Hospital Helena, MT

St. Peter's Health

St. Peter's Health in Helena, MT publishes cash prices for 432 common procedures listed here, from its own machine-readable price file updated Mar 16, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Montana median for 274 of 431 procedures and above it for 144. By typical cash price it ranks #6 of 29 Montana hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

2475 E Broadway St Helena MT 59601 Collected Sep 22, 2026 Source price file Check a bill from this hospital (406) 442-2480

Acute care hospital Nonprofit hospital Emergency department CMS star rating 3 of 5 CCN 270003 · CMS hospital register NPI 1528023520

Financial assistance

Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply

St. Peter's Health is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.

You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.

Source: IRS, section 501(r) requirements for nonprofit hospitals.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Abdominal CT scan without and with contrast CPT 74170 CT SCAN - BODY SCAN	$1,298.87	$1,528.08	$190.66	34% below	15%
Abdominal CT scan without and with contrast CPT 74170 HC CT ABDOMEN W/WO CONTRAST	$1,321.43	$1,554.62	$178.02	33% below	15%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT ABDOMEN W/WO CONTRAST	$1,321.43	$1,554.62	$1,476.89	—	15%
Abdominal X-ray, 2 views CPT 74019 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$154.65	$181.94	$113.89	43% below	15%
Abdominal X-ray, 2 views CPT 74019 HC DI ABDOMEN 2 VIEWS	$159.15	$187.24	$49.92	41% below	15%
Abdominal X-ray, 2 views inpatient CPT 74019 HC DI ABDOMEN 2 VIEWS	$159.15	$187.24	$177.88	—	15%
Ankle X-ray, complete, 3 or more views CPT 73610 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$180.47	$212.32	$94.30	16% below	15%
Ankle X-ray, complete, 3 or more views one side CPT 73610 HC DI ANKLE MIN 3 VIEW UNILATERAL	$187.06	$220.07	$53.58	13% below	15%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 HC DI ANKLE MIN 3 VIEW UNILATERAL	$187.06	$220.07	$209.07	—	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HC UPR/L EXTREMITY ART 1-2 LEVELS BILATERAL	$297.43	$349.92	$128.90	—	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 OTHER IMAGING SERVICES - ULTRASOUND	$297.43	$349.92	$138.05	at median	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 HC UPR/L EXTREMITY ART 1-2 LEVELS UNILATERAL	$297.43	$349.92	$128.90	at median	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 HC UPR/L EXTREMITY ART 1-2 LEVELS BILATERAL	$297.43	$349.92	$332.42	—	15%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT SCAN - GENERAL CLASSIFICATION	$1,032.68	$1,214.92	$240.49	23% below	15%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTREMITY W/O CONTRAST	$1,033.88	$1,216.33	$106.34	23% below	15%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPPER EXTREMITY W/O CONTRAST	$1,033.88	$1,216.33	$1,155.51	—	15%
Barium swallow (esophagus X-ray with contrast) CPT 74220 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$185.80	$218.59	$190.66	48% below	15%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC DI ESOPHAGRAM	$189.33	$222.74	$136.16	47% below	15%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC DI ESOPHAGRAM	$189.33	$222.74	$211.60	—	15%
Bone scan, whole body (nuclear medicine) CPT 78306 NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES	$1,097.08	$1,290.69	$431.18	19% below	15%
Bone scan, whole body (nuclear medicine) CPT 78306 HC NM BONE IMAGING WHOLE BODY	$1,105.27	$1,300.32	$401.83	19% below	15%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NM BONE IMAGING WHOLE BODY	$1,105.27	$1,300.32	$1,235.30	—	15%
Breast ultrasound, complete, one breast both sides CPT 76641 HC US BREAST BILATERAL COMPLETE INCL AXILLA - 4 QUADRANTS	$607.49	$714.69	$106.34	—	15%
Breast ultrasound, complete, one breast CPT 76641 OTHER IMAGING SERVICES - ULTRASOUND	$356.94	$419.93	$113.89	30% above	15%
Breast ultrasound, complete, one breast one side CPT 76641 HC US BREAST UNILATERAL COMPLETE INCL AXILLA - 4 QUADRANTS	$360.72	$424.38	$106.34	32% above	15%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 HC US BREAST BILATERAL LIMITED INCL AXILLA - 1 OR MORE ELEMENTS	$445.92	$524.61	$88.05	—	15%
Breast ultrasound, limited (one breast or one area) CPT 76642 OTHER IMAGING SERVICES - ULTRASOUND	$225.00	$264.71	$94.30	9% below	15%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 HC US BREAST UNILATERAL LIMITED INCL AXILLA - 1 OR MORE ELEMENTS	$233.47	$274.67	$88.05	5% below	15%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 HC US BREAST UNILATERAL LIMITED INCL AXILLA - 1 OR MORE ELEMENTS	$233.47	$274.67	$260.94	—	15%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT SCAN - BODY SCAN	$2,842.56	$3,344.18	$377.88	3% above	15%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CTA ABDOMEN AND PELVIS	$2,864.81	$3,370.37	$357.13	3% above	15%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CTA ABDOMEN AND PELVIS	$2,864.81	$3,370.37	$3,201.85	—	15%
CT angiography (CTA) of the head CPT 70496 CT SCAN - HEAD SCAN	$1,410.55	$1,659.47	$461.23	34% below	15%
CT angiography (CTA) of the head CPT 70496 HC CTA HEAD W/WO CONTRAST	$1,412.72	$1,662.02	$178.02	34% below	15%
CT angiography (CTA) of the head inpatient CPT 70496 HC CTA HEAD W/WO CONTRAST	$1,412.72	$1,662.02	$1,578.92	—	15%
CT angiography (CTA) of the neck CPT 70498 CT SCAN - HEAD SCAN	$1,411.17	$1,660.20	$466.01	34% below	15%
CT angiography (CTA) of the neck CPT 70498 HC CTA NECK W/WO CONTRAST	$1,413.88	$1,663.39	$178.02	34% below	15%
CT angiography (CTA) of the neck inpatient CPT 70498 HC CTA NECK W/WO CONTRAST	$1,413.88	$1,663.39	$1,580.22	—	15%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CTA PULMONARY W/WO CONTRAST	$1,626.01	$1,912.95	$178.02	27% below	15%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT SCAN - BODY SCAN	$1,629.36	$1,916.89	$262.49	26% below	15%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CTA PULMONARY W/WO CONTRAST	$1,626.01	$1,912.95	$1,817.30	—	15%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CTA CORONARY ARTERIES W/CONTRAST	$779.25	$916.77	$357.13	at median	15%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT HEART QUAN CALCIUM W/O CONTRAST	$246.59	$290.11	$88.05	40% below	15%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT SCAN - BODY SCAN	$259.57	$305.38	$94.30	37% below	15%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT SCAN - BODY SCAN	$1,838.98	$2,163.50	$256.45	14% below	15%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD & PELVIS W/O CONTRAST	$1,841.90	$2,166.94	$231.15	14% below	15%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABD & PELVIS W/O CONTRAST	$1,841.90	$2,166.94	$2,058.59	—	15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT SCAN - BODY SCAN	$2,236.54	$2,631.23	$376.89	21% below	15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN & PELVIS W/CONTRAST	$2,256.48	$2,654.68	$357.13	20% below	15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN & PELVIS W/CONTRAST	$2,256.48	$2,654.68	$2,521.95	—	15%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT SCAN - BODY SCAN	$2,240.15	$2,635.47	$382.49	28% below	15%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABD & PELVIS W/WO CONTRAST	$2,258.50	$2,657.06	$357.13	27% below	15%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABD & PELVIS W/WO CONTRAST	$2,258.50	$2,657.06	$2,524.21	—	15%
CT scan of the abdomen with contrast CPT 74160 CT SCAN - BODY SCAN	$1,226.96	$1,443.48	$190.66	32% below	15%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W/CONTRAST	$1,226.96	$1,443.48	$178.02	32% below	15%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W/CONTRAST	$1,226.96	$1,443.48	$1,371.31	—	15%
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN W/O CONTRAST	$1,033.12	$1,215.43	$106.34	24% below	15%
CT scan of the abdomen without contrast CPT 74150 CT SCAN - BODY SCAN	$1,087.49	$1,279.40	$1,215.43	20% below	15%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN W/O CONTRAST	$1,033.12	$1,215.43	$1,154.66	—	15%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SCAN - HEAD SCAN	$973.03	$1,144.74	$113.89	19% below	15%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL W/O CONTRAST	$998.89	$1,175.17	$106.34	16% below	15%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFACIAL W/O CONTRAST	$998.89	$1,175.17	$1,116.41	—	15%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD/BRAIN W/O CONTRAST	$991.87	$1,166.90	$106.34	16% below	15%
CT scan of the head or brain, no contrast dye CPT 70450 CT SCAN - HEAD SCAN	$992.30	$1,167.41	$1,109.05	16% below	15%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD/BRAIN W/O CONTRAST	$991.87	$1,166.90	$1,108.56	—	15%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT SCAN - HEAD SCAN	$993.17	$1,168.44	$379.54	—	15%
CT scan of the head with contrast CPT 70460 HC CT HEAD/BRAIN W/CONTRAST	$944.79	$1,111.52	$178.02	34% below	15%
CT scan of the head with contrast CPT 70460 CT SCAN - HEAD SCAN	$994.52	$1,170.02	$190.66	31% below	15%
CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD/BRAIN W/CONTRAST	$944.79	$1,111.52	$1,055.94	—	15%
CT scan of the head without and with contrast CPT 70470 HC CT HEAD/BRAIN W/WO CONTRAST	$1,198.87	$1,410.44	$178.02	34% below	15%
CT scan of the head without and with contrast CPT 70470 CT SCAN - HEAD SCAN	$1,228.95	$1,445.82	$466.01	32% below	15%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD/BRAIN W/WO CONTRAST	$1,198.87	$1,410.44	$1,339.92	—	15%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT SCAN - BODY SCAN	$980.93	$1,154.03	$113.89	31% below	15%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE W/O CONTRAST	$1,000.96	$1,177.60	$106.34	30% below	15%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT LUMBAR SPINE W/O CONTRAST	$1,000.96	$1,177.60	$1,118.72	—	15%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SCAN - BODY SCAN	$977.51	$1,150.01	$112.34	31% below	15%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT CERVICAL SPINE W/O CONTRAST	$999.03	$1,175.33	$106.34	29% below	15%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT CERVICAL SPINE W/O CONTRAST	$999.03	$1,175.33	$1,116.56	—	15%
CT scan of the pelvis, with contrast dye CPT 72193 CT SCAN - BODY SCAN	$1,127.23	$1,326.15	$187.26	30% below	15%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W/CONTRAST	$1,181.29	$1,389.75	$178.02	26% below	15%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W/CONTRAST	$1,181.29	$1,389.75	$1,320.26	—	15%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC US DUPLEX SCAN CAROTID BILATERAL S&I	$775.51	$912.36	$241.72	—	15%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB	$745.95	$877.59	$256.55	21% below	15%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC US DUPLEX SCAN CAROTID BILATERAL S&I	$775.51	$912.36	$866.74	—	15%
Chest CT scan without and with contrast CPT 71270 CT SCAN - BODY SCAN	$1,297.93	$1,526.98	$466.01	35% below	15%
Chest CT scan without and with contrast CPT 71270 HC CT THORAX DX W/WO CONTRAST	$1,297.93	$1,526.98	$178.02	35% below	15%
Chest CT scan without and with contrast inpatient CPT 71270 HC CT THORAX DX W/WO CONTRAST	$1,297.93	$1,526.98	$1,450.63	—	15%
Chest X-ray, 2 views CPT 71046 RADIOLOGY - DIAGNOSTIC - CHEST X-RAY	$148.93	$175.21	$93.91	33% below	15%
Chest X-ray, 2 views CPT 71046 HC DI CHEST 2 VIEWS	$150.88	$177.50	$44.79	32% below	15%
Chest X-ray, 2 views inpatient CPT 71046 HC DI CHEST 2 VIEWS	$150.88	$177.50	$168.63	—	15%
Chest X-ray, single view CPT 71045 HC DI CHEST 1 VIEW	$101.13	$118.98	$33.84	45% below	15%
Chest X-ray, single view CPT 71045 RADIOLOGY - DIAGNOSTIC - CHEST X-RAY	$101.73	$119.68	$93.86	45% below	15%
Chest X-ray, single view inpatient CPT 71045 HC DI CHEST 1 VIEW	$101.13	$118.98	$113.03	—	15%
Collarbone (clavicle) X-ray, complete CPT 73000 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$141.29	$166.22	$94.30	26% below	15%
Collarbone (clavicle) X-ray, complete one side CPT 73000 HC CLAVICLE COMPLETE UNILATERAL	$147.74	$173.81	$47.00	22% below	15%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 HC CLAVICLE COMPLETE UNILATERAL	$147.74	$173.81	$165.12	—	15%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 OTHER IMAGING SERVICES - ULTRASOUND	$361.41	$425.19	$113.89	28% below	15%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITONEAL COMPLETE	$364.06	$428.30	$106.34	27% below	15%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERITONEAL COMPLETE	$364.06	$428.30	$406.89	—	15%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC DXA BONE DENSITY AXIAL 1+ SITES	$227.61	$267.78	$60.87	29% below	15%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$232.93	$274.03	$113.89	27% below	15%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC DXA BONE DENSITY AXIAL 1+ SITES	$227.61	$267.78	$254.39	—	15%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC DXA BONE DENSITY/PERIPHERAL	$97.84	$115.11	$45.54	33% below	15%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$99.90	$117.53	$93.63	32% below	15%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US OB COMPLETE SINGLE GESTATION	$614.15	$722.53	$170.73	41% above	15%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 OTHER IMAGING SERVICES - ULTRASOUND	$614.15	$722.53	$686.40	41% above	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX DX W/O CONTRAST	$848.69	$998.46	$106.34	39% below	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT SCAN - BODY SCAN	$854.21	$1,004.95	$954.70	39% below	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT THORAX DX W/O CONTRAST	$848.69	$998.46	$948.54	—	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT SCAN - BODY SCAN	$854.21	$1,004.95	$113.89	—	15%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT SCAN - BODY SCAN	$1,072.53	$1,261.80	$362.79	35% below	15%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT THORAX DX W/CONTRAST	$1,075.67	$1,265.49	$178.02	35% below	15%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT THORAX DX W/CONTRAST	$1,075.67	$1,265.49	$1,202.22	—	15%
Diagnostic mammogram, both breasts both sides CPT 77066 HC DIAG MAMMO, BILATERAL INCL CAD WHEN PERFORMED	$236.27	$277.97	$158.40	—	15%
Diagnostic mammogram, both breasts CPT 77066 OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY	$229.75	$270.30	$108.67	33% below	15%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DIAG MAMMO, BILATERAL INCL CAD WHEN PERFORMED	$236.27	$277.97	$264.07	—	15%
Diagnostic mammogram, one breast CPT 77065 OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY	$141.21	$166.12	$85.15	45% below	15%
Diagnostic mammogram, one breast one side CPT 77065 HC DIAG MAMMO, UNILATERAL INCL CAD WHEN PERFORMED	$137.37	$161.61	$125.12	46% below	15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 HC DIAG MAMMO, UNILATERAL INCL CAD WHEN PERFORMED	$137.37	$161.61	$153.53	—	15%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DOPPLER LOWER EXTREMTIY BILATERAL	$567.62	$667.79	$241.72	—	15%
Duplex ultrasound of the leg arteries, both legs CPT 93925 OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB	$597.50	$702.94	$247.96	40% below	15%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC DOPPLER LOWER EXTREMTIY BILATERAL	$567.62	$667.79	$634.40	—	15%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DOPPLER EXTREM COMPLETE BILATERAL	$518.33	$609.80	$241.72	—	15%
Duplex ultrasound of the leg veins, both legs CPT 93970 OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB	$518.33	$609.80	$574.00	45% below	15%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC DOPPLER EXTREM COMPLETE BILATERAL	$518.33	$609.80	$579.31	—	15%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB	$453.47	$533.49	$245.19	—	15%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 CARDIOLOGY - ECHOCARDIOLOGY	$1,826.71	$2,149.07	$587.23	16% above	15%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC TTE COMP W/DPLR & COLOR W/O CONTRAST	$1,900.09	$2,235.40	$407.87	21% above	15%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC TTE COMP W/DPLR & COLOR W/CONTRAST	$2,126.65	$2,501.94	$790.06	36% above	15%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC TTE COMP W/DPLR & COLOR W/O CONTRAST	$1,900.09	$2,235.40	$2,123.63	—	15%
Elbow X-ray, 2 views CPT 73070 HC DI ELBOW 1 VIEW-LIMITED	$128.07	$150.67	$41.15	29% below	15%
Elbow X-ray, 2 views one side CPT 73070 HC DI ELBOW 2 VIEW UNILATERAL	$140.38	$165.15	$41.15	22% below	15%
Elbow X-ray, 2 views inpatient CPT 73070 HC DI ELBOW 1 VIEW-LIMITED	$128.07	$150.67	$143.14	—	15%
Elbow X-ray, 2 views inpatient one side CPT 73070 HC DI ELBOW 2 VIEW UNILATERAL	$140.38	$165.15	$156.89	—	15%
Elbow X-ray, complete, 3 or more views CPT 73080 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$219.52	$258.26	$94.75	2% above	15%
Elbow X-ray, complete, 3 or more views one side CPT 73080 HC DI ELBOW 3 VIEW UNILATERAL	$219.52	$258.26	$45.54	2% above	15%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 HC DI ELBOW 3 VIEW UNILATERAL	$219.52	$258.26	$245.35	—	15%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT ORBIT/SELLA/IAC W/O CONTRAST	$967.77	$1,138.55	$106.34	26% below	15%
Eye socket (orbit) CT scan without contrast CPT 70480 CT SCAN - HEAD SCAN	$1,008.15	$1,186.06	$236.41	23% below	15%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT ORBIT/SELLA/IAC W/O CONTRAST	$967.77	$1,138.55	$1,081.62	—	15%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC DI FACIAL BONES MIN 3 VIEWS	$488.29	$574.46	$66.72	51% above	15%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC DI FACIAL BONES MIN 3 VIEWS	$488.29	$574.46	$545.74	—	15%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC DI FOREARM 1 VIEW LIMITED	$202.16	$237.83	$41.88	9% above	15%
