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 |
|---|---|---|---|---|
| Diabetes (HbA1c) Test CPT 83036 | $63.20 | $79.00 | $12.14 – $29.97 | 2 |
| Diabetes training group per 30 min g0109 HCPCS G0136 | $28.80 | $36.00 | not published | 0 |
| Diab manage trn ind/group HCPCS G0109 | $24.00 | $30.00 | not published | 0 |
| Diag bronchoscope/catheter CPT 31643 | not published | not published | $5,216.13 – $5,216.13 | 1 |
| Diag laparo separate proc 49320 CPT 49320 | $485.60 | $607.00 | $17,007.37 – $17,007.37 | 1 |
| Diagnostic anoscopy CPT 46601 | $240.00 | $300.00 | $378.88 – $378.88 | 1 |
| Diagnostic anoscopy & biopsy CPT 46607 | not published | not published | $3,533.55 – $3,533.55 | 1 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $181.60 | $227.00 | $378.88 – $378.88 | 1 |
| Diagnostic digital breast tomosynthesis bil CPT 77062 | $62.40 | $78.00 | not published | 0 |
| Diagnostic digital breast tomosynthesis unil CPT 77061 | $62.40 | $78.00 | not published | 0 |
| Diagnostic laryngoscopy 31505 CPT 31505 | not published | not published | $583.27 – $583.27 | 1 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $276.00 | $345.00 | $583.27 – $583.27 | 1 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $314.40 | $393.00 | not published | 0 |
| Diagnostic Mammogram (one breast) CPT 77065 | $246.40 | $308.00 | not published | 0 |
| Diagnostic radio unlisted proc CPT 76499 | not published | not published | $283.48 – $283.48 | 1 |
| Dialysis one evaluation CPT 90945 | $1,357.60 | $1,697.00 | $1,245.22 – $1,245.22 | 1 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | not published | not published | $0.17 – $0.23 | 2 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $77.25 | $96.56 | $13.88 – $19.05 | 2 |
| Dicyclomine injection HCPCS J0500 | not published | not published | $26.27 – $36.04 | 2 |
| Diffusing capacity CPT 94729 | $113.60 | $142.00 | not published | 0 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $66.86 | $83.57 | $9.00 – $12.35 | 2 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | not published | not published | $11,179.31 – $15,338.01 | 2 |
| Digoxin total therapeutic drug level CPT 80162 | $158.40 | $198.00 | $16.60 – $41.00 | 2 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | $387.52 | $484.40 | $218.41 – $299.66 | 2 |
| Dilate esophagus CPT 43453 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| Dilate esophagus 1/mult pass CPT 43450 | $284.00 | $355.00 | $2,693.66 – $2,693.66 | 1 |
| Dilate tear duct opening CPT 68801 | not published | not published | $1,232.01 – $1,232.01 | 1 |
| Dilate urethra stricture CPT 53600 | $132.80 | $166.00 | $701.12 – $701.12 | 1 |
| Dilate urethra stricture CPT 53601 | $128.80 | $161.00 | $378.88 – $378.88 | 1 |
| Dilate urethra stricture CPT 53605 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Dilate urethra stricture CPT 53621 | not published | not published | $701.12 – $701.12 | 1 |
| Dilation/female urethra/initial 53660 CPT 53660 | not published | not published | $474.53 – $474.53 | 1 |
| Dilation of anal sphincter CPT 45905 | not published | not published | $3,533.55 – $3,533.55 | 1 |
| Dilation of cervical canal 57800 CPT 57800 | $115.20 | $144.00 | $9,225.99 – $9,225.99 | 1 |
| Dilation of rectal stricture 45910 CPT 45910 | not published | not published | $3,533.55 – $3,533.55 | 1 |
| Dilation of salivary duct CPT 42660 | not published | not published | $1,490.61 – $1,490.61 | 1 |
| Dilation of urethra CPT 53661 | $111.20 | $139.00 | $378.88 – $378.88 | 1 |
| Dilation of urethra CPT 53665 | $55.20 | $69.00 | $6,052.50 – $6,052.50 | 1 |
| Dilation of vagina CPT 57400 | $195.20 | $244.00 | $9,225.99 – $9,225.99 | 1 |
| Dilation salivary duct 42650 CPT 42650 | not published | not published | $4,529.52 – $4,529.52 | 1 |
| Dilation/urethral strict/male/ini 53620 CPT 53620 | not published | not published | $2,040.48 – $2,040.48 | 1 |
| Dilat xst trc ndurlgc px CPT 50436 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Dilat xst trc new access rcs CPT 50437 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Diltiazem 5 mg/ml intravenous solution HCPCS J1163 | not published | not published | $0.08 – $0.11 | 2 |
| Dimenhydrinate injection HCPCS J1240 | not published | not published | $17.42 – $23.90 | 2 |
| Dimethyl sulfoxide 50% 50 ml HCPCS J1212 | $1,853.59 | $2,316.99 | $1,671.51 – $2,293.32 | 2 |
| Diphenhydramine 12.5 mg/5 ml oral elixir HCPCS Q0163 | $2.80 | $3.50 | not published | 0 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $66.71 | $83.39 | $2.03 – $2.79 | 2 |
| Dir nsl mucous membrane test CPT 95065 | $44.00 | $55.00 | $110.81 – $110.81 | 1 |
| Disability dlco CPT 94727 | $178.40 | $223.00 | $474.53 – $474.53 | 1 |
| Disaccharidases CPT 82657 | $318.40 | $398.00 | $27.71 – $68.44 | 2 |
