Providence St Joseph Medical Center
6 13th Ave E, Polson, MT · Providence · · NPI 1821184888
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| 11-desoxycortisol - sendout CPT 82634 | $122.40 | $153.00 | $36.60 – $90.39 | 2 |
| 17-hydroxypregnenolone CPT 84143 | $64.00 | $80.00 | $28.51 – $70.41 | 2 |
| 17-ketosteroids CPT 83586 | $189.60 | $237.00 | $16.00 – $39.51 | 2 |
| 1st hosp/birthing center care per day nml nb 99460 CPT 99460 | $136.80 | $171.00 | $394.38 – $394.38 | 1 |
| 1st inpatient critical care pr day age 28 days/less than 99468 CPT 99468 | $1,314.40 | $1,643.00 | not published | 0 |
| 2019-ncov diagnostic p HCPCS U0001 | not published | not published | $44.90 – $110.89 | 2 |
| 24 hr ambulatory b/p monitor CPT 93786 | not published | not published | $378.88 – $378.88 | 1 |
| 2d tee w or without fol w/con,in HCPCS C8925 | $1,011.20 | $1,264.00 | $2,417.07 – $2,417.07 | 1 |
| 2d tte w or without fol w/con,co HCPCS C8923 | $1,011.20 | $1,264.00 | $2,417.07 – $2,417.07 | 1 |
| 3-d radiotherapy plan CPT 77295 | not published | not published | $4,374.64 – $4,374.64 | 1 |
| 3d recon without postprocess indpndt CPT 76376 | $326.40 | $408.00 | not published | 0 |
| 5' nucleotidase - sendout CPT 83915 | $60.00 | $75.00 | $13.94 – $34.42 | 2 |
| 99381 initial comp preventive med less than 1 year new CPT 99381 | $163.20 | $204.00 | not published | 0 |
| 99382 initial comp preventive med 1 to 4 years new CPT 99382 | $171.20 | $214.00 | not published | 0 |
| 99383 initial comp preventive med 5 to 11 years new CPT 99383 | $177.60 | $222.00 | not published | 0 |
| 99391 periodic comp preventive med less than 1 year est CPT 99391 | $146.40 | $183.00 | not published | 0 |
| 99392 periodic comp preventive med 1 to 4 years est CPT 99392 | $156.00 | $195.00 | not published | 0 |
| 99393 periodic comp preventive med 5 to 11 years est CPT 99393 | $156.00 | $195.00 | not published | 0 |
| 99394 periodic comp preventive med 12 to 17 years est CPT 99394 | $170.40 | $213.00 | not published | 0 |
| 99397 periodic comp preventive med 65+ years est CPT 99397 | $200.00 | $250.00 | not published | 0 |
| Abatacept (with maltose) 250 mg intravenous solution HCPCS J0129 | $2,675.71 | $3,344.64 | $100.11 – $137.35 | 2 |
| #a/b/c/c/h pnl-candida albicans ab CPT 86628 | $51.20 | $64.00 | $15.01 – $37.07 | 2 |
| Abd aorta w/runoff s&i CPT 75630 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $1,735.20 | $2,169.00 | $588.44 – $588.44 | 1 |
| Abdominal CT scan (with contrast) CPT 74160 | $1,600.00 | $2,000.00 | $588.44 – $588.44 | 1 |
| Abdominal CT scan (without contrast) CPT 74150 | $1,314.40 | $1,643.00 | $348.75 – $348.75 | 1 |
| Abdominal MRI (with and without contrast) CPT 74183 | $2,933.60 | $3,667.00 | $1,202.18 – $1,202.18 | 1 |
| Abdominal MRI (with contrast) CPT 74182 | $2,240.00 | $2,800.00 | $1,202.18 – $1,202.18 | 1 |
| Abdominal MRI (without contrast) CPT 74181 | $1,623.20 | $2,029.00 | $761.98 – $761.98 | 1 |
| Abdominal paracentesis w/image guidance CPT 49083 | $1,271.20 | $1,589.00 | $2,693.66 – $2,693.66 | 1 |
| Abdominal Ultrasound (complete) CPT 76700 | $431.20 | $539.00 | $348.75 – $348.75 | 1 |
| Abdominal Ultrasound (limited) CPT 76705 | $355.20 | $444.00 | $348.75 – $348.75 | 1 |