Forearm X-ray (radius and ulna), 2 views CPT 73090 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$212.64	$250.16	$94.30	14% above	15%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 HC DI FOREARM MIN 2 VIEW UNILATERAL	$146.65	$172.53	$41.88	21% below	15%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC DI FOREARM 1 VIEW LIMITED	$202.16	$237.83	$225.94	—	15%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 HC DI FOREARM MIN 2 VIEW UNILATERAL	$146.65	$172.53	$163.90	—	15%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC HEPATOBILIARY IMAGING	$1,070.97	$1,259.96	$401.83	12% below	15%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES	$1,106.02	$1,301.20	$430.36	9% below	15%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC HEPATOBILIARY IMAGING	$1,070.97	$1,259.96	$1,196.96	—	15%
Hand X-ray, 2 views CPT 73120 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$151.65	$178.41	$113.95	12% below	15%
Hand X-ray, 2 views one side CPT 73120 HC DI HAND 1 VIEW UNILATERAL-LIMITED	$113.00	$132.94	$44.79	34% below	15%
Hand X-ray, 2 views one side CPT 73120 HC DI HAND 2 VIEW UNILATERAL	$155.07	$182.44	$44.79	10% below	15%
Hand X-ray, 2 views inpatient one side CPT 73120 HC DI HAND 1 VIEW UNILATERAL-LIMITED	$113.00	$132.94	$126.29	—	15%
Hand X-ray, 2 views inpatient one side CPT 73120 HC DI HAND 2 VIEW UNILATERAL	$155.07	$182.44	$173.32	—	15%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$132.49	$155.87	$94.30	31% below	15%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HC DI OS CALCIS MIN 2 VIEW UNILATERAL	$133.98	$157.62	$41.15	30% below	15%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 HC DI OS CALCIS MIN 2 VIEW UNILATERAL	$133.98	$157.62	$149.74	—	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION	$2,599.68	$3,058.45	$1,083.47	12% above	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC SLEEP APNEA STUDY W/CPAP TITR	$2,872.14	$3,378.99	$1,017.39	24% above	15%
Knee X-ray, 3 views CPT 73562 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$210.57	$247.73	$94.30	at median	15%
Knee X-ray, 3 views one side CPT 73562 HC DI KNEE 3 VIEWS UNILATERAL	$211.02	$248.26	$60.87	at median	15%
Knee X-ray, 3 views inpatient one side CPT 73562 HC DI KNEE 3 VIEWS UNILATERAL	$211.02	$248.26	$235.85	—	15%
Knee X-ray, complete, 4 or more views CPT 73564 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$178.08	$209.50	$112.90	28% below	15%
Knee X-ray, complete, 4 or more views one side CPT 73564 HC DI KNEE MIN 4 VIEW UNILATERAL	$152.67	$179.61	$66.72	38% below	15%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 HC DI KNEE MIN 4 VIEW UNILATERAL	$152.67	$179.61	$170.63	—	15%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT SCAN - BODY SCAN	$1,149.42	$1,352.26	$113.89	12% below	15%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 HC CT LOWER EXTREMITY W/O CONTRAST UNILATERAL	$1,150.43	$1,353.45	$106.34	12% below	15%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 HC CT LOWER EXTREMITY W/O CONTRAST UNILATERAL	$1,150.43	$1,353.45	$1,285.78	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 OTHER IMAGING SERVICES - ULTRASOUND	$342.94	$403.46	$113.24	16% below	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC ULTRASOUND ABDOMEN LIMITED	$345.49	$406.46	$106.34	15% below	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC ULTRASOUND ABDOMEN LIMITED	$345.49	$406.46	$386.14	—	15%
Limited ultrasound of an arm or leg (non-vascular) both sides CPT 76882 HC US LIMITED JOINT OR NONVASC EXTREM BILATERAL	$106.52	$125.32	$67.45	—	15%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 OTHER IMAGING SERVICES - ULTRASOUND	$149.85	$176.30	$113.89	36% below	15%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 HC US LIMITED JOINT OR NONVASC EXTREM UNILATERAL	$150.75	$177.35	$67.45	35% below	15%
Limited ultrasound of an arm or leg (non-vascular) inpatient both sides CPT 76882 HC US LIMITED JOINT OR NONVASC EXTREM BILATERAL	$106.52	$125.32	$119.05	—	15%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 HC US LIMITED JOINT OR NONVASC EXTREM UNILATERAL	$150.75	$177.35	$168.48	—	15%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT LOW DOSE LUNG CA SCREEN W/O	$352.50	$414.70	$106.34	51% below	15%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT SCAN - BODY SCAN	$352.54	$414.75	$113.12	51% below	15%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT LOW DOSE LUNG CA SCREEN W/O	$352.50	$414.70	$393.97	—	15%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$116.88	$137.51	$94.30	40% below	15%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 HC DI TIBIA/FIBULA 2 VIEW UNILATERAL	$116.88	$137.51	$44.25	40% below	15%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 HC DI TIBIA/FIBULA 2 VIEW UNILATERAL	$116.88	$137.51	$130.63	—	15%
MR angiography (MRA) of the head without contrast CPT 70544 MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK	$1,822.03	$2,143.57	$915.52	at median	15%
MR angiography (MRA) of the head without contrast CPT 70544 HC MRA HEAD W/O CONTRAST	$1,822.03	$2,143.57	$241.72	at median	15%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRA HEAD W/O CONTRAST	$1,822.03	$2,143.57	$2,036.39	—	15%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 HC MRI BREAST W & WO, BILATERAL, INCL CAD	$2,916.42	$3,431.08	$357.13	—	15%
MRI of both breasts, without and then with contrast dye CPT 77049 MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION	$2,881.64	$3,390.16	$3,051.14	53% above	15%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION	$1,887.42	$2,220.50	$258.88	10% above	15%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI LOWER JOINT UNILATERAL W/O CONTRAST	$1,911.40	$2,248.70	$241.72	11% above	15%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI LOWER JOINT UNILATERAL W/O CONTRAST	$1,911.40	$2,248.70	$2,136.27	—	15%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - OTHER	$1,873.89	$2,204.58	$382.49	31% below	15%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI LOWER JOINT UNILATERAL W/WO CONTRAST	$1,780.20	$2,094.35	$357.13	34% below	15%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC COM CON MRI LOWER JOINT UNILATERAL W/WO CONTRAST - LIMITED	$2,105.32	$2,476.85	$357.13	22% below	15%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI LOWER JOINT UNILATERAL W/WO CONTRAST	$1,780.20	$2,094.35	$1,989.63	—	15%
MRI of the abdomen without contrast CPT 74181 MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION	$2,004.94	$2,358.75	$251.60	12% above	15%
MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN W/O CONTRAST	$2,024.78	$2,382.09	$241.72	13% above	15%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN W/O CONTRAST	$2,024.78	$2,382.09	$2,262.99	—	15%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN W/WO CONTRAST	$2,083.81	$2,451.54	$357.13	28% below	15%
MRI of the abdomen, without and then with contrast dye CPT 74183 MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION	$2,166.02	$2,548.26	$382.49	25% below	15%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN W/WO LIMITED METS	$2,464.32	$2,899.20	$357.13	15% below	15%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN W/WO CONTRAST	$2,083.81	$2,451.54	$2,328.96	—	15%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN LIMITED W/O CONTRAST	$1,766.09	$2,077.75	$241.72	1% below	15%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN W/O CONTRAST	$2,064.56	$2,428.89	$241.72	15% above	15%
MRI of the brain, no contrast dye CPT 70551 MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - BRAIN/BRAINSTEM	$2,070.70	$2,436.11	$258.88	16% above	15%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN LIMITED W/O CONTRAST	$1,766.09	$2,077.75	$1,973.86	—	15%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN W/O CONTRAST	$2,064.56	$2,428.89	$2,307.45	—	15%
MRI of the brain, with and without contrast dye CPT 70553 MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - BRAIN/BRAINSTEM	$2,530.30	$2,976.82	$382.49	10% below	15%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W/WO CONTRAST	$2,539.54	$2,987.69	$357.13	10% below	15%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI IAC'S W AND W/O CONTRAST LIMITED	$2,832.41	$3,332.25	$357.13	1% above	15%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN W/WO CONTRAST	$2,539.54	$2,987.69	$2,838.31	—	15%
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O CONTRAST-LIMITED	$1,620.73	$1,906.74	$241.72	8% below	15%
MRI of the lower back, no contrast dye CPT 72148 MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE)	$1,977.06	$2,325.95	$258.72	13% above	15%
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O CONTRAST	$1,978.59	$2,327.75	$241.72	13% above	15%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMBAR SPINE W/O CONTRAST-LIMITED	$1,620.73	$1,906.74	$1,811.40	—	15%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMBAR SPINE W/O CONTRAST	$1,978.59	$2,327.75	$2,211.36	—	15%
MRI of the lower back, without and then with contrast dye CPT 72158 MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE)	$2,189.80	$2,576.23	$382.49	18% below	15%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMBAR SPINE W/WO CONTRAST	$2,204.56	$2,593.60	$357.13	17% below	15%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMBAR SPINE W/WO CONTRAST -LIMITED	$2,210.92	$2,601.08	$357.13	17% below	15%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI LUMBAR SPINE W/WO CONTRAST	$2,204.56	$2,593.60	$2,463.92	—	15%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI LUMBAR SPINE W/WO CONTRAST -LIMITED	$2,210.92	$2,601.08	$2,471.03	—	15%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI THORACIC SPINE W/O CONTRAST	$1,752.39	$2,061.63	$241.72	at median	15%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE)	$1,752.39	$2,061.63	$261.08	at median	15%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI THORACIC SPINE W/O CONTRAST-LIMITED	$1,783.34	$2,098.05	$241.72	2% above	15%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI THORACIC SPINE W/O CONTRAST	$1,752.39	$2,061.63	$1,958.55	—	15%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI THORACIC SPINE W/O CONTRAST-LIMITED	$1,783.34	$2,098.05	$1,993.15	—	15%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE)	$2,303.30	$2,709.76	$350.20	14% below	15%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI CERVICAL SPINE W/WO CONTRAST-LIMITED	$2,341.30	$2,754.47	$357.13	13% below	15%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI CERVICAL SPINE W/WO CONTRAST	$2,389.67	$2,811.38	$357.13	11% below	15%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI CERVICAL SPINE W/WO CONTRAST-LIMITED	$2,341.30	$2,754.47	$2,616.75	—	15%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI CERVICAL SPINE W/WO CONTRAST	$2,389.67	$2,811.38	$2,670.81	—	15%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERVICAL SPINE W/O CONTRAST-LIMITED	$1,870.61	$2,200.72	$241.72	4% above	15%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE)	$1,885.19	$2,217.87	$578.63	4% above	15%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERVICAL SPINE W/O CONTRAST	$1,885.19	$2,217.87	$241.72	4% above	15%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI CERVICAL SPINE W/O CONTRAST-LIMITED	$1,870.61	$2,200.72	$2,090.68	—	15%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI CERVICAL SPINE W/O CONTRAST	$1,885.19	$2,217.87	$2,106.98	—	15%
MRI of the pelvis without and with contrast CPT 72197 MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION	$2,579.08	$3,034.22	$378.61	7% below	15%
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS W/WO CONTRAST	$2,583.80	$3,039.77	$357.13	7% below	15%
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS W/WO-LIMITED METS	$2,896.09	$3,407.16	$357.13	4% above	15%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS W/WO CONTRAST	$2,583.80	$3,039.77	$2,887.78	—	15%
MRI of the pelvis, no contrast dye CPT 72195 MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION	$2,512.88	$2,956.33	$258.88	33% above	15%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS W/O CONTRAST	$2,564.93	$3,017.57	$241.72	36% above	15%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS W/O CONTRAST	$2,564.93	$3,017.57	$2,866.69	—	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - OTHER	$2,026.80	$2,384.47	$258.88	29% above	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI UPPER EXTREM 1 JOINT W/O CONTRAST	$2,062.48	$2,426.45	$241.72	32% above	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI UPPER EXTREM 1 JOINT W/O CONTRAST	$2,062.48	$2,426.45	$2,305.13	—	15%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$302.95	$356.41	$112.24	7% below	15%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC DI CERVICAL SPINE 4 OR 5 VIEWS	$310.45	$365.23	$75.49	4% below	15%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC DI CERVICAL SPINE 4 OR 5 VIEWS	$310.45	$365.23	$346.97	—	15%
Neck soft tissue CT scan with contrast CPT 70491 CT SCAN - HEAD SCAN	$1,132.50	$1,332.35	$237.93	36% below	15%
Neck soft tissue CT scan with contrast CPT 70491 HC CT NECK SOFT TISSUE W/CONTRAST	$1,165.44	$1,371.10	$178.02	34% below	15%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT NECK SOFT TISSUE W/CONTRAST	$1,165.44	$1,371.10	$1,302.55	—	15%
Neck soft tissue CT scan without contrast CPT 70490 CT SCAN - HEAD SCAN	$872.19	$1,026.10	$965.87	28% below	15%
Neck soft tissue CT scan without contrast CPT 70490 HC CT NECK SOFT TISSUE W/O CONTRAST	$872.19	$1,026.10	$106.34	28% below	15%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT NECK SOFT TISSUE W/O CONTRAST	$872.19	$1,026.10	$974.80	—	15%
Neck soft tissue X-ray CPT 70360 HC DI NECK SOFT TISSUE	$158.69	$186.69	$44.06	19% below	15%
Neck soft tissue X-ray inpatient CPT 70360 HC DI NECK SOFT TISSUE	$158.69	$186.69	$177.36	—	15%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC HEART MUSCLE SPECT MULT	$2,537.74	$2,985.58	$819.56	17% above	15%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES	$2,566.47	$3,019.38	$1,398.21	18% above	15%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC HEART MUSCLE SPECT MULT	$2,537.74	$2,985.58	$2,836.30	—	15%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC PET CT SKULL TO MID THIGH	$4,868.83	$5,728.03	$1,458.59	11% below	15%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY	$4,952.41	$5,826.37	$1,550.16	9% below	15%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC PET CT SKULL TO MID THIGH	$4,868.83	$5,728.03	$5,441.63	—	15%
Pelvic CT scan without contrast CPT 72192 HC CT PELVIS W/O CONTRAST	$962.17	$1,131.97	$106.34	31% below	15%
Pelvic CT scan without contrast CPT 72192 CT SCAN - BODY SCAN	$965.68	$1,136.09	$113.89	30% below	15%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT PELVIS W/O CONTRAST	$962.17	$1,131.97	$1,075.37	—	15%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US EXAM, PELVIC, LIMITED	$299.46	$352.31	$49.19	3% below	15%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 OTHER IMAGING SERVICES - ULTRASOUND	$299.46	$352.31	$113.84	3% below	15%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US EXAM, PELVIC, LIMITED	$299.46	$352.31	$334.69	—	15%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 OTHER IMAGING SERVICES - ULTRASOUND	$538.02	$632.96	$112.92	1% below	15%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIC NON-OB S&I	$551.66	$649.01	$106.34	2% above	15%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIC NON-OB S&I	$551.66	$649.01	$616.56	—	15%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US PREG 2ND/3RD TRIMESTER	$289.74	$340.87	$106.34	39% below	15%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US PREG 2ND/3RD TRIMESTER	$289.74	$340.87	$323.83	—	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US, OB < 14 WKS, SINGLE FETUS	$398.44	$468.75	$106.34	10% below	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OTHER IMAGING SERVICES - ULTRASOUND	$418.60	$492.47	$113.89	6% below	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC US, OB < 14 WKS, SINGLE FETUS	$398.44	$468.75	$445.31	—	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OTHER IMAGING SERVICES - ULTRASOUND	$228.09	$268.34	$254.92	31% below	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC ULTRASOUND OB LIMITED	$233.90	$275.18	$106.19	29% below	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC ULTRASOUND OB LIMITED	$233.90	$275.18	$261.42	—	15%
Rib X-ray, one side, 2 views CPT 71100 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$164.82	$193.91	$95.22	29% below	15%
Rib X-ray, one side, 2 views one side CPT 71100 HC DI RIBS 2 VIEWS UNILATERAL	$164.82	$193.91	$49.92	29% below	15%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC DI RIBS 2 VIEWS UNILATERAL	$164.82	$193.91	$184.21	—	15%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$209.17	$246.08	$111.49	25% below	15%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC DI X-RAY EXAM OF RIBS/CHEST	$212.58	$250.09	$56.50	24% below	15%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC DI X-RAY EXAM OF RIBS/CHEST	$212.58	$250.09	$237.59	—	15%
Screening mammogram, both breasts both sides CPT 77067 HC SCREEN MAMMO, BILATERAL INCL CAD WHEN PERFORMED	$233.37	$274.55	$127.79	—	15%
Screening mammogram, both breasts CPT 77067 OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY	$57.42	$67.55	$23.97	79% below	15%
Screening mammogram, both breasts one side CPT 77067 HC SCREEN MAMMO, UNILATERAL INCL CAD WHEN PERFORMED	$146.23	$172.04	$127.79	47% below	15%
Screening mammogram, both breasts inpatient both sides CPT 77067 HC SCREEN MAMMO, BILATERAL INCL CAD WHEN PERFORMED	$233.37	$274.55	$260.82	—	15%
Shoulder X-ray, complete, 2 or more views CPT 73030 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$157.72	$185.56	$93.43	27% below	15%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 HC DI SHOULDER MIN 2 VIEWS UNILATERAL	$158.41	$186.36	$48.46	27% below	15%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 HC DI SHOULDER MIN 2 VIEWS UNILATERAL	$158.41	$186.36	$177.04	—	15%
