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 |
|---|---|---|---|---|
| Drainage of nose lesion int 30000 CPT 30000 | $392.80 | $491.00 | $678.14 – $678.14 | 1 |
| Drainage of nose lesion sept 30020 CPT 30020 | $408.00 | $510.00 | $1,490.61 – $1,490.61 | 1 |
| Drainage of pelvis bursa CPT 26991 | not published | not published | $4,680.86 – $4,680.86 | 1 |
| Drainage of pelvis lesion 26990 CPT 26990 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Drainage of prostate abscess CPT 52700 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Drainage of prostate abscess CPT 55720 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Drainage of prostate abscess CPT 55725 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Drainage of rectal abscess CPT 45005 | $484.80 | $606.00 | $3,533.55 – $3,533.55 | 1 |
| Drainage of rectal abscess 45020 CPT 45020 | not published | not published | $8,384.23 – $8,384.23 | 1 |
| Drainage of salivary gland CPT 42305 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Drainage of salivary gland CPT 42320 | not published | not published | $1,490.61 – $1,490.61 | 1 |
| Drainage of throat abscess CPT 42725 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Drainage of urethra abscess CPT 53040 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Drainage of urethra abscess 53060 CPT 53060 | not published | not published | $6,052.50 – $6,052.50 | 1 |
| Drainage of urinary leakage CPT 53080 | not published | not published | $2,040.48 – $2,040.48 | 1 |
| Drainage of urinary leakage CPT 53085 | not published | not published | $6,052.50 – $6,052.50 | 1 |
| Drain bladder by trocar/cath CPT 51101 | $233.60 | $292.00 | $3,048.91 – $3,048.91 | 1 |
| Drain blood from under nail 11740 CPT 11740 | $84.80 | $106.00 | $378.88 – $378.88 | 1 |
| Drain cath image guided peri/retroperitoneal transvag/transrectal CPT 49407 | $1,856.80 | $2,321.00 | $4,893.07 – $4,893.07 | 1 |
| Drain cath image guided visceral pq CPT 49405 | $2,996.80 | $3,746.00 | $4,893.07 – $4,893.07 | 1 |
| Drain cerebro spinal fluid 62272 CPT 62272 | $358.40 | $448.00 | $2,102.48 – $2,102.48 | 1 |
| Drain chest lesion CPT 21502 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Drain finger abscess;simple 26010 CPT 26010 | $524.00 | $655.00 | $589.25 – $589.25 | 1 |
| Drain lower leg bursa CPT 27604 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Drain lower leg lesion 27603 CPT 27603 | $778.40 | $973.00 | $8,429.22 – $8,429.22 | 1 |
| Drain neck/chest lesion 21501 CPT 21501 | $723.20 | $904.00 | $8,429.22 – $8,429.22 | 1 |
| Drain ovarn cyst abd CPT 58805 | $635.20 | $794.00 | $9,225.99 – $9,225.99 | 1 |
| Drain ovary abscess open CPT 58820 | not published | not published | $9,225.99 – $9,225.99 | 1 |
| Drain penis lesion CPT 54015 | not published | not published | $4,893.07 – $4,893.07 | 1 |
| Drain shoulder bone lesion CPT 23035 | $1,009.60 | $1,262.00 | $4,680.86 – $4,680.86 | 1 |
| Drain shoulder bursa 23031 CPT 23031 | not published | not published | $8,429.22 – $8,429.22 | 1 |
| Drain shoulder lesion CPT 23030 | not published | not published | $8,429.22 – $8,429.22 | 1 |
| Drain thigh/knee lesion 27301 CPT 27301 | $1,001.60 | $1,252.00 | $8,429.22 – $8,429.22 | 1 |
