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 |
|---|---|---|---|---|
| Administration chemotherapy IV push single/initial substance/drug CPT 96409 | $216.80 | $271.00 | $674.04 – $674.04 | 1 |
| Administration chemotherapy subcutaneous/im anti neoplastic hormonal CPT 96402 | $53.60 | $67.00 | $220.15 – $220.15 | 1 |
| Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 | $128.00 | $160.00 | $220.15 – $220.15 | 1 |
| Administration immunization 1 vaccine CPT 90471 | $52.00 | $65.00 | $220.15 – $220.15 | 1 |
| Administration immunization each additional component CPT 90461 | $13.60 | $17.00 | not published | 0 |
| Administration immunization each additional vaccine CPT 90472 | $52.00 | $65.00 | not published | 0 |
| Administration immunization first component each vaccine CPT 90460 | $34.40 | $43.00 | not published | 0 |
| Administration immunization intranasal/oral route 1 vaccine CPT 90473 | $16.80 | $21.00 | $220.15 – $220.15 | 1 |
| Administration immunization intranasal/oral route each additional vaccine CPT 90474 | $16.80 | $21.00 | not published | 0 |
| Administration vaccine hepatitis b HCPCS G0010 | not published | not published | $138.26 – $138.26 | 1 |
| Administration vaccine influenza virus HCPCS G0008 | not published | not published | $138.26 – $138.26 | 1 |
| Administration vaccine pneumococcal HCPCS G0009 | not published | not published | $138.26 – $138.26 | 1 |
| Administration vaccine rsv monoclonal ab seasonal dose im CPT 96381 | $29.60 | $37.00 | not published | 0 |
| Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 | $5,239.98 | $6,549.97 | $94.17 – $129.20 | 2 |
| Adrenal cortex & medulla img CPT 78075 | not published | not published | $4,330.91 – $4,330.91 | 1 |
| Advance care planning each additional 30 min 99498 CPT 99498 | $106.40 | $133.00 | not published | 0 |
| Aep hearing status deter i&r CPT 92651 | not published | not published | $474.53 – $474.53 | 1 |
| Aep neurodiagnostic i&r CPT 92653 | not published | not published | $913.84 – $913.84 | 1 |
| Aep thrshld est mlt freq i&r CPT 92652 | not published | not published | $913.84 – $913.84 | 1 |
| _afb id by dna probe rflx ast CPT 87149 | $243.20 | $304.00 | $25.06 – $61.89 | 2 |
| #afb mycobacteria suscep. #1 CPT 87190 | $264.80 | $331.00 | $9.14 – $22.57 | 2 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | $300.00 | $375.00 | $144.20 – $356.12 | 2 |
| Aflibercept injection HCPCS J0178 | not published | not published | $1,777.58 – $2,438.84 | 2 |
| After cataract laser surgery CPT 66821 | not published | not published | $1,731.92 – $1,731.92 | 1 |
| Agalsidase beta 35 mg intravenous solution HCPCS J0180 | not published | not published | $518.09 – $710.82 | 2 |
| Air conduction bilat CPT 92552 | $60.00 | $75.00 | $378.88 – $378.88 | 1 |
| Air injection into abdomen 49400 CPT 49400 | $525.60 | $657.00 | not published | 0 |
| Airway resistance by impulse oscillometry 94728 CPT 94728 | not published | not published | $913.84 – $913.84 | 1 |
| Albumin body fluid quantitative each specimen CPT 82042 | $12.00 | $15.00 | $9.73 – $24.02 | 2 |
| Albumin (human), 25%, 50ml HCPCS P9047 | $196.16 | $245.20 | $119.42 – $163.85 | 2 |
| Albumin, human 25 % intravenous solution HCPCS P9046 | not published | not published | $47.77 – $65.54 | 2 |