Sinus X-ray, complete, 3 or more views CPT 70220 HC DI SINUSES COMPLETE 3 OR MORE VIEWS	$223.62	$263.08	$52.10	13% below	15%
Sinus X-ray, complete, 3 or more views CPT 70220 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$235.39	$276.93	$263.08	9% below	15%
Skull X-ray, fewer than 4 views CPT 70250 HC DI SKULL <4 VIEWS	$170.58	$200.68	$52.10	28% below	15%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC DI SKULL <4 VIEWS	$170.58	$200.68	$190.65	—	15%
Sleep study in a lab (polysomnography) CPT 95810 EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION	$2,502.18	$2,943.74	$1,053.06	20% above	15%
Sleep study in a lab (polysomnography) CPT 95810 HC BASELINE SLEEP STUDY	$2,877.51	$3,385.30	$1,017.39	38% above	15%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 CARDIOLOGY - ECHOCARDIOLOGY	$1,165.14	$1,370.75	$587.23	at median	15%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC US TTE STRESS AND ECG W/PHYS COMPLETE W/O CONTRAST	$1,165.14	$1,370.75	$548.30	at median	15%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC US TTE STRESS AND ECG W/PHYS COMPLETE W/O CONTRAST	$1,165.14	$1,370.75	$1,302.21	—	15%
Swallow study (modified barium swallow, video X-ray) CPT 74230 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$157.06	$184.78	$173.93	64% below	15%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC DI SWALLOWING EVAL W/VIDEO	$157.06	$184.78	$178.02	64% below	15%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC DI SWALLOWING EVAL W/VIDEO	$157.06	$184.78	$175.54	—	15%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$111.94	$131.69	$93.16	48% below	15%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 HC DI FEMUR MIN 2 VIEW UNILATERAL	$111.25	$130.88	$52.10	48% below	15%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 HC DI FEMUR MIN 2 VIEW UNILATERAL	$111.25	$130.88	$124.34	—	15%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT THORACIC SPINE W/O CONTRAST	$933.98	$1,098.80	$106.34	34% below	15%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT SCAN - BODY SCAN	$936.97	$1,102.32	$241.31	34% below	15%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT THORACIC SPINE W/O CONTRAST	$933.98	$1,098.80	$1,043.86	—	15%
Toe X-ray, 2 or more views CPT 73660 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$119.31	$140.36	$94.30	31% below	15%
Toe X-ray, 2 or more views CPT 73660 HC DI TOES MIN 2 VIEWS UNLATERAL	$137.20	$161.41	$44.06	21% below	15%
Toe X-ray, 2 or more views inpatient CPT 73660 HC DI TOES MIN 2 VIEWS UNLATERAL	$137.20	$161.41	$153.34	—	15%
Transvaginal pelvic ultrasound CPT 76830 OTHER IMAGING SERVICES - ULTRASOUND	$175.30	$206.23	$113.89	58% below	15%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON-OB S&I	$180.09	$211.87	$106.34	57% below	15%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL NON-OB S&I	$180.09	$211.87	$201.28	—	15%
Transvaginal ultrasound during pregnancy CPT 76817 OTHER IMAGING SERVICES - ULTRASOUND	$398.44	$468.75	$441.23	at median	15%
Transvaginal ultrasound during pregnancy CPT 76817 HC TRANSVAGINAL ULTRASOUND PREGNANCY	$478.18	$562.57	$106.34	20% above	15%
Ultrasound of the abdomen, complete CPT 76700 OTHER IMAGING SERVICES - ULTRASOUND	$376.57	$443.03	$129.20	29% below	15%
Ultrasound of the abdomen, complete CPT 76700 HC ULTRASOUND ABDOMEN COMPLETE	$379.48	$446.45	$106.34	28% below	15%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC ULTRASOUND ABDOMEN COMPLETE	$379.48	$446.45	$424.13	—	15%
Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM AND CONTENTS	$435.78	$512.68	$106.34	12% below	15%
Ultrasound of the scrotum and testicles CPT 76870 OTHER IMAGING SERVICES - ULTRASOUND	$435.78	$512.68	$113.89	12% below	15%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US SCROTUM AND CONTENTS	$435.78	$512.68	$487.05	—	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 OTHER IMAGING SERVICES - ULTRASOUND	$297.11	$349.55	$113.89	31% below	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US HEAD/NECK SOFT TISSUE	$301.12	$354.26	$106.34	30% below	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US HEAD/NECK SOFT TISSUE	$301.12	$354.26	$336.55	—	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC DI X-RAY UPPER GI DELAY W/KUB (W/SM BOWEL)	$462.26	$543.83	$163.92	1% above	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$480.50	$565.29	$190.66	5% above	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC DI X-RAY UPPER GI DELAY W/KUB	$494.16	$581.36	$163.92	8% above	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC DI X-RAY UPPER GI DELAY W/KUB (W/SM BOWEL)	$462.26	$543.83	$516.64	—	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC DI X-RAY UPPER GI DELAY W/KUB	$494.16	$581.36	$552.29	—	15%
Upper arm X-ray (humerus), 2 views CPT 73060 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$179.17	$210.79	$94.30	11% below	15%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HC DI HUMERUS 1 VIEW UNILATERAL-LIMITED	$171.18	$201.39	$47.00	15% below	15%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HC DI HUMERUS MIN 2 VIEWS UNILATERAL	$183.75	$216.18	$47.00	8% below	15%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HC DI HUMERUS 1 VIEW UNILATERAL-LIMITED	$171.18	$201.39	$191.32	—	15%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HC DI HUMERUS MIN 2 VIEWS UNILATERAL	$183.75	$216.18	$205.37	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB	$777.96	$915.25	$113.89	21% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC DOPPLER EXTREMITY VEINS UNILATERAL	$225.97	$265.85	$106.34	65% below	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC DOPPLER EXTREMITY VEINS UNILATERAL	$225.97	$265.85	$252.56	—	15%
Wrist X-ray, 2 views CPT 73100 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$123.63	$145.45	$94.30	30% below	15%
Wrist X-ray, 2 views one side CPT 73100 HC DI WRIST 1 VIEW UNILATERAL-LIMITED	$104.97	$123.49	$49.92	41% below	15%
Wrist X-ray, 2 views one side CPT 73100 HC DI WRIST 2 VIEW UNILATERAL	$123.63	$145.45	$49.92	30% below	15%
Wrist X-ray, 2 views inpatient one side CPT 73100 HC DI WRIST 1 VIEW UNILATERAL-LIMITED	$104.97	$123.49	$117.32	—	15%
Wrist X-ray, 2 views inpatient one side CPT 73100 HC DI WRIST 2 VIEW UNILATERAL	$123.63	$145.45	$138.18	—	15%
Wrist X-ray, complete, 3 or more views CPT 73110 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$184.64	$217.22	$93.26	15% below	15%
Wrist X-ray, complete, 3 or more views one side CPT 73110 HC DI WRIST MIN 3 VIEW UNILAT	$186.21	$219.07	$61.60	14% below	15%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 HC DI WRIST MIN 3 VIEW UNILAT	$186.21	$219.07	$208.12	—	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$181.13	$213.10	$93.23	14% below	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC DI HIP UNILATERAL +/- PELVIS 2 OR 3 VIEW	$180.26	$212.07	$69.64	14% below	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HC DI HIP UNILATERAL +/- PELVIS 2 OR 3 VIEW	$180.26	$212.07	$201.47	—	15%
X-ray of the abdomen, 1 view CPT 74018 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$160.67	$189.02	$93.75	11% below	15%
X-ray of the abdomen, 1 view CPT 74018 HC ABDOMEN 1 VIEW	$160.79	$189.16	$41.15	11% below	15%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC ABDOMEN 1 VIEW	$160.79	$189.16	$179.70	—	15%
X-ray of the ankle, 2 views one side CPT 73600 HC DI ANKLE 2 VIEW UNILATERAL	$135.29	$159.17	$47.73	24% below	15%
X-ray of the ankle, 2 views inpatient one side CPT 73600 HC DI ANKLE 2 VIEW UNILATERAL	$135.29	$159.17	$151.21	—	15%
X-ray of the finger(s), 2 or more views CPT 73140 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$92.97	$109.38	$93.42	45% below	15%
X-ray of the finger(s), 2 or more views one side CPT 73140 HC DI FINGERS MIN 2 VIEWS UNILATERAL	$93.52	$110.02	$58.68	45% below	15%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 HC DI FINGERS MIN 2 VIEWS UNILATERAL	$93.52	$110.02	$104.52	—	15%
X-ray of the foot, 2 views CPT 73620 HC DI FOOT 1 VIEW-LIMITED	$104.94	$123.46	$41.15	39% below	15%
X-ray of the foot, 2 views CPT 73620 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$133.48	$157.03	$94.30	22% below	15%
X-ray of the foot, 2 views one side CPT 73620 HC DI FOOT 2 VIEW UNILATERAL	$133.48	$157.03	$41.15	22% below	15%
X-ray of the foot, 2 views inpatient CPT 73620 HC DI FOOT 1 VIEW-LIMITED	$104.94	$123.46	$117.29	—	15%
X-ray of the foot, 2 views inpatient one side CPT 73620 HC DI FOOT 2 VIEW UNILATERAL	$133.48	$157.03	$149.18	—	15%
X-ray of the foot, complete, 3 or more views CPT 73630 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$174.23	$204.98	$93.42	26% below	15%
X-ray of the foot, complete, 3 or more views one side CPT 73630 HC DI FOOT MIN 3 VIEW UNILATERAL	$175.68	$206.68	$49.92	26% below	15%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 HC DI FOOT MIN 3 VIEW UNILATERAL	$175.68	$206.68	$196.35	—	15%
X-ray of the hand, 3 or more views CPT 73130 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$180.95	$212.89	$93.83	21% below	15%
X-ray of the hand, 3 or more views one side CPT 73130 HC DI HAND MIN 3 VIEW UNILATERAL	$182.76	$215.01	$53.58	20% below	15%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HC DI HAND MIN 3 VIEW UNILATERAL	$182.76	$215.01	$204.26	—	15%
X-ray of the knee, 1 or 2 views CPT 73560 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$171.64	$201.93	$92.97	4% below	15%
X-ray of the knee, 1 or 2 views one side CPT 73560 HC DI KNEE 1-2 VIEWS UNILATERAL	$169.69	$199.64	$51.37	5% below	15%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 HC DI KNEE 1-2 VIEWS UNILATERAL	$169.69	$199.64	$189.66	—	15%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$201.51	$237.08	$112.29	20% below	15%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC DI LUMBAR SPINE 2 OR 3 VIEWS	$202.11	$237.78	$55.04	20% below	15%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC DI LUMBAR SPINE 2 OR 3 VIEWS	$202.11	$237.78	$225.89	—	15%
X-ray of the lower back, 4 or more views CPT 72110 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$241.77	$284.44	$110.01	28% below	15%
X-ray of the lower back, 4 or more views CPT 72110 HC DI L SPINE AP/LAT/OBL/OR FLEX/EXT	$242.87	$285.73	$72.58	27% below	15%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC DI L SPINE AP/LAT/OBL/OR FLEX/EXT	$242.87	$285.73	$271.44	—	15%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC DI THORACIC SPINE 2 VIEWS	$189.74	$223.22	$44.06	15% below	15%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$189.74	$223.22	$113.89	15% below	15%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC DI THORACIC SPINE 2 VIEWS	$189.74	$223.22	$212.06	—	15%
X-ray of the nasal bones, 3 or more views CPT 70160 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$249.38	$293.39	$94.30	19% above	15%
X-ray of the nasal bones, 3 or more views CPT 70160 HC DI NASAL BONES MIN 3 VIEWS	$249.38	$293.39	$56.50	19% above	15%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$195.16	$229.60	$93.88	9% below	15%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC DI CERVICAL SPINE 2 OR 3 VIEWS	$200.39	$235.75	$55.04	7% below	15%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC DI CERVICAL SPINE 2 OR 3 VIEWS	$200.39	$235.75	$223.96	—	15%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC DI PELVIS 1 OR 2 VIEWS	$173.44	$204.05	$40.42	20% below	15%
X-ray of the pelvis, 1 or 2 views CPT 72170 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$174.11	$204.84	$112.01	20% below	15%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC DI PELVIS 1 OR 2 VIEWS	$173.44	$204.05	$193.85	—	15%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$231.00	$271.76	$94.30	1% below	15%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC DI SACRUM/COCCYX MIN 2 VIEWS	$234.17	$275.49	$46.27	at median	15%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC DI SACRUM/COCCYX MIN 2 VIEWS	$234.17	$275.49	$261.72	—	15%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
ACTH blood test CPT 82024 LABORATORY - CHEMISTRY	$28.33	$33.33	$31.66	87% below	15%
ACTH blood test CPT 82024 HC ACTH HORMONE	$72.11	$84.83	$38.62	68% below	15%
ACTH blood test inpatient CPT 82024 HC ACTH HORMONE	$72.11	$84.83	$80.59	—	15%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 LABORATORY - CHEMISTRY	$25.60	$30.12	$5.30	51% below	15%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC TRANSAMINASE ALT/SGPT	$26.89	$31.63	$5.30	48% below	15%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC TRANSAMINASE ALT/SGPT	$26.89	$31.63	$30.05	—	15%
AST (aspartate aminotransferase) enzyme test CPT 84450 LABORATORY - CHEMISTRY	$30.73	$36.15	$5.18	39% below	15%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC TRANSAMINASE AST/SGOT	$32.27	$37.96	$5.18	36% below	15%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC TRANSAMINASE AST/SGOT	$32.27	$37.96	$36.06	—	15%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 LABORATORY - GENERAL CLASSIFICATION	$231.83	$272.74	$47.63	12% above	15%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS ACUTE PROFILE	$239.43	$281.68	$47.63	15% above	15%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC HEPATITIS ACUTE PROFILE	$239.43	$281.68	$267.60	—	15%
Albumin blood test CPT 82040 HC ALBUMIN SERUM	$19.74	$23.22	$4.95	36% below	15%
Albumin blood test CPT 82040 LABORATORY - CHEMISTRY	$78.68	$92.57	$13.39	155% above	15%
Albumin blood test inpatient CPT 82040 HC ALBUMIN SERUM	$19.74	$23.22	$22.06	—	15%
Aldosterone blood test CPT 82088 LABORATORY - CHEMISTRY	$29.55	$34.76	$33.02	85% below	15%
Aldosterone blood test CPT 82088 HC ALDOSTERONE; SERUM	$81.83	$96.27	$40.75	59% below	15%
Aldosterone blood test inpatient CPT 82088 HC ALDOSTERONE; SERUM	$81.83	$96.27	$91.46	—	15%
Alkaline phosphatase (ALP) blood test CPT 84075 HC ALKALINE PHOSPHATASE SERUM	$35.36	$41.60	$5.18	38% below	15%
Alkaline phosphatase (ALP) blood test CPT 84075 LABORATORY - CHEMISTRY	$68.66	$80.78	$16.77	19% above	15%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC ALKALINE PHOSPHATASE SERUM	$35.36	$41.60	$39.52	—	15%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE, EACH ALLERGEN	$10.11	$11.89	$5.22	79% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 LABORATORY - IMMUNOLOGY	$23.14	$27.22	$11.16	51% below	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE, EACH ALLERGEN	$10.11	$11.89	$11.30	—	15%
Alpha-fetoprotein (AFP) blood test CPT 82105 LABORATORY - CHEMISTRY	$69.52	$81.79	$16.77	40% below	15%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA-FETOPROTEIN; SERUM	$72.10	$84.82	$16.77	38% below	15%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ALPHA-FETOPROTEIN; SERUM	$72.10	$84.82	$80.58	—	15%
Ammonia blood test CPT 82140 LABORATORY - CHEMISTRY	$83.63	$98.39	$14.57	33% below	15%
Ammonia blood test CPT 82140 HC AMMONIA	$83.63	$98.39	$14.57	33% below	15%
Ammonia blood test inpatient CPT 82140 HC AMMONIA	$83.63	$98.39	$93.47	—	15%
Amylase blood test CPT 82150 LABORATORY - CHEMISTRY	$75.48	$88.81	$6.48	32% above	15%
Amylase blood test CPT 82150 HC AMYLASE	$75.80	$89.18	$6.48	32% above	15%
Amylase blood test inpatient CPT 82150 HC AMYLASE	$75.80	$89.18	$84.72	—	15%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CITRULLINATED PEPTIDE IGGCCP ANTIBODY	$27.46	$32.30	$12.95	72% below	15%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 LABORATORY - IMMUNOLOGY	$57.13	$67.21	$5.18	41% below	15%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC CITRULLINATED PEPTIDE IGGCCP ANTIBODY	$27.46	$32.30	$30.69	—	15%
Antinuclear antibody (ANA) blood test, screen CPT 86038 LABORATORY - IMMUNOLOGY	$47.26	$55.60	$12.05	37% below	15%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTI-NUCLEAR ANTIBODIES	$60.69	$71.40	$12.09	19% below	15%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTI-NUCLEAR ANTIBODIES	$60.69	$71.40	$67.83	—	15%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 LABORATORY - CHEMISTRY	$76.93	$90.50	$10.56	66% below	15%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE	$79.85	$93.94	$39.26	65% below	15%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE	$79.85	$93.94	$89.24	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE TISSUE	$49.65	$58.41	$8.62	34% below	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC WOUND CULTURE	$80.60	$94.82	$8.62	7% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 LABORATORY - BACTERIOLOGY AND MICROBIOLOGY	$83.09	$97.75	$8.62	10% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC EYE CULTURE AND GRAM STAIN	$83.12	$97.79	$8.62	10% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC RESPIRATORY CULTURE	$84.72	$99.67	$8.62	12% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CATHETER TIP CULTURE	$90.33	$106.27	$8.62	20% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC GENITAL CULTURE	$91.38	$107.51	$8.62	21% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE, BACTERIAL, OTHER SOURCE	$106.99	$125.87	$8.62	42% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CSF CULTURE AND GRAM STAIN	$106.99	$125.87	$8.62	42% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE TISSUE	$49.65	$58.41	$55.49	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC WOUND CULTURE	$80.60	$94.82	$90.08	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC RESPIRATORY CULTURE	$84.72	$99.67	$94.69	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC GENITAL CULTURE	$91.38	$107.51	$102.13	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE, BACTERIAL, OTHER SOURCE	$106.99	$125.87	$119.58	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CSF CULTURE AND GRAM STAIN	$106.99	$125.87	$119.58	—	15%
Basic metabolic panel (blood test) CPT 80048 LABORATORY - CHEMISTRY	$50.66	$59.60	$8.46	46% below	15%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL	$50.66	$59.60	$8.46	46% below	15%
Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL	$50.66	$59.60	$56.62	—	15%
