Hospital Bozeman, MT

Big Sky Medical Center

Big Sky Medical Center in Big Sky, MT publishes cash prices for 485 common procedures listed here, from its own machine-readable price file updated Jan 15, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Montana median for 214 of 479 procedures and above it for 214. By typical cash price it ranks #15 of 29 Montana hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

334 Town Center Ave, Big Sky, MT 59716 Collected Sep 28, 2026 Source price file Check a bill from this hospital (406) 995-6995

Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CCN 271389 · CMS hospital register NPI 1588141048

Financial assistance

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

Big Sky Medical Center 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 HC CT ABDOMEN WO THEN W CONT	$2,644.00	$3,305.00	$190.66–$3,305.00	35% above	20%
Abdominal X-ray, 2 views CPT 74019 HC RADIOLOGIC EXAM ABDOMEN 2 VIEWS - XR ABDOMEN 2 VW POSTER W DECUBITUS	$236.00	$295.00	$34.78–$295.00	13% below	20%
Ankle X-ray, complete, 3 or more views CPT 73610 CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS	$121.60	$152.00	$34.78–$152.00	44% below	20%
Ankle X-ray, complete, 3 or more views CPT 73610 HC X-RAY ANKLE MIN 3 VIEWS	$234.40	$293.00	$34.78–$293.00	9% above	20%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT EXT UPPER WO CONT	$1,756.00	$2,195.00	$113.89–$2,195.00	31% above	20%
Breast ultrasound, complete, one breast both sides CPT 76641 HC ULTRASOUND BREAST COMPLETE - US BREAST BILATERAL COMPLETE	$394.40	$493.00	$97.37–$493.00	—	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 HC ULTRASOUND BREAST LIMITED - US BREAST LEFT LIMITED	$393.60	$492.00	$80.60–$492.00	59% above	20%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CTA ABD PELVIS W CONTRAST+WO IF PERFORM	$4,023.20	$5,029.00	$370.20–$5,029.00	45% above	20%
CT angiography (CTA) of the head CPT 70496 HC CT ANGIOHEAD COMBO - CT HEAD ANGIO W AND WO IV CONTRAST	$2,917.60	$3,647.00	$190.66–$3,647.00	37% above	20%
CT angiography (CTA) of the neck CPT 70498 HC CT ANGIONECK COMBO - CT NECK ANGIO W AND WO IV CONTRAST	$2,917.60	$3,647.00	$190.66–$3,647.00	36% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CTA CHEST WCONT +WO IF PERF	$3,035.20	$3,794.00	$190.66–$3,794.00	37% above	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST	$727.20	$909.00	$274.40–$909.00	7% below	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD PELVIS WO CONTRAST	$2,915.20	$3,644.00	$177.96–$3,644.00	36% above	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABD PELVIS W CONTRAST	$3,748.80	$4,686.00	$295.29–$4,686.00	32% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABD PELVIS WO THEN W CONT	$4,136.00	$5,170.00	$331.31–$5,170.00	33% above	20%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W CONTRAST	$2,266.40	$2,833.00	$190.66–$2,833.00	25% above	20%
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN W/O DYE - CT ABDOMEN WO CONTRAST	$1,998.40	$2,498.00	$113.89–$2,498.00	47% above	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT SCANMAXILLOFACIAL W/O CONTRAST - CT SINUS WO CONTRAST	$1,405.60	$1,757.00	$113.89–$1,757.00	18% above	20%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT SCANHEAD/BRAINW/O CONTRAST MATL - CT HEAD WO CONTRAST	$1,665.60	$2,082.00	$103.06–$2,082.00	41% above	20%
CT scan of the head with contrast CPT 70460 HC CT SCAN HEAD CONTRAST - CT HEAD W CONTRAST	$1,676.80	$2,096.00	$144.15–$2,096.00	17% above	20%
CT scan of the head without and with contrast CPT 70470 HC CT SCAN HEAD COMBO - CT HEAD W WO CONTRAST	$2,093.60	$2,617.00	$168.81–$2,617.00	16% above	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE WO CONT	$1,987.20	$2,484.00	$113.89–$2,484.00	40% above	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT CERVICAL SPINE WO CONTRAST	$1,751.20	$2,189.00	$113.89–$2,189.00	24% above	20%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST	$2,346.40	$2,933.00	$190.66–$2,933.00	46% above	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC DUP SCAN EXTRACRANIAL ARTERIES COMPLT BI STUDY	$1,263.20	$1,579.00	$180.19–$1,579.00	—	20%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 HC DUPLEX SCAN EXTRACRANIALBILAT - CAROTID DUPLEX	$1,263.20	$1,579.00	$180.19–$1,579.00	33% above	20%
Chest CT scan without and with contrast CPT 71270 HC CT THORAX DIAGNOSTIC WO THEN W CONTRAST	$3,096.80	$3,871.00	$190.66–$3,871.00	56% above	20%
Chest X-ray, 2 views CPT 71046 CHG RADIOLOGIC EXAM CHEST 2 VIEWS	$139.20	$174.00	$31.93–$174.00	37% below	20%
Chest X-ray, 2 views CPT 71046 HC RADIOLOGIC EXAM CHEST 2 VIEWS - XR CHEST 2 VIEWS	$236.80	$296.00	$31.93–$296.00	7% above	20%
Chest X-ray, single view CPT 71045 HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST 1 VIEW	$186.40	$233.00	$24.34–$233.00	1% above	20%
Collarbone (clavicle) X-ray, complete CPT 73000 CHG RADEX CLAVICLE COMPLETE	$123.20	$154.00	$30.98–$154.00	35% below	20%
Collarbone (clavicle) X-ray, complete CPT 73000 HC X-RAY CLAVICLE COMPLETE	$206.40	$258.00	$30.98–$258.00	9% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC USRETROPERIT B-SCAN/REAL TIMECOMPLETE - US RETROPERITONEUM	$508.00	$635.00	$102.73–$635.00	1% above	20%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC OB US DETAILED SNGL FETUS - US OB DETAIL FETAL ANAT SING OR 1ST GEST	$426.40	$533.00	$168.19–$533.00	2% below	20%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 CHG US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION	$508.00	$635.00	$168.19–$635.00	17% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX DIAGNOSTIC WO CONTRAST	$1,856.00	$2,320.00	$113.89–$2,320.00	33% above	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT THORAX DIAGNOSTIC WITH CONTRAST	$2,534.40	$3,168.00	$162.49–$3,168.00	53% above	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 HC VASC DUPLEX EXTREM VENOUSBILAT	$1,512.00	$1,890.00	$177.34–$1,890.00	60% above	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC ECHO (2D) COMPLETE W DOPPLER & COLOR	$1,633.60	$2,042.00	$186.20–$2,042.00	4% above	20%
Elbow X-ray, 2 views CPT 73070 CHG RADEX ELBOW 2 VIEWS	$122.40	$153.00	$27.82–$153.00	32% below	20%
Elbow X-ray, 2 views CPT 73070 HC X-RAY ELBOW 2 VIEWS	$216.80	$271.00	$27.82–$271.00	20% above	20%
Elbow X-ray, complete, 3 or more views CPT 73080 CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS	$204.80	$256.00	$31.29–$256.00	5% below	20%
Elbow X-ray, complete, 3 or more views CPT 73080 HC X-RAY ELBOW MIN 3 VIEWS	$280.00	$350.00	$31.29–$350.00	30% above	20%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT SCANORBIT/SELLA/POST FOSSA/EARW/O - CT AUDITORY CANALS WO CONT	$1,516.80	$1,896.00	$113.89–$1,896.00	16% above	20%
Facial bones X-ray, complete, 3 or more views CPT 70150 CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS	$153.60	$192.00	$44.90–$192.00	53% below	20%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC X-RAY FACIAL BONES 3+ VW - XR FACIAL BONES 3+ VIEWS	$368.00	$460.00	$44.90–$460.00	14% above	20%
Forearm X-ray (radius and ulna), 2 views CPT 73090 CHG RADEX FOREARM 2 VIEWS	$123.20	$154.00	$27.82–$154.00	34% below	20%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC X-RAY FOREARM 2 VIEWS	$220.80	$276.00	$27.82–$276.00	19% above	20%
Hand X-ray, 2 views CPT 73120 CHG RADEX HAND 2 VIEWS	$108.00	$135.00	$30.03–$135.00	37% below	20%
Hand X-ray, 2 views CPT 73120 HC X-RAY HAND 2 VIEWS	$186.40	$233.00	$30.03–$233.00	9% above	20%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 CHG RADEX CALCANEUS MINIMUM 2 VIEWS	$107.20	$134.00	$27.19–$134.00	44% below	20%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC X-RAY HEEL/CALCANEUS 2 VIEWS	$188.00	$235.00	$27.19–$235.00	2% below	20%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 PR SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT	$306.40	$383.00	$89.45–$383.00	at median	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 PR POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND	$1,891.20	$2,364.00	$618.69–$2,364.00	19% below	20%
Knee X-ray, 3 views CPT 73562 CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS	$141.60	$177.00	$38.88–$177.00	33% below	20%
Knee X-ray, 3 views CPT 73562 HC X-RAY KNEE 3 VIEWS	$235.20	$294.00	$38.88–$294.00	12% above	20%
Knee X-ray, complete, 4 or more views CPT 73564 CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS	$135.20	$169.00	$44.90–$169.00	45% below	20%
Knee X-ray, complete, 4 or more views CPT 73564 HC X-RAY KNEE MIN 4 VIEWS	$255.20	$319.00	$44.90–$319.00	4% above	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXTREMITY WO CONTRAST	$2,054.40	$2,568.00	$113.89–$2,568.00	57% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMEN LIMITED - US ABDOMEN LIMITED	$407.20	$509.00	$82.51–$509.00	at median	20%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG	$94.40	$118.00	$60.05–$118.45	59% below	20%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US LMTD JOINT/NONVASC EXTREMITY STRUCTURE	$555.20	$694.00	$60.05–$694.00	139% above	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT THORAX LUNG CANCER SCR C-	$617.60	$772.00	$113.89–$772.00	15% below	20%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS	$160.00	$200.00	$30.03–$200.00	18% below	20%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC X-RAY TIB & FIB 2 VIEWS	$220.80	$276.00	$30.03–$276.00	13% above	20%
MR angiography (MRA) of the head without contrast CPT 70544 HC MR ANGIO HEAD - MR HEAD ANGIO WO IV CONTRAST	$2,909.60	$3,637.00	$210.23–$3,637.00	60% above	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOWER EXT JT WO CONTRAST	$2,189.60	$2,737.00	$197.58–$2,737.00	27% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXT JT WO THEN W CONT	$3,726.40	$4,658.00	$376.22–$4,658.00	37% above	20%
MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN (MRI) - MRI ABDOMEN WO CONTRAST	$2,510.40	$3,138.00	$190.94–$3,138.00	40% above	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN WO THEN W CONT	$3,994.40	$4,993.00	$329.74–$4,993.00	38% above	20%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN - MRI BRAIN WO CONTRAST	$2,636.80	$3,296.00	$191.25–$3,296.00	47% above	20%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN COMBO - MRI BRAIN W WO CONTRAST	$3,961.60	$4,952.00	$310.43–$4,952.00	41% above	20%
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE - MRI LUMBAR SPINE WO CONTRAST	$2,499.20	$3,124.00	$186.51–$3,124.00	43% above	20%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMBAR SPINE COMBO - MRI LUMBAR SPINE W WO CONTRAST	$3,796.00	$4,745.00	$311.38–$4,745.00	42% above	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI DORSAL SPINE - MRI THORACIC SPINE WO CONTRAST	$2,419.20	$3,024.00	$185.56–$3,024.00	38% above	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI CERV SPINE COMBO - MRI CERVICAL SPINE W WO CONTRAST	$3,796.00	$4,745.00	$312.02–$4,745.00	41% above	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERV SPINE - MRI CERVICAL SPINE WO CONTRAST	$2,271.20	$2,839.00	$185.88–$2,839.00	26% above	20%