| Abdominoplasty 15830 CPT 15830 | $1,765.60 | $2,207.00 | $19,392.63 – $19,392.63 | 1 |
| Abd paracentesis/w/o image guide 49082 CPT 49082 | $745.60 | $932.00 | $2,693.66 – $2,693.66 | 1 |
| Abl1 gene CPT 81170 | $1,009.60 | $1,262.00 | $375.00 – $926.10 | 2 |
| Ablate bone tumor(s) cryo perq 20983 CPT 20983 | $7,867.20 | $9,834.00 | $21,583.67 – $21,583.67 | 1 |
| Ablate bone tumor(s) perq CPT 20982 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Ablate heart dysrhythm focus CPT 93650 | not published | not published | $21,969.11 – $21,969.11 | 1 |
| Ablate inf turbinate submuc 30802 CPT 30802 | $416.80 | $521.00 | $4,529.52 – $4,529.52 | 1 |
| Ablate inf turbinate superf 30801 CPT 30801 | $329.60 | $412.00 | $4,529.52 – $4,529.52 | 1 |
| Ablate pulm tumor perq crybl CPT 32994 | not published | not published | $17,007.37 – $17,007.37 | 1 |
| Ablate pulm tumor perq rf CPT 32998 | not published | not published | $17,007.37 – $17,007.37 | 1 |
| Ablation cardiac vagal inputs atrium CPT 93799 | not published | not published | $474.53 – $474.53 | 1 |
| Ablation cryo abd perit om CPT 49999 | not published | not published | $2,693.66 – $2,693.66 | 1 |
| Ablation cryo adrenal tumor CPT 60699 | not published | not published | $17,007.37 – $17,007.37 | 1 |
| Ablation cryo pq chest wall tumor(s) w/guid CPT 23929 | not published | not published | $675.49 – $675.49 | 1 |
| Ablation cryo pq liver tumor(s) CPT 47383 | $9,201.60 | $11,502.00 | $17,007.37 – $17,007.37 | 1 |
| Ablation cryo retro lymph node CPT 38999 | $617.60 | $772.00 | $1,330.51 – $1,330.51 | 1 |
| Ablation cryo thigh/knee CPT 27599 | not published | not published | $675.49 – $675.49 | 1 |
| Ablation of upper extremity nerves rf CPT 64999 | $511.20 | $639.00 | $887.20 – $887.20 | 1 |
| Abltj mal prst8 tiss hifu CPT 55880 | not published | not published | $27,923.42 – $27,923.42 | 1 |
| Abobotulinumtoxina HCPCS J0586 | $1,091.48 | $1,364.35 | $20.63 – $28.31 | 2 |
| Abortion (mpr) CPT 59866 | not published | not published | $952.66 – $952.66 | 1 |
| Abrasion lesion single CPT 15786 | not published | not published | $589.25 – $589.25 | 1 |
| Abscess drain retroperitoneal surg code CPT 49406 | $2,996.80 | $3,746.00 | $4,893.07 – $4,893.07 | 1 |
| Acetaminophen 10 mg/ml soln 100 ml glass cont HCPCS J0131 | not published | not published | $0.12 – $0.17 | 2 |
| Acetaminophen level CPT 80143 | $106.40 | $133.00 | $23.30 – $57.54 | 2 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | $168.86 | $211.08 | $38.76 – $53.18 | 2 |
| Acetone qualitative CPT 82009 | $118.40 | $148.00 | $5.65 – $13.95 | 2 |
| Acetylcholine receptor modulating antibody CPT 86043 | not published | not published | $15.06 – $37.20 | 2 |
| Acetylcholinesterase assay CPT 82013 | $47.20 | $59.00 | $15.36 – $37.94 | 2 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | $176.68 | $220.85 | $0.83 – $1.14 | 2 |
| Acetylcysteine non-comp unit HCPCS J7608 | $46.47 | $58.09 | $20.01 – $27.45 | 2 |
| Acid perfusion of esophagus CPT 91030 | not published | not published | $1,577.43 – $1,577.43 | 1 |
| Acne surgery 10040 CPT 10040 | $171.20 | $214.00 | $589.25 – $589.25 | 1 |
| Aco annual medicare visit (awv), initial g0438aco HCPCS G0438 | $246.40 | $308.00 | not published | 0 |