| Disarticulation sho sec clsr CPT 23921 | not published | not published | $5,631.53 – $5,631.53 | 1 |
| Discography cerv/thor spine CPT 72285 | not published | not published | $5,865.36 – $5,865.36 | 1 |
| Dise eval slp do brth flx dx CPT 42975 | not published | not published | $583.27 – $583.27 | 1 |
| Dist revas ligation hemo CPT 36838 | not published | not published | $16,771.14 – $16,771.14 | 1 |
| Diverticulectomy/hypophar/esoph 43130 CPT 43130 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Division of fallopian tube 58605 CPT 58605 | $500.00 | $625.00 | not published | 0 |
| Dmd dup/delet analysis CPT 81161 | not published | not published | $348.75 – $861.27 | 2 |
| Dmpk gene detc abnor allele CPT 81234 | not published | not published | $171.25 – $422.92 | 2 |
| Dna antibody native/double stranded CPT 86225 | $142.40 | $178.00 | $17.18 – $42.42 | 2 |
| Dna gardnerella CPT 87510 | $36.80 | $46.00 | $25.06 – $61.89 | 2 |
| Dna probe chlamydia CPT 87490 | not published | not published | $28.44 – $70.23 | 2 |
| Dna probe gc CPT 87590 | $104.00 | $130.00 | $33.60 – $82.98 | 2 |
| Dna trichomonas CPT 87660 | $36.80 | $46.00 | $25.06 – $61.89 | 2 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $156.46 | $195.57 | $17.95 – $24.62 | 2 |
| Docetaxel 20 mg/ml intravenous solution (wrapper) HCPCS J9171 | not published | not published | $0.85 – $1.17 | 2 |
| Docetaxel (docivyx), 1 mg HCPCS J9172 | $173.82 | $217.28 | $110.42 – $151.50 | 2 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | $92.45 | $115.56 | $1.48 – $2.03 | 2 |
| Doppler echo complete CPT 93320 | $204.00 | $255.00 | not published | 0 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $154.40 | $193.00 | $474.53 – $474.53 | 1 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $132.80 | $166.00 | $378.88 – $378.88 | 1 |
| Dornase alfa non-comp unit HCPCS J7639 | not published | not published | $124.10 – $170.27 | 2 |
| Dostarlimab-gxly 50 mg/ml intravenous solution HCPCS J9272 | not published | not published | $548.60 – $752.68 | 2 |
| Doxorubicin 2 mg/ml intravenous solution (wrapper) HCPCS J9000 | $90.74 | $113.42 | $6.13 – $8.41 | 2 |
| Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension HCPCS Q2050 | $605.03 | $756.29 | $245.89 – $337.36 | 2 |
| Doxycycline hyclate 100 mg intravenous powder for solution HCPCS J1271 | $147.82 | $184.77 | $0.26 – $0.36 | 2 |
| Dpyd gene common variants CPT 81232 | not published | not published | $218.51 – $539.64 | 2 |
| Drainage absc/cyst/hmtma/vestibule mouth smpl CPT 40800 | $963.20 | $1,204.00 | $2,117.62 – $2,117.62 | 1 |
| Drainage ext aud canal abscess 69020 CPT 69020 | $351.20 | $439.00 | $2,117.62 – $2,117.62 | 1 |
| Drainage external ear complex 69005 CPT 69005 | $2,510.40 | $3,138.00 | $4,893.07 – $4,893.07 | 1 |
| Drainage external ear simple 69000 CPT 69000 | $278.40 | $348.00 | $2,117.62 – $2,117.62 | 1 |
| Drainage lymph node lesion 38300 CPT 38300 | not published | not published | $8,429.22 – $8,429.22 | 1 |
| Drainage lymph node lesion 38305 CPT 38305 | not published | not published | $8,429.22 – $8,429.22 | 1 |
| Drainage mouth roof lesion CPT 42000 | not published | not published | $678.14 – $678.14 | 1 |
| Drainage of arm bursa 23931 CPT 23931 | $454.40 | $568.00 | $4,893.07 – $4,893.07 | 1 |
| Drainage of bladder abscess CPT 51080 | not published | not published | $8,429.22 – $8,429.22 | 1 |
| Drainage of eye CPT 65800 | not published | not published | $7,046.29 – $7,046.29 | 1 |
| Drainage of eye CPT 65810 | not published | not published | $7,046.29 – $7,046.29 | 1 |
| Drainage of eye CPT 65815 | not published | not published | $7,046.29 – $7,046.29 | 1 |
| Drainage of forearm bursa CPT 25031 | $569.60 | $712.00 | $4,680.86 – $4,680.86 | 1 |
| Drainage of kidney lesion CPT 50390 | not published | not published | $2,117.62 – $2,117.62 | 1 |
| Drainage of mouth lesion CPT 41005 | not published | not published | $678.14 – $678.14 | 1 |
| Drainage of mouth lesion CPT 41006 | not published | not published | $4,529.52 – $4,529.52 | 1 |
| Drainage of mouth lesion CPT 41007 | not published | not published | $4,529.52 – $4,529.52 | 1 |
| Drainage of mouth lesion CPT 41008 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Drainage of mouth lesion CPT 41009 | not published | not published | $1,490.61 – $1,490.61 | 1 |
| Drainage of mouth lesion CPT 41015 | not published | not published | $1,490.61 – $1,490.61 | 1 |
| Drainage of mouth lesion CPT 41016 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Drainage of mouth lesion CPT 41017 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Drainage of mouth lesion CPT 41018 | not published | not published | $4,529.52 – $4,529.52 | 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.