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS WO THEN W CONT	$4,026.40	$5,033.00	$328.47–$5,033.00	45% above	20%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS WO CONTRAST	$2,676.80	$3,346.00	$223.51–$3,346.00	42% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI JOINT UPPER EXTREM WO CONTRAST	$2,189.60	$2,737.00	$197.89–$2,737.00	40% above	20%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS	$150.40	$188.00	$50.90–$188.00	54% below	20%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC RADEX SPINE CERVICAL 4 OR 5 VIEWS - XR CERVICAL SPINE COMP 4-5 VIEWS	$454.40	$568.00	$50.90–$568.00	40% above	20%
Neck soft tissue CT scan with contrast CPT 70491 HC CT SOFT TISSUE NECK W CONTRAST	$2,211.20	$2,764.00	$179.24–$2,764.00	26% above	20%
Neck soft tissue CT scan without contrast CPT 70490 HC CT SCANSOFT TISSUE NECKW/O CONTRAST - CT SOFT TISSUE NECK WO CONT	$1,152.80	$1,441.00	$113.89–$1,441.00	5% below	20%
Neck soft tissue X-ray CPT 70360 CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE	$105.60	$132.00	$29.72–$132.00	46% below	20%
Neck soft tissue X-ray CPT 70360 HC X-RAY NECK SOFT TISSUE - XR NECK SOFT TISSUE	$116.80	$146.00	$29.72–$146.00	40% below	20%
OCT scan of the retina (optical coherence tomography) both sides CPT 92134 PR CPTRIZED OPH DX IMG PST SEGMENT UNI/BI RETINA	$96.80	$121.00	$38.26–$121.00	—	20%
Pelvic CT scan without contrast CPT 72192 HC CT PELVIS WO CONTRAST	$1,828.80	$2,286.00	$113.89–$2,286.00	32% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 CHG US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U	$289.60	$362.00	$46.79–$362.00	7% below	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC SONO PELVIS LIMITED - US PELVIS LIMITED	$334.40	$418.00	$46.79–$418.00	8% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 CHG US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE	$351.20	$439.00	$99.90–$439.00	35% below	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC ECHOPELVIC (NONOBSTETRIC) - US PELVIS	$484.80	$606.00	$99.90–$606.00	10% below	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION	$420.80	$526.00	$113.89–$526.00	12% below	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC OB US >/= 14 WKS SNGL FETUS - US OB 14+ WEEKS SINGLE OR FIRST GEST	$518.40	$648.00	$113.89–$648.00	9% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 CHG US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT	$379.20	$474.00	$111.27–$474.00	15% below	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC OB US < 14 WKS SINGLE FETUS - US OB < 14 WEEKS SINGLE OR FIRST GEST	$627.20	$784.00	$111.27–$784.00	41% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 CHG US PREGNANT UTERUS LIMITED 1/> FETUSES	$385.60	$482.00	$76.82–$482.00	16% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC OB US LIMITED FETUS(S) - US OB LIMITED 1+ FETUSES	$396.80	$496.00	$76.82–$496.00	20% above	20%
Rib X-ray, one side, 2 views CPT 71100 HC X-RAY RIBS UNIL 2 VIEWS	$310.40	$388.00	$34.78–$388.00	33% above	20%
Rib X-ray, one side, 2 views one side CPT 71100 CHG RADEX RIBS UNILATERAL 2 VIEWS	$137.60	$172.00	$34.78–$172.00	41% below	20%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS	$120.80	$151.00	$40.16–$151.00	57% below	20%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 HC RAD EXAM RIBS UNILAT W CHEST MIN 3 VWS	$375.20	$469.00	$40.16–$469.00	35% above	20%
Shoulder X-ray, complete, 2 or more views CPT 73030 CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS	$128.80	$161.00	$33.19–$161.00	41% below	20%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC X-RAY SHOULDER COMPLETE MIN 2 VIEWS	$267.20	$334.00	$33.19–$334.00	23% above	20%
Sinus X-ray, complete, 3 or more views CPT 70220 HC X-RAY SINUSES 3+ VW - XR PARANASAL SINUSES 3+ VIEWS	$292.80	$366.00	$35.72–$366.00	14% above	20%
Skull X-ray, fewer than 4 views CPT 70250 HC X-RAY SKULL <4 VW - XR SKULL 1-3 VIEWS	$268.80	$336.00	$34.14–$336.00	13% above	20%
Sleep study in a lab (polysomnography) CPT 95810 PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND	$1,739.20	$2,174.00	$591.81–$2,174.00	17% below	20%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC ECHO STRESS TTE COMPLETE	$936.00	$1,170.00	$220.03–$1,170.00	20% below	20%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC X-RAY FEMUR MIN 2 VIEWS	$172.80	$216.00	$33.83–$216.00	19% below	20%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS	$195.20	$244.00	$33.83–$244.00	9% below	20%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT THORACIC SPINE WO CONT	$2,088.00	$2,610.00	$113.89–$2,610.00	47% above	20%
Toe X-ray, 2 or more views CPT 73660 CHG RADEX TOE MINIMUM 2 VIEWS	$104.80	$131.00	$27.82–$131.00	40% below	20%
Toe X-ray, 2 or more views CPT 73660 HC X-RAY TOE(S) MIN OF 2VIEWS	$129.60	$162.00	$27.82–$162.00	26% below	20%
Transvaginal pelvic ultrasound CPT 76830 CHG US TRANSVAGINAL	$349.60	$437.00	$113.17–$437.00	17% below	20%
Transvaginal pelvic ultrasound CPT 76830 HC ECHOGRAPHYTRANSVAGINAL - US PELVIS TRANSVAGINAL	$484.00	$605.00	$113.17–$605.00	15% above	20%
Transvaginal ultrasound during pregnancy CPT 76817 CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG	$294.40	$368.00	$87.88–$368.00	26% below	20%
Transvaginal ultrasound during pregnancy CPT 76817 HC TRANSVAGINAL US OBSTETRIC - US OB TRANSVAGINAL	$346.40	$433.00	$87.88–$433.00	13% below	20%
Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMB-SCAN &/OR REAL TIMECOMPLETE - US ABDOMEN	$528.80	$661.00	$110.32–$661.00	at median	20%
Ultrasound of the scrotum and testicles CPT 76870 HC ECHOSCROTUM & CONTENTS - US SCROTUM	$494.40	$618.00	$94.84–$618.00	1% below	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US HEAD/NECK TISSUESREAL TIME - US HEAD NECK SOFT TISSUE	$469.60	$587.00	$104.64–$587.00	9% above	20%
Upper arm X-ray (humerus), 2 views CPT 73060 CHG RADEX HUMERUS MINIMUM 2 VIEWS	$140.00	$175.00	$30.35–$175.00	30% below	20%
Upper arm X-ray (humerus), 2 views CPT 73060 HC X-RAY HUMERUS MIN 2 VIEWS	$220.80	$276.00	$30.35–$276.00	10% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC DUP SCAN EXTREMITY VEINS W/COMPRESSION & MANEUVERS - UNIL OR LMTD	$1,038.40	$1,298.00	$112.86–$1,298.00	62% above	20%
Wrist X-ray, 2 views CPT 73100 CHG RADEX WRIST 2 VIEWS	$120.80	$151.00	$32.24–$151.00	32% below	20%
Wrist X-ray, 2 views CPT 73100 HC X-RAY WRIST 2 VIEWS	$125.60	$157.00	$32.24–$157.00	29% below	20%
Wrist X-ray, complete, 3 or more views CPT 73110 CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS	$128.80	$161.00	$39.21–$161.00	41% below	20%
Wrist X-ray, complete, 3 or more views CPT 73110 HC X-RAY WRIST MIN 3 VIEWS	$265.60	$332.00	$39.21–$332.00	22% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS	$137.60	$172.00	$45.21–$172.00	35% below	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC X-RAY HIP UNILATERAL 2 OR 3 VIEWS	$154.40	$193.00	$45.21–$193.00	27% below	20%
X-ray of the abdomen, 1 view CPT 74018 HC RADIOLOGIC EXAM ABDOMEN 1 VIEW - XR ABDOMEN 1 VIEW	$138.40	$173.00	$28.77–$173.00	23% below	20%
X-ray of the ankle, 2 views CPT 73600 CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS	$108.00	$135.00	$30.67–$135.00	39% below	20%
X-ray of the ankle, 2 views CPT 73600 HC X-RAY ANKLE 2 VIEWS	$201.60	$252.00	$30.67–$252.00	13% above	20%
X-ray of the finger(s), 2 or more views CPT 73140 CHG RADEX FINGR MINIMUM 2 VIEWS	$122.40	$153.00	$36.36–$153.00	28% below	20%
X-ray of the finger(s), 2 or more views CPT 73140 HC X-RAY FINGER(S) MIN 2 VIEWS	$188.00	$235.00	$36.36–$235.00	11% above	20%
X-ray of the foot, 2 views CPT 73620 CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS	$124.00	$155.00	$27.19–$155.00	28% below	20%
X-ray of the foot, 2 views CPT 73620 HC X-RAY FOOT 1 OR 2 VIEWS	$186.40	$233.00	$27.19–$233.00	8% above	20%
X-ray of the foot, complete, 3 or more views CPT 73630 CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS	$168.80	$211.00	$32.57–$211.00	29% below	20%
X-ray of the foot, complete, 3 or more views CPT 73630 HC X-RAY FOOT MIN 3 VIEWS	$208.00	$260.00	$32.57–$260.00	12% below	20%
X-ray of the hand, 3 or more views CPT 73130 CHG RADEX HAND MINIMUM 3 VIEWS	$121.60	$152.00	$35.41–$152.00	47% below	20%
X-ray of the hand, 3 or more views CPT 73130 HC X-RAY HAND MIN 3 VIEWS	$234.40	$293.00	$35.41–$293.00	2% above	20%
X-ray of the knee, 1 or 2 views CPT 73560 CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS	$122.40	$153.00	$32.57–$153.00	31% below	20%
X-ray of the knee, 1 or 2 views CPT 73560 HC X-RAY KNEE 1 OR 2 VIEWS	$192.00	$240.00	$32.57–$240.00	8% above	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS	$122.40	$153.00	$37.94–$153.00	52% below	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC X-RAY LUMBAR SPINE 2/3 VW - XR LUMBAR SPINE 2-3 VIEWS	$302.40	$378.00	$37.94–$378.00	19% above	20%
X-ray of the lower back, 4 or more views CPT 72110 CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS	$164.00	$205.00	$49.32–$205.00	51% below	20%
X-ray of the lower back, 4 or more views CPT 72110 HC X-RAY LUMBAR SPINE 4 VW - XR LUMBAR SPINE COMPLETE 4+ VIEWS	$368.00	$460.00	$49.32–$460.00	10% above	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 CHG RADEX SPINE THORACIC 2 VIEWS	$194.40	$243.00	$31.29–$243.00	13% below	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC X-RAY THORACIC SPINE 2 VW - XR THORACIC SPINE 2 VIEWS	$306.40	$383.00	$31.29–$383.00	37% above	20%
X-ray of the nasal bones, 3 or more views CPT 70160 CHG RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS	$108.00	$135.00	$35.72–$135.00	49% below	20%
X-ray of the nasal bones, 3 or more views CPT 70160 HC X-RAY NASAL BONES - XR NASAL BONES	$280.00	$350.00	$35.72–$350.00	33% above	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS	$215.20	$269.00	$37.62–$269.00	at median	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC RADEX SPINE CERVICAL 2 OR 3 VIEWS - XR CERVICAL SPINE 2-3 VIEWS	$257.60	$322.00	$37.62–$322.00	20% above	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS	$210.40	$263.00	$26.55–$263.00	3% below	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC X-RAY PELVIS 1/2 VW - XR PELVIS 1-2 VIEWS	$280.00	$350.00	$26.55–$350.00	28% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS	$217.60	$272.00	$30.98–$272.00	7% below	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC X-RAY SACRUM/COCCYX 2+ VW - XR SACRUM COCCYX 2+ VIEWS	$341.60	$427.00	$30.98–$427.00	46% above	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
ACTH blood test CPT 82024 HC ASSAY OF ACTH - ACTH	$253.60	$317.00	$31.96–$317.00	12% above	20%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC TRANSFERASE ALANINE AMINO (ALT) (SGPT) - ALT (SGPT)	$35.20	$44.00	$4.39–$44.00	32% below	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC AST 84450	$42.40	$53.00	$4.28–$53.00	16% below	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS PANELACUTE - BUNDLED CHARGE	$246.40	$308.00	$39.42–$308.00	19% above	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP	$254.40	$318.00	$39.42–$318.00	23% above	20%
Albumin blood test CPT 82040 HC ASSAY OF SERUM ALBUMIN - ALBUMIN	$35.20	$44.00	$4.09–$44.00	14% above	20%
Aldosterone blood test CPT 82088 HC ASSAY OF ALDOSTERONE - ALDOSTERONE	$282.40	$353.00	$33.72–$353.00	43% above	20%