| Albumin (human), 5%, 250 ml HCPCS P9045 | not published | not published | $119.42 – $163.85 | 2 |
| Albumin, human 5 % intravenous solution HCPCS P9041 | not published | not published | $23.88 – $32.77 | 2 |
| Albumin ischemia modified CPT 82045 | not published | not published | $42.43 – $104.77 | 2 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $59.20 | $74.00 | $7.23 – $17.84 | 2 |
| Albumin serum plasma or whole blood CPT 82040 | $23.20 | $29.00 | $6.19 – $15.28 | 2 |
| Albuterol ipratrop non-comp HCPCS J7620 | $5.92 | $7.40 | $0.45 – $0.62 | 2 |
| Albuterol non-comp con HCPCS J7611 | $22.42 | $28.03 | $0.36 – $0.50 | 2 |
| Albuterol non-comp unit HCPCS J7613 | $12.66 | $15.82 | $0.17 – $0.23 | 2 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | $140.00 | $175.00 | $21.59 – $53.31 | 2 |
| Alcohol/sub misuse assess HCPCS G2011 | $24.80 | $31.00 | $81.43 – $81.43 | 1 |
| Alcohol/subs interv >30 min HCPCS G0397 | $99.20 | $124.00 | $475.42 – $475.42 | 1 |
| Alemtuzumab 12 mg/1.2 ml intravenous solution HCPCS J0202 | not published | not published | $5,491.58 – $7,534.45 | 2 |
| Alkaline phosphatase CPT 84075 | $52.80 | $66.00 | $6.48 – $15.99 | 2 |
| Allergen alpha lactalbumin ige CPT 86008 | $306.40 | $383.00 | $22.41 – $55.35 | 2 |
| Allergen egg white ige CPT 86003 | $336.80 | $421.00 | $6.53 – $16.11 | 2 |
| Allergen specific ige qual multi scrn ea CPT 86005 | not published | not published | $9.96 – $24.60 | 2 |
| Allergy injections; 2 or more 95117 CPT 95117 | $18.40 | $23.00 | $138.26 – $138.26 | 1 |
| Allergy injection; single 95115 CPT 95115 | $16.00 | $20.00 | $138.26 – $138.26 | 1 |
| Allergy Skin Testing CPT 95004 | $5.60 | $7.00 | $3,048.91 – $3,048.91 | 1 |
| Allg patch or app # of tests 95044 CPT 95044 | $8.00 | $10.00 | $3,048.91 – $3,048.91 | 1 |
| Allgrft implnt knee w/scope CPT 29867 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Allograft allowrap 4x4cm dry 16sqcm HCPCS Q4150 | not published | not published | $190.93 – $261.96 | 2 |
| Allograft amnioexcel plus 17mm disk HCPCS Q4137 | not published | not published | $226.61 – $310.91 | 2 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | not published | not published | $69.07 – $94.76 | 2 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | not published | not published | $338.25 – $464.07 | 2 |
| Allograft umbil cord+amniotic membrane-q4148-cost per sq cm HCPCS Q4148 | not published | not published | $283.64 – $389.16 | 2 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | not published | not published | $544.20 – $746.65 | 2 |
| Alloskin HCPCS Q4115 | not published | not published | $32.57 – $44.68 | 2 |
| All tstg perq&iq drugs/biol CPT 95018 | $29.60 | $37.00 | $110.81 – $110.81 | 1 |
| All tstg perq&iq w/venoms CPT 95017 | $12.80 | $16.00 | $81.43 – $81.43 | 1 |
| Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution HCPCS J0256 | $1,086.43 | $1,358.04 | $11.67 – $16.01 | 2 |
| Alpha-fetoprotein afp-l3 frac & total CPT 82107 | not published | not published | $80.51 – $198.83 | 2 |
| Alpha-fetoprotein amniotic CPT 82106 | $69.60 | $87.00 | $21.25 – $52.48 | 2 |
| Alpha-fetoprotein tumor marker CPT 82105 | $144.80 | $181.00 | $20.96 – $51.77 | 2 |
