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 |
|---|---|---|---|---|
| Ercp bil/panc duct; each stent plcmt 43274 CPT 43274 | not published | not published | $17,100.59 – $17,100.59 | 1 |
| Ercp ea duct/ampulla dilate CPT 43277 | not published | not published | $10,639.72 – $10,639.72 | 1 |
| Ercp lesion ablate w/dilate 43278 CPT 43278 | not published | not published | $10,639.72 – $10,639.72 | 1 |
| Ercp lithotripsy calculi CPT 43265 | not published | not published | $17,100.59 – $17,100.59 | 1 |
| Ercp remove duct calculi 43264 CPT 43264 | not published | not published | $10,639.72 – $10,639.72 | 1 |
| Ercp remove forgn body duct 43275 CPT 43275 | not published | not published | $10,639.72 – $10,639.72 | 1 |
| Ercp sphincter pressure meas CPT 43263 | not published | not published | $10,639.72 – $10,639.72 | 1 |
| Ercp stent exchange w/dilate CPT 43276 | not published | not published | $17,100.59 – $17,100.59 | 1 |
| Ercp w/specimen collection CPT 43260 | not published | not published | $10,639.72 – $10,639.72 | 1 |
| Eribulin 1 mg/2 ml (0.5 mg/ml) intravenous solution HCPCS J9179 | $1,851.89 | $2,314.86 | $235.31 – $322.85 | 2 |
| Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr HCPCS J1335 | $293.48 | $366.85 | $20.30 – $27.85 | 2 |
| ER Visit (level 1, minor) CPT 99281 | $160.80 | $201.00 | $245.03 – $245.03 | 1 |
| ER Visit (level 2) CPT 99282 | $356.80 | $446.00 | $455.82 – $455.82 | 1 |
| ER Visit (level 3) CPT 99283 | $513.60 | $642.00 | $799.54 – $799.54 | 1 |
| ER Visit (level 4) CPT 99284 | $787.20 | $984.00 | $1,245.22 – $1,245.22 | 1 |
| ER Visit (level 5, high severity) CPT 99285 | $1,182.40 | $1,478.00 | $1,788.50 – $1,788.50 | 1 |
| Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr HCPCS J1364 | not published | not published | $168.87 – $231.69 | 2 |
| Esd endoscopy or colonoscopy HCPCS C9779 | not published | not published | $10,639.72 – $10,639.72 | 1 |
| Esmolol 2,500 mg/250 ml (10 mg/ml) in sterile water intravenous soln HCPCS J1806 | not published | not published | $0.94 – $1.29 | 2 |
| Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only HCPCS J1805 | $357.19 | $446.49 | $0.63 – $0.87 | 2 |
| Esophageal motility CPT 78258 | not published | not published | $1,268.29 – $1,268.29 | 1 |
| Esophageal recording CPT 93615 | not published | not published | $3,645.00 – $3,645.00 | 1 |
| Esophageal recording CPT 93616 | not published | not published | $3,645.00 – $3,645.00 | 1 |
| Esophag muc integ w/eso egd HCPCS C9777 | not published | not published | $10,639.72 – $10,639.72 | 1 |
| Esophagosc dilate balloon 30 CPT 43214 | $280.80 | $351.00 | $5,682.83 – $5,682.83 | 1 |
| Esophagosc flex trnsn biopsy CPT 43198 | not published | not published | $2,693.66 – $2,693.66 | 1 |
| Esophagoscop mucosal resect CPT 43211 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| Esophagoscop stent placement CPT 43212 | not published | not published | $17,100.59 – $17,100.59 | 1 |
| Esophagoscop ultrasound exam CPT 43231 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| Esophagoscopy balloon <30mm CPT 43220 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| Esophagoscopy control bleed CPT 43227 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| Esophagoscopy flex biopsy CPT 43202 | $549.60 | $687.00 | $5,682.83 – $5,682.83 | 1 |
| Esophagoscopy/flex/diagnostic 43200 CPT 43200 | $936.80 | $1,171.00 | $2,693.66 – $2,693.66 | 1 |
| Esophagoscopy flex dx brush CPT 43197 | not published | not published | $2,693.66 – $2,693.66 | 1 |
| Esophagoscopy flex remove fb CPT 43215 | $1,275.20 | $1,594.00 | $5,682.83 – $5,682.83 | 1 |
| Esophagoscopy lesion ablate CPT 43229 | not published | not published | $10,639.72 – $10,639.72 | 1 |
| Esophagoscopy lesion removal CPT 43216 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| Esophagoscopy retro balloon CPT 43213 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| Esophagoscopy rigid balloon CPT 43195 | not published | not published | $10,639.72 – $10,639.72 | 1 |
| Esophagoscopy/rigid/diagnostic 43191 CPT 43191 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| Esophagoscopy rigid trnso 43180 CPT 43180 | $821.60 | $1,027.00 | $17,423.47 – $17,423.47 | 1 |
| Esophagoscopy snare les remv CPT 43217 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| Esophagoscopy w/us needle bx CPT 43232 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| Esophagoscp guide wire dilat 43196 CPT 43196 | not published | not published | $10,639.72 – $10,639.72 | 1 |
| Esophagoscp rig trnso biopsy CPT 43193 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| Esophagoscp rig trnso inject CPT 43192 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| Esophagoscp rig trnso rem fb CPT 43194 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| Esophagus endoscopy/ligation CPT 43205 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| Esophagus motility study CPT 91010 | $321.60 | $402.00 | $1,577.43 – $1,577.43 | 1 |