Alkaline phosphatase (ALP) blood test CPT 84075 CHG ASSAY OF PHOSPHATASE ALKALINE	$10.40	$13.00	$4.28–$13.00	82% below	20%
Alkaline phosphatase (ALP) blood test CPT 84075 HC ASSAY ALKAL PHOSPHATASE - ALKALINE PHOSPHATASE	$36.80	$46.00	$4.28–$46.00	36% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 CHG ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH	$9.60	$12.00	$4.32–$12.00	80% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN CASHEW IGE	$36.80	$46.00	$4.32–$46.00	22% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN WALNUT IGE	$36.80	$46.00	$4.32–$46.00	22% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN THISTLE RUSSIAN IGE	$36.80	$46.00	$4.32–$46.00	22% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN MUGWORT IGE	$36.80	$46.00	$4.32–$46.00	22% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN ON PANEL	$36.80	$46.00	$4.32–$46.00	22% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERG SPEC IGE QUANT	$36.80	$46.00	$4.32–$46.00	22% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN COTTONWOOD TREE IGE	$36.80	$46.00	$4.32–$46.00	22% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN EGG WHITE IGE	$36.80	$46.00	$4.32–$46.00	22% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN KOCHIA IGE	$36.80	$46.00	$4.32–$46.00	22% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN PECAN NUT IGE	$36.80	$46.00	$4.32–$46.00	22% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE - ALLERGEN CEDAR MOUNTAIN IGE	$36.80	$46.00	$4.32–$46.00	22% below	20%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA-FETOPROTEIN SERUM - ALPHA-FETOPROTEIN MARKER	$116.80	$146.00	$13.88–$146.00	1% above	20%
Ammonia blood test CPT 82140 HC ASSAY OF AMMONIA - AMMONIA	$161.60	$202.00	$12.06–$202.00	30% above	20%
Amylase blood test CPT 82150 HC ASSAY OF AMYLASE - AMYLASE	$57.60	$72.00	$5.36–$72.00	1% above	20%
Amylase blood test CPT 82150 CHG ASSAY OF AMYLASE	$64.80	$81.00	$5.36–$81.00	13% above	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY - CYCLIC CITRUL PEPTIDE ANTIBDY	$152.80	$191.00	$10.72–$191.00	58% above	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES - ANA (ANTINUCLEAR ANTIBODIES)	$72.00	$90.00	$10.00–$90.00	3% below	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE - B-TYPE NATRIURETIC PEPTIDE (BNP)	$229.60	$287.00	$32.49–$287.00	1% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CHG CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL	$20.00	$25.00	$7.13–$25.00	73% below	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE: BACT RESPITOR	$96.80	$121.00	$7.13–$121.00	28% above	20%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL CALCIUM TOTAL - BUNDLED CHARGE	$44.00	$55.00	$7.00–$55.00	53% below	20%
Basic metabolic panel (blood test) CPT 80048 CHG BASIC METABOLIC PANEL CALCIUM TOTAL	$48.80	$61.00	$7.00–$61.00	48% below	20%
Bilirubin blood test, total CPT 82247 CHG BILIRUBIN TOTAL	$8.80	$11.00	$4.15–$11.00	82% below	20%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL - BILIRUBIN TOTAL AND DIRECT	$60.80	$76.00	$4.15–$76.00	23% above	20%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL - BILIRUBIN TOTAL	$62.40	$78.00	$4.15–$78.00	26% above	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC SURGICAL PATH LEVEL IV	$296.80	$371.00	—	47% above	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC PROSTATE BIOPSY	$296.80	$371.00	—	47% above	20%
Blood culture for bacteria CPT 87040 HC CULTURE BLOOD	$204.80	$256.00	$8.54–$256.00	35% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC CHG COLLECTION VENOUS BLOODVENIPUNCTURE - DRAW CHARGE	$25.60	$32.00	$8.39–$32.00	35% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC COLLECTION VENOUS BLOODVENIPUNCTURE - BUNDLED CHARGE	$27.20	$34.00	$8.39–$34.00	43% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ED CHG COLLECTION VENOUS BLOOD Ã» LEGAL BLOOD ALCOHOL	$152.80	$191.00	$8.39–$191.00	704% above	20%
Blood glucose (sugar) test CPT 82947 CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP	$17.60	$22.00	$3.25–$22.00	55% below	20%
Blood glucose (sugar) test CPT 82947 HC ASSAY QUANTITATIVEBLOOD GLUCOSE - GLUCOSE RANDOM	$34.40	$43.00	$3.25–$43.00	12% below	20%
Blood glucose (sugar) test CPT 82947 HC ASSAY QUANTITATIVEBLOOD GLUCOSE - POCT GLUCOMETER	$35.20	$44.00	$3.25–$44.00	10% below	20%
Blood lead test CPT 83655 HC ASSAY OF LEAD - LEAD BLOOD	$32.80	$41.00	$10.02–$41.00	44% below	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 CHG GONADOTROPIN CHORIONIC QUALITATIVE	$34.40	$43.00	$6.22–$43.00	52% below	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC GONADOTROPIN CHORIONIC (HCG) QUALITATIVE	$52.00	$65.00	$6.22–$65.00	27% below	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 CHG BLOOD TYPING SEROLOGIC ABO	$20.80	$26.00	$2.47–$143.57	71% below	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING SEROLOGIC ABO - ABO/RH TYPE	$239.20	$299.00	$2.47–$299.00	232% above	20%
Blood urea nitrogen (BUN) test CPT 84520 HC ASSAY UREA NITROGEN QUAN - BLOOD UREA NITROGEN	$32.00	$40.00	$3.27–$40.00	33% below	20%
C-peptide blood test CPT 84681 HC ASSAY OF C-PEPTIDE - C-PEPTIDE	$113.60	$142.00	$17.22–$142.00	24% below	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN - C-REACTIVE PROTEIN	$43.20	$54.00	$4.28–$54.00	35% below	20%
C. difficile toxin gene test (stool PCR) CPT 87493 HC C. DIFFICILE DNA BY PCR	$312.80	$391.00	$30.84–$391.00	86% above	20%
CA 19-9 blood test (tumor marker) CPT 86301 HC IMMUNOASSAY TUMOR ANTIGEN CA 19-9 - CANCER ANTIGEN 19-9	$104.00	$130.00	$17.22–$130.00	22% below	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC IMMUNOASSAY TUMOR ANTIGEN CA 125 - CA 125	$115.20	$144.00	$17.22–$144.00	8% below	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 CHG IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ	$154.40	$193.00	$42.46–$193.00	28% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 CDMR SARS-COV-2 COVID-19 AMP PRB	$162.40	$203.00	$42.46–$203.00	34% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC SARS-COV-2 NAD	$176.80	$221.00	$42.46–$221.00	46% above	20%
Calcium blood test, total CPT 82310 HC ASSAY OF CALCIUM TOTAL - CALCIUM	$34.40	$43.00	$4.27–$43.00	1% below	20%
Carcinoembryonic antigen (CEA) test CPT 82378 HC CEA	$124.00	$155.00	$15.68–$155.00	16% above	20%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA ZOSTER SCREEN	$52.00	$65.00	$10.66–$65.00	5% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 C TRACHOMATIS NUC. ACID	$105.60	$132.00	$29.03–$132.00	16% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ	$113.60	$142.00	$29.03–$142.00	25% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC C TRACHOMATIS NUC. ACID	$224.00	$280.00	$29.03–$280.00	146% above	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL - BUNDLED CHARGE	$47.20	$59.00	$11.08–$59.00	43% below	20%
Complete blood count (CBC) with differential CPT 85025 HC COMPLETE CBC & AUTO DIFF WBC - ADDITIONAL CHARGE	$46.40	$58.00	$6.43–$58.00	41% below	20%
Complete blood count (CBC), no differential CPT 85027 CHG BLOOD COUNT COMPLETE AUTOMATED	$28.00	$35.00	$5.36–$35.00	44% below	20%
Complete blood count (CBC), no differential CPT 85027 HC CBC AUTOMATED NO DIFF	$48.80	$61.00	$5.36–$61.00	3% below	20%
Comprehensive metabolic panel (blood test) CPT 80053 HC METABOLIC PANELCOMPREHENSIVE - BUNDLED CHARGE	$47.20	$59.00	$8.74–$59.00	64% below	20%
Comprehensive metabolic panel (blood test) CPT 80053 CHG COMPREHENSIVE METABOLIC PANEL	$51.20	$64.00	$8.74–$64.00	61% below	20%
Cortisol blood test, total CPT 82533 HC CORTISOL SALIVA	$123.20	$154.00	$13.49–$154.00	10% above	20%
Cortisol blood test, total CPT 82533 HC CORTISOL TOTAL SER	$123.20	$154.00	$13.49–$154.00	10% above	20%
Cortisol blood test, total CPT 82533 HC TOTAL CORTISOL - ACTH STIMULATION 1 HOUR	$123.20	$154.00	$13.49–$154.00	10% above	20%
Cortisol blood test, total CPT 82533 HC TOTAL CORTISOL - CORTISOL AM	$123.20	$154.00	$13.49–$154.00	10% above	20%
Creatine kinase (CK) blood test, total CPT 82550 HC ASSAY OF CK (CPK) - CK	$56.00	$70.00	$5.39–$70.00	at median	20%
Creatinine blood test CPT 82565 CHG CREATININE BLOOD	$22.40	$28.00	$4.24–$28.00	48% below	20%
Creatinine blood test CPT 82565 HC ASSAY OF CREATININE - CREATININE SERUM	$48.80	$61.00	$4.24–$61.00	13% above	20%
Cytomegalovirus (CMV) antibody test CPT 86644 HC CMV ANTIBODY - CMV IGG	$88.00	$110.00	$11.90–$110.00	15% below	20%
D-dimer blood test (blood clot marker) CPT 85379 HC FIBRIN DEGRADPRODUCTSD-DIMER QUANT - D-DIMERQUANTITATIVE	$131.20	$164.00	$8.43–$164.00	17% above	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC DEHYDROEPIANDROSTERONE-SULFATE - DHEA-SULFATE	$154.40	$193.00	$18.39–$193.00	2% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG OF ABUSE SCREEN	$224.00	$280.00	$51.41–$280.00	19% above	20%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 CHG ELECTROLYTE PANEL	$42.40	$53.00	$5.80–$53.00	42% below	20%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTE PANEL - BUNDLED CHARGE	$54.40	$68.00	$5.80–$68.00	26% below	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC EPSTEIN B VIRUS-VCA	$28.00	$35.00	$15.01–$35.00	70% below	20%
Estradiol blood test CPT 82670 HC ASSAY OF ESTRADIOL - ESTRADIOL	$126.40	$158.00	$23.12–$158.00	15% below	20%
FSH (follicle-stimulating hormone) test CPT 83001 HC GONADOTROPIN (FSH) - FSH	$253.60	$317.00	$15.37–$317.00	103% above	20%
Fecal calprotectin (stool inflammation test) CPT 83993 HC CALPROTECTIN	$412.00	$515.00	$16.25–$515.00	59% above	20%
Ferritin blood test (iron stores) CPT 82728 HC ASSAY OF FERRITIN - FERRITIN	$92.80	$116.00	$11.28–$116.00	at median	20%
Fibrinogen blood test CPT 85384 HC FIBRINOGEN ACTIVITY - FIBRINOGENQUANTITATIVE	$92.00	$115.00	$8.05–$115.00	1% below	20%
Folate (folic acid) blood test CPT 82746 HC BLOOD FOLIC ACID SERUM - FOLATE	$104.00	$130.00	$12.16–$130.00	14% above	20%
Free T3 thyroid hormone test CPT 84481 HC TRIIODOTHYRONINE FREE ASSAY (FT-3) - T3 FREE	$111.20	$139.00	$14.01–$139.00	at median	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 CHG ASSAY OF FREE THYROXINE	$32.00	$40.00	$7.47–$40.00	58% below	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC ASSAY OF FREE THYROXINE - T4 FREE	$64.00	$80.00	$7.47–$80.00	15% below	20%
Free testosterone test CPT 84402 HC ASSAY OF TESTOSTERONE - TESTOSTERONE TOTAL FREE	$159.20	$199.00	$21.07–$199.00	19% above	20%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC ASSAY OF GGT - GAMMA GT	$51.20	$64.00	$5.96–$64.00	21% above	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HC GENERAL HEALTH PANEL - BUNDLED CHARGE	$96.00	$120.00	$51.49–$120.00	65% below	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE & DOSE 82950	$86.40	$108.00	$3.93–$108.00	40% above	20%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE TEST (GTT) - GTT 2 HOUR	$188.00	$235.00	$10.65–$235.00	79% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N GONORRHOEAE NUC. ACID	$89.60	$112.00	$29.03–$112.00	10% below	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ	$113.60	$142.00	$29.03–$142.00	14% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N.GONORRHOEAE DNA AMP PROB - GC DNA PCR	$124.00	$155.00	$29.03–$155.00	24% above	20%
