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 |
|---|---|---|---|---|
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | not published | not published | $675.49 – $675.49 | 1 |
| Ghs urine, hydroxproline total CPT 83505 | not published | not published | $30.38 – $75.01 | 2 |
| Ghs urine, porphyrins quant CPT 84120 | $159.20 | $199.00 | $18.39 – $45.41 | 2 |
| Ghs vaginal delivery only CPT 59409 | $1,248.00 | $1,560.00 | $9,225.99 – $9,225.99 | 1 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | $888.80 | $1,111.00 | $1,577.43 – $1,577.43 | 1 |
| Ghs windowing of cast CPT 29730 | not published | not published | $475.62 – $475.62 | 1 |
| Giardia lamblia antibody CPT 86674 | $124.80 | $156.00 | $18.40 – $45.44 | 2 |
| Gi endoscopic ultrasound CPT 76975 | not published | not published | $761.98 – $761.98 | 1 |
| Gi inhouse confirmation CPT 87045 | $127.20 | $159.00 | $11.80 – $29.14 | 2 |
| Gingivoplasty each quadrant CPT 41872 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Gi protein loss CPT 78282 | not published | not published | $1,268.29 – $1,268.29 | 1 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | not published | not published | $2,693.66 – $2,693.66 | 1 |
| Gi trc img intral colon i&r CPT 91113 | not published | not published | $2,711.70 – $2,711.70 | 1 |
| Gi trc img intral esophagus CPT 91111 | not published | not published | $2,693.66 – $2,693.66 | 1 |
| Gi wireless capsule measure CPT 91112 | not published | not published | $2,693.66 – $2,693.66 | 1 |
| Gjb2 gene full sequence CPT 81252 | not published | not published | $126.40 – $312.16 | 2 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $76.90 – $189.91 | 2 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $43.75 – $108.05 | 2 |
| Glassia injection HCPCS J0257 | not published | not published | $12.85 – $17.64 | 2 |
| Glaucoma scrn hgh risk direc HCPCS G0117 | not published | not published | $81.43 – $81.43 | 1 |
| Glaucoma scrn hgh risk direc HCPCS G0118 | not published | not published | $110.81 – $110.81 | 1 |
| Glaucoma surgery CPT 66150 | not published | not published | $13,037.66 – $13,037.66 | 1 |
| Glaucoma surgery CPT 66155 | not published | not published | $13,037.66 – $13,037.66 | 1 |
| Glaucoma surgery CPT 66160 | not published | not published | $7,046.29 – $7,046.29 | 1 |
| Glaucoma surgery CPT 66170 | not published | not published | $7,046.29 – $7,046.29 | 1 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $761.54 | $951.93 | $440.53 – $604.41 | 2 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | $367.98 | $459.98 | $325.98 – $447.25 | 2 |
| Glucagon plasma - sendout CPT 82943 | $179.20 | $224.00 | $17.86 – $44.11 | 2 |
| Glucose 1 hr post dose CPT 82950 | $42.40 | $53.00 | $5.94 – $14.66 | 2 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | $92.80 | $116.00 | $7.56 – $18.68 | 2 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $18.40 | $23.00 | $4.10 – $10.13 | 2 |
| Glucose blood quantitative CPT 82947 | $35.20 | $44.00 | $4.91 – $12.13 | 2 |
| Glucose body fluid CPT 82945 | $110.40 | $138.00 | $4.91 – $12.13 | 2 |
| Glucose monitoring continual min 72hr pt CPT 95249 | $98.40 | $123.00 | $187.55 – $187.55 | 1 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $136.00 | $170.00 | $16.09 – $39.73 | 2 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $16.80 | $21.00 | $4.90 – $12.10 | 2 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $74.24 | $92.80 | $0.97 – $1.34 | 2 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | $4,959.63 | $6,199.54 | $24.82 – $34.05 | 2 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $127.20 | $159.00 | $23.23 – $57.36 | 2 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $77.60 | $97.00 | $23.15 – $57.17 | 2 |
| Gonioscopy CPT 92020 | not published | not published | $378.88 – $378.88 | 1 |
| Goniotomy CPT 65820 | not published | not published | $13,037.66 – $13,037.66 | 1 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $2,395.80 | $2,994.75 | $1,651.84 – $2,266.32 | 2 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | not published | not published | $68.18 – $93.55 | 2 |
| Graft bone flex 2.5cm x 5cm grafton-cost per sq cm HCPCS Q4205 | not published | not published | $2,678.49 – $3,674.89 | 2 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | not published | not published | $149.22 – $204.72 | 2 |
| Graft hand or finger tendon CPT 26416 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | not published | not published | $147.16 – $201.91 | 2 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | not published | not published | $221.72 – $304.20 | 2 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | not published | not published | $306.40 – $420.38 | 2 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | not published | not published | $109.91 – $150.80 | 2 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | not published | not published | $200.66 – $275.30 | 2 |
