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 |
|---|---|---|---|---|
| CT neck soft tissue without contrast CPT 70490 | $917.60 | $1,147.00 | $348.75 – $348.75 | 1 |
| CT neck soft tissue without & w/contrast CPT 70492 | $1,142.40 | $1,428.00 | $588.44 – $588.44 | 1 |
| CT orbit/sella/fossa w/wo contrast CPT 70482 | $1,110.40 | $1,388.00 | $588.44 – $588.44 | 1 |
| CT orbit/sella/ or posterior outer inner or middle ear w/contrast CPT 70481 | $886.40 | $1,108.00 | $588.44 – $588.44 | 1 |
| CT orbit/sella/ or posterior outer inner or middle ear without contrast CPT 70480 | $50.40 | $63.00 | $348.75 – $348.75 | 1 |
| Ctrl nosebld postir subsq 30906 CPT 30906 | $560.00 | $700.00 | $678.14 – $678.14 | 1 |
| CT scan for therapy guide CPT 77014 | $700.00 | $875.00 | not published | 0 |
| CT Scan of Abdomen and Pelvis (with and without contrast) CPT 74178 | $3,709.60 | $4,637.00 | $1,202.18 – $1,202.18 | 1 |
| CT Scan of Abdomen and Pelvis (with contrast) CPT 74177 | $2,883.20 | $3,604.00 | $1,202.18 – $1,202.18 | 1 |
| CT Scan of Abdomen and Pelvis (without contrast) CPT 74176 | $2,518.40 | $3,148.00 | $761.98 – $761.98 | 1 |
| CT thoracic spine w/contrast CPT 72129 | $1,646.40 | $2,058.00 | $588.44 – $588.44 | 1 |
| CT thoracic spine without contrast CPT 72128 | $1,428.00 | $1,785.00 | $348.75 – $348.75 | 1 |
| CT thorax low dose for lung screening without contrast CPT 71271 | $293.60 | $367.00 | $348.75 – $348.75 | 1 |
| CT t-spine w /wo contrast CPT 72130 | $1,824.80 | $2,281.00 | $588.44 – $588.44 | 1 |
| CT upper extremity w/contrast (both sides) CPT 73201 | $1,364.80 | $1,706.00 | $1,202.18 – $1,202.18 | 1 |
| CT upper extremity without contrast (both sides) CPT 73200 | $1,345.60 | $1,682.00 | $348.75 – $348.75 | 1 |
| CT uppr extremity w/o&w/dye CPT 73202 | $1,592.00 | $1,990.00 | $588.44 – $588.44 | 1 |
| Cultr oocyte/embryo <4 days CPT 89250 | not published | not published | $513.12 – $513.12 | 1 |
| Cultr oocyte/embryo <4 days CPT 89251 | not published | not published | $513.12 – $513.12 | 1 |
| Cult skin graft fnhfg 15155 CPT 15155 | not published | not published | $10,614.75 – $10,614.75 | 1 |
| Cult skin grft t/arm/leg CPT 15150 | not published | not published | $5,631.53 – $5,631.53 | 1 |
| Culture aerobic additional method definitive id each CPT 87077 | $132.80 | $166.00 | $10.10 – $24.94 | 2 |
| Culture afb any source CPT 87116 | $80.80 | $101.00 | $13.50 – $33.34 | 2 |
| Culture anaerobic additional method definitive id each CPT 87076 | $96.00 | $120.00 | $10.10 – $24.94 | 2 |
| Culture anaerobic except blood CPT 87075 | $147.20 | $184.00 | $11.84 – $29.23 | 2 |
| Culture bact stool aero addl path ea CPT 87046 | $132.80 | $166.00 | $11.80 – $29.14 | 2 |
| Culture body fluid CPT 87070 | $118.40 | $148.00 | $10.78 – $26.61 | 2 |
| Culture fungi definitive id mold CPT 87107 | $142.40 | $178.00 | $12.90 – $31.86 | 2 |
| Culture fungi definitive id yeast CPT 87106 | $112.80 | $141.00 | $12.90 – $31.86 | 2 |
| Culture fungi other (except blood) CPT 87102 | $108.80 | $136.00 | $10.51 – $25.96 | 2 |
| Culture fungi skin/hair/nail CPT 87101 | $59.20 | $74.00 | $9.64 – $23.80 | 2 |
| Culture mycobacteria definitive id each isolate CPT 87118 | not published | not published | $18.26 – $45.10 | 2 |