| Alprostadil for injection HCPCS J0270 | $473.07 | $591.34 | not published | 0 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $21,626.26 | $27,032.82 | $211.84 – $290.65 | 2 |
| Alt/sgpt CPT 84460 | $35.20 | $44.00 | $6.63 – $16.36 | 2 |
| Altuviiio per factor viii iu HCPCS J7214 | not published | not published | $10.51 – $14.42 | 2 |
| Aluminum - quest CPT 82108 | $118.40 | $148.00 | $31.85 – $78.66 | 2 |
| Alveoloplasty each quadrant CPT 41874 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Alys cplx sp/pn npgt w/prgrm CPT 95972 | not published | not published | $325.68 – $325.68 | 1 |
| Amantadine (symmetrel)-sendout CPT 80375 | $60.80 | $76.00 | not published | 0 |
| Ambl bp mntr w/sw a/r CPT 93788 | not published | not published | $378.88 – $378.88 | 1 |
| Amikacin 4 mg/ml intravitreal injection - cnr HCPCS J0278 | not published | not published | $1.39 – $1.90 | 2 |
| Amino acid screen, urine CPT 82128 | not published | not published | $17.34 – $42.82 | 2 |
| Amino acid single qual CPT 82127 | not published | not published | $17.73 – $43.77 | 2 |
| Amino acids quant 2-5 CPT 82136 | $69.60 | $87.00 | $24.51 – $60.54 | 2 |
| Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr HCPCS J0281 | not published | not published | $3.36 – $4.62 | 2 |
| Aminolevulinic acid, 10% gel HCPCS J7345 | not published | not published | $4.07 – $5.59 | 2 |
| Aminolevulinic acid delta CPT 82135 | $189.60 | $237.00 | $20.56 – $50.78 | 2 |
| Aminolevulinic acid hcl top HCPCS J7308 | not published | not published | $886.22 – $1,215.89 | 2 |
| Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 | not published | not published | $18.67 – $25.62 | 2 |
| Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV HCPCS J0283 | $151.14 | $188.92 | $5.87 – $8.06 | 2 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | $72.36 | $90.45 | $1.14 – $1.56 | 2 |
| Amitriptyline (elavil) -sendout CPT 80335 | $128.00 | $160.00 | not published | 0 |
| Amivantamab-vmjw 50 mg/ml intravenous solution HCPCS J9061 | not published | not published | $49.97 – $68.55 | 2 |
| Ammonia CPT 82140 | $188.80 | $236.00 | $18.21 – $44.98 | 2 |
| Amniocentesisdiagnostic 59000 CPT 59000 | $499.20 | $624.00 | $2,295.45 – $2,295.45 | 1 |
| Amniocentesis therapeutic CPT 59001 | $499.20 | $624.00 | $952.66 – $952.66 | 1 |
| Amniotic fluid scan CPT 82143 | not published | not published | $11.69 – $28.86 | 2 |
| Amp f/th 1/2 jt/phalanx w/neurect local flap CPT 26952 | $1,028.00 | $1,285.00 | $9,712.92 – $9,712.92 | 1 |
| Amphetamine confirm urine -sendout CPT 80324 | $30.40 | $38.00 | not published | 0 |
| Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr HCPCS J0285 | not published | not published | $76.78 – $105.34 | 2 |
| Amphotericin b lipid complex HCPCS J0287 | not published | not published | $23.17 – $31.79 | 2 |
| Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J0289 | not published | not published | $50.89 – $69.82 | 2 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | $74.18 | $92.73 | $1.10 – $1.51 | 2 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | $98.59 | $123.24 | $3.36 – $4.61 | 2 |
| Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis CPT 81515 | not published | not published | $328.74 – $811.85 | 2 |
| Amp metatarsal w/toe single 28810 CPT 28810 | $622.40 | $778.00 | $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.