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 |
|---|---|---|---|---|
| Cystoscopy & ureter catheter CPT 52005 | $422.40 | $528.00 | $6,052.50 – $6,052.50 | 1 |
| Cystostomy cystotomy w/drainage 51040 CPT 51040 | $440.00 | $550.00 | $6,052.50 – $6,052.50 | 1 |
| Cystotomy/cystostomy fulg+/insj radact matrl 51020 CPT 51020 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Cystotomy excise/incise/repair 51535 CPT 51535 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Cystouretero & or pyeloscope CPT 52351 | $446.40 | $558.00 | $10,458.39 – $10,458.39 | 1 |
| Cysto/uretero stricture tx CPT 52344 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Cystouretero w/biopsy CPT 52354 | $613.60 | $767.00 | $15,343.31 – $15,343.31 | 1 |
| Cystouretero w/excise tumor CPT 52355 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Cysto/uretero w/lithotripsy CPT 52356 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Cystouretero w/lithotripsy CPT 52353 | $576.00 | $720.00 | $15,343.31 – $15,343.31 | 1 |
| Cystouretero w/renal strict CPT 52346 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Cystouretero w/stone remove CPT 52352 | $521.60 | $652.00 | $10,458.39 – $10,458.39 | 1 |
| Cysto/uretero w/up stricture CPT 52345 | $580.00 | $725.00 | $10,458.39 – $10,458.39 | 1 |
| Cystourethro cut ejacul duct CPT 52402 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Cystourethroscop/calib/dilat stric 52281 CPT 52281 | $456.00 | $570.00 | $6,052.50 – $6,052.50 | 1 |
| Cystourethroscopy w/biopsy(s) 52204 CPT 52204 | $572.00 | $715.00 | $6,052.50 – $6,052.50 | 1 |
| Cystourethro w/addl implant 52442 CPT 52442 | $1,338.40 | $1,673.00 | not published | 0 |
| Cystourethro w/implant CPT 52441 | $1,947.20 | $2,434.00 | not published | 0 |
| Cysto w/renal stricture tx CPT 52343 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Cysto w/up stricture tx CPT 52342 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Cysto w/ureter stricture tx CPT 52341 | $418.40 | $523.00 | $10,458.39 – $10,458.39 | 1 |
| Cytarabine 20 mg/ml injection solution HCPCS J9100 | not published | not published | $1.81 – $2.49 | 2 |
| Cytogenetics 25-99 CPT 88274 | not published | not published | $52.98 – $130.83 | 2 |
| Cytogenetics 3-5 CPT 88272 | not published | not published | $50.88 – $125.64 | 2 |
| Cytogenomic neo microra alys CPT 81277 | not published | not published | $1,450.00 – $3,580.92 | 2 |
| Cytogenom microarray copy nmbr var CPT 81228 | not published | not published | $1,125.00 – $2,778.30 | 2 |
| Cytomegalovirus (cmv) antibody igg CPT 86644 | $80.00 | $100.00 | $17.99 – $44.42 | 2 |
| Cytomegalovirus (cmv) antibody igm CPT 86645 | $88.00 | $110.00 | $21.06 – $52.02 | 2 |
| Cytomegalovirus dfa CPT 87271 | $51.20 | $64.00 | $16.78 – $41.43 | 2 |
| Cytomegalovirus imm IV /vial HCPCS J0850 | not published | not published | $4,071.25 – $5,585.75 | 2 |
| Cyto/molecular report CPT 88291 | $144.80 | $181.00 | not published | 0 |
| Cytopath c/v auto in fluid CPT 88174 | not published | not published | $31.71 – $78.32 | 2 |
| Cytopath c/v index add-on CPT 88155 | not published | not published | $18.31 – $45.22 | 2 |
| Cytopath fl nongyn filter CPT 88106 | not published | not published | $81.43 – $81.43 | 1 |