| Culture mycoplasma any source CPT 87109 | $94.40 | $118.00 | $19.24 – $47.51 | 2 |
| Culture quantitative aerobic other source CPT 87071 | not published | not published | $12.36 – $30.53 | 2 |
| Culture screening strep group a CPT 87081 | $109.60 | $137.00 | $8.29 – $20.47 | 2 |
| Culture typing added method CPT 87158 | not published | not published | $9.68 – $23.89 | 2 |
| Culture typing immunologic CPT 87147 | $102.40 | $128.00 | $6.48 – $15.99 | 2 |
| Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets CPT 87154 | not published | not published | $272.58 – $673.15 | 2 |
| Culture typing nucleic acid probe amplified per culture/isolate each organism CPT 87150 | not published | not published | $43.86 – $108.32 | 2 |
| Culture urine each isolate CPT 87088 | $23.20 | $29.00 | $10.11 – $24.97 | 2 |
| Culture virus isolation CPT 87250 | not published | not published | $24.45 – $60.38 | 2 |
| Curette/treat cornea CPT 65435 | not published | not published | $2,847.45 – $2,847.45 | 1 |
| Curette/treat cornea CPT 65436 | not published | not published | $6,898.76 – $6,898.76 | 1 |
| Cv line/pic reposition CPT 36597 | not published | not published | $4,854.90 – $4,854.90 | 1 |
| Cv stress test i&r only 93018 CPT 93018 | $21.60 | $27.00 | not published | 0 |
| Cv stress test/supervision only 93016 CPT 93016 | $32.00 | $40.00 | not published | 0 |
| Cyanocobalamin unsat binding capacity CPT 82608 | not published | not published | $17.90 – $44.21 | 2 |
| Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution HCPCS J3420 | $72.48 | $90.60 | $2.13 – $2.92 | 2 |
| Cyclic citrullinated peptide antibody CPT 86200 | $83.20 | $104.00 | $16.19 – $39.98 | 2 |
| Cyclophosphamide 1 gram intravenous powder for solution HCPCS J9075 | not published | not published | $1.40 – $1.93 | 2 |
| Cyclophosphamide 25 mg capsule HCPCS J8530 | not published | not published | $4.46 – $6.12 | 2 |
| Cyclosporine 250 mg/5 ml intravenous solution HCPCS J7516 | not published | not published | $163.55 – $224.39 | 2 |
| Cyclosporine 2 hour CPT 80158 | $101.60 | $127.00 | $22.56 – $55.72 | 2 |
| Cyclosporine modified 25 mg capsule HCPCS J7515 | not published | not published | $1.73 – $2.37 | 2 |
| Cyclosporine oral 100 mg HCPCS J7502 | not published | not published | $4.66 – $6.39 | 2 |
| Cyp2c19 gene com variants CPT 81225 | not published | not published | $364.20 – $899.43 | 2 |
| Cyp2c9 gene com variants CPT 81227 | not published | not published | $218.51 – $539.64 | 2 |
| Cyp2d6 gene com variants CPT 81226 | $1,379.20 | $1,724.00 | $563.64 – $1,391.96 | 2 |
| Cyp3a4 gene common variants CPT 81230 | not published | not published | $218.51 – $539.64 | 2 |
| Cyp3a5 gene common variants CPT 81231 | not published | not published | $218.51 – $539.64 | 2 |
| Cystatin c CPT 82610 | not published | not published | $23.15 – $57.17 | 2 |
| Cystic fibrosis cftr CPT 81223 | not published | not published | $623.75 – $1,540.41 | 2 |
| Cystine urine quantitative CPT 82131 | $169.60 | $212.00 | $28.73 – $70.94 | 2 |
| Cysto cgen post urtl valves CPT 52400 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Cystogram >= 3 views supervision & interpretation CPT 74430 | $481.60 | $602.00 | $1,202.18 – $1,202.18 | 1 |