H. pylori stool antigen test CPT 87338 HC IAAD IA HPYLORI STOOL - H PYLORI ANTIGEN STOOL	$77.60	$97.00	$11.89–$97.00	9% below	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV-1 QUANT&REVRSE TRNSCRPJ - HIV 1 RNA QUANT BY PCR	$298.40	$373.00	$70.41–$373.00	19% below	20%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV-1/HIV-2 SINGLE ASSAY - RAPID HIV 1 AND 2 SCREEN	$80.00	$100.00	$11.34–$100.00	4% below	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE	$65.60	$82.00	$19.92–$82.00	16% below	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV1 AG HIV 1 2 AB	$100.00	$125.00	$19.92–$125.00	28% above	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV DNA PROBE AMP	$149.60	$187.00	$29.03–$187.00	at median	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 CHG HEMOGLOBIN GLYCOSYLATED A1C	$43.20	$54.00	$8.04–$54.00	35% below	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC GLYCOSYLATED HEMOGLOBIN TEST - HEMOGLOBIN A1C	$64.00	$80.00	$8.04–$80.00	4% below	20%
Hemoglobin blood test CPT 85018 CHG BLOOD COUNT HEMOGLOBIN	$19.20	$24.00	$1.96–$24.00	33% below	20%
Hemoglobin blood test CPT 85018 HC HEMOGLOBIN - HEMOGLOBIN	$22.40	$28.00	$1.96–$28.00	22% below	20%
Hepatitis B core antibody test (total) CPT 86704 HC HEP B CORE AB TEST TOTAL - HEPATITIS B CORE ANTIBODY TOTAL	$82.40	$103.00	$9.98–$103.00	9% below	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURFACE AB TEST - HEPATITIS B SURFACE ANTIBODY	$88.00	$110.00	$8.88–$110.00	8% above	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN - HEPATITIS B SURFACE ANTIGEN	$101.60	$127.00	$8.55–$127.00	34% above	20%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C AB TEST - HEPATITIS C ANTIBODY	$139.20	$174.00	$11.81–$174.00	21% above	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION - HCV QUANT PCR	$884.80	$1,106.00	$35.44–$1,106.00	74% above	20%
Herpes blood test, HSV-1 antibody CPT 86695 HC HERPES SIMPLEX TEST TYPE 1 - HSV 1 IGG ANTIBODY	$75.20	$94.00	$10.92–$94.00	18% below	20%
Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES SIMPLEX TEST TYPE 2 - HSV 2 IGG ANTIBODY	$116.00	$145.00	$16.01–$145.00	20% above	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-REACTIVE PROTEINHIGH SENSITIVITY - HIGH SENSITIVITY CRP	$80.00	$100.00	$10.72–$100.00	3% above	20%
Homocysteine blood test CPT 83090 HC ASSAY OF HOMOCYSTINE - HOMOCYSTEINE TOTAL	$111.20	$139.00	$14.83–$139.00	17% below	20%
Insulin blood test CPT 83525 HC ASSAY OF INSULINTOTAL - INSULIN TOTAL	$126.40	$158.00	$9.46–$158.00	45% above	20%
Iron blood test (serum iron) CPT 83540 HC ASSAY OF IRON - IRON	$36.80	$46.00	$5.36–$46.00	41% below	20%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING TEST - IRON AND IRON BINDING CAPACITY PANEL - SR OR PL	$47.20	$59.00	$7.23–$59.00	29% below	20%
Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL - BUNDLED CHARGE	$39.20	$49.00	$7.18–$49.00	65% below	20%
LH (luteinizing hormone) test CPT 83002 HC GONADOTROPIN (LH) - LUTEINIZING HORMONE	$120.80	$151.00	$15.32–$151.00	6% above	20%
Lactate (lactic acid) blood test CPT 83605 HC ASSAY OF LACTIC ACID - LACTATE	$138.40	$173.00	$9.58–$173.00	at median	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE	$47.20	$59.00	$5.00–$59.00	at median	20%
Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE - LIPASE	$62.40	$78.00	$5.70–$78.00	28% below	20%
Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL - BUNDLED CHARGE	$46.40	$58.00	$6.76–$58.00	40% below	20%
Lyme disease antibody test CPT 86618 HC LYMES TOTAL	$177.60	$222.00	$14.09–$222.00	43% above	20%
Magnesium blood test CPT 83735 HC SUPERSATURATION MAGNESIUM	$77.60	$97.00	$5.55–$97.00	20% above	20%
Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM - MAGNESIUM	$77.60	$97.00	$5.55–$97.00	20% above	20%
Measles (rubeola) antibody test CPT 86765 HC RUBEOLA - RUBEOLA ANTIBODY IGG	$43.20	$54.00	$10.66–$54.00	31% below	20%
Mono test (heterophile antibody, Monospot) CPT 86308 CHG HETEROPHILE ANTIBODIES SCREEN	$20.00	$25.00	$4.28–$25.00	69% below	20%
Mono test (heterophile antibody, Monospot) CPT 86308 HC HETEROPHILE ANTIBODIESSCREEN - MONONUCLEOSIS SCREEN	$24.00	$30.00	$4.28–$30.00	63% below	20%
Mumps immunity blood test CPT 86735 HC MUMPS - MUMPS IGG ANTIBODY	$48.80	$61.00	$10.80–$61.00	5% below	20%
Obstetric blood test panel CPT 80055 HC OBSTETRIC PANEL - BUNDLED CHARGE	$143.20	$179.00	$51.20–$179.00	52% below	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PSA FREE	$85.60	$107.00	$15.22–$107.00	25% below	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATE SPECIFIC ANTIGENTOTAL - PSA	$82.40	$103.00	$15.22–$103.00	26% below	20%
Pap test (liquid-based, automated screening with review) CPT 88175 CHG CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS	$64.80	$81.00	$22.02–$81.00	18% below	20%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CHG CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN	$28.00	$35.00	$16.77–$35.00	55% below	20%
Parathyroid hormone (PTH) blood test CPT 83970 HC ASSAY OF PARATHORMONE - PTH INTACT	$260.00	$325.00	$34.15–$325.00	26% above	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD	$24.00	$30.00	$4.97–$30.00	59% below	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLAS TIME PARTIAL - APTT	$57.60	$72.00	$4.97–$72.00	1% below	20%
Phosphorus (phosphate) blood test CPT 84100 HC ASSAY OF INORGANIC PHOSPHORUS - PHOSPHORUS	$59.20	$74.00	$3.92–$74.00	12% above	20%
Potassium blood test CPT 84132 HC ASSAY OF SERUM POTASSIUM - POTASSIUM	$48.80	$61.00	$3.94–$61.00	2% above	20%
Progesterone blood test CPT 84144 HC ASSAY OF PROGESTERONE - PROGESTERONE	$167.20	$209.00	$17.26–$209.00	25% above	20%
Prolactin blood test CPT 84146 HC ASSAY OF PROLACTIN - PROLACTIN	$126.40	$158.00	$16.04–$158.00	5% above	20%
Prothrombin time (PT/INR) clotting test CPT 85610 CHG PROTHROMBIN TIME	$24.00	$30.00	$3.55–$30.00	27% below	20%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME - PROTIME-INR	$39.20	$49.00	$3.55–$49.00	19% above	20%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME - PROTHROMBIN MIXING STUDY	$39.20	$49.00	$3.55–$49.00	19% above	20%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC DRUG SCR PRESUMP DIRECT OPTICAL OBS	$153.60	$192.00	$10.42–$192.00	31% above	20%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC MRO REVIEW-HAIR DRUG TESTING	$253.60	$317.00	$10.42–$317.00	116% above	20%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC HAIR DRUG TEST	$253.60	$317.00	$10.42–$317.00	116% above	20%
Rapid flu test (influenza antigen) CPT 87804 CHG IAADIADOO INFLUENZA	$54.40	$68.00	$13.70–$68.00	3% below	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 CHG IAADIADOO STREPTOCOCCUS GROUP A	$52.80	$66.00	$13.68–$66.00	8% above	20%
Renin blood test CPT 84244 HC ASSAY OF RENIN - RENIN DIRECT ASSAY	$154.40	$193.00	$18.19–$193.00	10% below	20%
Rh blood typing CPT 86901 CHG BLOOD TYPING SEROLOGIC RH (D)	$20.80	$26.00	$2.47–$43.72	63% below	20%
Rh blood typing CPT 86901 HC BLOOD TYPING SEROLOGIC RH (D) Ã» ABO/RH TYPE	$75.20	$94.00	$2.47–$94.00	35% above	20%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QUANT - RHEUMATOID FACTOR	$46.40	$58.00	$4.69–$58.00	23% below	20%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA ANTIBODY SCRN IGG	$62.40	$78.00	$11.90–$78.00	4% below	20%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC RBC SED RATE AUTO - SEDIMENTATION RATE AUTOMATED	$22.40	$28.00	$2.23–$28.00	47% below	20%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 CHG SEDIMENTATION RATE RBC AUTOMATED	$25.60	$32.00	$2.23–$32.00	40% below	20%
Sodium blood test CPT 84295 HC ASSAY OF SERUM SODIUM - SODIUM	$56.00	$70.00	$3.98–$70.00	21% above	20%
Stool ova and parasites exam CPT 87177 HC OVA AND PARASITES SMEARS - OVA AND PARASITE EXAMINATION	$80.80	$101.00	$7.36–$101.00	17% above	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC BLD OCC FECAL HGB DETERM	$107.20	$134.00	$13.18–$134.00	111% above	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC FLUORES TREPONEMAL AB	$39.20	$49.00	$10.95–$49.00	42% below	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - RAPID PLASMA REAGIN-SYP	$57.60	$72.00	$3.53–$72.00	14% above	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON	$64.80	$81.00	$51.28–$81.00	66% below	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB TEST CELL MEDIATED ANTIGEN RESPONSEGAMMA INTERFRON - TB TEST	$195.20	$244.00	$51.28–$244.00	3% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 HC ASSAY OF TOTAL TESTOSTERONE - TESTOSTERONE	$165.60	$207.00	$21.36–$207.00	25% above	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC ANTITHYROID AB ANTI TPO	$76.80	$96.00	$12.04–$96.00	17% below	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC LIVER KDNEY MIC TYP1 AB	$76.80	$96.00	$12.04–$96.00	17% below	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH	$81.60	$102.00	$13.90–$102.00	10% below	20%
Total IgE blood test CPT 82785 HC ASSAY OF GAMMAGLOBULIN IGE - IMMUNOGLOBULIN IGE	$77.60	$97.00	$13.62–$97.00	9% below	20%
Total cholesterol blood test CPT 82465 HC ASSAY BLD/SERUM CHOLESTEROL - CHOLESTEROL TOTAL	$30.40	$38.00	$3.60–$38.00	14% below	20%
Total thyroxine (T4) blood test CPT 84436 HC ASSAY OF TOTAL THYROXINE - T4 (THYROID HORMONE)	$52.80	$66.00	$5.68–$66.00	7% below	20%
Total triiodothyronine (T3) blood test CPT 84480 HC TRIIODOTHYRONINE TOTAL ASSAY TT-3 - T3 (THYROID HORMONE)	$52.80	$66.00	$11.73–$66.00	41% below	20%
Transferrin blood test CPT 84466 HC ASSAY OF TRANSFERRIN - TRANSFERRIN	$76.80	$96.00	$10.55–$96.00	31% below	20%
Triglycerides blood test CPT 84478 HC ASSAY OF TRIGLYCERIDES - TRIGLYCERIDES	$59.20	$74.00	$4.75–$74.00	41% above	20%
Troponin test, quantitative CPT 84484 CHG ASSAY OF TROPONIN QUANTITATIVE	$88.80	$111.00	$10.32–$111.00	3% below	20%
Troponin test, quantitative CPT 84484 HC ASSAY OF TROPONIN QUANT - TROPONIN T	$106.40	$133.00	$10.32–$133.00	16% above	20%
Uric acid blood test CPT 84550 CHG ASSAY OF BLOOD/URIC ACID	$7.20	$9.00	$3.74–$9.00	82% below	20%
Uric acid blood test CPT 84550 HC ASSAY OF URIC ACID BLOOD - URIC ACID	$34.40	$43.00	$3.74–$43.00	16% below	20%
Urinalysis with microscope exam, automated CPT 81001 CHG URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY	$20.00	$25.00	$2.62–$25.00	54% below	20%
Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS AUTO W/SCOPE - URINALYSIS MICROSCOPIC	$23.20	$29.00	$2.62–$29.00	47% below	20%
Urinalysis without microscope exam, automated CPT 81003 CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY	$15.20	$19.00	$1.86–$19.00	44% below	20%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTO W/O SCOPE - URINALYSIS CHEM ONLY	$17.60	$22.00	$1.86–$22.00	35% below	20%
Urinalysis without microscope exam, manual CPT 81002 CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP	$15.20	$19.00	$2.88–$19.00	at median	20%
Urinalysis without microscope exam, manual CPT 81002 HC URINALYSIS DIP STICK NON-AUTO W/O MICROSCP	$17.60	$22.00	$2.88–$22.00	16% above	20%
Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE	$35.20	$44.00	$6.68–$44.00	61% below	20%
Urine culture for bacteria, with colony count CPT 87086 HC CULTURE URINE	$71.20	$89.00	$6.68–$89.00	21% below	20%
Urine microalbumin (albumin) test CPT 82043 HC MICROALBUMIN QUANTITATIVE - MICROALBUMIN / CREATININE URINE RATIO	$52.00	$65.00	$4.78–$65.00	5% below	20%
