.67	$80.84	$64.67–$80.84	—	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME (PT)	$64.67	$80.84	$64.67–$80.84	—	20%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUGS OF ABUSE CONFIRMATION	$91.62	$114.52	$91.62–$114.52	22% below	20%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUGS OF ABUSE CONFIRMATION	$91.62	$114.52	$91.62–$114.52	—	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP SCREEN RAPID	$132.92	$166.15	$132.92–$166.15	173% above	20%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP SCREEN RAPID	$132.92	$166.15	$132.92–$166.15	—	20%
Renin blood test CPT 84244 RENIN	$120.35	$150.44	$120.35–$150.44	30% below	20%
Renin blood test inpatient CPT 84244 RENIN	$120.35	$150.44	$120.35–$150.44	—	20%
Rh blood typing CPT 86901 RH	$116.77	$145.96	$116.77–$145.96	109% above	20%
Rh blood typing inpatient CPT 86901 RH	$116.77	$145.96	$116.77–$145.96	—	20%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR (RA) QUANTITATIV	$66.47	$83.09	$66.47–$83.09	11% above	20%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR (RA) QUANTITATIV	$66.47	$83.09	$66.47–$83.09	—	20%
Rubella antibody test (immunity check) CPT 86762 RUBELLA	$107.78	$134.73	$107.78–$134.73	66% above	20%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA	$107.78	$134.73	$107.78–$134.73	—	20%
Sodium blood test CPT 84295 SODIUM BLOOD	$57.48	$71.85	$57.48–$71.85	24% above	20%
Sodium blood test inpatient CPT 84295 SODIUM BLOOD	$57.48	$71.85	$57.48–$71.85	—	20%
Stool ova and parasites exam CPT 87177 OVA AND PARASITE	$82.63	$103.29	$82.63–$103.29	19% above	20%
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITE	$82.63	$103.29	$82.63–$103.29	—	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HEMOCCULT	$91.62	$114.52	$91.62–$114.52	81% above	20%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HEMOCCULT	$91.62	$114.52	$91.62–$114.52	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR VDRL	$59.27	$74.09	$59.27–$74.09	17% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR VDRL	$59.27	$74.09	$59.27–$74.09	—	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON TB GOLD	$242.51	$303.14	$242.51–$303.14	28% above	20%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON TB GOLD	$242.51	$303.14	$242.51–$303.14	—	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TTL	$168.85	$211.06	$168.85–$211.06	27% above	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TTL	$168.85	$211.06	$168.85–$211.06	—	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID MICROSOMAL ANTIBODY	$145.50	$181.87	$145.50–$181.87	58% above	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROPEROXIDASE ANTIBODIES (TPO)	$145.50	$181.87	$145.50–$181.87	58% above	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROPEROXIDASE ANTIBODIES (TPO)	$145.50	$181.87	$145.50–$181.87	—	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID MICROSOMAL ANTIBODY	$145.50	$181.87	$145.50–$181.87	—	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH-THYROID STIMULATING HORMONE	$170.66	$213.32	$170.66–$213.32	89% above	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH-THYROID STIMULATING HORMONE	$170.66	$213.32	$170.66–$213.32	—	20%
Total IgE blood test CPT 82785 IMMUNOGLOBULIN IGE	$107.78	$134.73	$107.78–$134.73	27% above	20%
Total IgE blood test inpatient CPT 82785 IMMUNOGLOBULIN IGE	$107.78	$134.73	$107.78–$134.73	—	20%
Total cholesterol blood test CPT 82465 CHOLESTEROL	$71.86	$89.82	$71.86–$89.82	104% above	20%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL	$71.86	$89.82	$71.86–$89.82	—	20%
Total thyroxine (T4) blood test CPT 84436 T4-TOTAL	$84.43	$105.54	$84.43–$105.54	49% above	20%
Total thyroxine (T4) blood test inpatient CPT 84436 T4-TOTAL	$84.43	$105.54	$84.43–$105.54	—	20%
Total triiodothyronine (T3) blood test CPT 84480 T3, TOTAL	$172.46	$215.57	$172.46–$215.57	91% above	20%
Total triiodothyronine (T3) blood test inpatient CPT 84480 T3, TOTAL	$172.46	$215.57	$172.46–$215.57	—	20%
Transferrin blood test CPT 84466 TRANSFERRIN	$167.06	$208.82	$167.06–$208.82	50% above	20%
Transferrin blood test inpatient CPT 84466 TRANSFERRIN	$167.06	$208.82	$167.06–$208.82	—	20%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS RNA AMP	$165.26	$206.58	$165.26–$206.58	56% above	20%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS RNA AMP	$165.26	$206.58	$165.26–$206.58	—	20%
