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 |
|---|---|---|---|---|
| Inj, aspara, rylaze, 0.1 mg HCPCS J9021 | not published | not published | $124.42 – $170.71 | 2 |
| Inj atezolizumb 5mg hya-tqjs HCPCS J9024 | not published | not published | $71.18 – $97.66 | 2 |
| Inj avacincaptad pegol 0.1mg HCPCS J2782 | not published | not published | $238.27 – $326.90 | 2 |
| Inj aval alfa-nqpt 4mg HCPCS J0219 | not published | not published | $181.69 – $249.28 | 2 |
| Inj., benralizumab, 1 mg HCPCS J0517 | not published | not published | $378.29 – $519.02 | 2 |
| Inj, bezlotoxumab, 10 mg HCPCS J0565 | not published | not published | $89.61 – $122.94 | 2 |
| Inj bimatoprost itc imp1mcg HCPCS J7351 | not published | not published | $477.82 – $655.57 | 2 |
| Inj, biorphen, 20 micrograms HCPCS J2372 | not published | not published | $0.38 – $0.52 | 2 |
| Inj, bortezomib, hospira HCPCS J9049 | not published | not published | $3.48 – $4.77 | 2 |
| Inj, brixadi, 7 days or less HCPCS J0577 | not published | not published | $951.36 – $1,305.27 | 2 |
| Inj brixadi, more than 7 day HCPCS J0578 | not published | not published | $3,805.44 – $5,221.06 | 2 |
| Inj, brolucizumab-dbll, 1 mg HCPCS J0179 | not published | not published | $778.94 – $1,068.70 | 2 |
| Inj, bupivacaine liposome HCPCS J0666 | not published | not published | $3.36 – $4.61 | 2 |
| Inj. byooviz, 0.1 mg HCPCS Q5124 | not published | not published | $139.84 – $191.87 | 2 |
| Inj cefazolin sodium, baxter HCPCS J0689 | not published | not published | $3.00 – $4.11 | 2 |
| Inj cefazolin sodium, hikma HCPCS J0688 | not published | not published | $2.06 – $2.82 | 2 |
| Inj cefazolin (wg crit care) HCPCS J0687 | not published | not published | $2.25 – $3.09 | 2 |
| Inj. cefepime hcl (baxter) HCPCS J0701 | not published | not published | $13.21 – $18.12 | 2 |
| Inj, cefepime hcl (b braun) HCPCS J0703 | not published | not published | $11.42 – $15.66 | 2 |
| Inj, cefiderocol, 10 mg HCPCS J0699 | not published | not published | $5.40 – $7.41 | 2 |
| Inj ceftolozane tazobactam HCPCS J0695 | not published | not published | $20.54 – $28.18 | 2 |
| Inj. cetirizine hcl 0.5mg HCPCS J1201 | not published | not published | $36.89 – $50.62 | 2 |
| Inj, cimerli, 0.1 mg HCPCS Q5128 | not published | not published | $194.65 – $267.07 | 2 |
| Inj, cipaglucosidase, 5 mg HCPCS J1203 | not published | not published | $202.04 – $277.20 | 2 |
| Inj, clindamycin (baxter) HCPCS J0737 | not published | not published | $3.86 – $5.30 | 2 |
| Inj crotalidae im f(ab')2 eq HCPCS J0841 | not published | not published | $2,349.31 – $3,223.26 | 2 |
| Inj cutaquig 100 mg HCPCS J1551 | not published | not published | $31.97 – $43.86 | 2 |
| Inj cuvitru, 100 mg HCPCS J1555 | not published | not published | $39.58 – $54.30 | 2 |
| Inj, cyclophos (baxter) 5mg HCPCS J9076 | not published | not published | $11.31 – $15.52 | 2 |
| Inj cyclophos dr.reddy's 5mg HCPCS J9072 | not published | not published | $20.26 – $27.79 | 2 |
| Inj cyclophosphamd auromedic HCPCS J9071 | not published | not published | $1.76 – $2.42 | 2 |
| Inj cyclophosphamd (ingenus) HCPCS J9073 | not published | not published | $2.60 – $3.57 | 2 |
| Inj, cyclophosphamd, sandoz HCPCS J9074 | not published | not published | $9.47 – $13.00 | 2 |
| Inj, daptomycin (baxter) HCPCS J0874 | not published | not published | $0.14 – $0.19 | 2 |