Urine pregnancy test, read by color change CPT 81025 SERTRALINE HCL 25 MG PO TABS	$32.00	$40.00	$7.13–$40.00	27% below	20%
Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY TEST - PREGNANCY URINE	$44.00	$55.00	$7.13–$55.00	at median	20%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN B-12 - VITAMIN B12	$102.40	$128.00	$12.47–$128.00	11% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC ASSAY OF VIT DCALCIFEDIOL W FRACTIONS IF PERFORMED - VITAMIN D 25	$116.80	$146.00	$24.49–$146.00	15% below	20%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC ASSAY DIHYDROXYVITAMIN D W/FRACTIONS IF PERFORMED - VITAMIN D 1	$265.60	$332.00	$31.85–$332.00	20% above	20%
Zinc blood test CPT 84630 HC ASSAY OF ZINC - ZINC	$104.00	$130.00	$9.42–$130.00	9% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC CHORIONIC GONADOTROPIN QUANT - HCG QUANTITATIVE BLOOD	$99.20	$124.00	$12.45–$124.00	14% below	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Adenoid removal (adenoidectomy), child under 12 CPT 42830 PR ADENOIDECTOMY PRIMARY <AGE 12	$554.40	$693.00	$204.96–$3,612.26	7% below	20%
Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 PR ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2	$4,201.60	$5,252.00	$1,622.80–$14,331.57	41% below	20%
Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 PR APPENDEC RPTD APPENDIX ABSC/PRITONITIS	$2,280.80	$2,851.00	$830.75–$2,851.00	11% above	20%
Appendectomy, open surgery CPT 44950 PR APPENDECTOMY	$1,681.60	$2,102.00	$609.14–$6,950.08	11% above	20%
Balloon dilation of the maxillary sinus opening, one side CPT 31295 PR NASAL/SINUS NDSC SURG W/DILATION MAXILLARY SINUS	$633.60	$792.00	$554.40–$7,710.53	64% below	20%
Botox injections for chronic migraine CPT 64615 PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$401.60	$502.00	$146.29–$502.00	68% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC ED CLSD TX ANDKLE FX WO MANIP	$470.40	$588.00	$256.91–$588.00	3% below	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 PR CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ	$926.40	$1,158.00	$256.91–$1,158.00	91% above	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC ED 28470 CLSD TX METATARSAL FX WO MANIP	$470.40	$588.00	$213.89–$588.00	39% above	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 PR CLOSED TX METATARSAL FRACTURE W/O MANIPULATION	$624.00	$780.00	$213.89–$780.00	84% above	20%
Cardiac catheterization with coronary angiogram CPT 93458 PR CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I	$1,708.00	$2,135.00	$971.95–$3,582.57	86% below	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC EP CARDIOVERSION ELECTIVE;EXTERN	$867.20	$1,084.00	$145.05–$1,084.00	at median	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC ED CARDIOVERSION ELECTRIC EXT - CARDIOVERSION EXTERNAL	$867.20	$1,084.00	$145.05–$1,084.00	at median	20%
Cataract surgery with lens implant CPT 66984 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP	$1,706.40	$2,133.00	$510.02–$2,540.37	6% below	20%
Cervical biopsy CPT 57500 PR BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX	$477.60	$597.00	$146.27–$969.86	33% above	20%
Cesarean delivery, including prenatal and postpartum care CPT 59510 PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM	$7,088.00	$8,860.00	$3,143.17–$8,860.00	25% above	20%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 PR CIRCUMCISION AGE >28 DAYS	$607.20	$759.00	$186.93–$2,281.71	8% above	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 GUAIFENESIN-DM 100-10 MG/5ML PO SYRP	$406.40	$508.00	$140.87–$2,281.71	95% above	20%
Circumcision, surgical, older than a newborn CPT 54160 PR CIRCUMCISION NEONATE	$406.40	$508.00	$210.39–$743.45	28% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC ED CLSD TX DISTAL RADIAL FX	$860.80	$1,076.00	$256.91–$1,076.00	88% above	20%
Colonoscopy with endoscopic ultrasound CPT 45391 PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX	$865.60	$1,082.00	$239.64–$1,313.30	at median	20%
Colonoscopy with polyp removal CPT 45385 PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ	$1,015.20	$1,269.00	$429.69–$1,313.30	52% below	20%
Colonoscopy with tissue sample CPT 45380 PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE	$761.60	$952.00	$410.48–$1,313.30	60% below	20%
Colonoscopy, diagnostic CPT 45378 PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD	$590.40	$738.00	$321.95–$1,015.50	67% below	20%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 PR COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX	$1,255.20	$1,569.00	$298.52–$3,541.49	42% above	20%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 PR COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE	$589.60	$737.00	$161.01–$737.00	69% above	20%
Complex cataract surgery with lens implant CPT 66982 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH CPLX WO ECP	$2,016.00	$2,520.00	$698.64–$2,540.37	8% below	20%
Coronary stent placement, one artery CPT 92928 PR PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH	$2,098.40	$2,623.00	$541.87–$12,631.58	60% below	20%
Cystoscopy with ureteral stent placement CPT 52332 PR CYSTO W/INSERT URETERAL STENT	$558.40	$698.00	$378.92–$3,841.60	9% below	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 PR CYSTOURETHROSCOPY	$536.80	$671.00	$227.24–$743.45	21% above	20%
D&C (dilation and curettage), not related to pregnancy CPT 58120 PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC	$740.00	$925.00	$284.82–$3,541.49	at median	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 PR DESTRUCTION PREMALIGNANT LESION 1ST	$206.40	$258.00	$64.48–$258.00	20% above	20%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 PR TYMPANOSTOMY GENERAL ANESTHESIA	$432.80	$541.00	$152.86–$1,649.91	69% below	20%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 BUTALBITAL-ASA-CAFF-CODEINE 50-325-40-30 MG PO CAPS	$454.40	$568.00	$193.06–$568.00	4% above	20%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC ED 69209 REMOVAL IMPACTED CERUMEN UNILATERAL	$60.80	$76.00	$15.17–$76.00	38% above	20%
Earwax removal with instruments, one ear one side CPT 69210 HC ED REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT	$163.20	$204.00	$45.48–$204.00	91% above	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX	$283.20	$354.00	$96.62–$354.00	15% above	20%
Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 PR NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY	$1,095.20	$1,369.00	$303.95–$7,710.53	at median	20%
Endoscopic sinus surgery: opening the frontal sinus CPT 31276 PR NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS	$1,381.60	$1,727.00	$355.70–$7,710.53	4% below	20%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 PR NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY	$538.40	$673.00	$169.51–$4,106.67	18% below	20%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 PR NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS	$872.00	$1,090.00	$249.97–$7,710.53	at median	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN	$572.00	$715.00	$249.38–$771.36	51% below	20%
Eye injection into the vitreous (intravitreal injection) CPT 67028 PR INTRAVITREAL NJX PHARMACOLOGIC AGT SPX	$364.00	$455.00	$106.50–$455.00	21% below	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL	$383.20	$479.00	$168.44–$991.64	66% below	20%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 PR RPR AA HERNIA 1ST 3-10 CM REDUCIBLE	$840.00	$1,050.00	$540.56–$6,950.08	5% below	20%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 PR RPR AA HERNIA 1ST > 10 CM REDUCIBLE	$953.60	$1,192.00	$727.14–$6,950.08	90% below	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 PR RPR AA HERNIA 1ST < 3 CM REDUCIBLE	$483.20	$604.00	$323.10–$3,930.80	at median	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD	$282.40	$353.00	$176.69–$1,015.50	74% below	20%
Gallbladder removal, laparoscopic CPT 47562 PR LAPAROSCOPY SURG CHOLECYSTECTOMY	$1,931.20	$2,414.00	$628.10–$6,498.54	3% above	20%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY	$1,967.20	$2,459.00	$682.62–$6,498.54	at median	20%
Gallbladder removal, open surgery through a larger incision CPT 47600 PR CHOLECYSTECTOMY	$3,447.20	$4,309.00	$1,014.30–$4,309.00	20% above	20%
Hemorrhoid banding (rubber band ligation) CPT 46221 PR HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS	$649.60	$812.00	$269.50–$1,015.50	2% below	20%
Hemorrhoidectomy (internal and external), one area CPT 46255 PR HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP	$1,018.40	$1,273.00	$494.26–$3,054.58	23% above	20%
Hysterectomy through an abdominal incision (total) CPT 58150 PR TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY	$5,075.20	$6,344.00	$966.27–$6,344.00	41% above	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 PR CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI	$295.20	$369.00	$229.49–$369.00	at median	20%
Hysteroscopy with endometrial ablation CPT 58563 PR HYSTEROSCOPY ENDOMETRIAL ABLATION	$2,000.80	$2,501.00	$1,750.70–$5,498.42	18% below	20%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C	$2,543.20	$3,179.00	$1,250.20–$3,541.49	at median	20%
IUD insertion (the device itself billed separately) CPT 58300 PR INSERTION INTRAUTERINE DEVICE IUD	$340.00	$425.00	$104.60–$425.00	18% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 HC ED DRAIN SKIN ABSCESS SIMPLE	$416.00	$520.00	$121.02–$520.00	89% above	20%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE	$1,474.40	$1,843.00	$498.88–$3,930.80	46% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS	$260.80	$326.00	$54.96–$328.80	79% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ED ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	$303.20	$379.00	$61.88–$379.00	10% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	$315.20	$394.00	$61.88–$394.00	14% above	20%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 PR INSERTION DRUG DELIVERY IMPLANT	$430.40	$538.00	$95.67–$538.00	50% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US	$264.00	$330.00	$52.43–$330.00	29% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ED ASP INJ JOINT BURSA SMALL WO US GUID	$418.40	$523.00	$51.17–$523.00	143% above	20%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 PR LAPAROSCOPIC APPENDECTOMY	$1,376.80	$1,721.00	$573.29–$6,498.54	at median	20%
Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 PR LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/<	$2,006.40	$2,508.00	$768.78–$11,596.44	6% below	20%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 PR LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY	$2,264.00	$2,830.00	$865.66–$11,596.44	17% below	20%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA	$974.40	$1,218.00	$413.77–$6,498.54	at median	20%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 PR LAPS SURG RPR RECURRENT INGUINAL HERNIA	$1,511.20	$1,889.00	$539.90–$6,498.54	at median	20%