Triglycerides blood test CPT 84478 TRIGLYCERIDES	$64.67	$80.84	$64.67–$80.84	54% above	20%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES	$64.67	$80.84	$64.67–$80.84	—	20%
Troponin test, quantitative CPT 84484 TROPONIN I HS	$174.25	$217.81	$174.25–$217.81	89% above	20%
Troponin test, quantitative inpatient CPT 84484 TROPONIN I HS	$174.25	$217.81	$174.25–$217.81	—	20%
Uric acid blood test CPT 84550 URIC ACID SERUM	$62.87	$78.59	$62.87–$78.59	53% above	20%
Uric acid blood test inpatient CPT 84550 URIC ACID SERUM	$62.87	$78.59	$62.87–$78.59	—	20%
Urinalysis with microscope exam, manual CPT 81000 .URINALYSIS W/MICROSCOPIC	$30.54	$38.18	$30.54–$38.18	69% above	20%
Urinalysis with microscope exam, manual inpatient CPT 81000 .URINALYSIS W/MICROSCOPIC	$30.54	$38.18	$30.54–$38.18	—	20%
Urinalysis without microscope exam, manual CPT 81002 .URINALYSIS W/OUT MICROSCOPIC	$25.14	$31.43	$25.14–$31.43	66% above	20%
Urinalysis without microscope exam, manual inpatient CPT 81002 .URINALYSIS W/OUT MICROSCOPIC	$25.14	$31.43	$25.14–$31.43	—	20%
Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE	$111.37	$139.21	$111.37–$139.21	23% above	20%
Urine culture for bacteria, with colony count inpatient CPT 87086 URINE CULTURE	$111.37	$139.21	$111.37–$139.21	—	20%
Urine microalbumin (albumin) test CPT 82043 MICRO-ALBUMIN URINE RANDOM	$100.60	$125.75	$100.60–$125.75	83% above	20%
Urine microalbumin (albumin) test inpatient CPT 82043 MICRO-ALBUMIN URINE RANDOM	$100.60	$125.75	$100.60–$125.75	—	20%
Vitamin B12 (cobalamin) blood test CPT 82607 B12	$201.19	$251.49	$201.19–$251.49	118% above	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 B12	$201.19	$251.49	$201.19–$251.49	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D	$285.62	$357.02	$285.62–$357.02	108% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D2 AND D3 25-HYDROXYVITAMIN	$304.60	$380.75	$304.60–$380.75	122% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D	$285.62	$357.02	$285.62–$357.02	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D2 AND D3 25-HYDROXYVITAMIN	$304.60	$380.75	$304.60–$380.75	—	20%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VITAMIN D 1 DIHYDROXY	$240.71	$300.89	$240.71–$300.89	9% above	20%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VITAMIN D 1 DIHYDROXY	$240.71	$300.89	$240.71–$300.89	—	20%
Zinc blood test CPT 84630 ZINC	$75.45	$94.31	$75.45–$94.31	21% below	20%
Zinc blood test inpatient CPT 84630 ZINC	$75.45	$94.31	$75.45–$94.31	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG QUANTITATIVE	$174.25	$217.81	$174.25–$217.81	51% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG QUANTITATIVE	$174.25	$217.81	$174.25–$217.81	—	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLSD TX ANKLE MALLEOULUS FX W/O MAN	$786.24	$982.80	$786.24–$982.80	62% above	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLSD TX METATARSAL FX W/O MAN EA	$204.96	$256.20	$204.96–$256.20	39% below	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC EXT	$1,508.22	$1,885.28	$1,508.22–$1,885.28	74% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLSD TX DISTAL RAD FX W/O MAN	$828.24	$1,035.30	$828.24–$1,035.30	81% above	20%
D&C (dilation and curettage), not related to pregnancy CPT 58120 D&C NON-OBSTETRICAL	$2,490.60	$3,113.25	$2,490.60–$3,113.25	237% above	20%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 D&C NON-OBSTETRICAL	$2,490.60	$3,113.25	$2,490.60–$3,113.25	—	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 CL DESTRUCT BENIGN LESION 1ST	$156.21	$195.26	$156.21–$195.26	9% below	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT BENIGN LESION 1ST	$167.16	$208.95	$167.16–$208.95	3% below	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCT BENIGN LESION 1ST	$167.16	$208.95	$167.16–$208.95	—	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 CL REM IMPACTED CERUMEN	$33.96	$42.45	$33.96–$42.45	23% below	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED CERUMEN IRRIGATION	$48.28	$60.35	$48.28–$60.35	10% above	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REM IMPACTED CERUMEN W/IRR/LAV UNI	$90.72	$113.40	$90.72–$113.40	107% above	20%