Bilirubin blood test, total CPT 82247 LABORATORY - CHEMISTRY	$12.72	$14.97	$5.02	74% below	15%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL	$13.03	$15.33	$5.02	74% below	15%
Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN TOTAL	$13.03	$15.33	$14.56	—	15%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC SURG PATH LEVEL-IV GROSS & MICRO	$103.67	$121.96	$53.43	49% below	15%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 LABORATORY PATHOLOGICAL - HISTOLOGY	$346.21	$407.30	$91.77	72% above	15%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC SURG PATH LEVEL-IV GROSS & MICRO	$103.67	$121.96	$115.86	—	15%
Blood culture for bacteria CPT 87040 HC CULTURE BLOOD	$20.93	$24.62	$10.32	86% below	15%
Blood culture for bacteria CPT 87040 LABORATORY - BACTERIOLOGY AND MICROBIOLOGY	$21.52	$25.32	$23.84	86% below	15%
Blood culture for bacteria inpatient CPT 87040 HC CULTURE BLOOD	$20.93	$24.62	$23.39	—	15%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC VENIPUNCTURE POC	$14.71	$17.30	$5.85	23% below	15%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC VENIPUNCTURE	$15.22	$17.91	$5.85	20% below	15%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 LABORATORY - GENERAL CLASSIFICATION	$15.31	$18.01	$9.09	19% below	15%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC COM CON LEGAL BLOOD DRAW	$61.17	$71.97	$5.85	222% above	15%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC VENIPUNCTURE	$15.22	$17.91	$17.01	—	15%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE; QUAN BLOOD	$26.04	$30.64	$3.93	34% below	15%
Blood glucose (sugar) test CPT 82947 LABORATORY - CHEMISTRY	$26.04	$30.64	$3.93	34% below	15%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE; QUAN BLOOD POC	$27.86	$32.78	$3.93	29% below	15%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE; QUAN BLOOD	$26.04	$30.64	$29.11	—	15%
Blood lead test CPT 83655 HC LEAD	$19.80	$23.29	$12.11	66% below	15%
Blood lead test CPT 83655 LABORATORY - CHEMISTRY	$47.60	$56.00	$12.41	19% below	15%
Blood lead test inpatient CPT 83655 HC LEAD	$19.80	$23.29	$22.13	—	15%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 LABORATORY - CHEMISTRY	$51.01	$60.02	$57.02	28% below	15%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC PREGNANCY TEST QUALITATIVE	$52.26	$61.48	$7.52	27% below	15%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC PREGNANCY TEST QUALITATIVE	$52.26	$61.48	$58.41	—	15%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING, SEROLOGIC; ABO	$42.83	$50.39	$5.83	41% below	15%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 LABORATORY - IMMUNOLOGY	$65.82	$77.43	$72.88	9% below	15%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPING, SEROLOGIC; ABO	$42.83	$50.39	$47.87	—	15%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 LABORATORY - IMMUNOLOGY	$42.83	$50.39	$138.05	—	15%
Blood urea nitrogen (BUN) test CPT 84520 HC UREA NITROGEN QUANT	$22.89	$26.93	$3.95	52% below	15%
Blood urea nitrogen (BUN) test CPT 84520 LABORATORY - CHEMISTRY	$25.60	$30.12	$5.30	46% below	15%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC UREA NITROGEN QUANT	$22.89	$26.93	$25.58	—	15%
C-peptide blood test CPT 84681 LABORATORY - CHEMISTRY	$41.79	$49.16	$20.81	72% below	15%
C-peptide blood test CPT 84681 HC C-PEPTIDE	$41.79	$49.16	$20.81	72% below	15%
C-peptide blood test inpatient CPT 84681 HC C-PEPTIDE	$41.79	$49.16	$46.70	—	15%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 LABORATORY - IMMUNOLOGY	$58.14	$68.40	$5.18	12% below	15%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN	$59.98	$70.57	$5.18	9% below	15%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-REACTIVE PROTEIN	$59.98	$70.57	$67.04	—	15%
C. difficile toxin gene test (stool PCR) CPT 87493 HC C DIFF AMPLIFIED PROBE	$166.01	$195.30	$37.27	1% below	15%
C. difficile toxin gene test (stool PCR) CPT 87493 LABORATORY - BACTERIOLOGY AND MICROBIOLOGY	$166.01	$195.30	$37.27	1% below	15%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC C DIFF AMPLIFIED PROBE	$166.01	$195.30	$185.54	—	15%
CA 19-9 blood test (tumor marker) CPT 86301 LABORATORY - IMMUNOLOGY	$57.58	$67.74	$67.74	57% below	15%
CA 19-9 blood test (tumor marker) CPT 86301 HC CANCER ANTIGEN 19-9	$60.46	$71.13	$20.81	54% below	15%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC CANCER ANTIGEN 19-9	$60.46	$71.13	$67.57	—	15%
CA-125 blood test (ovarian cancer marker) CPT 86304 LABORATORY - IMMUNOLOGY	$57.58	$67.74	$20.81	54% below	15%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC CANCER ANTIGEN 125	$178.13	$209.56	$20.81	42% above	15%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC CANCER ANTIGEN 125	$178.13	$209.56	$199.08	—	15%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 LABORATORY - GENERAL CLASSIFICATION	$65.41	$76.95	$51.31	46% below	15%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC COVID-19/SARS-COV-2 CPT 87635 INF AGENT DET W/WO RESP CDC SITE U0001	$68.68	$80.80	$51.31	43% below	15%
Calcium blood test, total CPT 82310 LABORATORY - CHEMISTRY	$27.59	$32.46	$30.84	21% below	15%
Calcium blood test, total CPT 82310 HC CALCIUM; TOTAL	$28.97	$34.08	$5.16	17% below	15%
Calcium blood test, total inpatient CPT 82310 HC CALCIUM; TOTAL	$28.97	$34.08	$32.38	—	15%
Carcinoembryonic antigen (CEA) test CPT 82378 LABORATORY - CHEMISTRY	$59.53	$70.03	$18.96	44% below	15%
Carcinoembryonic antigen (CEA) test CPT 82378 HC CARCINOEMBRONIC ANTIGEN (CEA)	$62.50	$73.53	$18.96	42% below	15%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC CARCINOEMBRONIC ANTIGEN (CEA)	$62.50	$73.53	$69.85	—	15%
Chickenpox (varicella) immunity blood test CPT 86787 LABORATORY - IMMUNOLOGY	$24.63	$28.98	$12.88	50% below	15%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA ZOSTER ANTIBODY	$25.87	$30.43	$12.88	48% below	15%
Chickenpox (varicella) immunity blood test CPT 86787 HC COM CON VARICELLA ZOSTER IGM	$41.85	$49.23	$12.88	15% below	15%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA ZOSTER ANTIBODY IGG	$182.57	$214.79	$12.88	269% above	15%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA ZOSTER ANTIBODY	$25.87	$30.43	$28.91	—	15%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC COM CON VARICELLA ZOSTER IGM	$41.85	$49.23	$46.77	—	15%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA ZOSTER ANTIBODY IGG	$182.57	$214.79	$204.05	—	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC COM CON DTC CHLAMYDIA TRACH BY AMP DNA	$77.22	$90.85	$35.09	15% below	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 LABORATORY - BACTERIOLOGY AND MICROBIOLOGY	$99.88	$117.50	$35.09	10% above	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA TRACH BY AMP DNA	$104.87	$123.38	$35.09	15% above	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC CHLAMYDIA TRACH BY AMP DNA	$104.87	$123.38	$117.21	—	15%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LABORATORY - CHEMISTRY	$48.25	$56.76	$8.46	42% below	15%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL	$78.68	$92.57	$13.39	6% below	15%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL	$78.68	$92.57	$87.94	—	15%
Complete blood count (CBC) with differential CPT 85025 LABORATORY - HEMATOLOGY	$72.12	$84.85	$7.77	9% below	15%
Complete blood count (CBC) with differential CPT 85025 HC CBC/PLT AUTO DIFFERENTIAL	$73.88	$86.92	$7.77	6% below	15%
Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC/PLT AUTO DIFFERENTIAL	$73.88	$86.92	$82.57	—	15%
Complete blood count (CBC), no differential CPT 85027 LABORATORY - HEMATOLOGY	$20.59	$24.22	$6.47	59% below	15%
Complete blood count (CBC), no differential CPT 85027 HC CBC W/O DIFFERENTIAL	$21.28	$25.04	$6.47	58% below	15%
Complete blood count (CBC), no differential inpatient CPT 85027 HC CBC W/O DIFFERENTIAL	$21.28	$25.04	$23.79	—	15%
Comprehensive metabolic panel (blood test) CPT 80053 LABORATORY - CHEMISTRY	$48.25	$56.76	$56.76	63% below	15%
Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHENSIVE METABOLIC PANEL	$76.93	$90.50	$10.56	41% below	15%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHENSIVE METABOLIC PANEL	$76.93	$90.50	$85.98	—	15%
Cortisol blood test, total CPT 82533 LABORATORY - CHEMISTRY	$109.01	$128.24	$16.30	3% below	15%
Cortisol blood test, total CPT 82533 HC CORTISOL TOTAL	$109.75	$129.12	$16.30	2% below	15%
Cortisol blood test, total inpatient CPT 82533 HC CORTISOL TOTAL	$109.75	$129.12	$122.66	—	15%
Creatine kinase (CK) blood test, total CPT 82550 HC CPK CREATINE PHOSPHOKINASE	$57.41	$67.54	$6.51	3% above	15%
Creatine kinase (CK) blood test, total CPT 82550 LABORATORY - CHEMISTRY	$74.94	$88.16	$13.39	34% above	15%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CPK CREATINE PHOSPHOKINASE	$57.41	$67.54	$64.16	—	15%
Creatinine blood test CPT 82565 LABORATORY - CHEMISTRY	$12.72	$14.97	$5.12	71% below	15%
Creatinine blood test CPT 82565 HC CREATININE BLOOD	$13.36	$15.72	$5.12	69% below	15%
Creatinine blood test CPT 82565 HC CREATININE BLOOD POCL/POCBS	$14.42	$16.96	$5.12	67% below	15%
Creatinine blood test inpatient CPT 82565 HC CREATININE BLOOD	$13.36	$15.72	$14.93	—	15%
Creatinine blood test inpatient CPT 82565 HC CREATININE BLOOD POCL/POCBS	$14.42	$16.96	$16.11	—	15%
Cytomegalovirus (CMV) antibody test CPT 86644 LABORATORY - IMMUNOLOGY	$27.52	$32.38	$14.39	73% below	15%
Cytomegalovirus (CMV) antibody test CPT 86644 HC CYTOMEGALOVIRUS ANTIOBYD	$30.15	$35.47	$14.39	71% below	15%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC CYTOMEGALOVIRUS ANTIOBYD	$30.15	$35.47	$33.70	—	15%
D-dimer blood test (blood clot marker) CPT 85379 LABORATORY - HEMATOLOGY	$70.36	$82.78	$7.77	37% below	15%
D-dimer blood test (blood clot marker) CPT 85379 HC D DIMER QUAN	$111.66	$131.36	$10.18	1% below	15%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC D DIMER QUAN	$111.66	$131.36	$124.79	—	15%
DHEA sulfate (DHEA-S) blood test CPT 82627 LABORATORY - GENERAL CLASSIFICATION	$51.06	$60.07	$22.23	66% below	15%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC DHEA SULFATE	$52.30	$61.53	$22.23	66% below	15%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC DHEA SULFATE	$52.30	$61.53	$58.45	—	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC PAIN MANAGEMENT PANEL W/REFLEX TO QUANTITATION	$194.51	$228.83	$62.14	4% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG SCREEN PRESMPTV,ANY NO. BY INSTR CHEM ANAL	$261.35	$307.47	$62.14	39% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 LABORATORY - CHEMISTRY	$1,121.66	$1,319.60	$114.43	497% above	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC PAIN MANAGEMENT PANEL W/REFLEX TO QUANTITATION	$194.51	$228.83	$217.39	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG SCREEN PRESMPTV,ANY NO. BY INSTR CHEM ANAL	$261.35	$307.47	$292.10	—	15%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTE PANEL	$44.65	$52.53	$7.01	39% below	15%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC VIRAL CAPSID IGM	$48.55	$57.12	$18.14	49% below	15%
Epstein-Barr virus (EBV) antibody test CPT 86665 LABORATORY - IMMUNOLOGY	$68.53	$80.63	$18.14	27% below	15%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC ANTIBODY; EPSTEIN-BARR, VIRAL CAPSID, EACH (A/G/M)	$76.77	$90.32	$18.14	19% below	15%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC VIRAL CAPSID IGG	$76.92	$90.49	$18.14	19% below	15%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC VIRAL CAPSID IGM	$48.55	$57.12	$54.26	—	15%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC ANTIBODY; EPSTEIN-BARR, VIRAL CAPSID, EACH (A/G/M)	$76.77	$90.32	$85.80	—	15%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC VIRAL CAPSID IGG	$76.92	$90.49	$85.97	—	15%
Estradiol blood test CPT 82670 LABORATORY - CHEMISTRY	$73.77	$86.79	$27.94	51% below	15%
Estradiol blood test CPT 82670 HC ESTRADIOL	$75.57	$88.90	$27.94	49% below	15%
Estradiol blood test inpatient CPT 82670 HC ESTRADIOL	$75.57	$88.90	$84.46	—	15%
FSH (follicle-stimulating hormone) test CPT 83001 LABORATORY - CHEMISTRY	$110.76	$130.30	$18.58	12% below	15%
FSH (follicle-stimulating hormone) test CPT 83001 HC GONADOTROPIN FSH	$113.46	$133.48	$18.58	9% below	15%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC GONADOTROPIN FSH	$113.46	$133.48	$126.81	—	15%
Fecal calprotectin (stool inflammation test) CPT 83993 LABORATORY - CHEMISTRY	$88.64	$104.29	$19.63	66% below	15%
Fecal calprotectin (stool inflammation test) CPT 83993 HC ASSAY FOR CALPROTECTIN FECAL	$91.93	$108.15	$19.63	64% below	15%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC ASSAY FOR CALPROTECTIN FECAL	$91.93	$108.15	$102.74	—	15%
Ferritin blood test (iron stores) CPT 82728 LABORATORY - CHEMISTRY	$45.68	$53.74	$8.68	51% below	15%
Ferritin blood test (iron stores) CPT 82728 HC FERRITIN	$114.37	$134.55	$13.63	23% above	15%
Ferritin blood test (iron stores) inpatient CPT 82728 HC FERRITIN	$114.37	$134.55	$127.82	—	15%
Fibrinogen blood test CPT 85384 LABORATORY - HEMATOLOGY	$244.38	$287.51	$9.72	163% above	15%
Fibrinogen blood test CPT 85384 HC FIBRINOGEN ACTIVITY	$244.38	$287.51	$9.72	163% above	15%
Fibrinogen blood test inpatient CPT 85384 HC FIBRINOGEN ACTIVITY	$244.38	$287.51	$273.13	—	15%
Folate (folic acid) blood test CPT 82746 LABORATORY - CHEMISTRY	$46.50	$54.70	$14.70	49% below	15%
Folate (folic acid) blood test CPT 82746 HC FOLIC ACID; SERUM	$48.20	$56.71	$14.70	47% below	15%
Folate (folic acid) blood test inpatient CPT 82746 HC FOLIC ACID; SERUM	$48.20	$56.71	$53.87	—	15%
Free T3 thyroid hormone test CPT 84481 LABORATORY - CHEMISTRY	$83.73	$98.51	$16.80	24% below	15%
Free T3 thyroid hormone test CPT 84481 HC TRIIODOTHYRONINE T3 FREE	$141.55	$166.53	$16.94	28% above	15%
Free T3 thyroid hormone test inpatient CPT 84481 HC TRIIODOTHYRONINE T3 FREE	$141.55	$166.53	$158.20	—	15%
Free T4 (free thyroxine) thyroid blood test CPT 84439 LABORATORY - CHEMISTRY	$29.55	$34.76	$6.70	61% below	15%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC FREE THYROXINE	$83.60	$98.35	$9.02	11% above	15%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC FREE THYROXINE	$83.60	$98.35	$93.43	—	15%
Free testosterone test CPT 84402 LABORATORY - CHEMISTRY	$49.82	$58.61	$25.47	63% below	15%
Free testosterone test CPT 84402 HC TESTOSTERONE FREE	$51.15	$60.18	$25.47	62% below	15%
Free testosterone test inpatient CPT 84402 HC TESTOSTERONE FREE	$51.15	$60.18	$57.17	—	15%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 LABORATORY - CHEMISTRY	$32.15	$37.83	$7.20	24% below	15%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC GAMMA GLUTAMYL TRANSFERASE	$33.39	$39.28	$7.20	21% below	15%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC GAMMA GLUTAMYL TRANSFERASE	$33.39	$39.28	$37.32	—	15%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 LABORATORY - CHEMISTRY	$178.64	$210.16	$105.25	35% below	15%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HC GENERAL HEALTH PANEL	$205.43	$241.68	$99.83	26% below	15%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 LABORATORY - CHEMISTRY	$63.22	$74.38	$70.22	3% above	15%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE; POST GLUCOSE DOSE	$65.65	$77.24	$4.75	7% above	15%
Glucose tolerance test, 3 samples CPT 82951 LABORATORY - CHEMISTRY	$66.03	$77.68	$73.80	37% below	15%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE 3 SPEC	$71.41	$84.01	$12.87	32% below	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 LABORATORY - BACTERIOLOGY AND MICROBIOLOGY	$102.24	$120.29	$35.09	2% above	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N. GONORRHOEAE (GC) BY AMP DNA	$104.74	$123.22	$35.09	5% above	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N. GONORRHOEAE (GC) BY AMP DNA	$104.74	$123.22	$117.06	—	15%
H. pylori stool antigen test CPT 87338 LABORATORY - BACTERIOLOGY AND MICROBIOLOGY	$162.94	$191.70	$14.38	91% above	15%
H. pylori stool antigen test CPT 87338 HC H PYLORI STOOL	$168.98	$198.80	$14.38	98% above	15%
H. pylori stool antigen test inpatient CPT 87338 HC H PYLORI STOOL	$168.98	$198.80	$188.86	—	15%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV-1 QUANT&REVRSE TRNSCRP J	$185.72	$218.49	$85.10	49% below	15%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 LABORATORY - BACTERIOLOGY AND MICROBIOLOGY	$226.27	$266.20	$85.10	38% below	15%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV 1 RNA BY PCR	$235.62	$277.20	$85.10	36% below	15%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC HIV 1 RNA BY PCR	$235.62	$277.20	$263.34	—	15%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV-1/2 ANTIBODY DIAGNOSTIC	$46.05	$54.18	$48.76	45% below	15%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV-1/2 ANTIBODY DIAGNOSTIC	$46.05	$54.18	$51.47	—	15%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 LABORATORY - BACTERIOLOGY AND MICROBIOLOGY	$46.05	$54.18	$24.08	41% below	15%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB; SINGLE	$48.36	$56.89	$24.08	38% below	15%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB; SINGLE	$48.36	$56.89	$54.05	—	15%
HPV test for high-risk types, one combined (pooled) result CPT 87624 LABORATORY - BACTERIOLOGY AND MICROBIOLOGY	$163.20	$192.00	$35.09	9% above	15%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC HPV HIGH RISK TYPES POOLED RSLT	$171.36	$201.60	$35.09	15% above	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC HEMOGLOBIN A1C	$40.09	$47.17	$9.71	40% below	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 LABORATORY - CHEMISTRY	$131.91	$155.19	$29.60	97% above	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC HEMOGLOBIN A1C	$40.09	$47.17	$44.81	—	15%
Hemoglobin blood test CPT 85018 HC HEMOGLOBIN	$21.00	$24.70	$2.37	27% below	15%
Hemoglobin blood test CPT 85018 LABORATORY - HEMATOLOGY	$21.02	$24.73	$2.37	27% below	15%
Hemoglobin blood test inpatient CPT 85018 HC HEMOGLOBIN	$21.00	$24.70	$23.47	—	15%
Hepatitis B core antibody test (total) CPT 86704 LABORATORY - IMMUNOLOGY	$26.55	$31.24	$12.05	71% below	15%