| Drain thyroid/tongue cyst CPT 60000 | $280.80 | $351.00 | $4,529.52 – $4,529.52 | 1 |
| Dress/debride pt-tck burn/5-10% bs 16025 CPT 16025 | $232.80 | $291.00 | $589.25 – $589.25 | 1 |
| Dress/debride pt-thick burn/<5% bs 16020 CPT 16020 | $200.00 | $250.00 | $589.25 – $589.25 | 1 |
| Dress/debrid prtl-thick burn l 16030 CPT 16030 | not published | not published | $1,217.32 – $1,217.32 | 1 |
| Dressing change not for burn w/anes 15852 CPT 15852 | $66.40 | $83.00 | $1,895.66 – $1,895.66 | 1 |
| Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm HCPCS Q4108 | not published | not published | $110.51 – $151.62 | 2 |
| Drng hand tendon sheath 26020 CPT 26020 | $823.20 | $1,029.00 | $9,712.92 – $9,712.92 | 1 |
| Drng of eyelid abscess 67700 CPT 67700 | $425.60 | $532.00 | $863.77 – $863.77 | 1 |
| Drng of finger abscess comp 26011 CPT 26011 | $731.20 | $914.00 | $4,893.07 – $4,893.07 | 1 |
| Drng of hydrocele 55000 CPT 55000 | $179.20 | $224.00 | $2,117.62 – $2,117.62 | 1 |
| Drng of mouth lesion 40801 CPT 40801 | not published | not published | $1,490.61 – $1,490.61 | 1 |
| Drng of ovarian cyst(s) 58800 CPT 58800 | not published | not published | $9,225.99 – $9,225.99 | 1 |
| Drng of palm multi bursas 26030 CPT 26030 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Drng of palm single bursa 26025 CPT 26025 | $641.60 | $802.00 | $9,712.92 – $9,712.92 | 1 |
| Drng of pelvic abscess transrectal 45000 CPT 45000 | not published | not published | $3,533.55 – $3,533.55 | 1 |
| Drng of salivary cyst 42409 CPT 42409 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Drng of scrotum abscess 55100 CPT 55100 | $340.80 | $426.00 | $4,893.07 – $4,893.07 | 1 |
| Drng open subdiaphragmatic/subphrenic absc 49040 CPT 49040 | $1,490.40 | $1,863.00 | not published | 0 |
| Drng salivary gland simple 42300 CPT 42300 | not published | not published | $4,529.52 – $4,529.52 | 1 |
| Drng salivary gland submax/subling 42310 CPT 42310 | not published | not published | $1,490.61 – $1,490.61 | 1 |
| Dronabinol 2.5mg oral HCPCS Q0167 | not published | not published | $3.77 – $5.17 | 2 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | $69.06 | $86.33 | $12.06 – $16.55 | 2 |
| Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm HCPCS Q4103 | not published | not published | $27.86 – $38.22 | 2 |
| Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 | not published | not published | $26.33 – $36.13 | 2 |
| Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm HCPCS Q4124 | not published | not published | $5.58 – $7.66 | 2 |
| Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm HCPCS Q4104 | not published | not published | $120.96 – $165.95 | 2 |
| Drug admin & hemodynmic meas CPT 93463 | $277.60 | $347.00 | not published | 0 |
| Drug assay caffeine CPT 80155 | $67.20 | $84.00 | $48.21 – $119.07 | 2 |
| Drug assay posaconazole CPT 80187 | not published | not published | $33.89 – $83.69 | 2 |
| Drug assay rufinamide CPT 80210 | $121.60 | $152.00 | $33.89 – $83.69 | 2 |
| Drug assay vedolizumab CPT 80280 | not published | not published | $48.21 – $119.07 | 2 |
| Drug assay voriconazole CPT 80285 | not published | not published | $33.89 – $83.69 | 2 |
| Drug asy hydroxychloroquine CPT 80220 | not published | not published | $23.30 – $57.54 | 2 |
