Skag,
The exhaust outlet is 4" on the HX-40. You will need a new downpipe. I'm not sure if you have a 4" exhaust now, but it's best to install one so there will be no restriction.
It will bolt up to the OE exhaust manifold.
I recommmend getting your HX-40 from Joe D or Piers @ BD Power. The turbo comes 'clocked' for the Dodge Ram, includes a 4" down pipe, all gaskets and the wastegate linkage is modified to hook up to the OE Dodge actuator.
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Bill R
94 2500 SLT 4x4 5 Speed, 3. 54 LS, JRE 4" exhaust, Autometer Pyro, Boost & Water temp gauges, Bosch 215 HP injectors, Timing @ 14. 7 º, JRE Stage III #4 plate 270/675, AFC spring kit, Scotty Air, Bully Dog Propane Injection, Roadmaster Active Suspension, Optima Red Tops, Geno`s Exhaust Blanket,Espar Heater (won it!), Synthetic lubes throughout.