| Cysto impl 4 or more HCPCS C9740 | not published | not published | $27,923.42 – $27,923.42 | 1 |
| Cysto, litho, vacuum kidney HCPCS C9761 | not published | not published | $27,923.42 – $27,923.42 | 1 |
| Cystometrogram w/up 51727 CPT 51727 | $507.20 | $634.00 | $2,040.48 – $2,040.48 | 1 |
| Cystorrhaphy wound simple 51860 CPT 51860 | $1,090.40 | $1,363.00 | $27,923.42 – $27,923.42 | 1 |
| Cystoscopy and biopsy CPT 52007 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Cystoscopy and radiotracer CPT 52250 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Cystoscopy and treatment CPT 52214 | $1,052.80 | $1,316.00 | $10,458.39 – $10,458.39 | 1 |
| Cystoscopy and treatment CPT 52224 | $1,101.60 | $1,377.00 | $10,458.39 – $10,458.39 | 1 |
| Cystoscopy and treatment CPT 52234 | $362.40 | $453.00 | $10,458.39 – $10,458.39 | 1 |
| Cystoscopy and treatment CPT 52235 | $424.80 | $531.00 | $10,458.39 – $10,458.39 | 1 |
| Cystoscopy and treatment CPT 52240 | $576.00 | $720.00 | $15,343.31 – $15,343.31 | 1 |
| Cystoscopy and treatment CPT 52260 | $304.00 | $380.00 | $6,052.50 – $6,052.50 | 1 |
| Cystoscopy and treatment CPT 52265 | $565.60 | $707.00 | $6,052.50 – $6,052.50 | 1 |
| Cystoscopy and treatment CPT 52276 | $389.60 | $487.00 | $6,052.50 – $6,052.50 | 1 |
| Cystoscopy and treatment CPT 52277 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Cystoscopy and treatment CPT 52283 | $500.00 | $625.00 | $6,052.50 – $6,052.50 | 1 |
| Cystoscopy and treatment CPT 52285 | $496.00 | $620.00 | $2,040.48 – $2,040.48 | 1 |
| Cystoscopy and treatment CPT 52290 | $359.20 | $449.00 | $6,052.50 – $6,052.50 | 1 |
| Cystoscopy and treatment CPT 52300 | $412.00 | $515.00 | $10,458.39 – $10,458.39 | 1 |
| Cystoscopy and treatment CPT 52301 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Cystoscopy and treatment CPT 52305 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Cystoscopy and treatment CPT 52310 | $448.80 | $561.00 | $6,052.50 – $6,052.50 | 1 |
| Cystoscopy and treatment CPT 52315 | $670.40 | $838.00 | $6,052.50 – $6,052.50 | 1 |
| Cystoscopy and treatment CPT 52320 | $363.20 | $454.00 | $10,458.39 – $10,458.39 | 1 |
| Cystoscopy and treatment CPT 52330 | $856.80 | $1,071.00 | $10,458.39 – $10,458.39 | 1 |
| Cystoscopy (Bladder Scope) CPT 52000 | $363.20 | $454.00 | $2,040.48 – $2,040.48 | 1 |
| Cystoscopy chemodenervation CPT 52287 | $544.80 | $681.00 | $6,052.50 – $6,052.50 | 1 |
| Cystoscopy & duct catheter CPT 52010 | not published | not published | $2,040.48 – $2,040.48 | 1 |
| Cystoscopy implant stent CPT 52282 | $416.00 | $520.00 | $10,458.39 – $10,458.39 | 1 |
| Cystoscopy inject material CPT 52327 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Cystoscopy prostatic imp 1-3 HCPCS C9739 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Cystoscopy removal of clots CPT 52001 | $624.80 | $781.00 | $10,458.39 – $10,458.39 | 1 |
| Cystoscopy & revise urethra CPT 52270 | not published | not published | $6,052.50 – $6,052.50 | 1 |
| Cystoscopy & revise urethra CPT 52275 | not published | not published | $6,052.50 – $6,052.50 | 1 |
| Cystoscopy stone removal CPT 52325 | $470.40 | $588.00 | $15,343.31 – $15,343.31 | 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.