| Drug of abuse screen urine CPT 80305 | $15.20 | $19.00 | $15.75 – $38.90 | 2 |
| Drug screen quant tiagabine CPT 80199 | not published | not published | $33.89 – $83.69 | 2 |
| Drug test def 15-21 classes HCPCS G0482 | $316.00 | $395.00 | $248.43 – $613.51 | 2 |
| Drug test def 1-7 classes HCPCS G0480 | $120.80 | $151.00 | $143.04 – $353.25 | 2 |
| Drug test def 22+ classes HCPCS G0483 | $409.60 | $512.00 | $308.65 – $762.24 | 2 |
| Drug test def 8-14 classes HCPCS G0481 | $140.00 | $175.00 | $195.74 – $483.39 | 2 |
| Drug test prsmv instrmnt CPT 80306 | $247.20 | $309.00 | $21.43 – $52.91 | 2 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $787.20 | $984.00 | $77.68 – $191.83 | 2 |
| Drvvt confirm - quest CPT 85597 | not published | not published | $22.48 – $55.50 | 2 |
| Dstrj extensive retinopathy CPT 67227 | not published | not published | $11,405.88 – $11,405.88 | 1 |
| Dstrj nulyt agt gnclr nrv CPT 64624 | not published | not published | $5,865.36 – $5,865.36 | 1 |
| Dstr mal les s/n/h/f/g >4.0 CPT 17276 | $424.00 | $530.00 | $1,217.32 – $1,217.32 | 1 |
| Dstr mal ls f/e/e/n/l/m2.1-3 CPT 17283 | $356.00 | $445.00 | $1,217.32 – $1,217.32 | 1 |
| Dstr mal ls f/e/e/n/l/m3.1-4 CPT 17284 | $412.80 | $516.00 | $1,895.66 – $1,895.66 | 1 |
| Dstr mal ls f/e/e/n/l/m>4.0 CPT 17286 | $518.40 | $648.00 | $1,895.66 – $1,895.66 | 1 |
| Dstry eye lesn,fdr vssl tech HCPCS G0186 | not published | not published | $1,731.92 – $1,731.92 | 1 |
| Ductogram sgl duct CPT 77053 | not published | not published | $761.98 – $761.98 | 1 |
| Duodenal motility study CPT 91022 | not published | not published | $1,577.43 – $1,577.43 | 1 |
| Duplex scan bilateral study 93985 CPT 93985 | not published | not published | $761.98 – $761.98 | 1 |
| Duplex scan unilateral study 93986 CPT 93986 | not published | not published | $348.75 – $348.75 | 1 |
| Dup scan/hemodialysis access 93990 CPT 93990 | $434.40 | $543.00 | $348.75 – $348.75 | 1 |
| Dup scan/lwr xtr vasc stdy bilat 93924 CPT 93924 | $464.00 | $580.00 | $913.84 – $913.84 | 1 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $761.60 | $952.00 | $761.98 – $761.98 | 1 |
| Durvalumab 50 mg/ml intravenous solution HCPCS J9173 | $5,640.61 | $7,050.76 | $191.81 – $263.17 | 2 |
| Dxa bone density axl vrt fx CPT 77085 | $201.60 | $252.00 | $348.75 – $348.75 | 1 |
| Dx bronchoscope/brush 31623 CPT 31623 | not published | not published | $5,216.13 – $5,216.13 | 1 |
| Dx bronchoscope/lavage 31624 CPT 31624 | $381.60 | $477.00 | $5,216.13 – $5,216.13 | 1 |
| Dx bronchoscope/wash 31622 CPT 31622 | $373.60 | $467.00 | $5,216.13 – $5,216.13 | 1 |
| Dx dark adaptation exam i&r CPT 92284 | not published | not published | $1,232.01 – $1,232.01 | 1 |
| Dx duod intub w/asp spec 43756 CPT 43756 | not published | not published | $2,693.66 – $2,693.66 | 1 |
| Dx duod intub w/asp specs CPT 43757 | not published | not published | $2,693.66 – $2,693.66 | 1 |
| Dx gastr intub w/asp spec CPT 43754 | not published | not published | $913.84 – $913.84 | 1 |
| Dx gastr intub w/asp specs CPT 43755 | not published | not published | $474.53 – $474.53 | 1 |
| Dx laryngoscopy newborn CPT 31520 | not published | not published | $1,230.61 – $1,230.61 | 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.