Hepatitis B core antibody test (total) CPT 86704 HC AB; HBCAB - TOTAL	$27.53	$32.39	$12.05	69% below	15%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC AB; HBCAB - TOTAL	$27.53	$32.39	$30.77	—	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 LABORATORY - IMMUNOLOGY	$26.22	$30.85	$12.05	68% below	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURFACE ANTIBODY	$60.21	$70.84	$10.74	26% below	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURFACE ANTIBODY	$60.21	$70.84	$67.30	—	15%
Hepatitis B surface antigen (HBsAg) test CPT 87340 LABORATORY - BACTERIOLOGY AND MICROBIOLOGY	$48.63	$57.21	$10.33	36% below	15%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC HEPATITIS B SURFACE AG EIA	$50.30	$59.18	$10.33	34% below	15%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC HEPATITIS B SURFACE AG EIA	$50.30	$59.18	$56.22	—	15%
Hepatitis C antibody blood test (screening) CPT 86803 LABORATORY - IMMUNOLOGY	$29.89	$35.16	$14.27	74% below	15%
Hepatitis C antibody blood test (screening) CPT 86803 HC HCV TEST	$93.01	$109.42	$14.27	19% below	15%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HCV TEST	$93.01	$109.42	$103.95	—	15%
Hepatitis C viral load (HCV RNA) test CPT 87522 LABORATORY - BACTERIOLOGY AND MICROBIOLOGY	$102.29	$120.34	$58.10	80% below	15%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C RNA QUANTITATIVE	$106.34	$125.11	$42.84	79% below	15%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEPATITIS C RNA QUANTITATIVE	$106.34	$125.11	$118.85	—	15%
Herpes blood test, HSV-1 antibody CPT 86695 LABORATORY - IMMUNOLOGY	$53.01	$62.37	$13.19	42% below	15%
Herpes blood test, HSV-1 antibody CPT 86695 HC HERPES TYPE I AB IGG	$57.08	$67.15	$13.19	37% below	15%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC HERPES TYPE I AB IGG	$57.08	$67.15	$63.79	—	15%
Herpes blood test, HSV-2 antibody CPT 86696 LABORATORY - IMMUNOLOGY	$100.79	$118.58	$19.35	4% above	15%
Herpes blood test, HSV-2 antibody CPT 86696 HC AB HSV TYPE 2	$100.79	$118.58	$19.35	4% above	15%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC AB HSV TYPE 2	$100.79	$118.58	$112.65	—	15%
High-sensitivity CRP (hs-CRP) test CPT 86141 LABORATORY - IMMUNOLOGY	$25.18	$29.63	$12.95	68% below	15%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC CRP-HIGH SENSITIVITY	$26.01	$30.60	$12.95	66% below	15%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC CRP-HIGH SENSITIVITY	$26.01	$30.60	$29.07	—	15%
Homocysteine blood test CPT 83090 LABORATORY - CHEMISTRY	$16.25	$19.12	$6.47	88% below	15%
Homocysteine blood test CPT 83090 HC HOMOCYSTEINE	$35.99	$42.34	$17.92	73% below	15%
Homocysteine blood test inpatient CPT 83090 HC HOMOCYSTEINE	$35.99	$42.34	$40.22	—	15%
Insulin blood test CPT 83525 LABORATORY - CHEMISTRY	$21.86	$25.72	$11.43	75% below	15%
Insulin blood test CPT 83525 HC INSULIN; TOTAL	$22.96	$27.01	$11.43	74% below	15%
Insulin blood test inpatient CPT 83525 HC INSULIN; TOTAL	$22.96	$27.01	$25.66	—	15%
Iron blood test (serum iron) CPT 83540 HC IRON	$16.25	$19.12	$6.47	74% below	15%
Iron blood test (serum iron) CPT 83540 LABORATORY - CHEMISTRY	$111.64	$131.35	$13.63	78% above	15%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON	$16.25	$19.12	$18.16	—	15%
Iron-binding capacity (TIBC) test CPT 83550 LABORATORY - CHEMISTRY	$15.74	$18.51	$6.47	76% below	15%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY	$29.75	$35.00	$8.74	55% below	15%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING CAPACITY	$29.75	$35.00	$33.25	—	15%
Kidney function blood test panel CPT 80069 LABORATORY - CHEMISTRY	$15.52	$18.26	$18.26	86% below	15%
Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL	$47.97	$56.43	$8.68	57% below	15%
Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL	$47.97	$56.43	$53.61	—	15%
LH (luteinizing hormone) test CPT 83002 LABORATORY - CHEMISTRY	$106.06	$124.78	$18.52	7% below	15%
LH (luteinizing hormone) test CPT 83002 HC LEUTENIZINE HORMONE-LH	$110.26	$129.72	$18.52	4% below	15%
LH (luteinizing hormone) test inpatient CPT 83002 HC LEUTENIZINE HORMONE-LH	$110.26	$129.72	$123.23	—	15%
Lactate (lactic acid) blood test CPT 83605 HC LACTIC ACID POC	$64.92	$76.38	$11.57	53% below	15%
Lactate (lactic acid) blood test CPT 83605 LABORATORY - CHEMISTRY	$65.38	$76.92	$11.57	53% below	15%
Lactate (lactic acid) blood test CPT 83605 HC LACTIC ACID	$65.38	$76.92	$11.57	53% below	15%
Lactate (lactic acid) blood test inpatient CPT 83605 HC LACTIC ACID POC	$64.92	$76.38	$72.56	—	15%
Lactate (lactic acid) blood test inpatient CPT 83605 HC LACTIC ACID	$65.38	$76.92	$73.07	—	15%
Lactate dehydrogenase (LDH) blood test CPT 83615 LABORATORY - CHEMISTRY	$32.81	$38.60	$6.04	30% below	15%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LACTATE DEHYDROGENASE	$33.89	$39.87	$6.04	28% below	15%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LACTATE DEHYDROGENASE	$33.89	$39.87	$37.88	—	15%
Lipase blood test (pancreas enzyme) CPT 83690 LABORATORY - CHEMISTRY	$89.40	$105.18	$6.89	3% above	15%
Lipase blood test (pancreas enzyme) CPT 83690 HC LIPASE	$93.00	$109.41	$6.89	7% above	15%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC LIPASE	$93.00	$109.41	$103.94	—	15%
Liver function blood test panel CPT 80076 LABORATORY - CHEMISTRY	$18.64	$21.93	$8.17	76% below	15%
Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL	$19.27	$22.67	$8.17	75% below	15%
Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL	$19.27	$22.67	$21.54	—	15%
Lyme disease antibody test CPT 86618 LABORATORY - IMMUNOLOGY	$69.34	$81.58	$76.79	44% below	15%
Lyme disease antibody test CPT 86618 HC LYME DISEASE ANTIBODY	$74.04	$87.10	$17.03	40% below	15%
Lyme disease antibody test inpatient CPT 86618 HC LYME DISEASE ANTIBODY	$74.04	$87.10	$82.75	—	15%
Magnesium blood test CPT 83735 HC MAGNESIUM 24HR URINE	$26.95	$31.70	$6.70	58% below	15%
Magnesium blood test CPT 83735 HC MAGNESIUM, BLOOD	$31.60	$37.18	$6.70	51% below	15%
Magnesium blood test CPT 83735 LABORATORY - CHEMISTRY	$73.26	$86.19	$10.56	13% above	15%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM, BLOOD	$31.03	$36.50	$34.68	—	15%
Measles (rubeola) antibody test CPT 86765 LABORATORY - IMMUNOLOGY	$24.84	$29.22	$12.88	60% below	15%
Measles (rubeola) antibody test CPT 86765 HC RUBEOLA IGG ANTIBODY	$25.87	$30.43	$12.88	59% below	15%
Measles (rubeola) antibody test CPT 86765 HC RUBEOLA ANTIBODIES IGM	$32.12	$37.79	$12.88	49% below	15%
Measles (rubeola) antibody test inpatient CPT 86765 HC RUBEOLA IGG ANTIBODY	$25.87	$30.43	$28.91	—	15%
Measles (rubeola) antibody test inpatient CPT 86765 HC RUBEOLA ANTIBODIES IGM	$32.12	$37.79	$35.90	—	15%
Mono test (heterophile antibody, Monospot) CPT 86308 LABORATORY - IMMUNOLOGY	$57.60	$67.77	$5.18	12% below	15%
Mono test (heterophile antibody, Monospot) CPT 86308 HC HETEROPHILE SCREEN	$59.01	$69.42	$10.10	10% below	15%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC HETEROPHILE SCREEN	$59.01	$69.42	$65.95	—	15%
Mumps immunity blood test CPT 86735 HC MUMPS IGM ANTIBODY	$19.13	$22.51	$13.05	63% below	15%
Mumps immunity blood test CPT 86735 LABORATORY - IMMUNOLOGY	$24.96	$29.36	$13.05	51% below	15%
Mumps immunity blood test CPT 86735 HC MUMPS IGG ANTIBODY	$26.21	$30.83	$13.05	49% below	15%
Mumps immunity blood test inpatient CPT 86735 HC MUMPS IGM ANTIBODY	$19.13	$22.51	$21.38	—	15%
Mumps immunity blood test inpatient CPT 86735 HC MUMPS IGG ANTIBODY	$26.21	$30.83	$29.29	—	15%
Obstetric blood test panel CPT 80055 LABORATORY - CHEMISTRY	$381.88	$449.27	$122.94	27% above	15%
PSA (prostate-specific antigen) blood test, free CPT 84154 LABORATORY - CHEMISTRY	$40.98	$48.21	$18.39	64% below	15%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE	$43.03	$50.62	$18.39	62% below	15%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE	$43.03	$50.62	$48.09	—	15%
PSA (prostate-specific antigen) blood test, total CPT 84153 LABORATORY - CHEMISTRY	$76.05	$89.47	$39.26	32% below	15%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATE SPECIFIC ANTIGEN COMPLEX	$88.92	$104.61	$18.39	21% below	15%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATIC SPECIFIC ANTIGEN TOTAL	$88.92	$104.61	$18.39	21% below	15%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PROSTATIC SPECIFIC ANTIGEN TOTAL	$88.92	$104.61	$99.38	—	15%
Pap test (liquid-based, automated screening with review) CPT 88175 LABORATORY PATHOLOGICAL - CYTOLOGY	$124.89	$146.93	$139.58	57% above	15%
Pap test (liquid-based, automated screening with review) CPT 88175 HC PAP THIN LAYER AUTO PREP & SCREEN	$124.89	$146.93	$26.49	57% above	15%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 LABORATORY PATHOLOGICAL - CYTOLOGY	$112.12	$131.90	$25.52	80% above	15%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC CERV/VAG THIN PREP CYTO SCREEN	$124.89	$146.93	$23.96	101% above	15%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC CERV/VAG THIN PREP CYTO SCREEN	$124.89	$146.93	$139.58	—	15%
Parathyroid hormone (PTH) blood test CPT 83970 LABORATORY - CHEMISTRY	$38.18	$44.92	$9.71	82% below	15%
Parathyroid hormone (PTH) blood test CPT 83970 HC PARATHORMONE; PTH	$189.14	$222.52	$41.28	9% below	15%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PARATHORMONE; PTH	$189.14	$222.52	$211.39	—	15%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC PARTIAL THROMBOPLASTIN TIME	$60.61	$71.30	$6.01	4% above	15%
Partial thromboplastin time (PTT) clotting test CPT 85730 LABORATORY - HEMATOLOGY	$73.88	$86.92	$7.77	27% above	15%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PARTIAL THROMBOPLASTIN TIME	$60.61	$71.30	$67.74	—	15%
Phosphorus (phosphate) blood test CPT 84100 LABORATORY - CHEMISTRY	$43.17	$50.79	$4.74	19% below	15%
Phosphorus (phosphate) blood test CPT 84100 HC PHOSPHORUS	$44.68	$52.56	$4.74	16% below	15%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC PHOSPHORUS	$44.68	$52.56	$49.93	—	15%
Potassium blood test CPT 84132 LABORATORY - CHEMISTRY	$5.48	$6.45	$6.45	89% below	15%
Potassium blood test CPT 84132 HC POTASSIUM; SERUM	$80.08	$94.21	$4.76	67% above	15%
Potassium blood test CPT 84132 HC POTASSIUM; SERUM - POC	$85.68	$100.80	$4.76	78% above	15%
Potassium blood test inpatient CPT 84132 HC POTASSIUM; SERUM	$80.08	$94.21	$89.50	—	15%
Progesterone blood test CPT 84144 LABORATORY - CHEMISTRY	$196.01	$230.60	$20.86	47% above	15%
Progesterone blood test CPT 84144 HC PROGESTERONE	$202.44	$238.16	$20.86	52% above	15%
Prolactin blood test CPT 84146 LABORATORY - CHEMISTRY	$105.76	$124.43	$19.38	12% below	15%
Prolactin blood test CPT 84146 HC PROLACTIN	$109.68	$129.03	$19.38	9% below	15%
Prolactin blood test inpatient CPT 84146 HC PROLACTIN	$109.68	$129.03	$122.58	—	15%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME	$22.81	$26.84	$4.29	31% below	15%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME POCL/POCBS	$24.08	$28.33	$4.29	27% below	15%
Prothrombin time (PT/INR) clotting test CPT 85610 LABORATORY - HEMATOLOGY	$56.89	$66.93	$2.70	72% above	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME	$22.81	$26.84	$25.50	—	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME POCL/POCBS	$24.08	$28.33	$26.91	—	15%
Renin blood test CPT 84244 HC RENIN	$379.10	$446.00	$21.99	122% above	15%
Renin blood test CPT 84244 LABORATORY - CHEMISTRY	$379.10	$446.00	$21.99	122% above	15%
Renin blood test inpatient CPT 84244 HC RENIN	$379.10	$446.00	$423.70	—	15%
Rh blood typing CPT 86901 LABORATORY - IMMUNOLOGY	$56.21	$66.13	$62.82	1% above	15%
Rh blood typing CPT 86901 HC BLOOD TYPING; SEROLOGIC; RH D	$59.02	$69.44	$5.83	6% above	15%
Rh blood typing inpatient CPT 86901 HC BLOOD TYPING; SEROLOGIC; RH D	$59.02	$69.44	$65.97	—	15%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QUANT	$15.13	$17.80	$5.67	75% below	15%
Rheumatoid factor (RF) test CPT 86431 LABORATORY - IMMUNOLOGY	$29.22	$34.38	$14.55	51% below	15%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR QUANT	$15.13	$17.80	$16.91	—	15%
Rubella antibody test (immunity check) CPT 86762 LABORATORY - IMMUNOLOGY	$53.95	$63.47	$14.39	17% below	15%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA ANTIBODY	$55.27	$65.02	$14.39	15% below	15%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA ANTIBODY	$55.27	$65.02	$61.77	—	15%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC AUTOM ERYTHROCYTE SED RATE	$56.89	$66.93	$2.70	34% above	15%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 LABORATORY - HEMATOLOGY	$71.54	$84.16	$7.77	69% above	15%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC AUTOM ERYTHROCYTE SED RATE	$56.89	$66.93	$63.58	—	15%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 HC SEMEN ANALYSIS COMPLETE	$421.31	$495.66	$12.31	166% above	15%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 LABORATORY - GENERAL CLASSIFICATION	$421.31	$495.66	$466.56	166% above	15%
Sodium blood test CPT 84295 HC SODIUM; SERUM - POC	$11.42	$13.44	$4.81	75% below	15%
Sodium blood test CPT 84295 HC SODIUM; SERUM	$22.98	$27.03	$4.81	50% below	15%
Sodium blood test CPT 84295 LABORATORY - CHEMISTRY	$22.98	$27.03	$4.81	50% below	15%
Sodium blood test inpatient CPT 84295 HC SODIUM; SERUM	$22.98	$27.03	$25.68	—	15%
Stool ova and parasites exam CPT 87177 LABORATORY - BACTERIOLOGY AND MICROBIOLOGY	$33.46	$39.36	$8.90	52% below	15%
Stool ova and parasites exam CPT 87177 HC OVA AND PARASITE EXAM	$34.27	$40.32	$8.90	50% below	15%
Stool ova and parasites exam inpatient CPT 87177 HC OVA AND PARASITE EXAM	$34.27	$40.32	$38.30	—	15%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 LABORATORY - GENERAL CLASSIFICATION	$58.90	$69.30	$15.92	16% above	15%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC OCCULT BLD FHG QUAL 1-3	$60.88	$71.62	$15.92	20% above	15%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC OCCULT BLD FHG QUAL 1-3	$60.88	$71.62	$68.04	—	15%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC ANTIBODY TREPONEMA PALLIDUM	$28.34	$33.34	$13.24	58% below	15%
Syphilis antibody test (Treponema pallidum) CPT 86780 LABORATORY - IMMUNOLOGY	$28.34	$33.34	$13.24	58% below	15%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC TREPONEMA PALLIDUM AB BY TP-PA	$33.22	$39.08	$13.24	50% below	15%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC ANTIBODY TREPONEMA PALLIDUM	$28.34	$33.34	$31.67	—	15%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC TREPONEMA PALLIDUM AB BY TP-PA	$33.22	$39.08	$37.13	—	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 LABORATORY - IMMUNOLOGY	$52.43	$61.68	$4.27	4% above	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILLIS NON-TREPONEMAL	$53.86	$63.37	$4.27	6% above	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC RPR REFLEX TO TITER, FTA & TPPA	$54.70	$64.35	$4.27	8% above	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC VDRL SPINAL FLUID QUAL	$74.67	$87.85	$4.27	47% above	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILLIS NON-TREPONEMAL	$53.86	$63.37	$60.20	—	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC RPR REFLEX TO TITER, FTA & TPPA	$54.70	$64.35	$61.13	—	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC VDRL SPINAL FLUID QUAL	$74.67	$87.85	$83.46	—	15%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 LABORATORY - IMMUNOLOGY	$57.13	$67.21	$5.18	70% below	15%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB TEST, CELL IMMUN MEASURE RL	$82.98	$97.62	$61.98	56% below	15%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB TEST, CELL IMMUN MEASURE RL	$82.98	$97.62	$92.74	—	15%
Testosterone blood test, total (not free testosterone) CPT 84403 LABORATORY - CHEMISTRY	$50.22	$59.09	$25.81	62% below	15%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE TOTAL	$51.82	$60.97	$25.81	61% below	15%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE TOTAL	$51.82	$60.97	$57.92	—	15%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC THYROID PEROXIDASE ANTIBODY	$29.22	$34.38	$14.55	68% below	15%
Thyroid peroxidase (TPO) antibody test CPT 86376 LABORATORY - IMMUNOLOGY	$39.84	$46.87	$14.55	57% below	15%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC LIVER KIDNEY MICROSOMAL ANTIBO	$56.97	$67.02	$14.55	38% below	15%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC THYROID PEROXIDASE ANTIBODY	$29.22	$34.38	$32.66	—	15%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC LIVER KIDNEY MICROSOMAL ANTIBO	$56.97	$67.02	$63.67	—	15%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 LABORATORY - CHEMISTRY	$29.55	$34.76	$34.76	67% below	15%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORMONE	$87.74	$103.22	$16.80	3% below	15%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC THYROID STIMULATING HORMONE	$83.73	$98.51	$93.58	—	15%
Total IgE blood test CPT 82785 LABORATORY - CHEMISTRY	$39.33	$46.27	$16.46	54% below	15%
Total IgE blood test CPT 82785 HC IMMUNOGLOBULIN E	$40.89	$48.10	$16.46	52% below	15%
Total IgE blood test inpatient CPT 82785 HC IMMUNOGLOBULIN E	$40.89	$48.10	$45.70	—	15%
Total cholesterol blood test CPT 82465 HC CHOLESTEROL	$27.93	$32.86	$4.35	21% below	15%
Total thyroxine (T4) blood test CPT 84436 LABORATORY - CHEMISTRY	$48.19	$56.69	$6.87	15% below	15%
Total thyroxine (T4) blood test CPT 84436 HC THYROXINE TOTAL T4	$48.19	$56.69	$6.87	15% below	15%
Total triiodothyronine (T3) blood test CPT 84480 LABORATORY - CHEMISTRY	$59.11	$69.54	$14.18	34% below	15%
Total triiodothyronine (T3) blood test CPT 84480 HC TRIIODOTHYRONINE TOTAL	$61.25	$72.06	$14.18	32% below	15%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC TRIIODOTHYRONINE TOTAL	$61.25	$72.06	$68.46	—	15%
Transferrin blood test CPT 84466 LABORATORY - CHEMISTRY	$49.02	$57.67	$12.76	56% below	15%
Transferrin blood test CPT 84466 HC TRANSFERRIN LEVEL	$50.97	$59.96	$12.76	54% below	15%
Transferrin blood test inpatient CPT 84466 HC TRANSFERRIN LEVEL	$50.97	$59.96	$56.96	—	15%
Trichomonas test (NAAT) CPT 87661 HC TRICHOMONAS VAGINALIS AMPLIF	$75.31	$88.60	$35.09	29% below	15%
Triglycerides blood test CPT 84478 LABORATORY - CHEMISTRY	$23.70	$27.88	$5.74	44% below	15%
Triglycerides blood test CPT 84478 HC TRIGLYCERIDES	$24.88	$29.27	$5.74	41% below	15%