| Cytopathology cellular enhancement technique non-gyn CPT 88112 | $211.20 | $264.00 | $163.59 – $163.59 | 1 |
| Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review CPT 88175 | not published | not published | $33.26 – $82.15 | 2 |
| Cytopathology cervical/vaginal thin layer manual screening CPT 88142 | $94.40 | $118.00 | $25.33 – $62.54 | 2 |
| Cytopathology concentration technique smears & interpretation CPT 88108 | $148.80 | $186.00 | $110.81 – $110.81 | 1 |
| Cytopathology fluids/washings/brushings smears with interpretation CPT 88104 | $47.20 | $59.00 | $110.81 – $110.81 | 1 |
| Cytopathology fna adequacy evaluation each separate additional episode same site CPT 88177 | $154.40 | $193.00 | not published | 0 |
| Cytopathology fna adequacy evaluation first episode each site CPT 88172 | not published | not published | $513.12 – $513.12 | 1 |
| Cytopathology fna adequacy evaluation first episode each site interp/rpt CPT 88173 | $102.40 | $128.00 | $163.59 – $163.59 | 1 |
| Cytopath smear other source CPT 88160 | $109.60 | $137.00 | $81.43 – $81.43 | 1 |
| Cytopath smear other source CPT 88162 | not published | not published | $163.59 – $163.59 | 1 |
| Cytopath smear oth prep screen & interp CPT 88161 | not published | not published | $81.43 – $81.43 | 1 |
| Cytopath tbs c/v manual CPT 88164 | $59.20 | $74.00 | $22.74 – $56.15 | 2 |
| Cytotoxic antibody screening CPT 86807 | not published | not published | $98.31 – $242.79 | 2 |
| Cytotoxic antibody screening CPT 86808 | not published | not published | $37.10 – $91.62 | 2 |
| Cytp urine 3-5 probes cmptr CPT 88121 | not published | not published | $513.12 – $513.12 | 1 |
| Dacarbazine 100 mg intravenous solution HCPCS J9130 | not published | not published | $8.59 – $11.78 | 2 |
| Dactinomycin 0.5 mg intravenous solution HCPCS J9120 | not published | not published | $681.58 – $935.12 | 2 |
| Dalbavancin 500 mg intravenous solution HCPCS J0875 | not published | not published | $34.99 – $48.00 | 2 |
| Dalteparin sodium HCPCS J1645 | not published | not published | $40.59 – $55.69 | 2 |
| Daptomycin 500 mg/10 ml intravenous solution HCPCS J0878 | $121.39 | $151.74 | $0.07 – $0.09 | 2 |
| Daptomycin (xellia) unrefrig HCPCS J0872 | not published | not published | $0.12 – $0.16 | 2 |
| Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln HCPCS J9144 | $13,815.66 | $17,269.58 | $123.00 – $168.76 | 2 |
| Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe HCPCS J0881 | $9,534.50 | $11,918.12 | $6.74 – $9.25 | 2 |
| Darbepoetin alfa, esrd use HCPCS J0882 | not published | not published | $6.74 – $9.25 | 2 |
| Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution HCPCS J9153 | not published | not published | $573.96 – $787.47 | 2 |
| Daunorubicin 5 mg/ml intravenous solution HCPCS J9150 | not published | not published | $44.46 – $61.01 | 2 |
| Dbrdmt prmlg les w/pdt CPT 96574 | $401.60 | $502.00 | $589.25 – $589.25 | 1 |
| D&c after delivery 59160 CPT 59160 | $412.00 | $515.00 | $9,225.99 – $9,225.99 | 1 |
| D&c/diagnostic/therapeutic/non ob 58120 CPT 58120 | $444.80 | $556.00 | $9,225.99 – $9,225.99 | 1 |
| Dch glucoscan CPT 82948 | $20.00 | $25.00 | $6.30 – $15.56 | 2 |
| Dch pulmonary stress test CPT 94621 | not published | not published | $913.84 – $913.84 | 1 |
| Dch validity tests CPT 81002 | $25.60 | $32.00 | $4.35 – $10.74 | 2 |