Laparoscopic removal of an adjustable gastric band and its port CPT 43774 PR LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT	$2,444.80	$3,056.00	$911.12–$4,237.64	at median	20%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES	$1,463.20	$1,829.00	$620.06–$6,498.54	at median	20%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 PR POST-CATARACT LASER SURGERY	$796.80	$996.00	$315.43–$996.00	10% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC ED LAYR CLOS WND TRUNKARMLEG <2.5 CM	$728.00	$910.00	$249.96–$910.00	76% above	20%
Lower-back epidural injection, with imaging guidance CPT 62323 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN	$566.40	$708.00	$245.27–$771.36	8% below	20%
Lower-back epidural injection, without imaging guidance CPT 62322 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN	$289.60	$362.00	$128.28–$991.64	31% below	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL	$522.40	$653.00	$233.89–$991.64	50% below	20%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 PR LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR	$2,614.40	$3,268.00	$877.99–$7,956.97	35% below	20%
Lumbar fusion with interbody cage and posterolateral graft (TLIF), one level CPT 22633 PR ARTHRODESIS COMBINED TQ 1NTRSPC LUMBAR	$4,451.20	$5,564.00	$1,723.59–$20,483.57	—	20%
Lumbar laminectomy (spinal decompression), one level CPT 63047 PR LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT LUMBAR	$2,822.40	$3,528.00	$1,059.43–$7,956.97	34% below	20%
Lumbar spinal fusion (posterior), one level CPT 22612 PR ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC LUMBAR	$4,871.20	$6,089.00	$1,506.58–$20,483.57	at median	20%
Lumpectomy (partial mastectomy) CPT 19301 PR MASTECTOMY PARTIAL	$1,658.40	$2,073.00	$628.47–$4,265.21	at median	20%
Mastectomy (total removal of the breast) CPT 19303 PR MASTECTOMY SIMPLE COMPLETE	$2,602.40	$3,253.00	$910.65–$7,263.86	at median	20%
Miscarriage treatment with D&C, first trimester CPT 59820 PR TX MISSED ABORTION FIRST TRIMESTER SURGICAL	$1,672.00	$2,090.00	$528.63–$3,541.49	40% below	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<	$413.60	$517.00	$122.29–$783.68	85% above	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<	$454.40	$568.00	$136.85–$783.68	54% above	20%
Nail removal (partial or complete), one nail CPT 11730 HC ED REMOVAL OF NAIL PLATE	$267.20	$334.00	$109.35–$334.00	41% above	20%
Occipital nerve block (injection for headaches) CPT 64405 PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE	$271.20	$339.00	$71.63–$339.00	8% below	20%
Pacemaker implant (dual chamber) CPT 33208 PR INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT	$3,046.40	$3,808.00	$480.91–$11,656.70	84% below	20%
Paracentesis with imaging guidance CPT 49083 PR ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE	$812.00	$1,015.00	$275.29–$1,044.30	at median	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC ED REMOVAL OF NAIL BED	$774.40	$968.00	$152.96–$968.00	107% above	20%
Prostate biopsy CPT 55700 PR PROSTATE NEEDLE BIOPSY ANY APPROACH	$659.20	$824.00	$228.42–$2,281.71	1% below	20%
Prostate removal (prostatectomy), laparoscopic CPT 55866 PR LAPS PROSTECT RETROPUBIC RAD W/NRV SPARING ROBOT	$5,384.80	$6,731.00	$1,121.66–$11,596.44	3% above	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL	$1,031.20	$1,289.00	$419.10–$2,175.08	27% below	20%
Removal of a breast lump, open surgery CPT 19120 PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION	$1,118.40	$1,398.00	$496.40–$4,265.21	at median	20%
Removal of a foreign object under the skin, simple CPT 10120 HC ED REMOVE FOREIGN BODY SIMPLE	$912.00	$1,140.00	$145.05–$1,140.00	193% above	20%
Removal of one lobe of the thyroid (lobectomy) CPT 60220 PR TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY	$2,059.20	$2,574.00	$672.40–$6,498.54	at median	20%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 PR COLON CA SCRN NOT HI RSK IND	$589.60	$737.00	$322.25–$1,015.50	69% below	20%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 PR COLORECTAL SCRN; HI RISK IND	$589.60	$737.00	$321.95–$1,015.50	56% below	20%
Septoplasty to straighten the nasal septum CPT 30520 PR SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF	$1,406.40	$1,758.00	$645.34–$3,612.26	at median	20%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 PR LITHOTRIPSY XTRCORP SHOCK WAVE	$3,019.20	$3,774.00	$703.09–$3,841.60	42% above	20%
Short arm cast (elbow to hand) CPT 29075 HC ED 29075 APPL CAST FOREARM ARM	$256.00	$320.00	$84.96–$320.00	20% above	20%
Short arm splint (forearm and hand) CPT 29125 HC APPL SHORT ARM SPLINT STATIC	$116.00	$145.00	$64.76–$145.00	27% below	20%
Short arm splint (forearm and hand) CPT 29125 HC ED APPLY FOREARM SPLINTSTATIC	$238.40	$298.00	$64.76–$298.00	50% above	20%
Short leg cast (below the knee) CPT 29405 HC ED 29405 APPL CAST SHORT LEG	$260.80	$326.00	$77.70–$326.00	16% above	20%
Short leg cast (below the knee) CPT 29405 PR APPLICATION SHORT LEG CAST BELOW KNEE-TOE	$260.80	$326.00	$77.70–$326.00	16% above	20%
Short leg splint (calf to foot) CPT 29515 HC ED APPLY LOWER LEG SPLINT	$393.60	$492.00	$69.82–$492.00	106% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC ED RESUPERF WND BODY <2.5CM	$428.80	$536.00	$89.70–$536.00	73% above	20%
Skin biopsy, punch, one lesion CPT 11104 PR PUNCH BIOPSY SKIN SINGLE LESION	$628.80	$786.00	$118.84–$786.00	96% above	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 PR EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/<	$571.20	$714.00	$188.01–$783.68	74% above	20%
Skin tag removal, up to 15 tags CPT 11200 PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15	$264.00	$330.00	$88.16–$330.00	43% above	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC ED SPINAL PUNCTURELUMBARDIAGNOSTIC	$601.60	$752.00	$138.63–$771.36	38% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC ED RESUP NPTERF WND BODY 2.6-7.5 CM	$528.80	$661.00	$108.63–$661.00	91% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC ED RESUPERF WND FACE <2.5 CM	$670.40	$838.00	$106.74–$838.00	91% above	20%
TURP (transurethral resection of the prostate) CPT 52601 PR TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE	$3,876.80	$4,846.00	$686.05–$5,662.34	at median	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 PR TANGENTIAL BIOPSY SKIN SINGLE LESION	$500.80	$626.00	$95.46–$626.00	115% above	20%
Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING	$3,063.20	$3,829.00	$295.53–$3,829.00	230% above	20%
Tonsil and adenoid removal, age 12 or older CPT 42821 PR TONSILLECTOMY & ADENOIDECTOMY AGE 12/>	$812.00	$1,015.00	$291.76–$3,612.26	at median	20%
Tonsil and adenoid removal, child under 12 CPT 42820 PR TONSILLECTOMY & ADENOIDECTOMY <AGE 12	$780.00	$975.00	$279.43–$6,589.10	at median	20%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 PR TONSILLECTOMY PRIMARY/SECONDARY AGE 12/>	$672.00	$840.00	$245.68–$3,612.26	at median	20%
Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 PR TONSILLECTOMY PRIMARY/SECONDARY <AGE 12	$851.20	$1,064.00	$258.01–$6,589.10	at median	20%
Total thyroid removal (thyroidectomy) CPT 60240 PR THYROIDECTOMY TOTAL/COMPLETE	$3,272.00	$4,090.00	$870.36–$6,498.54	at median	20%
Trigger finger release surgery CPT 26055 PR TENDON SHEATH INCISION	$705.60	$882.00	$562.80–$1,782.60	at median	20%
Trigger point injections, 1 or 2 muscles CPT 20552 HC ED INJECT TRIGGER POINT 1 OR 2	$347.20	$434.00	$49.90–$434.00	91% above	20%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 PR LAPAROSCOPY FULGURATION OVIDUCTS	$2,449.60	$3,062.00	$355.05–$6,498.54	27% above	20%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM	$628.80	$786.00	$550.20–$2,112.95	53% below	20%
Upper endoscopy (EGD) with biopsy CPT 43239 PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE	$619.20	$774.00	$356.50–$1,044.30	60% below	20%
Upper endoscopy (EGD) with injection into the lining CPT 43236 PR ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION	$549.60	$687.00	$379.91–$1,044.30	19% below	20%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH	$688.00	$860.00	$467.41–$2,112.95	62% below	20%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS	$658.40	$823.00	$391.25–$1,044.30	at median	20%
Upper endoscopy (EGD), diagnostic CPT 43235 PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC	$540.00	$675.00	$272.73–$1,044.30	49% below	20%
Upper endoscopy with drainage of a pseudocyst through the stomach wall CPT 43240 PR EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST	$1,101.60	$1,377.00	$364.34–$6,630.48	at median	20%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 PR CYSTO W/URETEROSCOPY W/LITHOTRIPSY	$3,396.80	$4,246.00	$364.30–$5,662.34	at median	20%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT	$1,415.20	$1,769.00	$386.38–$5,662.34	67% below	20%
Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 PR ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB	$7,000.80	$8,751.00	$2,411.83–$8,751.00	34% above	20%
Vaginal delivery, including prenatal and postpartum care CPT 59400 PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM	$5,370.40	$6,713.00	$2,847.27–$6,713.00	11% above	20%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS	$1,888.80	$2,361.00	$318.80–$2,361.00	—	20%
Vein ablation, radiofrequency, first vein CPT 36475 PR ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN	$6,535.20	$8,169.00	$1,001.97–$8,169.00	130% above	20%
Wart removal, up to 14 warts CPT 17110 PR DESTRUCTION BENIGN LESIONS UP TO 14	$244.80	$306.00	$108.42–$306.00	29% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 THYROID 60 MG PO TABS	$297.60	$372.00	$123.23–$445.02	12% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC ED DEBRIDEMENT SKIN SUB-Q TISSUE=<20 SQ CM	$524.80	$656.00	$123.23–$656.00	97% above	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Montana	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION SERVICE	$1,246.40	$1,558.00	$40.15–$1,558.00	65% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC PF NEBULIZER TREATMENT	$116.00	$145.00	$7.58–$226.54	6% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 EPINEPHRINE FOR INHALATION 1 MG/ML	$251.20	$314.00	$7.58–$314.00	129% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 HC RT INHALATION TREATMENT	$80.80	$101.00	$7.58–$226.54	26% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 HC RT INHALATION TREATMENT - SUBSEQ DAY	$80.80	$101.00	$7.58–$226.54	26% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 HC RT HAND HELD NEBULIZER	$96.80	$121.00	$7.58–$226.54	12% below	20%
Chemotherapy IV infusion, first hour CPT 96413 PR CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG	$500.80	$626.00	$122.65–$626.00	1% below	20%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 PR OPH SVCS MEDICAL XM&EVAL COMPRE NEW PT 1/> VST	$221.60	$277.00	$138.02–$277.00	at median	20%
Comprehensive eye exam, returning patient CPT 92014 PR OPH SVCS MEDICAL XM&EVAL COMPRE EST PT 1/>VST	$178.40	$223.00	$119.19–$223.00	at median	20%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 PR COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ	$160.80	$201.00	$34.46–$201.00	32% above	20%