Triglycerides blood test inpatient CPT 84478 HC TRIGLYCERIDES	$24.88	$29.27	$27.81	—	15%
Troponin test, quantitative CPT 84484 HC TROPONIN QUANTITATIVE	$74.03	$87.09	$12.47	20% below	15%
Troponin test, quantitative CPT 84484 LABORATORY - CHEMISTRY	$83.56	$98.30	$16.80	9% below	15%
Troponin test, quantitative inpatient CPT 84484 HC TROPONIN QUANTITATIVE	$74.03	$87.09	$82.74	—	15%
Uric acid blood test CPT 84550 LABORATORY - CHEMISTRY	$27.19	$31.99	$4.52	34% below	15%
Uric acid blood test CPT 84550 HC URIC ACID BLOOD	$28.21	$33.19	$4.52	31% below	15%
Uric acid blood test inpatient CPT 84550 HC URIC ACID BLOOD	$28.21	$33.19	$31.53	—	15%
Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS W/MICROSCOPY	$55.28	$65.04	$3.17	26% above	15%
Urinalysis with microscope exam, automated CPT 81001 LABORATORY - UROLOGY	$55.65	$65.47	$3.17	27% above	15%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS W/MICROSCOPY	$55.28	$65.04	$61.79	—	15%
Urinalysis without microscope exam, automated CPT 81003 LABORATORY - UROLOGY	$29.55	$34.77	$2.25	9% above	15%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS W/O MICRO AUTOMATED	$29.65	$34.88	$2.25	9% above	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS W/O MICRO AUTOMATED	$29.65	$34.88	$33.14	—	15%
Urine culture for bacteria, with colony count CPT 87086 HC CULTURE URINE	$46.55	$54.76	$8.07	49% below	15%
Urine culture for bacteria, with colony count CPT 87086 LABORATORY - BACTERIOLOGY AND MICROBIOLOGY	$49.35	$58.05	$8.08	45% below	15%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC CULTURE URINE	$46.55	$54.76	$52.02	—	15%
Urine microalbumin (albumin) test CPT 82043 HC MICROALBUMIN, URINE, QUANT	$16.10	$18.94	$5.78	71% below	15%
Urine microalbumin (albumin) test CPT 82043 LABORATORY - CHEMISTRY	$40.09	$47.17	$9.71	27% below	15%
Urine microalbumin (albumin) test inpatient CPT 82043 HC MICROALBUMIN, URINE, QUANT	$16.10	$18.94	$17.99	—	15%
Urine pregnancy test, read by color change CPT 81025 LABORATORY - UROLOGY	$52.09	$61.29	$58.22	18% above	15%
Urine pregnancy test, read by color change CPT 81025 HC PREGNANCY TEST URINE POC	$53.19	$62.58	$8.61	21% above	15%
Urine pregnancy test, read by color change CPT 81025 HC PREGNANCY TEST URINE	$53.36	$62.78	$8.61	21% above	15%
Urine pregnancy test, read by color change inpatient CPT 81025 HC PREGNANCY TEST URINE POC	$53.19	$62.58	$59.45	—	15%
Urine pregnancy test, read by color change inpatient CPT 81025 HC PREGNANCY TEST URINE	$53.36	$62.78	$59.64	—	15%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN B-12	$34.24	$40.28	$15.08	63% below	15%
Vitamin B12 (cobalamin) blood test CPT 82607 LABORATORY - CHEMISTRY	$48.25	$56.76	$8.46	48% below	15%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC VITAMIN B-12	$34.24	$40.28	$38.27	—	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 LABORATORY - CHEMISTRY	$48.25	$56.76	$8.46	65% below	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC VITAMIN D 25 HYDROXY	$138.51	$162.95	$29.60	1% above	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC VITAMIN D 25 HYDROXY	$138.51	$162.95	$154.80	—	15%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 LABORATORY - CHEMISTRY	$27.59	$32.46	$5.16	88% below	15%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC VITAMIN D 1 25 INCLDNG FRACTN	$86.73	$102.03	$38.50	61% below	15%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC VITAMIN D 1 25 INCLDNG FRACTN	$86.73	$102.03	$96.93	—	15%
Zinc blood test CPT 84630 LABORATORY - CHEMISTRY	$22.51	$26.49	$11.39	76% below	15%
Zinc blood test CPT 84630 HC ZINC	$23.06	$27.13	$11.39	76% below	15%
Zinc blood test inpatient CPT 84630 HC ZINC	$23.06	$27.13	$25.77	—	15%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 LABORATORY - CHEMISTRY	$107.14	$126.04	$65.60	7% below	15%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC HUMAN CHORIONIC GONADOTROPIN QUANT	$111.56	$131.25	$15.05	3% below	15%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC HUMAN CHORIONIC GONADOTROPIN QUANT	$111.56	$131.25	$124.69	—	15%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$13,507.00	$15,890.59	$15,876.91	111% above	15%
Botox injections for chronic migraine CPT 64615 HC CHEMODENERV MUSC MIGRAINE	$239.46	$281.72	$295.19	at median	15%
Botox injections for chronic migraine CPT 64615 PBB CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$239.46	$281.72	$295.19	at median	15%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC BX BREAST 1ST LESION STEREO	$1,191.95	$1,402.29	$183.66	45% below	15%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY	$1,254.68	$1,476.09	$1,735.28	42% below	15%
Cardiac catheterization with coronary angiogram CPT 93458 CARDIOLOGY - CARDIAC CATH LAB	$12,662.82	$14,897.44	$8,022.54	5% above	15%
Cardiac catheterization with coronary angiogram one side CPT 93458 HC LT HEART/CORONARY LVGRAM	$13,129.03	$15,445.92	$1,158.71	9% above	15%
Cardiac catheterization with coronary angiogram inpatient one side CPT 93458 HC LT HEART/CORONARY LVGRAM	$13,129.03	$15,445.92	$14,673.62	—	15%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOLOGY - GENERAL CLASSIFICATION	$1,116.23	$1,313.21	$700.84	29% above	15%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTRIC EXTERNAL	$1,223.41	$1,439.30	$118.88	41% above	15%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION ELECTRIC EXTERNAL	$1,223.41	$1,439.30	$1,367.34	—	15%
Carpal tunnel release, open surgery CPT 64721 HC NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE	$1,320.54	$1,553.58	$1,952.77	19% below	15%
Carpal tunnel release, open surgery CPT 64721 PBB NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE	$1,320.54	$1,553.58	$1,952.77	19% below	15%
Carpal tunnel release, open surgery CPT 64721 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$2,835.09	$3,335.40	$2,091.42	74% above	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC CIRCUMCISION	$236.95	$278.76	$2,048.51	13% above	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC CIRCUMCISION	$236.95	$278.76	$264.82	—	15%
Colonoscopy with polyp removal CPT 45385 GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION	$2,990.59	$3,518.35	$1,254.82	41% above	15%
Colonoscopy with tissue sample CPT 45380 GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION	$3,147.44	$3,702.87	$631.40	64% above	15%
Colonoscopy, diagnostic CPT 45378 GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION	$2,310.31	$2,718.01	$2,446.21	29% above	15%
Colonoscopy, diagnostic inpatient CPT 45378 GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION	$2,474.29	$2,910.93	$701.39	—	15%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 PBB COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE	$236.15	$277.82	$304.19	32% below	15%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC COLPOSCOPY W/BX AND ECC	$261.00	$307.06	$304.19	25% below	15%
Coronary stent placement, one artery CPT 92928 HC PERQ TCAT PLMT NTRAC ST 1 LES 1+C SEGMENTS - LD	$5,202.77	$6,120.90	$11,340.57	at median	15%
Coronary stent placement, one artery CPT 92928 HC PERQ TCAT PLMT NTRAC ST 1 LES 1+C SEGMENTS - LC	$5,202.77	$6,120.90	$11,340.57	at median	15%
Coronary stent placement, one artery CPT 92928 HC PERQ TCAT PLMT NTRAC ST 1 LES 1+C SEGMENTS - RC	$5,202.77	$6,120.90	$11,340.57	at median	15%
Coronary stent placement, one artery CPT 92928 HC PERQ TCAT PLMT NTRAC ST 1 LES 1+C SEGMENTS	$6,335.02	$7,452.96	$11,340.57	22% above	15%
Coronary stent placement, one artery CPT 92928 CARDIOLOGY - CARDIAC CATH LAB	$12,622.49	$14,849.99	$12,145.75	143% above	15%
Coronary stent placement, one artery CPT 92928 HC PERQ TCAT PLMT NTRAC ST 1 LES 1+C SEGMENTS - LM	$14,181.37	$16,683.96	$11,340.57	173% above	15%
Coronary stent placement, one artery CPT 92928 HC PERQ TCAT PLMT NTRAC ST 1 LES 1+C SEGMENTS - RI	$14,181.37	$16,683.96	$11,340.57	173% above	15%
Cystoscopy with ureteral stent placement CPT 52332 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$3,091.09	$3,636.58	$3,765.99	402% above	15%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 PBB CYSTOURETHROSCOPY	$660.21	$776.72	$667.47	48% above	15%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC CYSTOURETHROSCOPY	$663.65	$780.76	$667.47	49% above	15%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 PBB CYSTOURETHROSCOPY	$660.21	$776.72	$737.88	—	15%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$2,923.27	$3,439.14	$3,237.26	106% above	15%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 PBB TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA	$445.96	$524.66	$509.25	2% above	15%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 HC TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA	$445.96	$524.66	$509.25	2% above	15%
Earwax removal by irrigation (rinsing), one ear both sides CPT 69209 HC REMOVAL IMPACTED CERUMEN IRRIGATION/LAVAGE BILATERAL	$62.24	$73.22	$23.45	—	15%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC REMOVAL IMPACTED CERUMEN IRRIGATION/LAVAGE UNILATERAL	$10.17	$11.96	$23.45	77% below	15%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 PBB PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT	$12.31	$14.48	$59.40	72% below	15%
Earwax removal with instruments, one ear one side CPT 69210 HC REMOVAL IMPACTED CERUMEN REQ INSTR; UNILATERAL	$175.11	$206.01	$36.58	105% above	15%
Earwax removal with instruments, one ear one side CPT 69210 PBB REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT	$175.11	$206.01	$59.40	105% above	15%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC ENDOMETRIAL BIOPSY W/ECC	$143.53	$168.86	$201.17	42% below	15%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 PBB ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX	$158.64	$186.64	$201.17	35% below	15%
Endoscopic sinus surgery: opening the frontal sinus CPT 31276 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$8,101.16	$9,530.78	$7,413.97	461% above	15%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 OPERATING ROOM SERVICES - MINOR SURGERY	$1,184.72	$1,393.79	$741.69	2% above	15%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC NJX INTERLAMINAR CRV/THRC	$1,610.19	$1,894.34	$117.74	38% above	15%
Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV BILATERAL	$1,891.87	$2,225.73	$98.31	—	15%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 OPERATING ROOM SERVICES - MINOR SURGERY	$5,613.60	$6,604.24	$953.50	402% above	15%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$8,829.61	$10,387.78	$6,118.70	901% above	15%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$28,142.45	$33,108.77	$14,996.71	187% above	15%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION	$1,633.88	$1,922.21	$997.00	50% above	15%
Gallbladder removal, laparoscopic CPT 47562 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$6,205.19	$7,300.22	$6,296.31	232% above	15%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$7,641.92	$8,990.50	$6,248.60	288% above	15%
Hemorrhoid banding (rubber band ligation) CPT 46221 PBB HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS	$712.16	$837.83	$754.05	8% above	15%
Hemorrhoid banding (rubber band ligation) CPT 46221 HC LIGATION OF HEMORRHOID(S)	$779.98	$917.62	$825.86	18% above	15%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC HYSTEROSALPINGOGRAM INJECTION	$395.47	$465.26	$123.24	34% above	15%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$395.47	$465.26	$437.95	34% above	15%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$3,364.16	$3,957.84	$3,405.28	32% above	15%
IUD insertion (the device itself billed separately) CPT 58300 PBB INSERTION INTRAUTERINE DEVICE IUD	$123.37	$145.14	$130.63	57% below	15%
Incision and drainage of a simple or single skin abscess CPT 10060 PBB INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE	$330.15	$388.41	$198.70	50% above	15%
Incision and drainage of a simple or single skin abscess CPT 10060 EMERGENCY ROOM - GENERAL CLASSIFICATION	$347.52	$408.85	$212.81	58% above	15%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I&D ABSCESS SIMPLE OR SINGLE	$399.65	$470.18	$109.36	82% above	15%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I&D ABSCESS SIMPLE OR SINGLE	$399.65	$470.18	$446.67	—	15%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$8,101.17	$9,530.79	$3,620.11	195% above	15%
Injection into a tendon sheath or ligament (for example trigger finger) both sides CPT 20550 HC COM CON INJ TENDON/LIGAMENT/CYST BILAT	$857.04	$1,008.28	$43.06	—	15%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJ SGL TENDON SHTH OR LIGAMENT	$276.07	$324.79	$43.06	90% above	15%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 PBB INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS	$334.19	$393.16	$295.19	130% above	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound both sides CPT 20610 HC MAJOR JOINT ASPRTN/INJ BILATERAL W/O US GUIDE	$387.35	$455.71	$99.12	—	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 PBB ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	$275.85	$324.53	$295.19	at median	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 CLINIC - GENERAL CLASSIFICATION	$407.74	$479.69	$434.19	48% above	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC MAJOR JOINT ASPRTN/INJ UNILATERAL W/O US GUIDE	$275.85	$324.53	$99.12	at median	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 HC MAJOR JOINT ASPRTN/INJ UNILATERAL W/O US GUIDE	$275.85	$324.53	$308.30	—	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) both sides CPT 20605 HC MEDIUM JOINT ASPIRTN/INJECT BILATERAL W/O US GUIDE	$239.60	$281.88	$295.19	—	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 PBB ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US	$197.92	$232.85	$295.19	3% below	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 HC MEDIUM JOINT ASPIRTN/INJECT UNILATERAL W/O US GUIDE	$219.18	$257.86	$80.92	7% above	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient both sides CPT 20605 HC MEDIUM JOINT ASPIRTN/INJECT BILATERAL W/O US GUIDE	$239.60	$281.88	$267.79	—	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 HC MEDIUM JOINT ASPIRTN/INJECT UNILATERAL W/O US GUIDE	$219.18	$257.86	$244.97	—	15%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 PBB ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US	$193.66	$227.83	$295.19	13% above	15%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM	$261.24	$307.34	$222.29	52% above	15%
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 HC SMALL JOINT ASPRNT/INJECT UNILATERAL W/O US GUIDE	$234.42	$275.79	$78.00	36% above	15%
Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 HC SMALL JOINT ASPRNT/INJECT UNILATERAL W/O US GUIDE	$234.42	$275.79	$262.00	—	15%
Knee arthroscopy with meniscus trim CPT 29881 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$4,612.30	$5,426.23	$4,982.95	70% above	15%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$6,185.89	$7,277.52	$6,549.77	68% above	15%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$4,395.04	$5,170.64	$4,653.57	219% above	15%
Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$11,053.28	$13,003.86	$3,282.01	415% above	15%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$5,992.51	$7,050.01	$6,697.51	121% above	15%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$9,097.99	$10,703.52	$5,747.44	834% above	15%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$9,360.34	$11,012.16	$10,241.30	519% above	15%
Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ DX/THER INTRALAMINAR LUMBAR/SACRAL W/IMAGING	$1,661.44	$1,954.63	$108.97	171% above	15%
Lower-back epidural injection, with imaging guidance CPT 62323 OPERATING ROOM SERVICES - MINOR SURGERY	$1,714.85	$2,017.47	$741.69	180% above	15%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ DX/THER INTRALAMINAR LUMBAR/SACRAL W/IMAGING	$1,661.44	$1,954.63	$1,856.90	—	15%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 PBB NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL	$1,099.56	$1,293.60	$890.29	5% above	15%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ ANES/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL	$1,114.52	$1,311.20	$122.31	6% above	15%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 OPERATING ROOM SERVICES - MINOR SURGERY	$1,578.86	$1,857.49	$953.50	50% above	15%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$12,975.68	$15,265.50	$7,650.93	224% above	15%
Lumbar laminectomy (spinal decompression), one level CPT 63047 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$10,363.18	$12,191.98	$7,650.93	142% above	15%
Lumbar spinal fusion (posterior), one level CPT 22612 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$25,545.53	$30,053.56	$28,550.89	424% above	15%
Lumpectomy (partial mastectomy) CPT 19301 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$3,385.44	$3,982.87	$4,101.16	104% above	15%
Mastectomy (total removal of the breast) CPT 19303 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$6,452.58	$7,591.27	$6,525.28	148% above	15%
Miscarriage treatment with D&C, first trimester CPT 59820 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$4,535.62	$5,336.02	$4,962.50	63% above	15%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC EXC FACE MM B9+MARG0.5<CM	$509.53	$599.45	$703.59	73% above	15%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 PBB EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<	$521.54	$613.58	$703.59	77% above	15%
Nail removal (partial or complete), one nail CPT 11730 PBB AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1	$154.69	$181.99	$198.70	18% below	15%
Nail removal (partial or complete), one nail CPT 11730 HC AVLSION NAIL PLATE PARTL/COMPL SGL	$170.98	$201.15	$198.70	10% below	15%
Occipital nerve block (injection for headaches) CPT 64405 PBB INJECTION AA&/STRD GREATER OCCIPITAL NERVE	$243.91	$286.95	$295.19	17% below	15%