| Dcm pq ndl dsk sgl/mlt lv lmbr w/guide CPT 62287 | not published | not published | $5,865.36 – $5,865.36 | 1 |
| Dcmprn orbit only transcrnl CPT 61330 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Dcmprn plantar digital nerve CPT 64726 | not published | not published | $5,865.36 – $5,865.36 | 1 |
| D&c of cervical stump CPT 57558 | $4,557.60 | $5,697.00 | $9,225.99 – $9,225.99 | 1 |
| Deamidated gliadin antibody iga CPT 86258 | $80.00 | $100.00 | $15.06 – $37.20 | 2 |
| Debrid ecz/inf skin up tp 10% body 11000 CPT 11000 | $86.40 | $108.00 | $1,895.66 – $1,895.66 | 1 |
| Debridement (>20 cm) charge pt CPT 97598 | $148.80 | $186.00 | not published | 0 |
| Debridement bone <= 20 sq cm CPT 11044 | $456.00 | $570.00 | $4,893.07 – $4,893.07 | 1 |
| Debridement/bone/20 sq cm or less 11046 CPT 11046 | $108.80 | $136.00 | not published | 0 |
| Debridement/bone/ea add 20 sq cm 11047 CPT 11047 | $180.80 | $226.00 | not published | 0 |
| Debridement subcutaneous tissue <= 20 sq cm CPT 11042 | $192.00 | $240.00 | $1,217.32 – $1,217.32 | 1 |
| Debride nail1-5 11720 CPT 11720 | $49.60 | $62.00 | $187.55 – $187.55 | 1 |
| Debride nail6 or more 11721 CPT 11721 | $93.60 | $117.00 | $187.55 – $187.55 | 1 |
| Debride/rmv fb/open fx/skin/sq/musc11011 CPT 11011 | $740.80 | $926.00 | $2,117.62 – $2,117.62 | 1 |
| Debride skin bone at fx site CPT 11012 | $3,936.80 | $4,921.00 | $8,429.22 – $8,429.22 | 1 |
| Debride skn/sq/musc/abd wall 11004 CPT 11004 | $832.80 | $1,041.00 | not published | 0 |
| Debride skn/sq t/m/f necro infctj abdl wall 11005 CPT 11005 | $1,138.40 | $1,423.00 | not published | 0 |
| Debride/subq tissue/ea add 20sq cm 11045 CPT 11045 | $60.80 | $76.00 | not published | 0 |
| Debrid mastoidectomy cavity simple 69220 CPT 69220 | $113.60 | $142.00 | $589.25 – $589.25 | 1 |
| Debrid/rmv fgn bdy/open fx/skin/sq 11010 CPT 11010 | $673.60 | $842.00 | $2,117.62 – $2,117.62 | 1 |
| Debr inf skin add-on 11001 CPT 11001 | $40.80 | $51.00 | not published | 0 |
| Debr musc/fascia 20sq cm/< 11043 CPT 11043 | $344.00 | $430.00 | $1,895.66 – $1,895.66 | 1 |
| Decalcification CPT 88311 | $66.40 | $83.00 | not published | 0 |
| Decitabine 50 mg intravenous solution HCPCS J0894 | $2,258.52 | $2,823.15 | $3.58 – $4.91 | 2 |
| Declotting thrombolytic agent implanted vas access device 36 CPT 36593 | $153.60 | $192.00 | $1,085.34 – $1,085.34 | 1 |
| Decomp fasct leg ant+/lat+pst cmprt 27602 CPT 27602 | $708.00 | $885.00 | $9,712.92 – $9,712.92 | 1 |
| Decomp forearm 1 space 25020 CPT 25020 | not published | not published | $4,680.86 – $4,680.86 | 1 |
| Decomp forearm 2 spaces w/debrid 25025 CPT 25025 | not published | not published | $4,680.86 – $4,680.86 | 1 |
| Decompress fasciotomyhand 26037 CPT 26037 | $860.80 | $1,076.00 | $9,712.92 – $9,712.92 | 1 |
| Decompress fingers/hand CPT 26035 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Decompress forearm 1 space CPT 25023 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Decompress forearm 2 spaces CPT 25024 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Decompression fasct forearm CPT 24495 | $1,374.40 | $1,718.00 | $21,583.67 – $21,583.67 | 1 |
| Decompression of leg CPT 27892 | not published | not published | $9,712.92 – $9,712.92 | 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.