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 |
|---|---|---|---|---|
| Infect ag drug suscept pheno predict CPT 87900 | not published | not published | $162.94 – $402.39 | 2 |
| Infect ag eia chlamydia trachomatis CPT 87320 | not published | not published | $18.75 – $46.31 | 2 |
| Infect ag eia influenza a or b ea CPT 87400 | $134.40 | $168.00 | $17.66 – $43.62 | 2 |
| Infect ag genotype na cytomegalovirus CPT 87910 | not published | not published | $321.81 – $794.75 | 2 |
| Infect ag genotype na dna hepatitis b CPT 87912 | not published | not published | $321.81 – $794.75 | 2 |
| Infect ag genotype na hiv-1 other region CPT 87906 | $536.00 | $670.00 | $160.91 – $397.39 | 2 |
| Infect ag genotype na hiv-1 revr trn/prt CPT 87901 | $698.40 | $873.00 | $321.81 – $794.75 | 2 |
| Infect ag ia direct hiv-1 antgn CPT 87806 | $83.20 | $104.00 | $40.96 – $101.16 | 2 |
| Infect ag ia optc obs chlamydia trach CPT 87810 | not published | not published | $44.11 – $108.94 | 2 |
| Infect ag ia optc obs influenza CPT 87804 | $51.20 | $64.00 | $20.69 – $51.09 | 2 |
| Infect ag if ea plyvlnt antsrm CPT 87300 | $53.60 | $67.00 | $14.98 – $36.98 | 2 |
| Infect ag if hep delta agent CPT 87380 | not published | not published | $22.95 – $56.68 | 2 |
| Infect ag if influenza a CPT 87276 | not published | not published | $20.09 – $49.61 | 2 |
| Infect ag if influenza b CPT 87275 | not published | not published | $15.31 – $37.82 | 2 |
| Infect ag if legionella pneumophila CPT 87278 | $98.40 | $123.00 | $19.50 – $48.16 | 2 |
| Infect ag if nos ea CPT 87299 | not published | not published | $20.13 – $49.70 | 2 |
| Infect ag if pneumocystis carinii CPT 87281 | $118.40 | $148.00 | $14.98 – $36.98 | 2 |
| Infect ag if varicella zoster CPT 87290 | $110.40 | $138.00 | $16.78 – $41.43 | 2 |
| Infect ag na chlamydia trachomatis qnt CPT 87492 | not published | not published | $66.84 – $165.06 | 2 |
| Infect ag na hep b amp CPT 87516 | not published | not published | $43.86 – $108.32 | 2 |
| Infect ag na herpes simplex quant CPT 87530 | not published | not published | $53.55 – $132.25 | 2 |
| Infect ag na hpv high-risk types CPT 87624 | $145.60 | $182.00 | $43.86 – $108.32 | 2 |
| Infect ag na influenza r/amp 1st 2 types CPT 87502 | $214.40 | $268.00 | $119.75 – $295.73 | 2 |
| Infect ag na influenza revr/amp ea type CPT 87501 | not published | not published | $64.14 – $158.39 | 2 |
| Infect ag na orthopoxvirus amp prb each CPT 87593 | $122.40 | $153.00 | $64.14 – $158.39 | 2 |
| Infect ag na resp virus 12-25 targets CPT 87633 | $1,736.80 | $2,171.00 | $520.98 – $1,286.60 | 2 |
| Infect ag phenotype na hiv-1 1-10 drugs CPT 87903 | not published | not published | $610.83 – $1,508.49 | 2 |
| Infect ag phenotype na hiv-1 ea addl drg CPT 87904 | not published | not published | $32.59 – $80.48 | 2 |
| Infectious agent antigen immunoassay direct optical observation sars-cov-2 CPT 87811 | not published | not published | $51.73 – $127.74 | 2 |
| Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin CPT 87324 | $51.20 | $64.00 | $14.98 – $36.98 | 2 |
| Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans CPT 87327 | $51.20 | $64.00 | $16.78 – $41.43 | 2 |
| Infectious agent antigen immunoassay ql/sq multi step cryptosporidium CPT 87328 | $71.20 | $89.00 | $17.28 – $42.66 | 2 |
| Infectious agent antigen immunoassay ql/sq multi step giardia CPT 87329 | $92.80 | $116.00 | $14.98 – $36.98 | 2 |
| Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool CPT 87338 | $79.20 | $99.00 | $17.98 – $44.39 | 2 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn CPT 87340 | $63.20 | $79.00 | $12.91 – $31.89 | 2 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization CPT 87341 | $98.40 | $123.00 | $12.91 – $31.89 | 2 |
| Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies CPT 87389 | $84.80 | $106.00 | $30.10 – $74.33 | 2 |
| Infectious agent antigen immunoassay ql/sq multi step legionella urine CPT 87449 | $276.00 | $345.00 | $14.98 – $36.98 | 2 |
| Infectious agent antigen immunoassay ql/sq multi step rotavirus CPT 87425 | $91.20 | $114.00 | $14.98 – $36.98 | 2 |
| Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin CPT 87427 | $110.40 | $138.00 | $14.98 – $36.98 | 2 |
| Infectious agent nucleic acid amplified probe CPT 87798 | $399.20 | $499.00 | $43.86 – $108.32 | 2 |
| Infectious agent nucleic acid amplified probe chlamydia trachomatis CPT 87491 | $104.00 | $130.00 | $43.86 – $108.32 | 2 |
| Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s) CPT 87493 | $237.60 | $297.00 | $46.59 – $115.05 | 2 |
| Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets CPT 87483 | $170.40 | $213.00 | $520.98 – $1,286.60 | 2 |
| Infectious agent nucleic acid amplified probe hsv-1 CPT 87529 | $169.60 | $212.00 | $43.86 – $108.32 | 2 |
| Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus CPT 87641 | $168.00 | $210.00 | $43.86 – $108.32 | 2 |
| Infectious agent nucleic acid amplified probe mycobacteria tuberculosis CPT 87556 | $598.40 | $748.00 | $52.10 – $128.67 | 2 |
| Infectious agent nucleic acid amplified probe neisseria gonorrhoeae CPT 87591 | $109.60 | $137.00 | $43.86 – $108.32 | 2 |
| Infectious agent nucleic acid amplified probe sars-cov-2/covid-19 CPT 87635 | $117.60 | $147.00 | $64.14 – $158.39 | 2 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b CPT 87636 | $390.40 | $488.00 | $178.29 – $440.30 | 2 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv CPT 87637 | $468.00 | $585.00 | $178.29 – $440.30 | 2 |
| Infectious agent nucleic acid amplified probe streptococcus group a CPT 87651 | not published | not published | $43.86 – $108.32 | 2 |
| Infectious agent nucleic acid amplified probe trichomonas vaginalis CPT 87661 | $44.00 | $55.00 | $43.86 – $108.32 | 2 |
| Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance CPT 87564 | not published | not published | $95.96 – $236.99 | 2 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets CPT 87507 | $844.80 | $1,056.00 | $520.98 – $1,286.60 | 2 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets CPT 87505 | $844.80 | $1,056.00 | $160.36 – $396.03 | 2 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets CPT 87506 | $459.20 | $574.00 | $328.74 – $811.85 | 2 |
| Infectious agent nucleic acid quantification bk virus CPT 87799 | $485.60 | $607.00 | $53.55 – $132.25 | 2 |
| Infectious agent nucleic acid quantification hepatitis b CPT 87517 | $276.00 | $345.00 | $53.55 – $132.25 | 2 |
| Infectious agent nucleic acid quantification hepatitis c CPT 87522 | $1,024.00 | $1,280.00 | $53.55 – $132.25 | 2 |
| Infectious agent nucleic acid quantification hiv-1 CPT 87536 | $292.00 | $365.00 | $106.38 – $262.70 | 2 |
| Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets CPT 87631 | $428.80 | $536.00 | $178.29 – $440.30 | 2 |
| Infliximab 100 mg intravenous solution HCPCS J1745 | $2,925.44 | $3,656.80 | $70.15 – $96.25 | 2 |
| Infliximab-axxq 100 mg intravenous solution HCPCS Q5121 | not published | not published | $46.99 – $64.48 | 2 |
| Infliximab-dyyb 100 mg intravenous solution HCPCS Q5103 | $1,168.25 | $1,460.31 | $44.28 – $60.75 | 2 |