| Aco annual medicare visit (awv), subsq g0439aco HCPCS G0439 | $194.40 | $243.00 | not published | 0 |
| Aco ccm; at least 20 min 99490aco CPT 99490 | $92.80 | $116.00 | $247.51 – $247.51 | 1 |
| Aco ccm; ea addl 20 min 99439aco CPT 99439 | $69.60 | $87.00 | not published | 0 |
| Aco cmplx chron care addl 20 min 99489aco CPT 99489 | $108.80 | $136.00 | not published | 0 |
| Aco cmplx chron care without pt visit, 60 min 99487aco CPT 99487 | $202.40 | $253.00 | $475.42 – $475.42 | 1 |
| Aco cont gluc mnt phys/qhp eqp 95250aco CPT 95250 | $289.60 | $362.00 | $394.38 – $394.38 | 1 |
| Aco depression screen annual medicare g0444aco HCPCS G0444 | $27.20 | $34.00 | $96.85 – $96.85 | 1 |
| Aco med nutria tx/group, ea 30 min 97804aco CPT 97804 | $25.60 | $32.00 | not published | 0 |
| Acoustic immitance testing CPT 92570 | $48.00 | $60.00 | $474.53 – $474.53 | 1 |
| Acoustic refl threshold tst CPT 92568 | not published | not published | $110.81 – $110.81 | 1 |
| Acromp/acromionectomy prtl CPT 23130 | $916.80 | $1,146.00 | $9,712.92 – $9,712.92 | 1 |
| Actigraphy testing CPT 95803 | not published | not published | $187.55 – $187.55 | 1 |
| Actinotherapy uv light CPT 96900 | $49.60 | $62.00 | $110.81 – $110.81 | 1 |
| Acup 1/> w/estim 1st 15 min CPT 97813 | $79.20 | $99.00 | $81.43 – $81.43 | 1 |
| Acup 1/> wo estim 1st 15 min CPT 97810 | not published | not published | $81.43 – $81.43 | 1 |
| Acute hepatitis panel CPT 80074 | $173.60 | $217.00 | $59.54 – $147.03 | 2 |
| Acute venous thrombus image CPT 78456 | not published | not published | $4,330.91 – $4,330.91 | 1 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | $74.74 | $93.42 | $0.07 – $0.09 | 2 |
| #acylcarnitineprfl CPT 82017 | $53.60 | $67.00 | $21.09 – $52.08 | 2 |
| Acylcarnitines qual CPT 82016 | not published | not published | $20.61 – $50.90 | 2 |
| Adapt behavior tx phys/qhp CPT 97155 | not published | not published | $247.51 – $247.51 | 1 |
| Adding walker to prev cast CPT 29440 | $65.60 | $82.00 | $475.62 – $475.62 | 1 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | $103.29 | $129.11 | $1.03 – $1.41 | 2 |
| Adenovirus ag ia CPT 87301 | not published | not published | $14.98 – $36.98 | 2 |
| Adenovirus antibody,serum - quest CPT 86603 | $144.80 | $181.00 | $16.09 – $39.73 | 2 |
| Adenovirus assay w/optic CPT 87809 | not published | not published | $27.20 – $67.17 | 2 |
| Adh-sendout CPT 84588 | $103.20 | $129.00 | $42.43 – $104.77 | 2 |
| Adj gastric band via subq port CPT 43999 | not published | not published | $2,693.66 – $2,693.66 | 1 |
| Adjmt/revj ext fixj sys anes CPT 20693 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Adj tis trans/see area/10.1-30sqcm 14041 CPT 14041 | $1,388.00 | $1,735.00 | $5,631.53 – $5,631.53 | 1 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | $460.78 | $575.97 | not published | 0 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $128.00 | $160.00 | $220.15 – $220.15 | 1 |
| Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr CPT 96417 | $108.00 | $135.00 | $220.15 – $220.15 | 1 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $613.60 | $767.00 | $1,085.34 – $1,085.34 | 1 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.