Occipital nerve block (injection for headaches) one side CPT 64405 HC INJECTION, GREATER OCCIPITAL NERVE UNILATERAL	$437.89	$515.16	$59.06	49% above	15%
Occipital nerve block (injection for headaches) inpatient CPT 64405 PBB INJECTION AA&/STRD GREATER OCCIPITAL NERVE	$243.91	$286.95	$272.60	—	15%
Paracentesis with imaging guidance CPT 49083 SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM	$841.64	$990.17	$993.08	4% above	15%
Paracentesis with imaging guidance CPT 49083 HC PARACENTESIS WITH IMAGING	$841.64	$990.17	$118.50	4% above	15%
Paracentesis with imaging guidance inpatient CPT 49083 HC PARACENTESIS WITH IMAGING	$841.64	$990.17	$940.66	—	15%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 PBB EXCISION NAIL MATRIX PERMANENT REMOVAL	$370.39	$435.75	$399.53	1% below	15%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC REMOVAL NAILBED PARTL/COMPLETE	$785.70	$924.35	$110.88	110% above	15%
Prostate biopsy CPT 55700 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$2,835.09	$3,335.40	$2,193.95	326% above	15%
Radiofrequency ablation of facet joint nerves, lower back, one level both sides CPT 64635 HC CT FACET RHIZOTOMY L OR SACRAL SPINE BILATERAL SINGLE LEVEL	$2,931.09	$3,448.34	$242.72	—	15%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM	$2,733.49	$3,215.87	$2,091.42	94% above	15%
Radiofrequency ablation of facet joint nerves, lower back, one level one side CPT 64635 HC CT FACET RHIZOTOMY L OR SACRAL SPINE UNILATERAL SINGLE LEVEL	$1,766.95	$2,078.77	$242.72	25% above	15%
Removal of a breast lump, open surgery CPT 19120 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$3,692.15	$4,343.71	$3,909.34	230% above	15%
Removal of a foreign object under the skin, simple CPT 10120 HC INC & REM FB, SQ; SMPL	$311.13	$366.03	$112.02	at median	15%
Removal of a foreign object under the skin, simple CPT 10120 SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM	$327.50	$385.29	$427.90	5% above	15%
Removal of a foreign object under the skin, simple CPT 10120 PBB INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE	$343.87	$404.55	$399.53	11% above	15%
Removal of one lobe of the thyroid (lobectomy) CPT 60220 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$11,206.65	$13,184.29	$12,410.37	444% above	15%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION	$2,622.75	$3,085.59	$967.18	37% above	15%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION	$2,503.19	$2,944.93	$825.17	87% above	15%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 EXTRA-CORPOREAL SHOCK WAVE THERAPY (FORMERLY LITHOTRIPSY) - GENERAL CLASSIFICATION	$14,686.78	$17,278.56	$4,907.31	592% above	15%
Short arm cast (elbow to hand) CPT 29075 PBB APPLICATION CAST ELBOW FINGER SHORT ARM	$262.79	$309.17	$265.58	23% above	15%
Short arm cast (elbow to hand) CPT 29075 HC APPLY FOREARM CAST	$262.79	$309.17	$265.58	23% above	15%
Short arm splint (forearm and hand) CPT 29125 PBB APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC	$269.18	$316.68	$128.90	69% above	15%
Short arm splint (forearm and hand) CPT 29125 HC APPLY FOREARM SPLINT STATIC	$276.27	$325.02	$43.06	74% above	15%
Short arm splint (forearm and hand) CPT 29125 EMERGENCY ROOM - GENERAL CLASSIFICATION	$276.27	$325.02	$308.77	74% above	15%
Short arm splint (forearm and hand) CPT 29125 OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION	$283.35	$333.35	$138.05	78% above	15%
Short arm splint (forearm and hand) inpatient CPT 29125 HC APPLY FOREARM SPLINT STATIC	$276.27	$325.02	$308.77	—	15%
Short leg cast (below the knee) CPT 29405 PBB APPLICATION SHORT LEG CAST BELOW KNEE-TOE	$215.22	$253.20	$265.58	4% below	15%
Short leg cast (below the knee) CPT 29405 HC APPLY CAST BELOW KNEE TO TOES (SHORT LEG)	$230.28	$270.92	$265.58	3% above	15%
Short leg splint (calf to foot) CPT 29515 EMERGENCY ROOM - GENERAL CLASSIFICATION	$395.89	$465.75	$168.99	107% above	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 PBB SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<	$240.41	$282.83	$198.70	3% below	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC REPAIR SIMPLE S/N/A/G/TR/E TO 2.5CM	$431.12	$507.20	$49.54	74% above	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 EMERGENCY ROOM - GENERAL CLASSIFICATION	$1,502.70	$1,767.88	$656.63	507% above	15%
Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BX SKIN; SINGLE LESION	$333.17	$391.97	$399.53	4% above	15%
Skin biopsy, punch, one lesion CPT 11104 PBB PUNCH BIOPSY SKIN SINGLE LESION	$333.17	$391.97	$399.53	4% above	15%
Skin tag removal, up to 15 tags CPT 11200 PBB REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15	$196.83	$231.57	$198.70	7% above	15%
Skin tag removal, up to 15 tags CPT 11200 HC SKIN TAG REMOVAL UP TO 15 LESIONS	$196.83	$231.57	$198.70	7% above	15%
Spinal tap (lumbar puncture), diagnostic CPT 62270 RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION	$782.84	$920.99	$741.69	80% above	15%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC LUMBAR PUNCTURE DIAGNOSTIC	$804.80	$946.82	$68.20	85% above	15%
Spinal tap (lumbar puncture), diagnostic CPT 62270 PBB DIAGNOSTIC LUMBAR SPINAL PUNCTURE	$821.98	$967.04	$692.52	89% above	15%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC LUMBAR PUNCTURE DIAGNOSTIC	$804.80	$946.82	$899.48	—	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 PBB SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM	$250.95	$295.24	$198.70	10% below	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC REPAIR SIMP 2.6-7.5CM (SUPERFICIAL) S/N/A/G/TR/E	$277.37	$326.32	$198.70	at median	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 EMERGENCY ROOM - GENERAL CLASSIFICATION	$550.72	$647.90	$609.88	99% above	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 EMERGENCY ROOM - GENERAL CLASSIFICATION	$550.72	$647.90	$602.55	57% above	15%
TURP (transurethral resection of the prostate) CPT 52601 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$6,299.22	$7,410.85	$5,444.56	62% above	15%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 PBB TANGENTIAL BIOPSY SKIN SINGLE LESION	$328.05	$385.94	$198.70	41% above	15%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGENTIAL BX SKIN; SINGLE LESION	$351.02	$412.96	$42.67	51% above	15%
Thoracentesis with imaging guidance both sides CPT 32555 HC THORACENTESIS/ASPIRATION WITH IMAGING BILATERAL	$1,009.69	$1,187.87	$618.26	—	15%
Thoracentesis with imaging guidance CPT 32555 OPERATING ROOM SERVICES - MINOR SURGERY	$864.31	$1,016.84	$662.16	7% below	15%
Thoracentesis with imaging guidance one side CPT 32555 HC THORACENTESIS/ASPIRATION WITH IMAGING UNILATERAL	$951.92	$1,119.90	$122.69	3% above	15%
Thoracentesis with imaging guidance inpatient one side CPT 32555 HC THORACENTESIS/ASPIRATION WITH IMAGING UNILATERAL	$951.92	$1,119.90	$1,063.91	—	15%
Total hip replacement CPT 27130 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$9,878.64	$11,621.93	$10,459.74	53% above	15%
Total knee replacement CPT 27447 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$9,136.33	$10,748.62	$10,211.19	at median	15%
Total shoulder replacement CPT 23472 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$9,749.76	$11,470.30	$20,010.00	5% above	15%
Trigger finger release surgery CPT 26055 HC INCISE FINGER TENDON SHEATH	$1,048.04	$1,232.99	$1,600.41	49% above	15%
Trigger finger release surgery CPT 26055 PBB TENDON SHEATH INCISION	$1,048.04	$1,232.99	$1,600.41	49% above	15%
Trigger finger release surgery CPT 26055 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$2,835.09	$3,335.40	$1,714.04	302% above	15%
Trigger point injections, 1 or 2 muscles CPT 20552 PBB INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES	$190.20	$223.77	$295.19	4% above	15%
Trigger point injections, 1 or 2 muscles CPT 20552 HC INJECT TRIGGER POINT(S), 1 - 2 MUSCLE	$211.38	$248.68	$42.30	16% above	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST 1ST LESION US GUIDE	$1,242.15	$1,461.35	$173.75	21% below	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 OTHER IMAGING SERVICES - ULTRASOUND	$1,249.53	$1,470.03	$1,735.28	20% below	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC BX BREAST 1ST LESION US GUIDE	$1,242.15	$1,461.35	$1,388.28	—	15%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION	$1,308.82	$1,539.78	$1,385.80	2% below	15%
Upper endoscopy (EGD) with biopsy CPT 43239 GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION	$2,417.35	$2,843.95	$751.85	56% above	15%
Upper endoscopy (EGD) with injection into the lining CPT 43236 GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION	$2,274.50	$2,675.88	$2,154.00	234% above	15%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION	$2,615.67	$3,077.26	$2,031.68	43% above	15%
Upper endoscopy (EGD), diagnostic CPT 43235 GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION	$1,945.86	$2,289.24	$903.72	85% above	15%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$4,228.89	$4,975.17	$3,521.31	24% above	15%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$2,229.47	$2,622.90	$2,123.49	48% below	15%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$2,465.30	$2,900.35	$2,730.10	51% above	15%
Vein ablation, radiofrequency, first vein CPT 36475 PBB ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN	$2,311.40	$2,719.29	$3,147.50	19% below	15%
Vein ablation, radiofrequency, first vein one side CPT 36475 HC ENDOVENOUS RF 1ST VEIN UNILATERAL	$2,473.19	$2,909.64	$3,147.50	13% below	15%
Wart removal, up to 14 warts CPT 17110 PBB DESTRUCTION BENIGN LESIONS UP TO 14	$195.46	$229.95	$198.70	3% above	15%
Wart removal, up to 14 warts CPT 17110 HC DESTRUCT BENIGN LESION 1-14	$195.46	$229.95	$198.70	3% above	15%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEB SUBQ TISSUE 20 SQ CM/<	$799.65	$940.77	$66.68	200% above	15%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 OPERATING ROOM SERVICES - MINOR SURGERY	$799.65	$940.77	$430.00	200% above	15%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 PBB DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<	$808.47	$951.14	$399.53	203% above	15%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEB SUBQ TISSUE 20 SQ CM/<	$799.65	$940.77	$893.73	—	15%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 OPERATING ROOM SERVICES - GENERAL CLASSIFICATION	$7,602.76	$8,944.42	$7,650.93	21% above	15%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC ADMIN BLOOD TRANSFUSION DAILY	$975.75	$1,147.94	$58.03	29% above	15%
Blood transfusion (giving blood or blood components) CPT 36430 ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - ADMINISTRATION (E.G., TRANS	$975.75	$1,147.94	$468.22	29% above	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC ADMIN BLOOD TRANSFUSION DAILY	$975.75	$1,147.94	$1,090.54	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RESPIRATORY SERVICES - GENERAL CLASSIFICATION	$430.87	$506.90	$261.28	292% above	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AIRWAY INHALATION TREATMENT	$432.21	$508.48	$19.05	294% above	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC AIRWAY INHALATION TREATMENT	$432.21	$508.48	$483.06	—	15%
Chemotherapy IV infusion, first hour CPT 96413 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV	$475.14	$558.99	$365.66	6% below	15%
Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO INFUSION INITIAL 1ST HR	$481.38	$566.33	$150.51	4% below	15%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO INFUSION INITIAL 1ST HR	$481.38	$566.33	$538.01	—	15%
Critical care, first 30 to 74 minutes CPT 99291 HC ER CRITICAL CARE W/MOD	$2,649.36	$3,116.89	$239.28	43% above	15%
Critical care, first 30 to 74 minutes CPT 99291 EMERGENCY ROOM - GENERAL CLASSIFICATION	$2,677.45	$3,149.95	$894.94	45% above	15%
Critical care, first 30 to 74 minutes CPT 99291 HC ER CRITICAL CARE	$2,837.39	$3,338.10	$239.28	53% above	15%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC ER CRITICAL CARE W/MOD	$2,649.36	$3,116.89	$2,961.05	—	15%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC ER CRITICAL CARE	$2,837.39	$3,338.10	$3,171.20	—	15%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION	$1,137.54	$1,338.28	$329.49	43% above	15%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEG AWAKE/DROWSY	$1,308.17	$1,539.02	$311.40	64% above	15%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC EEG AWAKE/DROWSY	$1,308.17	$1,539.02	$1,462.07	—	15%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG/ECG (ELECTROCARDIOGRAM) - GENERAL CLASSIFICATION	$101.24	$119.11	$52.36	83% above	15%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 HC COM CON EKG W/READ	$116.43	$136.98	$14.30	111% above	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG/ECG (ELECTROCARDIOGRAM) - GENERAL CLASSIFICATION	$114.78	$135.04	$61.60	26% below	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC COM CON EKG W/READ	$116.43	$136.98	$26.18	25% below	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC EKG 12 LEAD;TRACING ONLY W/O INTERP	$124.54	$146.52	$26.18	19% below	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC COM CON EKG W/READ	$116.43	$136.98	$130.13	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC EKG 12 LEAD;TRACING ONLY W/O INTERP	$124.54	$146.52	$139.19	—	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENCY ROOM - GENERAL CLASSIFICATION	$255.71	$300.83	$94.30	22% above	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC EMERGENCY ROOM - LEVEL 1 W/MOD	$294.06	$345.95	$24.39	41% above	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC EMERGENCY ROOM-LEVEL 1	$294.06	$345.95	$24.39	41% above	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC EMERGENCY ROOM - LEVEL 1 W/MOD	$294.06	$345.95	$328.65	—	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC EMERGENCY ROOM-LEVEL 1	$294.06	$345.95	$328.65	—	15%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY ROOM - GENERAL CLASSIFICATION	$417.52	$491.20	$165.39	18% above	15%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC EMERGENCY ROOM-LEVEL 2	$466.16	$548.42	$46.87	32% above	15%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC EMERGENCY ROOM - LEVEL 2 W/MOD	$466.16	$548.42	$46.87	32% above	15%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC EMERGENCY ROOM-LEVEL 2	$466.16	$548.42	$521.00	—	15%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC EMERGENCY ROOM - LEVEL 2 W/MOD	$466.16	$548.42	$521.00	—	15%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY ROOM - GENERAL CLASSIFICATION	$592.98	$697.62	$296.55	11% above	15%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC EMERGENCY ROOM-LEVEL 3	$681.92	$802.26	$70.11	28% above	15%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC EMERGENCY ROOM - LEVEL 3 W/MOD	$681.92	$802.26	$70.11	28% above	15%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC EMERGENCY ROOM - LEVEL 3 W/MOD	$681.92	$802.26	$762.15	—	15%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC EMERGENCY ROOM-LEVEL 3	$681.92	$802.26	$762.15	—	15%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC EMERGENCY ROOM-LEVEL 4	$1,035.68	$1,218.45	$128.79	22% above	15%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC EMERGENCY ROOM - LEVEL 4 W/MOD	$1,035.68	$1,218.45	$128.79	22% above	15%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY ROOM - GENERAL CLASSIFICATION	$1,801.18	$2,119.04	$456.05	112% above	15%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC EMERGENCY ROOM - LEVEL 4 W/MOD	$1,035.68	$1,218.45	$1,157.53	—	15%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC EMERGENCY ROOM-LEVEL 4	$1,035.68	$1,218.45	$1,157.53	—	15%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY ROOM - GENERAL CLASSIFICATION	$1,184.76	$1,393.84	$587.03	8% below	15%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC EMERGENCY ROOM-LEVEL 5	$1,445.23	$1,700.27	$187.08	13% above	15%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC EMERGENCY ROOM - LEVEL 5 W/MOD	$1,502.70	$1,767.88	$187.08	17% above	15%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC EMERGENCY ROOM-LEVEL 5	$1,445.23	$1,700.27	$1,615.26	—	15%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC EMERGENCY ROOM - LEVEL 5 W/MOD	$1,502.70	$1,767.88	$1,679.49	—	15%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOLOGY - STRESS TEST	$672.83	$791.57	$333.51	16% above	15%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC CARDIOVASCULAR STRESS TEST	$672.83	$791.57	$102.65	16% above	15%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC CARDIOVASCULAR STRESS TEST	$672.83	$791.57	$751.99	—	15%
Family therapy with the patient, 50 minutes CPT 90847 HC FAMILY PSYTX W/PT 50 MIN	$123.33	$145.09	$160.67	23% below	15%
Family therapy with the patient, 50 minutes CPT 90847 BEHAVIORAL HEALTH TREATMENTS/SERVICES - FAMILY THERAPY	$129.82	$152.73	$172.08	19% below	15%
Family therapy with the patient, 50 minutes CPT 90847 PBB FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS	$136.31	$160.37	$160.67	15% below	15%
Family therapy without the patient, 50 minutes CPT 90846 HC FAMILY PSYTX W/O PT 50 MIN	$149.29	$175.64	$108.60	5% below	15%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC FAMILY PSYTX W/O PT 50 MIN	$149.29	$175.64	$166.86	—	15%
Group psychotherapy session CPT 90853 HC GROUP THERAPY	$67.86	$79.84	$92.50	3% below	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV/INJECTION THERAPY	$337.88	$397.51	$226.11	33% above	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV INFUSN HYDRATION INITIAL HR	$363.41	$427.54	$36.58	43% above	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV INFUSN HYDRATION INITIAL HR	$363.41	$427.54	$384.79	—	15%
IV infusion of a medicine, first hour CPT 96365 IV/INJECTION THERAPY	$95.69	$112.58	$76.22	72% below	15%
IV infusion of a medicine, first hour CPT 96365 HC IV INFUSION THERAP INITIAL HR	$372.55	$438.29	$76.21	8% above	15%
IV infusion of a medicine, first hour inpatient CPT 96365 HC IV INFUSION THERAP INITIAL HR	$372.55	$438.29	$394.46	—	15%