Earwax removal with instruments, one ear CPT 69210 CL REM IMPACT CERUMEN W/	$97.02	$121.28	$97.02–$121.28	14% above	20%
Earwax removal with instruments, one ear CPT 69210 REM IMPACT CERUMEN W/INSTRUMENT UNI	$105.00	$131.25	$105.00–$131.25	23% above	20%
Earwax removal with instruments, one ear CPT 69210 REM IIMPACT CERUMEN W/INSTRUMENT	$127.34	$159.18	$127.34–$159.18	49% above	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOMETRIAL BIOPSY	$160.44	$200.55	$160.44–$200.55	35% below	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDOMETRIAL BIOPSY	$160.44	$200.55	$160.44–$200.55	—	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 SIGMOIDOSCOPY DX W/WO SPECIMEN COLLECT	$1,180.20	$1,475.25	$1,180.20–$1,475.25	8% above	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 SIGMOIDOSCOPY DX W/WO SPECIMEN COLLECT	$1,180.20	$1,475.25	$1,180.20–$1,475.25	—	20%
IUD insertion (the device itself billed separately) CPT 58300 INSERT INTRAUTERINE DEVICE	$1,338.10	$1,672.63	$1,338.10–$1,672.63	365% above	20%
IUD insertion (the device itself billed separately) CPT 58300 INSERT INTRAUTERINE DEVICE IUD	$1,545.54	$1,931.93	$1,545.54–$1,931.93	437% above	20%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERT INTRAUTERINE DEVICE	$1,338.10	$1,672.63	$1,338.10–$1,672.63	—	20%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERT INTRAUTERINE DEVICE IUD	$1,545.54	$1,931.93	$1,545.54–$1,931.93	—	20%
Incision and drainage of a simple or single skin abscess CPT 10060 CL I&D SIMPLE	$289.12	$361.40	$289.12–$361.40	31% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D SIMPLE	$303.24	$379.05	$303.24–$379.05	38% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS	$621.42	$776.77	$621.42–$776.77	182% above	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D SIMPLE	$303.24	$379.05	$303.24–$379.05	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 CL THERAPEUTIC INJ TENDON/LIGAMENT	$131.94	$164.93	$131.94–$164.93	9% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 SINGLE POINT INJECTION/TENDON, LIG	$222.60	$278.25	$222.60–$278.25	53% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 SINGLE POINT INJECTION/TENDON, LIG	$222.60	$278.25	$222.60–$278.25	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 CL INJ/ASP JOINT MAJOR JNT/BURSA WO US	$150.38	$187.98	$150.38–$187.98	45% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJ/ASP JOINT MAJ JNT/BUR WO US 20610	$404.04	$505.05	$404.04–$505.05	46% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJ/ASP JOINT MAJOR JNT/BURSA WO US	$404.04	$505.05	$404.04–$505.05	46% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DTAIN/INJ JOINT/BURSA W/O US	$950.69	$1,188.36	$950.69–$1,188.36	245% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 INJ/ASP JOINT MAJ JNT/BUR WO US 20610	$404.04	$505.05	$404.04–$505.05	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 INJ/ASP JOINT MAJOR JNT/BURSA WO US	$404.04	$505.05	$404.04–$505.05	—	20%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 CL INSERTION DRUG DELIVERY IMPLANT	$86.03	$107.54	$86.03–$107.54	70% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 CL INJ/ASP JOINT MED JNT/BURSA WO US	$126.13	$157.66	$126.13–$157.66	38% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 INJ/ASP JNT MED JNT/BURSA W/O US 20605	$284.76	$355.95	$284.76–$355.95	39% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 INJ/ASP JNT MED JNT/BURSA W/O US 20605	$284.76	$355.95	$284.76–$355.95	—	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 CL INJ/ASP JOINT SMALL JNT/BURSA WO US	$122.25	$152.81	$122.25–$152.81	29% below	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 INJ/ASP JOINT SMALL JNT/BURSA WOUS 20600	$252.00	$315.00	$252.00–$315.00	47% above	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 INJ/ASP JOINT SMALL JNT/BURSA WOUS 20600	$252.00	$315.00	$252.00–$315.00	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REPAIR INTERM S/A/T/E 2.5CM/<	$202.22	$252.78	$202.22–$252.78	51% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REP ITERM S/A/T/E/ <=2.5 CM	$618.24	$772.80	$618.24–$772.80	50% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REP INTERM S/A/T/E/ <=2.5CM	$749.77	$937.21	$749.77–$937.21	82% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 REP ITERM S/A/T/E/ <=2.5 CM	$618.24	$772.80	$618.24–$772.80	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC B9 LES TRNK/ARM/LEG <=0.5CM	$522.48	$653.10	$522.48–$653.10	133% above	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC B9 LES TRNK/ARM/LEG <=0.5CM	$522.48	$653.10	$522.48–$653.10	—	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC OF BENIGN LES 0.5CM FACE	$525.00	$656.25	$525.00–$656.25	78% above	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC OF BENIGN LES 0.5CM FACE	$525.00	$656.25	$525.00–$656.25	—	20%