| Esoph balloon distension tst CPT 91040 | not published | not published | $1,577.43 – $1,577.43 | 1 |
| Esoph egd dilation <30 mm CPT 43249 | $1,692.00 | $2,115.00 | $5,682.83 – $5,682.83 | 1 |
| Esoph endoscopy dilation CPT 43226 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| Esoph imped function test CPT 91037 | $299.20 | $374.00 | $913.84 – $913.84 | 1 |
| Esoph imped funct test > 1hr CPT 91038 | not published | not published | $1,577.43 – $1,577.43 | 1 |
| Esoph optical endomicroscopy CPT 43206 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| Esoph scope w/sclerosis inj CPT 43204 | $200.00 | $250.00 | $5,682.83 – $5,682.83 | 1 |
| Esoph scope w/submucous inj CPT 43201 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| Essure 58565 CPT 58565 | $2,572.80 | $3,216.00 | $15,124.47 – $15,124.47 | 1 |
| Established Patient Office Visit (level 1) CPT 99211 | $113.60 | $142.00 | not published | 0 |
| Established Patient Office Visit (level 2) CPT 99212 | $113.60 | $142.00 | not published | 0 |
| Established Patient Office Visit (level 3) CPT 99213 | $150.40 | $188.00 | not published | 0 |
| Established Patient Office Visit (level 4) CPT 99214 | $192.00 | $240.00 | not published | 0 |
| Established Patient Office Visit (level 5) CPT 99215 | $269.60 | $337.00 | not published | 0 |
| Estradiol total CPT 82670 | $120.80 | $151.00 | $34.93 – $86.25 | 2 |
| Estradiol valerate 10 mg inj HCPCS J1380 | not published | not published | $17.35 – $23.81 | 2 |
| Estrogens total-sendout CPT 82672 | $91.20 | $114.00 | $27.13 – $66.99 | 2 |
| Ethanolamine oleate 100 mg HCPCS J1430 | not published | not published | $1,168.91 – $1,603.75 | 2 |
| Ethmoidectomy extranasal total 31205 CPT 31205 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Ethylene glycol -sendout CPT 82693 | not published | not published | $18.63 – $46.00 | 2 |
| Etonogestrel implant system HCPCS J7307 | $2,819.62 | $3,524.53 | not published | 0 |
| Etoposide 20 mg/ml intravenous solution HCPCS J9181 | $612.06 | $765.08 | $2.93 – $4.02 | 2 |
| Etoposide 50 mg cap HCPCS J8560 | not published | not published | $170.47 – $233.88 | 2 |
| Euflexxa inj per dose HCPCS J7323 | $311.20 | $389.00 | $257.58 – $353.41 | 2 |
| Euglobulin lysis CPT 85360 | not published | not published | $10.51 – $25.96 | 2 |
| Evacuate mole of uterus CPT 59870 | $796.80 | $996.00 | $9,225.99 – $9,225.99 | 1 |
| Eval aud rehab status/first hr 92626 CPT 92626 | not published | not published | $474.53 – $474.53 | 1 |
| Eval/fit voice prosthesis iii, st CPT 92607 | $155.20 | $194.00 | not published | 0 |
| Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen CPT 84112 | $145.60 | $182.00 | $122.64 – $302.87 | 2 |
| Evaluation of speech fluency 92521 CPT 92521 | $202.40 | $253.00 | not published | 0 |
| Evaluation psychiatric diagnostic CPT 90791 | $256.80 | $321.00 | $475.42 – $475.42 | 1 |
| Event monitor CPT 93270 | $195.20 | $244.00 | $114.22 – $114.22 | 1 |
| Evoked auditory tst complete CPT 92588 | not published | not published | $913.84 – $913.84 | 1 |
| Evoked oa emissions ltd CPT 92587 | $76.80 | $96.00 | $913.84 – $913.84 | 1 |
| Evoked potentials auditory screening automated analysis CPT 92650 | $189.60 | $237.00 | not published | 0 |
| Evoked potentials upper limbs CPT 95925 | not published | not published | $913.84 – $913.84 | 1 |
| Evoked potential visual not glaucoma CPT 95930 | not published | not published | $913.84 – $913.84 | 1 |
| Evok oa screening qual CPT 92558 | $14.40 | $18.00 | not published | 0 |
| Exam of vagina w/scope 57420 CPT 57420 | $196.00 | $245.00 | $952.66 – $952.66 | 1 |
| Exam pelvic add-on CPT 99459 | $32.00 | $40.00 | not published | 0 |
| Exam plvc w/anes othr thn lcl CPT 57410 | $154.40 | $193.00 | $9,225.99 – $9,225.99 | 1 |
| Ex arm/elbow tum deep < 5 cm CPT 24076 | $833.60 | $1,042.00 | $8,429.22 – $8,429.22 | 1 |
| Ex arm/elbow tum deep 5 cm/> CPT 24073 | $1,051.20 | $1,314.00 | $8,429.22 – $8,429.22 | 1 |
| Exc abd les sc 3 cm/> CPT 22903 | $668.00 | $835.00 | $8,429.22 – $8,429.22 | 1 |
| Exc abdl tum deep < 5 cm CPT 22900 | $858.40 | $1,073.00 | $8,429.22 – $8,429.22 | 1 |
| Exc abdl tum deep 5 cm/> CPT 22901 | $1,008.00 | $1,260.00 | $8,429.22 – $8,429.22 | 1 |
| Exc arm/elbo les sc >=3cm 24071 CPT 24071 | $600.80 | $751.00 | $8,429.22 – $8,429.22 | 1 |
| Exc arm/elbo les sc <3cm 24075 CPT 24075 | $803.20 | $1,004.00 | $4,893.07 – $4,893.07 | 1 |
| Exc aurl glomus tum trnscanl CPT 69550 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Exc aurl glomus tum trnsmstd CPT 69552 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Exc back les sbq <3 cm 21930 CPT 21930 | $750.40 | $938.00 | $4,893.07 – $4,893.07 | 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.