Critical care, first 30 to 74 minutes CPT 99291 HC ED CRITICAL CARE E&M 30-74 MIN	$2,197.60	$2,747.00	$258.38–$2,747.00	19% above	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY	$934.40	$1,168.00	$333.51–$1,168.00	17% above	20%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R	$55.20	$69.00	$13.59–$69.00	at median	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC ELECTROCARDIOGRAM TRACING	$164.80	$206.00	$5.99–$206.00	7% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC EMERGENCY DEPARTMENT LEVEL 1 VISIT LIMITED/MINOR PROB	$229.60	$287.00	$10.74–$287.00	10% above	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC EMERGENCY DEPARTMENT LEVEL 2 VISIT LOW/MODER SEVERITY	$422.40	$528.00	$39.15–$528.00	20% above	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC EMERGENCY DEPARTMENT LEVEL 3 VISIT MODERATE SEVERITY	$736.00	$920.00	$66.61–$920.00	38% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED VISIT LEVEL 4 W PROCEDURE	$1,160.00	$1,450.00	$113.33–$1,450.00	36% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED E/M VISIT - LEVEL 4	$1,160.00	$1,450.00	$113.33–$1,450.00	36% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED 99284 SANE VISIT LEVEL 4	$1,160.00	$1,450.00	$113.33–$1,450.00	36% above	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC EMERGENCY DEPARTMENT LEVEL 5 VISIT HIGH SEVERITY&THREAT FUNC	$1,660.80	$2,076.00	$164.15–$2,076.00	30% above	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 PR CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY	$127.20	$159.00	$35.72–$346.85	78% below	20%
Eye exam, returning patient, intermediate CPT 92012 PR OPH SVCS MEDICAL XM&EVAL INTERMEDIATE EST PT	$118.40	$148.00	$84.42–$148.00	at median	20%
Family therapy with the patient, 50 minutes CPT 90847 PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS	$349.60	$437.00	$97.03–$437.00	118% above	20%
Family therapy without the patient, 50 minutes CPT 90846 PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS	$259.20	$324.00	$92.61–$324.00	65% above	20%
Group psychotherapy session CPT 90853 PR GROUP PSYCHOTHERAPY	$92.00	$115.00	$26.24–$115.00	32% above	20%
Holter monitor, heart rhythm recording up to 48 hours, with report CPT 93224 PR XTRNL ECG REC<48 HRS RECORDING SCAN A/R R&I	$408.00	$510.00	$68.29–$510.00	at median	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC ED IV INFUSION HYDRATION 31-60 MIN	$351.20	$439.00	$30.67–$439.00	38% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV INFUSION HYDRATION 31-60 MIN	$398.40	$498.00	$30.67–$498.00	57% above	20%
IV infusion of a medicine, first hour CPT 96365 HC IV INFUSION THERAP/PROPH/DIAGNOSTINITIAL1ST HOUR	$396.80	$496.00	$59.42–$496.00	15% above	20%
IV push of a medicine, first drug CPT 96374 HC ED INJECTIONTHERAP/PROPH/DIAGNOST IV PUSH INITIAL DRUG	$212.80	$266.00	$34.78–$266.00	33% above	20%
IV push of a medicine, first drug CPT 96374 HC INJECTIONTHERAP/PROPH/DIAGNOST IV PUSH INITIAL DRUG	$212.80	$266.00	$34.78–$266.00	33% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJECTIONTHERAP/PROPH/DIAGNOST IM OR SUBCUT	$124.00	$155.00	$13.59–$155.00	58% above	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PR PSYCHIATRIC DIAGNOSTIC EVALUATION	$478.40	$598.00	$163.43–$598.00	117% above	20%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 PR NERVE CONDUCTION STUDIES 7-8 STUDIES	$641.60	$802.00	$165.96–$802.00	153% above	20%
New patient office visit, about 30 minutes CPT 99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES	$381.60	$477.00	$105.82–$477.00	129% above	20%
New patient office visit, about 45 minutes CPT 99204 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES	$537.60	$672.00	$158.57–$672.00	127% above	20%
New patient office visit, about 60 minutes CPT 99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES	$676.80	$846.00	$209.11–$846.00	103% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 PR OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES	$266.40	$333.00	$68.56–$333.00	86% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MED NUTR THER 1ST INDIV EA 15 MIN	$38.40	$48.00	$33.60–$48.00	15% below	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PR PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS	$190.40	$238.00	$95.16–$238.00	5% below	20%
Preventive checkup, new patient aged 18–39 CPT 99385 EMPLOYMENT PX NEW PT 18-39YR	$40.00	$50.00	$35.00–$122.29	80% below	20%
Preventive checkup, new patient aged 18–39 CPT 99385 BZN LIMITED PHYSICAL NEW 18-39 YO	$40.00	$50.00	$35.00–$122.29	80% below	20%
Preventive checkup, new patient aged 18–39 CPT 99385 SPORTS, CAMP, OTHER SPECIAL PX NEW PT 18-39YR	$40.00	$50.00	$35.00–$122.29	80% below	20%
Preventive checkup, new patient aged 18–39 CPT 99385 MSU SPORTS PHYSICAL NEW 18-39 YO	$76.00	$95.00	$66.50–$122.29	62% below	20%
Preventive checkup, new patient aged 18–39 CPT 99385 DOT PX NEW PT 18-39YR	$80.80	$101.00	$70.70–$122.29	59% below	20%
Preventive checkup, new patient aged 18–39 CPT 99385 FAA FLIGHT PX NEW PT 18-39YR	$144.80	$181.00	$122.29–$181.00	27% below	20%
Preventive checkup, new patient aged 18–39 CPT 99385 PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS	$370.40	$463.00	$122.29–$463.00	86% above	20%
Preventive checkup, new patient aged 40–64 CPT 99386 EMPLOYMENT PX NEW PT 40-64YR	$40.00	$50.00	$35.00–$140.94	83% below	20%
Preventive checkup, new patient aged 40–64 CPT 99386 BZN LIMITED PHYSICAL NEW 40-64 YO	$40.00	$50.00	$35.00–$140.94	83% below	20%
Preventive checkup, new patient aged 40–64 CPT 99386 SPORTS, CAMP, OTHER SPECIAL PX NEW PT 40-64 YR	$40.00	$50.00	$35.00–$140.94	83% below	20%
Preventive checkup, new patient aged 40–64 CPT 99386 DOT PX NEW PT 40-64YR	$80.80	$101.00	$70.70–$140.94	65% below	20%
Preventive checkup, new patient aged 40–64 CPT 99386 FAA FLIGHT PX NEW PT 40-64 YO	$144.80	$181.00	$126.70–$181.00	37% below	20%
Preventive checkup, new patient aged 40–64 CPT 99386 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS	$436.80	$546.00	$140.94–$546.00	90% above	20%
Preventive checkup, new patient aged 65 or older CPT 99387 BZN LIMITED PHYSICAL NEW 65 AND OVER	$40.00	$50.00	$35.00–$152.95	82% below	20%
Preventive checkup, new patient aged 65 or older CPT 99387 SPORTS, CAMP, OTHER SPECIAL PX NEW PT 65+YR	$40.00	$50.00	$35.00–$152.95	82% below	20%
Preventive checkup, new patient aged 65 or older CPT 99387 DOT PX NEW PT 65+YR	$80.80	$101.00	$70.70–$152.95	64% below	20%
Preventive checkup, new patient aged 65 or older CPT 99387 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>	$459.20	$574.00	$152.95–$574.00	102% above	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 BZN LIMITED PHYSICAL EST 18-39 YO	$39.20	$49.00	$34.30–$110.29	78% below	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 SPORTS, CAMP, OTHER SPECIAL PX EST PT 18-39YR	$40.00	$50.00	$35.00–$110.29	78% below	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 EMPLOYMENT PX EST PT 18-39YR	$40.00	$50.00	$35.00–$110.29	78% below	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 MSU SPORTS PHYSICAL EST 18-39 YO	$76.00	$95.00	$66.50–$110.29	57% below	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 DOT PX EST PT 18-39YR	$80.80	$101.00	$70.70–$110.29	55% below	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 FAA FLIGHT PX EST PT 18-39YR	$144.80	$181.00	$110.29–$181.00	19% below	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 PR PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS	$304.80	$381.00	$110.29–$381.00	71% above	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 SPORTS, CAMP, OTHER SPECIAL PX EST PT 40-64YR	$40.00	$50.00	$35.00–$117.24	79% below	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 BZN LIMITED PHYSICAL EST 40-64 YO	$40.00	$50.00	$35.00–$117.24	79% below	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 EMPLOYMENT PX EST PT 40-64YR	$40.00	$50.00	$35.00–$117.24	79% below	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 DOT PX EST PT 40-64 YR	$80.80	$101.00	$70.70–$117.24	58% below	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 DOT (MN) PX EST PT 40-64 YR	$80.80	$101.00	$70.70–$117.24	58% below	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 FAA FLIGHT PX EST PT 40-64YR	$144.80	$181.00	$117.24–$181.00	24% below	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 PR PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS	$337.60	$422.00	$117.24–$422.00	76% above	20%
Preventive checkup, returning patient aged 65 or older CPT 99397 DOT PX EST PT 65+ YR	$80.80	$101.00	$70.70–$126.09	57% below	20%
Preventive checkup, returning patient aged 65 or older CPT 99397 FAA FLIGHT PX EST PT 65+ YR	$144.80	$181.00	$126.09–$181.00	23% below	20%
Preventive checkup, returning patient aged 65 or older CPT 99397 PR PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER	$361.60	$452.00	$126.09–$452.00	93% above	20%
Psychiatric evaluation with medical services CPT 90792 PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES	$354.40	$443.00	$172.08–$443.00	16% above	20%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR	$266.40	$333.00	$113.76–$346.85	at median	20%
Psychotherapy for crisis, first 60 minutes CPT 90839 PR PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES	$352.80	$441.00	$139.08–$441.00	68% above	20%
Psychotherapy session, 30 minutes CPT 90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES	$164.80	$206.00	$74.28–$206.00	47% above	20%
Psychotherapy session, 45 minutes CPT 90834 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES	$234.40	$293.00	$97.99–$293.00	63% above	20%
Psychotherapy session, 60 minutes CPT 90837 PR PSYCHOTHERAPY W/PATIENT 60 MINUTES	$269.60	$337.00	$144.45–$337.00	46% above	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES	$50.40	$63.00	$13.91–$63.00	68% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN	$484.00	$605.00	$171.25–$605.00	76% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN	$246.40	$308.00	$86.26–$308.00	75% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN	$304.00	$380.00	$121.66–$380.00	52% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN	$189.60	$237.00	$53.72–$237.00	79% above	20%
Specialist consultation, low complexity or 30+ minutes CPT 99243 PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES	$436.80	$546.00	$106.50–$546.00	46% above	20%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES	$531.20	$664.00	$151.99–$664.00	37% above	20%
Speech and language evaluation CPT 92523 PR EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION	$317.60	$397.00	$216.24–$397.00	13% below	20%
Speech therapy session, individual CPT 92507 PR TX SPEECH LANG VOICE COMMJ&/AUD PROC DO INDIV	$180.00	$225.00	$72.40–$225.00	2% below	20%
Spirometry (breathing test) CPT 94010 PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ	$161.60	$202.00	$25.93–$202.00	6% above	20%
Spirometry before and after a bronchodilator CPT 94060 HC EVAL OF BRONCHOSPASM - SPIROMETRY WITH BRONCHODILATOR	$492.80	$616.00	$36.99–$616.00	11% above	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PR PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE	$172.00	$215.00	$90.73–$215.00	5% above	20%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 PR CV STRS TST XERS&/OR RX CONT ECG W/SI&R	$412.80	$516.00	$68.28–$516.00	5% above	20%
Visual field test, extended both sides CPT 92083 PR EXTENDED VISUAL FIELD XM UNI/BI I&R	$152.00	$190.00	$60.08–$190.00	—	20%