Nail removal (partial or complete), one nail CPT 11730 CL AVULSION OF NAIL PLATE	$220.24	$275.30	$220.24–$275.30	16% above	20%
Nail removal (partial or complete), one nail CPT 11730 AVULSION OF NAIL PLATE	$228.48	$285.60	$228.48–$285.60	20% above	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION OF NAIL PLATE	$228.48	$285.60	$228.48–$285.60	—	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 CL EXC NAIL AND NAIL MATRIX	$373.53	$466.91	$373.53–$466.91	at median	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL AND NAIL MATRIX	$461.16	$576.45	$461.16–$576.45	23% above	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED	$978.61	$1,223.26	$978.61–$1,223.26	162% above	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXC NAIL AND NAIL MATRIX	$461.16	$576.45	$461.16–$576.45	—	20%
Removal of a foreign object under the skin, simple CPT 10120 REMOVAL FOREIGN BODY, SIMPLE	$360.36	$450.45	$360.36–$450.45	16% above	20%
Removal of a foreign object under the skin, simple CPT 10120 CL REMOVAL FOREIGN BODY, SIMPLE	$361.89	$452.36	$361.89–$452.36	16% above	20%
Removal of a foreign object under the skin, simple CPT 10120 INC & REM FB SUBQ SIMPLE	$437.03	$546.29	$437.03–$546.29	40% above	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVAL FOREIGN BODY, SIMPLE	$360.36	$450.45	$360.36–$450.45	—	20%
Short arm cast (elbow to hand) CPT 29075 SHORT ARM CAST APPLICATION	$203.28	$254.10	$203.28–$254.10	5% below	20%
Short arm cast (elbow to hand) inpatient CPT 29075 SHORT ARM CAST APPLICATION	$203.28	$254.10	$203.28–$254.10	—	20%
Short arm splint (forearm and hand) CPT 29125 CL SHORT ARM SPLINT APPLICATION	$153.29	$191.61	$153.29–$191.61	4% below	20%
Short arm splint (forearm and hand) CPT 29125 SHORT ARM SPLINT APPLICATION	$210.00	$262.50	$210.00–$262.50	32% above	20%
Short arm splint (forearm and hand) CPT 29125 FOREARM SPL APPLICATION	$254.68	$318.35	$254.68–$318.35	60% above	20%
Short arm splint (forearm and hand) inpatient CPT 29125 SHORT ARM SPLINT APPLICATION	$210.00	$262.50	$210.00–$262.50	—	20%
Short leg cast (below the knee) CPT 29405 SHORT LEG CAST APPLICATION	$205.80	$257.25	$205.80–$257.25	8% below	20%
Short leg cast (below the knee) inpatient CPT 29405 SHORT LEG CAST APPLICATION	$205.80	$257.25	$205.80–$257.25	—	20%
Short leg splint (calf to foot) CPT 29515 SHORT LEG SPLINT APPLICATION	$215.88	$269.85	$215.88–$269.85	13% above	20%
Short leg splint (calf to foot) inpatient CPT 29515 SHORT LEG SPLINT APPLICATION	$215.88	$269.85	$215.88–$269.85	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 CL REP SIMP S/N/AX/GEN/TRUNK <=2.5CM	$259.05	$323.81	$259.05–$323.81	5% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REP SIMP S/N/AX/GEN/TRUNK <=2.5CM	$311.64	$389.55	$311.64–$389.55	26% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 REP SIMP S/N/AX/GEN/TRUNK <=2.5CM	$311.64	$389.55	$311.64–$389.55	—	20%
Skin biopsy, punch, one lesion CPT 11104 CL PUNCH BIOPSY OF SKIN SINGLE	$298.82	$373.53	$298.82–$373.53	7% below	20%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION BIOPSY	$397.32	$496.65	$397.32–$496.65	24% above	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION BIOPSY	$397.32	$496.65	$397.32–$496.65	—	20%
Skin tag removal, up to 15 tags CPT 11200 CL BEGNIGN REM SKIN TAGS <-15	$144.57	$180.71	$144.57–$180.71	22% below	20%