| Granisetron hcl injection HCPCS J1626 | not published | not published | $0.51 – $0.70 | 2 |
| Great toe with reduction 28495 CPT 28495 | $264.00 | $330.00 | $675.49 – $675.49 | 1 |
| Grfg autol fat lipo 25 cc/< CPT 15773 | not published | not published | $5,631.53 – $5,631.53 | 1 |
| Grfg autol fat lipo 50 cc/< CPT 15771 | not published | not published | $10,614.75 – $10,614.75 | 1 |
| Grfg autol soft tiss dir exc CPT 15769 | not published | not published | $10,614.75 – $10,614.75 | 1 |
| Growth hormone antibody CPT 86277 | not published | not published | $19.68 – $48.59 | 2 |
| Growth stimulation gene 2 CPT 83006 | not published | not published | $94.50 – $233.38 | 2 |
| Gstrst open wo constj tube CPT 43830 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| G-tube reposition CPT 43761 | not published | not published | $701.12 – $701.12 | 1 |
| Gu dilat ureter/urethra s&i CPT 74485 | not published | not published | $6,052.50 – $6,052.50 | 1 |
| Guided cath fluid drainage 10030 CPT 10030 | $1,439.20 | $1,799.00 | $2,117.62 – $2,117.62 | 1 |
| Gum graft CPT 41870 | not published | not published | $4,529.52 – $4,529.52 | 1 |
| Gynecomastia (males) 19300 CPT 19300 | $872.00 | $1,090.00 | $11,217.60 – $11,217.60 | 1 |
| Hair removal by electrolysis 17380 CPT 17380 | not published | not published | $1,895.66 – $1,895.66 | 1 |
| Hair trnspl 1-15 punch grfts CPT 15775 | not published | not published | $1,217.32 – $1,217.32 | 1 |
| Hair trnspl >15 punch grafts CPT 15776 | not published | not published | $1,217.32 – $1,217.32 | 1 |
| Haloperidol decanoate 50 mg/ml intramuscular solution HCPCS J1631 | $7.20 | $9.00 | $10.53 – $14.45 | 2 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $68.82 | $86.02 | $1.88 – $2.58 | 2 |
| Hand tendon/muscle transfer CPT 26494 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Hand tendon reconstruction CPT 26500 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Hand tendon reconstruction CPT 26502 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Hand X-ray CPT 73130 | $225.60 | $282.00 | $283.48 – $283.48 | 1 |
| Haptoglobin quantitative CPT 83010 | $92.80 | $116.00 | $15.73 – $38.83 | 2 |
| Harvest auto stem cells CPT 38206 | not published | not published | $4,437.20 – $4,437.20 | 1 |
| Harvest cultured skin graft 15040 CPT 15040 | not published | not published | $5,631.53 – $5,631.53 | 1 |
| Harvest eye tissue alograft CPT 68371 | not published | not published | $6,898.76 – $6,898.76 | 1 |
| Harvest stem cell concentrte CPT 38215 | not published | not published | $1,330.51 – $1,330.51 | 1 |
| Hast w/i&r phys/qhp CPT 94452 | not published | not published | $378.88 – $378.88 | 1 |
| Hast w/oxygen titrate CPT 94453 | not published | not published | $378.88 – $378.88 | 1 |
| Hba1/hba2 full gene sequence CPT 81259 | not published | not published | $750.00 – $1,852.20 | 2 |
| Hba1/hba2 gene dup/del vrnts CPT 81269 | not published | not published | $253.00 – $624.81 | 2 |
| Hba1/hba2 gene fam vrnt CPT 81258 | not published | not published | $469.06 – $1,158.40 | 2 |
| Hbb full gene sequence CPT 81364 | not published | not published | $405.73 – $1,001.98 | 2 |
| Hbb gene com variants CPT 81361 | not published | not published | $218.51 – $539.64 | 2 |
| Hbb gene dup/del variants CPT 81363 | not published | not published | $253.00 – $624.81 | 2 |
| Hbb gene known fam variant CPT 81362 | not published | not published | $469.06 – $1,158.40 | 2 |
| Hbot, full body chamber, 30m HCPCS G0277 | not published | not published | $408.09 – $408.09 | 1 |
| Hc fl sm bowel enteroclss tube w kub double contrast CPT 74251 | not published | not published | $588.44 – $588.44 | 1 |
| Hcg free betachain test CPT 84704 | not published | not published | $19.11 – $47.20 | 2 |
| Hcg qualitative CPT 84703 | $71.20 | $89.00 | $9.40 – $23.21 | 2 |
| Hcg quantitative CPT 84702 | $118.40 | $148.00 | $18.81 – $46.46 | 2 |
| Hc metata joint dislocation anes CPT 28635 | not published | not published | $4,680.86 – $4,680.86 | 1 |
| Hc mohs micrographic h/n/h/f/g 1st stage 5 blocks CPT 17311 | not published | not published | $1,895.66 – $1,895.66 | 1 |
| Hc mohs trunk/arm/leg 1st stage 5 blocks CPT 17313 | not published | not published | $1,895.66 – $1,895.66 | 1 |
| Hc nm cardiac blood pool planar 1 stdy wal motn eject fract CPT 78481 | not published | not published | $1,646.19 – $1,646.19 | 1 |
| Hc nm fusion spect CT unlisted CPT 78999 | not published | not published | $1,268.29 – $1,268.29 | 1 |
| Hc nm kidney imaging with flow CPT 78701 | not published | not published | $1,268.29 – $1,268.29 | 1 |
| Hc nm myocard infarct avid plnr tomo spect w/wo quant CPT 78469 | not published | not published | $1,646.19 – $1,646.19 | 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.