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 PR IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE	$63.20	$79.00	$55.30–$79.32	18% above	20%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 PR SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE	$163.20	$204.00	$142.80–$204.00	at median	20%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 COVID-19 MRNA VACC (MODERNA) 50 MCG/0.5ML IM SUSY	$163.20	$204.00	$142.80–$204.00	at median	20%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 HC SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE	$163.20	$204.00	$142.80–$204.00	at median	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 PR SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE	$138.40	$173.00	$121.10–$173.00	at median	20%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR	$176.00	$220.00	$154.00–$220.00	18% below	20%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE	$211.20	$264.00	$184.28–$264.00	2% below	20%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE	$71.20	$89.00	$62.26–$89.00	14% below	20%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTAP-IPV VACCINE IM SUSP	$71.20	$89.00	$62.26–$89.00	14% below	20%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTAP-IPV VACCINE 0.5 ML IM SUSY	$71.20	$89.00	$62.26–$89.00	14% below	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP	$32.80	$41.00	$28.70–$41.00	36% below	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 PR DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM	$32.80	$41.00	$28.70–$41.00	36% below	20%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR	$111.20	$139.00	$97.30–$139.00	at median	20%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DTAP-HEPATITIS B RECOMB-IPV IM SUSY	$112.00	$140.00	$98.00–$140.00	1% above	20%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE	$130.40	$163.00	$114.10–$163.00	at median	20%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTAP-IPV-HIB VACCINE IM SUSR	$131.20	$164.00	$114.80–$164.00	1% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY	$36.80	$46.00	$21.23–$46.00	52% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE	$36.80	$46.00	$21.23–$46.00	52% above	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV 9-VALENT RECOMB VACCINE IM SUSY	$353.60	$442.00	$309.40–$442.00	1% above	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV 9-VALENT RECOMB VACCINE IM (WRAPPED)	$353.60	$442.00	$309.40–$442.00	1% above	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 PR 9VHPV VACC 2/3 DOSE SCHED IM USE	$353.60	$442.00	$309.40–$442.00	1% above	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV 9-VALENT RECOMB VACCINE IM SUSP	$353.60	$442.00	$309.40–$442.00	1% above	20%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 PR HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM	$145.60	$182.00	$127.08–$182.00	at median	20%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEPATITIS A-HEP B RECOMB VAC 720-20 ELU-MCG/ML IM SUSY	$146.40	$183.00	$127.08–$183.00	1% above	20%
Hepatitis A vaccine, adult dose CPT 90632 PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE	$96.00	$120.00	$66.96–$120.00	at median	20%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE 1440 EL U/ML IM SUSP	$96.00	$120.00	$66.96–$120.00	at median	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE	$44.00	$55.00	$38.50–$55.00	9% below	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VACCINE 25 UNIT/0.5ML IM SUSP	$44.80	$56.00	$38.69–$56.00	7% below	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VACCINE 720 EL U/0.5ML IM SUSP	$44.80	$56.00	$38.69–$56.00	7% below	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSY	$80.80	$101.00	$66.86–$101.00	15% below	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE	$80.80	$101.00	$66.86–$101.00	15% below	20%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 PR HEPB VACCINE ADULT 2/4 DOSE SCHEDULE FOR IM USE	$168.00	$210.00	$147.00–$210.00	8% above	20%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HEPATITIS B VAC RECOMB ADJ 20 MCG/0.5ML IM SOSY	$170.40	$213.00	$149.10–$213.00	10% above	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY	$28.80	$36.00	$25.20–$36.00	20% below	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM	$32.00	$40.00	$28.00–$40.00	11% below	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSP	$32.00	$40.00	$28.00–$40.00	11% below	20%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE	$34.40	$43.00	$30.10–$43.00	28% below	20%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HAEMOPHILUS B POLYSAC CONJ VAC 7.5 MCG/0.5 ML IM SUSP	$35.20	$44.00	$30.79–$44.00	26% below	20%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE	$30.40	$38.00	$12.95–$38.00	14% below	20%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM	$76.00	$95.00	$66.50–$95.00	11% below	20%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 HC IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM	$76.00	$95.00	$66.50–$95.00	11% below	20%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY	$76.00	$95.00	$66.50–$95.00	11% below	20%
Japanese encephalitis vaccine (Ixiaro), 2-dose schedule CPT 90738 PR JAPANESE ENCEPHALITIS VACCINE INACTIVATED IM	$477.60	$597.00	$417.90–$597.00	—	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR	$109.60	$137.00	$94.51–$137.00	16% below	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 PR MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ	$109.60	$137.00	$94.51–$137.00	16% below	20%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MEASLES-MUMPS-RUBELLA-VARICELL SC SUSR	$320.00	$400.00	$280.00–$400.00	13% below	20%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 PR MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ	$320.00	$400.00	$280.00–$400.00	13% below	20%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE	$181.60	$227.00	$158.90–$227.00	at median	20%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL A C Y&W-135 OLIG IM SOLN	$181.60	$227.00	$158.90–$227.00	at median	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 PR MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM	$257.60	$322.00	$208.45–$322.00	8% below	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY	$257.60	$322.00	$208.45–$322.00	8% below	20%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PR PCV13 VACCINE FOR INTRAMUSCULAR USE	$240.00	$300.00	$210.00–$300.00	16% below	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY	$302.40	$378.00	$264.60–$378.00	5% below	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PR PCV20 VACCINE FOR INTRAMUSCULAR USE	$302.40	$378.00	$264.60–$378.00	5% below	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE	$135.20	$169.00	$118.30–$169.00	5% below	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY	$136.00	$170.00	$119.00–$170.00	4% below	20%
Polio vaccine, inactivated (IPV) CPT 90713 PR POLIOVIRUS VACCINE INACTIVATED SUBQ/IM	$48.80	$61.00	$42.70–$61.00	41% below	20%
Polio vaccine, inactivated (IPV) CPT 90713 POLIOVIRUS VACCINE INACTIVATED IJ INJ	$489.60	$612.00	$42.94–$612.00	490% above	20%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 NIRSEVIMAB-ALIP 100 MG/ML IM SOSY	$499.20	$624.00	$436.80–$624.00	56% below	20%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 PR RSV MONOC ANTB SEASN 1 ML IM	$523.20	$654.00	$457.80–$654.00	54% below	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 PR RSV MONOC ANTB SEASN .5ML IM	$296.00	$370.00	$259.00–$523.39	75% below	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5ML IM SOSY	$499.20	$624.00	$436.80–$624.00	59% below	20%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV PRE-FUSION F A&B VAC RCMB 120 MCG/0.5ML IM SOLR	$340.00	$425.00	$297.07–$425.00	13% below	20%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE	$340.00	$425.00	$297.07–$425.00	13% below	20%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 PR RSV VACC PREF RECOMB ADJT IM	$339.20	$424.00	$296.06–$424.00	13% above	20%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 RSVPREF3 VAC RECOMB ADJUVANTED 120 MCG/0.5ML IM SUSR	$339.20	$424.00	$296.06–$424.00	13% above	20%
Rabies vaccine, one dose CPT 90675 PR RABIES VACCINE INTRAMUSCULAR	$476.80	$596.00	$332.63–$596.00	12% below	20%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC IM SUSR	$477.60	$597.00	$332.63–$597.00	12% below	20%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE	$144.80	$181.00	$126.70–$181.00	at median	20%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTAVIRUS VAC LIVE PENTAVALENT PO SOLN	$113.60	$142.00	$99.40–$142.00	6% below	20%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE	$113.60	$142.00	$99.40–$142.00	6% below	20%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR	$228.80	$286.00	$199.28–$286.00	1% above	20%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX	$228.80	$286.00	$199.28–$286.00	1% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LFU IM INJ	$42.40	$53.00	$37.10–$53.00	37% below	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE	$42.40	$53.00	$37.10–$53.00	37% below	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 PR TDAP VACCINE 7 YRS/> IM	$54.40	$68.00	$36.59–$68.00	48% below	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY	$55.20	$69.00	$36.59–$69.00	47% below	20%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 PR TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM	$161.60	$202.00	$141.40–$202.00	7% above	20%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 TYPHOID VI POLYSACCHARIDE VACC 25 MCG/0.5ML IM SOSY	$161.60	$202.00	$141.40–$202.00	7% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZ ADMIN1 SINGLE/COMB VAC/TOXOID	$86.40	$108.00	$19.60–$108.00	77% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZADMINEACH ADDL	$53.60	$67.00	$13.91–$67.00	68% above	20%

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

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

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

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

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

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

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

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

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

Source file: https://bozemanhealth.org/wp-content/uploads/2026/02/474718253_big-sky-medical-center_standardcharges.json