| Inj, daptomycin (hospira) HCPCS J0877 | not published | not published | $0.13 – $0.18 | 2 |
| Inj daptomycin (xellia) HCPCS J0873 | not published | not published | $0.09 – $0.13 | 2 |
| Inj daxibotulinumtoxina-lanm HCPCS J0589 | not published | not published | $7.00 – $9.60 | 2 |
| Inj, decitabine (sun pharma) HCPCS J0893 | not published | not published | $1.75 – $2.40 | 2 |
| Inj, donanemab-azbt, 2 mg HCPCS J0175 | not published | not published | $9.32 – $12.79 | 2 |
| Inj dupuytren cord w/enzyme CPT 20527 | $128.00 | $160.00 | $887.20 – $887.20 | 1 |
| Inj, durolane 1 mg HCPCS J7318 | $891.20 | $1,114.00 | $15.04 – $20.63 | 2 |
| Inj dx for sinogram CPT 20501 | $265.60 | $332.00 | not published | 0 |
| Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides) CPT 64454 | not published | not published | $2,102.48 – $2,102.48 | 1 |
| Injection arthrography hip without anesthesia (both sides) CPT 27093 | $335.20 | $419.00 | not published | 0 |
| Injection, belinostat, 10mg HCPCS J9032 | not published | not published | $117.09 – $160.65 | 2 |
| Injection, burosumab-twza 1m HCPCS J0584 | not published | not published | $1,083.53 – $1,486.60 | 2 |
| Injection carpal tunnel therapeutic (both sides) CPT 20526 | $121.60 | $152.00 | $887.20 – $887.20 | 1 |
| Injection, daratumumab 10 mg HCPCS J9145 | $3,863.11 | $4,828.89 | $157.13 – $215.58 | 2 |
| Injection, doxercalciferol HCPCS J1270 | not published | not published | $0.84 – $1.15 | 2 |
| Injection, edaravone, 1 mg HCPCS J1301 | not published | not published | $42.38 – $58.15 | 2 |
| Injection epidural blood patch or clot CPT 62273 | $684.80 | $856.00 | $2,102.48 – $2,102.48 | 1 |
| Injection eye drug CPT 67028 | not published | not published | $1,085.34 – $1,085.34 | 1 |
| Injection for arthrography wrist (both sides) CPT 25246 | $630.40 | $788.00 | not published | 0 |
| Injection for bladder x-ray CPT 51600 | $536.00 | $670.00 | not published | 0 |
| Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides) CPT 23350 | $565.60 | $707.00 | not published | 0 |
| Injection for ureter x-ray CPT 50690 | $452.00 | $565.00 | not published | 0 |
| Injection, fulvestrant HCPCS J9395 | $332.73 | $415.91 | $15.70 – $21.54 | 2 |
| Injection glatiramer acetate HCPCS J1595 | $646.72 | $808.40 | not published | 0 |
| Injection, inclisiran, 1 mg HCPCS J1306 | not published | not published | $27.79 – $38.13 | 2 |
| Injection into brain canal CPT 61026 | not published | not published | $2,102.48 – $2,102.48 | 1 |
| Injection into brain canal CPT 61055 | not published | not published | $887.20 – $887.20 | 1 |
| Injection into hemorrhoid(s) CPT 46500 | $475.20 | $594.00 | $2,711.70 – $2,711.70 | 1 |
| Injection into spinal artery CPT 62294 | not published | not published | $2,780.68 – $2,780.68 | 1 |
| Injection into vocal cord CPT 31513 | $189.60 | $237.00 | $1,230.61 – $1,230.61 | 1 |
| Injection, khapzory, 0.5 mg HCPCS J0642 | not published | not published | $2.52 – $3.46 | 2 |
| Injection, necitumumab, 1 mg HCPCS J9295 | not published | not published | $12.89 – $17.69 | 2 |
| Injection of sinus tract CPT 20500 | not published | not published | $4,529.52 – $4,529.52 | 1 |
| Injection,onabotulinumtoxina HCPCS J0585 | $8.80 | $11.00 | $14.63 – $20.07 | 2 |
| Injection px peyronie ds CPT 54200 | $176.80 | $221.00 | $701.12 – $701.12 | 1 |