Skin tag removal, up to 15 tags CPT 11200 BENIGN REM SKIN TAGS<=15	$183.12	$228.90	$183.12–$228.90	1% below	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 BENIGN REM SKIN TAGS<=15	$183.12	$228.90	$183.12–$228.90	—	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE DX	$750.12	$937.65	$750.12–$937.65	72% above	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE DX	$750.12	$937.65	$750.12–$937.65	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 CL REP SIMP S/N/AX/GEN/TRUNK 2.6-7.5CM	$318.22	$397.78	$318.22–$397.78	15% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REP SIMP S/N/AX/GEN/TRUNK 2.6-7.5CM	$336.00	$420.00	$336.00–$420.00	21% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REP SIMP S/N/AX/GEN/TRUNK 2.6-7.5 CM	$407.49	$509.36	$407.49–$509.36	47% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 REP SIMP S/N/AX/GEN/TRUNK 2.6-7.5CM	$336.00	$420.00	$336.00–$420.00	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 CL LAC REPAIR F/E/E/N/L/M 2.5 CM	$153.15	$191.44	$153.15–$191.44	56% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 LAC REPAIR UP TO 2.5 CM FACIAL	$325.92	$407.40	$325.92–$407.40	7% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 LAC REPAIR UP TO 2.5 CM FACIAL	$325.92	$407.40	$325.92–$407.40	—	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 BIOPSY OF SKIN SINGLE LESION	$206.64	$258.30	$206.64–$258.30	11% below	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 CL TANGENTIAL BIOBSY SINGLE	$217.33	$271.66	$217.33–$271.66	7% below	20%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 BIOPSY OF SKIN SINGLE LESION	$206.64	$258.30	$206.64–$258.30	—	20%
Trigger finger release surgery CPT 26055 CL INCISE FINGER TENDON SHEATH	$455.35	$569.19	$455.35–$569.19	35% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 CL INJ TRIGGER POINT 1/2 MUSCLE	$42.03	$52.54	$42.03–$52.54	77% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 CL INJ SINGLE/MLT TRIG POINT 1-2 MUSCl	$65.44	$81.80	$65.44–$81.80	64% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 SINGLE/MULT TRIG PT IN 1-2 MUSC GR	$334.32	$417.90	$334.32–$417.90	83% above	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 SINGLE/MULT TRIG PT IN 1-2 MUSC GR	$334.32	$417.90	$334.32–$417.90	—	20%
Upper endoscopy (EGD) with biopsy CPT 43239 ENDOSCOPE TO DUODENUM W/BIOPSY	$1,529.64	$1,912.05	$1,529.64–$1,912.05	1% below	20%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 ENDOSCOPE TO DUODENUM W/BIOPSY	$1,529.64	$1,912.05	$1,529.64–$1,912.05	—	20%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD FLEX TRANSORAL DX W/WO SPECIMEN COLL	$1,525.44	$1,906.80	$1,525.44–$1,906.80	45% above	20%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD FLEX TRANSORAL DX W/WO SPECIMEN COLL	$1,525.44	$1,906.80	$1,525.44–$1,906.80	—	20%
Wart removal, up to 14 warts CPT 17110 CL DEST FLAT WARTS UP TO 14	$134.86	$168.58	$134.86–$168.58	29% below	20%
Wart removal, up to 14 warts CPT 17110 DEST FLAT WARTS UP TO 14	$230.16	$287.70	$230.16–$287.70	21% above	20%
Wart removal, up to 14 warts inpatient CPT 17110 DEST FLAT WARTS UP TO 14	$230.16	$287.70	$230.16–$287.70	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 CL DEB SKIN/SUBQ 20 SQ CM OR LESS	$299.80	$374.75	$299.80–$374.75	12% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT, SKIN AND SUB Q	$625.80	$782.25	$625.80–$782.25	135% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT, SKIN AND SUB Q	$625.80	$782.25	$625.80–$782.25	—	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION,BLOOD OR BLOOD COMPONENTS	$768.10	$960.13	$768.10–$960.13	1% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION	$841.26	$1,051.58	$841.26–$1,051.58	11% above	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION	$841.26	$1,051.58	$841.26–$1,051.58	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 CL NEBULIZER TREATMENT	$41.72	$52.15	$41.72–$52.15	62% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT	$159.60	$199.50	$159.60–$199.50	45% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 ER AIRWAY INHALATION	$193.55	$241.94	$193.55–$241.94	76% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT	$159.60	$199.50	$159.60–$199.50	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 ER AIRWAY INHALATION	$193.55	$241.94	$193.55–$241.94	—	20%