| Influenza dna amp prob addl CPT 87503 | $155.20 | $194.00 | $36.53 – $90.20 | 2 |
| Influenza virus vaccine, inact hemagglutinin tiv pf inj CPT 90673 | not published | not published | $187.86 – $257.74 | 2 |
| Influenza virus vaccine, live trivalent intranasal CPT 90660 | not published | not published | $64.96 – $89.12 | 2 |
| Infuse radioactive materials CPT 77750 | not published | not published | $857.96 – $857.96 | 1 |
| Ingest challenge ea addl 60 min CPT 95079 | $128.00 | $160.00 | not published | 0 |
| Ingest challenge ini 120 min CPT 95076 | $185.60 | $232.00 | $1,577.43 – $1,577.43 | 1 |
| Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis CPT 94642 | not published | not published | $624.86 – $624.86 | 1 |
| Initial foot exam pt lops HCPCS G0245 | $96.00 | $120.00 | $394.38 – $394.38 | 1 |
| Initial hosp neonate 28 d/less than not critically ill 99477 CPT 99477 | $497.60 | $622.00 | not published | 0 |
| Initial nursing facility care/day 35 minutes CPT 99305 | $184.80 | $231.00 | not published | 0 |
| Initial nursing facility care/day 45 minutes CPT 99306 | $236.80 | $296.00 | not published | 0 |
| Initial nursing facility care/day low severity 99304 CPT 99304 | $128.00 | $160.00 | not published | 0 |
| Initiation & management bipap/cpap initial day CPT 94660 | $243.20 | $304.00 | $624.86 – $624.86 | 1 |
| Init pm e/m new pat 65+ yrs CPT 99387 | $242.40 | $303.00 | not published | 0 |
| Init/sub psych care m 1st 30 HCPCS G2214 | not published | not published | $247.51 – $247.51 | 1 |
| Inj, abilify asimtufii, 1 mg HCPCS J0402 | not published | not published | $13.58 – $18.63 | 2 |
| Inj, abilify maintena, 1 mg HCPCS J0401 | $5.60 | $7.00 | $16.28 – $22.34 | 2 |
| Inj acetaminoph 10mg/ibu 3mg HCPCS J0138 | not published | not published | $0.49 – $0.67 | 2 |
| Inj, acetaminophen (b braun) HCPCS J0136 | not published | not published | $0.11 – $0.15 | 2 |
| Inj acetaminophen -fresenius HCPCS J0134 | not published | not published | $0.13 – $0.17 | 2 |
| Inj, acetaminophen (hikma) HCPCS J0137 | not published | not published | $0.11 – $0.15 | 2 |
| Inj. acthar gel to 40 units HCPCS J0801 | not published | not published | $9,421.71 – $12,926.59 | 2 |
| Inj, adstiladrin, per tx dos HCPCS J9029 | not published | not published | $142,719.87 – $195,811.66 | 2 |
| Inj, aducanumab-avwa, 2 mg HCPCS J0172 | not published | not published | $13.45 – $18.45 | 2 |
| Inj, adzynma, 10 iu HCPCS J7171 | not published | not published | $80.07 – $109.85 | 2 |
| Inj, aflibercept-ayyh, 1 mg HCPCS Q5147 | not published | not published | $1,955.44 – $2,682.86 | 2 |
| Inj, aflibercept hd, 1 mg HCPCS J0177 | not published | not published | $719.41 – $987.03 | 2 |
| Inj, afstyla, 1 i.u HCPCS J7210 | not published | not published | $3.55 – $4.87 | 2 |
| Inj allopurinol sodium 1 mg HCPCS J0206 | not published | not published | $10.22 – $14.02 | 2 |
| Inj, alyglo, 500 mg HCPCS J1552 | not published | not published | $295.02 – $404.77 | 2 |
| Inj alymsys 10 mg HCPCS Q5126 | not published | not published | $95.85 – $131.51 | 2 |
| Inj anifrolumab-fnia 1mg HCPCS J0491 | not published | not published | $40.73 – $55.89 | 2 |
| Inj. (ani), up to 40 units HCPCS J0802 | not published | not published | $7,981.47 – $10,950.57 | 2 |
| Inj., aristada initio, 1 mg HCPCS J1943 | not published | not published | $7.32 – $10.05 | 2 |
| Inj. asceniv HCPCS J1554 | not published | not published | $1,117.14 – $1,532.71 | 2 |
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.