IV push of a medicine, first drug CPT 96374 PBB IVP INITIAL THERAPEUTIC	$161.95	$190.53	$210.69	1% above	15%
IV push of a medicine, first drug CPT 96374 IV/INJECTION THERAPY	$253.54	$298.28	$225.65	59% above	15%
IV push of a medicine, first drug CPT 96374 HC IVP INITIAL THERAPEUTIC	$253.54	$298.28	$42.30	59% above	15%
IV push of a medicine, first drug inpatient CPT 96374 HC IVP INITIAL THERAPEUTIC	$253.54	$298.28	$268.45	—	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM	$76.94	$90.52	$85.99	2% below	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IV/INJECTION THERAPY	$76.94	$90.52	$73.36	2% below	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJECTION IM/SC THERAPEUTIC	$83.53	$98.27	$15.24	6% above	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJECTION IM/SC THERAPEUTIC	$83.53	$98.27	$88.44	—	15%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PSYCH DIAGNOSTIC EVALUATION	$110.36	$129.83	$160.67	50% below	15%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PBB PSYCHIATRIC DIAGNOSTIC EVALUATION	$110.36	$129.83	$160.67	50% below	15%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 PBB NERVE CONDUCTION STUDIES 7-8 STUDIES	$187.63	$220.74	$311.40	26% below	15%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC NERVE CONDUCTION STUDIES 7-8 STUDIES	$190.11	$223.66	$311.40	25% below	15%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC NRV CNDJ TEST 7-8 STUDIES	$207.38	$243.98	$311.40	18% below	15%
Neuromuscular re-education, 15 minutes CPT 97112 OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION	$68.52	$80.62	$25.32	22% below	15%
Neuromuscular re-education, 15 minutes CPT 97112 HC OT NEUROMUS RE-ED PER 15 MIN	$68.58	$80.68	$38.10	22% below	15%
Neuromuscular re-education, 15 minutes CPT 97112 HC PT NEUROMUS RE-ED PER 15 MIN	$71.26	$83.83	$38.10	19% below	15%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC OT NEUROMUS RE-ED PER 15 MIN	$68.58	$80.68	$76.65	—	15%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC PT NEUROMUS RE-ED PER 15 MIN	$71.26	$83.83	$79.64	—	15%
New patient office visit, about 30 minutes CPT 99203 HC OFFICE/OUTPATIENT VISIT NEW LEVEL 3	$136.00	$160.00	$144.00	18% below	15%
New patient office visit, about 30 minutes CPT 99203 HC OFFICE/OUTPATIENT VISIT NEW LEVEL 3	$136.00	$160.00	$81.10	18% below	15%
New patient office visit, about 30 minutes inpatient CPT 99203 HC OFFICE/OUTPATIENT VISIT NEW LEVEL 3	$136.00	$160.00	$152.00	—	15%
New patient office visit, about 45 minutes CPT 99204 HC OFFICE/OUTPATIENT VISIT NEW LEVEL 4	$194.07	$228.32	$131.98	18% below	15%
New patient office visit, about 45 minutes CPT 99204 HC OFFICE/OUTPATIENT VISIT NEW LEVEL 4	$194.07	$228.32	$205.49	18% below	15%
New patient office visit, about 45 minutes CPT 99204 CLINIC - GENERAL CLASSIFICATION	$199.18	$234.33	$220.58	16% below	15%
New patient office visit, about 45 minutes inpatient CPT 99204 HC OFFICE/OUTPATIENT VISIT NEW LEVEL 4	$194.07	$228.32	$216.90	—	15%
New patient office visit, about 60 minutes CPT 99205 HC OFFICE/OUTPATIENT VISIT NEW LEVEL 5	$136.00	$160.00	$144.00	59% below	15%
New patient office visit, about 60 minutes CPT 99205 HC OFFICE/OUTPATIENT VISIT NEW LEVEL 5	$136.00	$160.00	$179.51	59% below	15%
New patient office visit, about 60 minutes inpatient CPT 99205 HC OFFICE/OUTPATIENT VISIT NEW LEVEL 5	$136.00	$160.00	$152.00	—	15%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC OFFICE/OUTPATIENT VISIT NEW LEVEL 2	$136.00	$160.00	$46.88	5% below	15%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC OFFICE/OUTPATIENT VISIT NEW LEVEL 2	$136.00	$160.00	$144.00	5% below	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING	$49.81	$58.60	$30.70	10% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MED NUTRITION INDIV 1ST EA 15MIN	$54.03	$63.57	$31.62	19% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MED NUTRITION INDIV 1ST EA 15MIN	$54.03	$63.57	$60.39	—	15%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEXITY	$283.29	$333.28	$98.31	66% above	15%
Occupational therapy evaluation, low complexity CPT 97165 OCCUPATIONAL THERAPY - EVALUATION OR REEVALUATION	$284.32	$334.49	$99.55	66% above	15%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEXITY	$283.29	$333.28	$316.62	—	15%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEXITY	$228.23	$268.51	$92.59	14% above	15%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION	$230.21	$270.84	$257.30	15% above	15%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEXITY	$228.23	$268.51	$255.08	—	15%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION	$230.21	$270.84	$34.60	—	15%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEXITY	$248.27	$292.08	$92.59	46% above	15%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION	$248.55	$292.42	$275.76	46% above	15%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEXITY	$248.27	$292.08	$277.48	—	15%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION	$248.98	$292.92	$97.98	—	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MODERATE COMPLEXITY	$226.10	$266.00	$92.59	19% above	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION	$230.10	$270.71	$256.00	21% above	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MODERATE COMPLEXITY	$226.10	$266.00	$252.70	—	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION	$230.10	$270.71	$157.02	—	15%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC PT MANUAL THERAPY (SOFT TISSUE, MOB, MANIPULATION, TRACTION) PER 15 MIN	$77.73	$91.45	$30.49	1% below	15%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION	$79.15	$93.12	$21.23	1% above	15%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC OT MANUAL THERAPY (SOFT TISSUE, MOB, MANIPULATION, TRACTION) PER 15 MIN	$79.74	$93.81	$30.49	2% above	15%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC PT MANUAL THERAPY (SOFT TISSUE, MOB, MANIPULATION, TRACTION) PER 15 MIN	$77.73	$91.45	$86.88	—	15%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC OT MANUAL THERAPY (SOFT TISSUE, MOB, MANIPULATION, TRACTION) PER 15 MIN	$79.74	$93.81	$89.12	—	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PHYSICAL THERAPY - GENERAL CLASSIFICATION	$56.43	$66.39	$62.78	33% below	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC PT THERAPEUTIC EX PER 15 MIN	$56.78	$66.80	$33.15	32% below	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC OT THERAPEUTIC EX PER 15 MIN	$58.77	$69.14	$33.15	30% below	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PHYSICAL THERAPY - GENERAL CLASSIFICATION	$54.47	$64.08	$22.30	—	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC PT THERAPEUTIC EX PER 15 MIN	$56.78	$66.80	$63.46	—	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC OT THERAPEUTIC EX PER 15 MIN	$58.77	$69.14	$65.68	—	15%
Preventive checkup, returning patient aged 40–64 CPT 99396 PBB PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS	$86.16	$101.36	$128.87	55% below	15%
Preventive checkup, returning patient aged 40–64 CPT 99396 HC PREVENTIVE VISIT,EST,40-64	$92.18	$108.45	$128.87	52% below	15%
Preventive checkup, returning patient aged 65 or older CPT 99397 PBB PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER	$90.69	$106.69	$96.02	52% below	15%
Preventive checkup, returning patient aged 65 or older CPT 99397 HC PREVENTIVE VISIT,EST,65 & OVER	$109.78	$129.15	$116.24	41% below	15%
Psychotherapy for crisis, first 60 minutes CPT 90839 BEHAVIORAL HEALTH TREATMENTS/SERVICES - INDIVIDUAL THERAPY	$145.75	$171.47	$171.47	30% below	15%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC PSYTX CRISIS INITIAL 60 MIN	$145.75	$171.47	$140.60	30% below	15%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC PSYTX CRISIS INITIAL 60 MIN	$145.75	$171.47	$162.90	—	15%
Psychotherapy session, 30 minutes CPT 90832 PBB PSYCHOTHERAPY W/PATIENT 30 MINUTES	$118.27	$139.14	$160.67	6% above	15%
Psychotherapy session, 30 minutes CPT 90832 BEHAVIORAL HEALTH TREATMENTS/SERVICES - INDIVIDUAL THERAPY	$124.49	$146.46	$146.46	11% above	15%
Psychotherapy session, 30 minutes CPT 90832 HC PSYTX PT&/FAMILY 30 MINUTES	$143.17	$168.43	$160.67	28% above	15%
Psychotherapy session, 45 minutes CPT 90834 PBB PSYCHOTHERAPY W/PATIENT 45 MINUTES	$103.12	$121.32	$160.67	28% below	15%
Psychotherapy session, 45 minutes CPT 90834 BEHAVIORAL HEALTH TREATMENTS/SERVICES - INDIVIDUAL THERAPY	$119.41	$140.48	$130.65	17% below	15%
Psychotherapy session, 45 minutes CPT 90834 HC PSYTX, 45 MIN WITH PATIENT	$119.41	$140.48	$160.67	17% below	15%
Psychotherapy session, 60 minutes CPT 90837 PBB PSYCHOTHERAPY W/PATIENT 60 MINUTES	$101.06	$118.89	$160.67	45% below	15%
Psychotherapy session, 60 minutes CPT 90837 BEHAVIORAL HEALTH TREATMENTS/SERVICES - INDIVIDUAL THERAPY	$122.33	$143.92	$133.85	34% below	15%
Psychotherapy session, 60 minutes CPT 90837 HC PSYTX, 60 MIN WITH PATIENT	$122.33	$143.92	$160.67	34% below	15%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES	$22.07	$25.97	$29.79	27% below	15%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 PREVENTIVE CARE SERVICES - GENERAL CLASSIFICATION	$22.07	$25.97	$31.91	27% below	15%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC SMOKING CESSATION ASYMPTOMATIC >3 & UP TO 10 MIN	$22.07	$25.97	$29.79	27% below	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OFFICE/OUTPATIENT VISIT EST LEVEL 5	$237.52	$279.44	$251.50	13% below	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OFFICE/OUTPATIENT VISIT EST LEVEL 5	$237.52	$279.44	$142.64	13% below	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC OFFICE/OUTPATIENT VISIT EST LEVEL 5	$237.52	$279.44	$265.47	—	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 CLINIC - GENERAL CLASSIFICATION	$115.04	$135.34	$128.57	18% below	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OFFICE/OUTPATIENT VISIT EST LEVEL 3	$136.00	$160.00	$65.17	3% below	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OFFICE/OUTPATIENT VISIT EST LEVEL 3	$136.00	$160.00	$55.25	3% below	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC OFFICE/OUTPATIENT VISIT EST LEVEL 3	$136.00	$160.00	$152.00	—	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 CLINIC - GENERAL CLASSIFICATION	$136.00	$160.00	$152.00	32% below	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OFFICE/OUTPATIENT VISIT EST LEVEL 4	$136.00	$160.00	$144.00	32% below	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OFFICE/OUTPATIENT VISIT EST LEVEL 4	$136.00	$160.00	$128.87	32% below	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC OFFICE/OUTPATIENT VISIT EST LEVEL 4	$136.00	$160.00	$152.00	—	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM	$136.00	$160.00	$152.00	28% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OFFICE/OUTPATIENT VISIT EST LEVEL 2	$136.00	$160.00	$128.87	28% above	15%
Speech and language evaluation CPT 92523 SPEECH THERAPY - LANGUAGE PATHOLOGY - EVALUATION OR REEVALUATION	$185.67	$218.44	$83.43	49% below	15%
Speech and language evaluation CPT 92523 HC ST EVAL ST SOUND PROD W/LANG COMP	$551.50	$648.82	$209.57	52% above	15%
Speech and language evaluation inpatient CPT 92523 HC ST EVAL ST SOUND PROD W/LANG COMP	$551.50	$648.82	$616.38	—	15%
Speech therapy session, individual CPT 92507 HC ST TRTMT SPEECH LANG VOICE INDIV	$191.38	$225.15	$85.74	4% above	15%
Speech therapy session, individual CPT 92507 SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION	$192.62	$226.61	$72.40	5% above	15%
Speech therapy session, individual inpatient CPT 92507 HC ST TRTMT SPEECH LANG VOICE INDIV	$191.38	$225.15	$213.89	—	15%
Spirometry (breathing test) CPT 94010 PULMONARY FUNCTION - GENERAL CLASSIFICATION	$154.60	$181.88	$167.57	1% above	15%
Spirometry (breathing test) CPT 94010 PBB SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ	$154.60	$181.88	$156.46	1% above	15%
Spirometry (breathing test) CPT 94010 HC SPIROMETRY	$154.95	$182.29	$82.21	1% above	15%
Spirometry (breathing test) inpatient CPT 94010 HC SPIROMETRY	$154.95	$182.29	$173.18	—	15%
Spirometry before and after a bronchodilator CPT 94060 PBB BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN	$323.29	$380.34	$311.40	27% below	15%
Spirometry before and after a bronchodilator CPT 94060 PULMONARY FUNCTION - GENERAL CLASSIFICATION	$340.31	$400.36	$378.60	23% below	15%
Spirometry before and after a bronchodilator CPT 94060 HC SPIROMETRY BEFORE/AFTER B.D.	$388.75	$457.35	$140.71	13% below	15%
Spirometry before and after a bronchodilator inpatient CPT 94060 PULMONARY FUNCTION - GENERAL CLASSIFICATION	$340.31	$400.36	$314.08	—	15%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC SPIROMETRY BEFORE/AFTER B.D.	$388.75	$457.35	$434.48	—	15%
TMS (transcranial magnetic stimulation), first session with mapping CPT 90867 PBB REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M	$609.95	$717.59	$645.83	—	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC PT THERAPEUTIC ACTIVITY 15 MIN	$64.68	$76.09	$42.67	26% below	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC OT THERAPEUTIC ACTIVITY 15 MIN	$86.19	$101.40	$42.67	1% below	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION	$87.61	$103.07	$97.92	1% above	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC PT THERAPEUTIC ACTIVITY 15 MIN	$64.68	$76.09	$72.29	—	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC OT THERAPEUTIC ACTIVITY 15 MIN	$86.19	$101.40	$96.33	—	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION	$87.61	$103.07	$24.58	—	15%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION	$186.56	$219.48	$136.59	14% above	15%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMY THERAPEUTIC	$240.49	$282.93	$108.60	47% above	15%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 PBB FLU VACCINE, 65 YRS +, (FLUAD), TRIVALENT, ADJUVANTED, PF, 0.5 ML SYRINGE	$53.55	$63.00	$38.00	at median	15%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 HC SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE	$89.25	$105.00	$68.06	45% below	15%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)	$89.25	$105.00	$67.73	45% below	15%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 HC SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE	$89.25	$105.00	$99.75	—	15%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)	$22.31	$26.25	$16.93	8% below	15%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 HC VAC INFLUNZA TRI-VAL SPLT PF 11-12	$22.31	$26.25	$9.84	8% below	15%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 PBB VAC INFLUNZA TRI-VAL SPLT PF 11-12	$22.31	$26.25	$9.84	8% below	15%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 PBB HPV VIRUS VACCINE 9 VAL IM	$204.60	$240.71	$216.64	41% below	15%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 PBB HEP A & B VACCINE (PF)	$161.19	$189.63	$170.67	11% above	15%
Hepatitis A vaccine, adult dose CPT 90632 PBB VACCINE HEP A ADULT IM	$76.54	$90.05	$81.05	20% below	15%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 PBB VACCINE HEPATITS B	$112.46	$132.30	$51.29	18% above	15%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 PBB HIB VACCINE, PRP-OMP, IM	$42.70	$50.23	$45.21	10% below	15%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)	$42.08	$49.51	$44.56	19% above	15%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 PBB FLU VACCINE, 65 YRS +, (FLUZONE HD), TRIVALENT, PF, 0.5 ML SYR	$88.52	$104.14	$93.73	4% above	15%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)	$129.98	$152.92	$98.63	53% above	15%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 PBB FLU VACCINE, 65 YRS +, (FLUZONE HD), TRIVALENT, PF, 0.5 ML SYR	$88.52	$104.14	$98.93	—	15%
MMR vaccine (measles, mumps and rubella), live CPT 90707 PBB VACC MEASLES-MUMPS-RUBELLA PF	$75.50	$88.82	$79.94	42% below	15%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 PBB MENINGOCOCCAL QUADRIV VACC, IM	$143.71	$169.07	$152.16	21% below	15%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PBB VACCINE PNEUMOCOCCAL CONJUGATE	$235.23	$276.74	$201.89	18% below	15%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)	$129.98	$152.92	$152.92	59% below	15%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PBB PCV20 VACCINE FOR INTRAMUSCULAR USE	$485.22	$570.85	$235.69	53% above	15%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PBB VACCINE PNEUMOCOCCAL 23 POLYVALENT	$138.34	$162.75	$25.68	3% below	15%
Polio vaccine, inactivated (IPV) CPT 90713 PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)	$146.17	$171.97	$154.77	76% above	15%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 HC RSV VACCINE	$441.79	$519.75	$467.78	13% above	15%
Rabies vaccine, one dose CPT 90675 PBB VACCINE RABIES IM	$381.66	$449.01	$313.68	30% below	15%
Rabies vaccine, one dose CPT 90675 PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)	$1,375.63	$1,618.39	$780.08	153% above	15%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 PBB ZOSTER (SHINGLES) VACCINE HZV REOMBINANT SUBUNIT ADJ IM	$202.60	$238.35	$214.52	11% below	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 HC VACC DIPH/PERTUSS/ACEL/TET PF	$141.13	$166.03	$65.21	36% above	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)	$154.53	$181.80	$172.71	49% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN PNEUMOCOCCAL VACCINE	$28.25	$33.24	$71.17	42% below	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN INFLUENZA VACCINE	$29.35	$34.53	$71.17	40% below	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION	$78.53	$92.39	$32.60	61% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZATION ADMIN;ONE VACCINE	$86.64	$101.93	$71.17	78% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN HEPATITIS B VACCINE	$103.22	$121.43	$71.17	112% above	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION	$30.98	$36.45	$32.80	3% below	15%

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.sphealth.org/sites/default/files/Pricing%20Transparency/810233121_st-peters-health-regional-medical-center_standardcharges.csv