Chemotherapy IV infusion, first hour CPT 96413 ONC CHEMO IV INFUSION 1 HR	$727.44	$909.30	$727.44–$909.30	44% above	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 ONC CHEMO IV INFUSION 1 HR	$727.44	$909.30	$727.44–$909.30	—	20%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FACILITY 30-74 MINUTES	$2,151.52	$2,689.40	$2,151.52–$2,689.40	16% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG OP REFERRAL	$140.28	$175.35	$140.28–$175.35	9% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TRACING ONLY HOSP OUTPAT	$162.02	$202.53	$162.02–$202.53	5% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG OP REFERRAL	$140.28	$175.35	$140.28–$175.35	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TRACING ONLY HOSP OUTPAT	$162.02	$202.53	$162.02–$202.53	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER LIMITED/MINOR VISIT FACILITY	$227.18	$283.97	$227.18–$283.97	9% above	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPT LOW/MOD FACILITY	$378.96	$473.70	$378.96–$473.70	7% above	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMEGRENCY DEPT MODERATE FACILITY	$626.51	$783.14	$626.51–$783.14	18% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPT HIGH/URGENT FACILIT	$998.34	$1,247.93	$998.34–$1,247.93	17% above	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPT HIGH SEV/THREAT FAC	$1,484.26	$1,855.33	$1,484.26–$1,855.33	16% above	20%
Family therapy with the patient, 50 minutes CPT 90847 FAMILY/COUPLE PSYCHOTHERAPY WITH PAT	$159.60	$199.50	$159.60–$199.50	at median	20%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY/COUPLE PSYCHOTHERAPY WITH PAT	$159.60	$199.50	$159.60–$199.50	—	20%
Family therapy without the patient, 50 minutes CPT 90846 FAMILY/COUPLES PSYCHOTHERAPY WITHOUT PAT	$154.56	$193.20	$154.56–$193.20	2% below	20%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY/COUPLES PSYCHOTHERAPY WITHOUT PAT	$154.56	$193.20	$154.56–$193.20	—	20%
Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY NO FAMILY	$42.00	$52.50	$42.00–$52.50	40% below	20%
Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY NO FAMILY	$42.00	$52.50	$42.00–$52.50	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 CL IV HYDRATION>31	$83.44	$104.30	$83.44–$104.30	67% below	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION 31 MIN TO 1 HR	$278.88	$348.60	$278.88–$348.60	10% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ER IV HYDRATION >31	$338.21	$422.76	$338.21–$422.76	33% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ONC IV HYDRATION >31	$444.70	$555.88	$444.70–$555.88	75% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION 31 MIN TO 1 HR	$278.88	$348.60	$278.88–$348.60	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 ONC IV HYDRATION >31	$444.70	$555.88	$444.70–$555.88	—	20%
IV infusion of a medicine, first hour CPT 96365 PR IV TX/DX INITIAL HR	$326.76	$408.45	$326.76–$408.45	5% below	20%
IV infusion of a medicine, first hour CPT 96365 ER IV TX/DX INITIAL HR	$396.29	$495.36	$396.29–$495.36	15% above	20%
IV infusion of a medicine, first hour CPT 96365 ONC IV TX/DX INITIAL HR	$494.76	$618.45	$494.76–$618.45	44% above	20%
IV infusion of a medicine, first hour inpatient CPT 96365 PR IV TX/DX INITIAL HR	$326.76	$408.45	$326.76–$408.45	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 ER IV TX/DX INITIAL HR	$396.29	$495.36	$396.29–$495.36	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 ONC IV TX/DX INITIAL HR	$494.76	$618.45	$494.76–$618.45	—	20%
IV push of a medicine, first drug CPT 96374 CL IV PUSH INITIAL	$93.14	$116.42	$93.14–$116.42	42% below	20%
IV push of a medicine, first drug CPT 96374 PR IV PUSH INITIAL	$172.20	$215.25	$172.20–$215.25	8% above	20%
IV push of a medicine, first drug CPT 96374 ER IV PUSH INITIAL	$208.84	$261.05	$208.84–$261.05	31% above	20%
IV push of a medicine, first drug CPT 96374 ONC THER/PROPH/DIAG INJ IV PUSH	$287.89	$359.86	$287.89–$359.86	80% above	20%
IV push of a medicine, first drug inpatient CPT 96374 PR IV PUSH INITIAL	$172.20	$215.25	$172.20–$215.25	—	20%
IV push of a medicine, first drug inpatient CPT 96374 ONC THER/PROPH/DIAG INJ IV PUSH	$287.89	$359.86	$287.89–$359.86	—	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 CL INJ IM/SUBQ	$33.96	$42.45	$33.96–$42.45	57% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ONC THER/PROH/DIAG INJ SC/IM	$53.19	$66.49	$53.19–$66.49	32% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 PR INJ IM/SUBQ	$84.84	$106.05	$84.84–$106.05	8% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ER INJ IM/SUBQ	$102.89	$128.61	$102.89–$128.61	31% above	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ONC THER/PROH/DIAG INJ SC/IM	$53.19	$66.49	$53.19–$66.49	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 PR INJ IM/SUBQ	$84.84	$106.05	$84.84–$106.05	—	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 INTAKE-PSYCHOLOGICAL WITHOUT MEDICAL SER	$216.72	$270.90	$216.72–$270.90	2% below	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 INTAKE-PSYCHOLOGICAL WITHOUT MEDICAL SER	$216.72	$270.90	$216.72–$270.90	—	20%