| Injection radioactive tracer sentinel node (both sides) CPT 38792 | $122.40 | $153.00 | $1,268.29 – $1,268.29 | 1 |
| Injection, renflexis HCPCS Q5104 | $1,242.18 | $1,552.73 | $56.37 – $77.34 | 2 |
| Injection, ruconest HCPCS J0596 | not published | not published | $82.66 – $113.40 | 2 |
| Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides) HCPCS G0260 | not published | not published | $2,102.48 – $2,102.48 | 1 |
| Injection(s) anesthetic agent(s) and/or steroid femoral nerve left CPT 64447 | $474.40 | $593.00 | $2,102.48 – $2,102.48 | 1 |
| Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides) CPT 64450 | $192.00 | $240.00 | $2,102.48 – $2,102.48 | 1 |
| Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides) CPT 64483 | $916.00 | $1,145.00 | $2,780.68 – $2,780.68 | 1 |
| Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level CPT 64491 | $208.00 | $260.00 | not published | 0 |
| Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level CPT 64490 | $1,365.60 | $1,707.00 | $2,780.68 – $2,780.68 | 1 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance CPT 64494 | $208.00 | $260.00 | not published | 0 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level CPT 64493 | $996.00 | $1,245.00 | $2,780.68 – $2,780.68 | 1 |
| Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance CPT 62321 | $872.00 | $1,090.00 | $2,102.48 – $2,102.48 | 1 |
| Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance CPT 62323 | $872.00 | $1,090.00 | $2,102.48 – $2,102.48 | 1 |
| Injection, siltuximab HCPCS J2860 | not published | not published | $364.40 – $499.96 | 2 |
| Injection(s) tendon sheath/ligament aponeurosis single (both sides) CPT 20550 | $86.40 | $108.00 | $887.20 – $887.20 | 1 |
| Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s) CPT 20552 | $350.40 | $438.00 | $887.20 – $887.20 | 1 |
| Injection(s) trigger point(s) single/multiple >= 3 muscle(s) CPT 20553 | $411.20 | $514.00 | $887.20 – $887.20 | 1 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug CPT 96375 | $80.00 | $100.00 | $138.26 – $138.26 | 1 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug CPT 96376 | $176.80 | $221.00 | not published | 0 |
| Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug CPT 96374 | $264.80 | $331.00 | $674.04 – $674.04 | 1 |
| Injection therapeutic/prophylactic/diagnostic subcutaneous/im CPT 96372 | $170.40 | $213.00 | $220.15 – $220.15 | 1 |
| Injection treatment of eye CPT 66020 | not published | not published | $7,046.29 – $7,046.29 | 1 |
| Injection treatment of eye CPT 66030 | not published | not published | $7,046.29 – $7,046.29 | 1 |
| Injection treatment of nerve CPT 64605 | not published | not published | $5,865.36 – $5,865.36 | 1 |
| Injection treatment of nerve CPT 64610 | not published | not published | $5,865.36 – $5,865.36 | 1 |
| Injection treatment of nerve CPT 64681 | not published | not published | $2,780.68 – $2,780.68 | 1 |
| Injection treatment of nose CPT 30200 | not published | not published | $1,490.61 – $1,490.61 | 1 |
| Inject sacroiliac joint CPT 27096 | $1,104.00 | $1,380.00 | not published | 0 |
| Inject/treat eye socket CPT 67500 | not published | not published | $863.77 – $863.77 | 1 |
| Inject/treat eye socket CPT 67505 | not published | not published | $863.77 – $863.77 | 1 |
| Inject/treat eye socket CPT 67515 | not published | not published | $863.77 – $863.77 | 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.