New patient office visit, about 30 minutes CPT 99203 CL NEW PT DETAIL HIST MOD COMP 99203	$218.30	$272.87	$218.30–$272.87	31% above	20%
New patient office visit, about 45 minutes CPT 99204 CL NEW PAT COMP/MOD COMPLEXITY	$247.41	$309.26	$247.41–$309.26	4% above	20%
New patient office visit, about 60 minutes CPT 99205 CL NEW PATIENT COMP OFC CALL 99205	$417.18	$521.48	$417.18–$521.48	25% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 CL NEW PATIENT LIMITED OFC CALL 99202	$174.64	$218.30	$174.64–$218.30	22% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INITIAL ASSESSMENT 15 MINUTES	$56.00	$70.00	$56.00–$70.00	24% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT INITIAL ASSESSMENT 15 MINUTES	$56.00	$70.00	$56.00–$70.00	—	20%
Preventive checkup, new patient aged 18–39 CPT 99385 INITIAL PREVENTIVE MED NEW PAT 18-39YRS	$40.00	$50.00	$40.00–$50.00	80% below	20%
Preventive checkup, new patient aged 18–39 CPT 99385 CL PREEMPLOYMENT PHYSICAL OFFICE 18-3	$139.71	$174.64	$139.71–$174.64	30% below	20%
Preventive checkup, new patient aged 18–39 CPT 99385 CL PREEMPLOYMENT PHYSICAL LABORER	$139.71	$174.64	$139.71–$174.64	30% below	20%
Preventive checkup, new patient aged 18–39 CPT 99385 CL WELL ADULT INITIAL 18-39YRS	$139.71	$174.64	$139.71–$174.64	30% below	20%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 INITIAL PREVENTIVE MED NEW PAT 18-39YRS	$40.00	$50.00	$40.00–$50.00	—	20%
Preventive checkup, new patient aged 40–64 CPT 99386 INITIAL PREVENTIVE MED NEW PAT 40-64 YRS	$40.00	$50.00	$40.00–$50.00	83% below	20%
Preventive checkup, new patient aged 40–64 CPT 99386 CL PREEMPLOYMENT PHYSICAL LABORER 40	$152.33	$190.41	$152.33–$190.41	34% below	20%
Preventive checkup, new patient aged 40–64 CPT 99386 CL PREEMPLOYMENT PHYSICAL OFFICE 40-6	$152.33	$190.41	$152.33–$190.41	34% below	20%
Preventive checkup, new patient aged 40–64 CPT 99386 CL WELL ADULT INITIAL 40-64YRS	$152.33	$190.41	$152.33–$190.41	34% below	20%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 INITIAL PREVENTIVE MED NEW PAT 40-64 YRS	$40.00	$50.00	$40.00–$50.00	—	20%
Preventive checkup, new patient aged 65 or older CPT 99387 CL WELL ADULT INITIAL 65YRS & OLDER	$166.87	$208.59	$166.87–$208.59	27% below	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 PERIODIC PREVENTIVE MED EST PAT 18-39YRS	$40.00	$50.00	$40.00–$50.00	78% below	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 CL WELL ADULT PERIODIC 18-39YRS	$125.16	$156.45	$125.16–$156.45	30% below	20%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PERIODIC PREVENTIVE MED EST PAT 18-39YRS	$40.00	$50.00	$40.00–$50.00	—	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 PERIODIC PREVENTIVE MED EST PAT 40-64YRS	$40.00	$50.00	$40.00–$50.00	79% below	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 CL WELL ADULT PERIODIC 40-64YRS	$129.04	$161.30	$129.04–$161.30	33% below	20%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PERIODIC PREVENTIVE MED EST PAT 40-64YRS	$40.00	$50.00	$40.00–$50.00	—	20%
Preventive checkup, returning patient aged 65 or older CPT 99397 CL WELL ADULT PERIODIC 65YRS & OLDER	$142.62	$178.28	$142.62–$178.28	24% below	20%
Psychotherapy for crisis, first 60 minutes CPT 90839 PSYCHOTHERAPY FOR CRISIS 60MIN	$219.24	$274.05	$219.24–$274.05	5% above	20%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 PSYCHOTHERAPY FOR CRISIS 60MIN	$219.24	$274.05	$219.24–$274.05	—	20%
Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHERAPY 30 MIN	$105.84	$132.30	$105.84–$132.30	6% below	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTHERAPY 30 MIN	$105.84	$132.30	$105.84–$132.30	—	20%
Psychotherapy session, 45 minutes CPT 90834 PSYCHOTHERAPY 45 MIN	$126.00	$157.50	$126.00–$157.50	12% below	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTHERAPY 45 MIN	$126.00	$157.50	$126.00–$157.50	—	20%
Psychotherapy session, 60 minutes CPT 90837 INDIVIDUAL PSYCHOTHERAPY 53 MIN+	$138.60	$173.25	$138.60–$173.25	25% below	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 INDIVIDUAL PSYCHOTHERAPY 53 MIN+	$138.60	$173.25	$138.60–$173.25	—	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 CL SMOKING/TOBACCO COUNSEL 3-10 MIN	$35.90	$44.88	$35.90–$44.88	19% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 CL EST PT COMP OFC CALL 99215	$164.94	$206.17	$164.94–$206.17	40% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OP TIME HIGH 40MIN	$492.00	$615.00	$492.00–$615.00	79% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 CL CDL PHYSICAL 99213	$114.48	$143.10	$114.48–$143.10	19% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 CL EST PT LIMITED OFC CALL 99213	$114.48	$143.10	$114.48–$143.10	19% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP TIME COMPLEX 20 MIN	$399.84	$499.80	$399.84–$499.80	184% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 CL EST PT EXTEND OFC CALL 99214	$145.53	$181.91	$145.53–$181.91	27% below	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OP TIME 30 MIN	$462.84	$578.55	$462.84–$578.55	131% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 CL WRESTLING CONSULTING	$107.70	$134.62	$107.70–$134.62	2% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 CL SPORTS PHYSICAL 99212	$107.70	$134.62	$107.70–$134.62	2% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 CL EST PT BRIEF OFFICE CALL 99212	$107.70	$134.62	$107.70–$134.62	2% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP TIME INT 10 MIN	$315.00	$393.75	$315.00–$393.75	198% above	20%
Spirometry (breathing test) CPT 94010 CL SPIROMETRY	$83.44	$104.30	$83.44–$104.30	45% below	20%
Spirometry (breathing test) CPT 94010 SPIROMETRY -NO POST BRONCHODILATOR	$304.00	$380.00	$304.00–$380.00	99% above	20%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY -NO POST BRONCHODILATOR	$304.00	$380.00	$304.00–$380.00	—	20%
Spirometry before and after a bronchodilator CPT 94060 SPIROMETRY W/POST TESTING ALBUTEROL	$557.60	$697.00	$557.60–$697.00	25% above	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 SPIROMETRY W/POST TESTING ALBUTEROL	$557.60	$697.00	$557.60–$697.00	—	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY (1 UNIT)	$326.94	$408.67	$326.94–$408.67	100% above	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY (1 UNIT)	$326.94	$408.67	$326.94–$408.67	—	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 CL ADMINISTRATION FLU INJECTION	$35.29	$44.11	$35.29–$44.11	28% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 CL ADMINISTRATION PNEU INJECTION	$35.29	$44.11	$35.29–$44.11	28% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 CL ADMINISTRATION HEP B VACCINE	$35.29	$44.11	$35.29–$44.11	28% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 CL IMMUNIZATION AMINSTRATION	$35.29	$44.11	$35.29–$44.11	28% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 CL IMMUNIZATION ADMINISTRATION	$35.29	$44.11	$35.29–$44.11	28% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 PR VACCINE ADMIN INITIAL	$56.28	$70.35	$56.28–$70.35	15% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ER VACCINE ADMIN INITIAL	$68.26	$85.32	$68.26–$85.32	40% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 PR VACCINE ADMIN INITIAL	$56.28	$70.35	$56.28–$70.35	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ER VACCINE ADMIN INITIAL	$68.26	$85.32	$68.26–$85.32	—	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 CL IMMUNIZATION ADMIN EA ADD'L	$31.78	$39.72	$31.78–$39.72	1% below	20%

Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More

Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More

List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More

Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More

Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.

Off list How much lower the cash price is than the list price.

No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More

At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More

Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.

Source file: https://www.mvmc.org/documents/content/810255832_mountainview-medical-center-inc._standardcharges.csv