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 |
|---|---|---|---|---|
| Ip/obs cnsltj new/est low 45 CPT 99253 | $164.80 | $206.00 | not published | 0 |
| Ip/obs cnsltj new/est mod 60 CPT 99254 | $236.80 | $296.00 | not published | 0 |
| Ip/obs consltj new/est hi 80 CPT 99255 | $286.40 | $358.00 | not published | 0 |
| Ip/obs consltj new/est sf 35 CPT 99252 | $106.40 | $133.00 | not published | 0 |
| Ipratropium bromide non-comp HCPCS J7644 | $4.77 | $5.96 | $0.89 – $1.22 | 2 |
| Irinotecan 20 mg/ml intravenous solution (wrapper) HCPCS J9206 | $396.60 | $495.75 | $3.14 – $4.31 | 2 |
| Irinotecan liposomal 4.3 mg/ml intravenous HCPCS J9205 | not published | not published | $146.82 – $201.44 | 2 |
| Iron CPT 83540 | $304.00 | $380.00 | $8.09 – $19.97 | 2 |
| Iron binding capacity CPT 83550 | $131.20 | $164.00 | $10.93 – $26.98 | 2 |
| Iron dextran 50 mg/ml injection solution HCPCS J1750 | $112.38 | $140.47 | $40.56 – $55.65 | 2 |
| Iron stain peripheral blood CPT 85536 | not published | not published | $8.60 – $21.24 | 2 |
| Iron sucrose 20 mg iron/ml intravenous solution (wrapper) HCPCS J1756 | $121.39 | $151.74 | $0.50 – $0.69 | 2 |
| Irradiation of blood product each unit reference CPT 86945 | $234.40 | $293.00 | $110.81 – $110.81 | 1 |
| Irrigation implantable venous access device for drug delivery systems CPT 96523 | $108.80 | $136.00 | $187.55 – $187.55 | 1 |
| Irrigation sphenoid sinus CPT 31002 | not published | not published | $4,529.52 – $4,529.52 | 1 |
| Irrigation vagina and/or appl medicament tx disease CPT 57150 | not published | not published | $187.55 – $187.55 | 1 |
| Isatuximab-irfc 20 mg/ml intravenous solution HCPCS J9227 | not published | not published | $186.44 – $255.79 | 2 |
| Island pedicle flap graft CPT 15740 | not published | not published | $5,631.53 – $5,631.53 | 1 |
| Ivc venogram s&i CPT 75825 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour CPT 96367 | $131.20 | $164.00 | $220.15 – $220.15 | 1 |
| IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 | $174.40 | $218.00 | not published | 0 |
| IV infusion therapy/prophylaxis/diagnosis each additional 1 hour CPT 96366 | $94.40 | $118.00 | $138.26 – $138.26 | 1 |
| IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour CPT 96365 | $516.80 | $646.00 | $674.04 – $674.04 | 1 |
| IV inj ra drug dx study CPT 78808 | not published | not published | $1,268.29 – $1,268.29 | 1 |
| IV njx tst vasc flo flap/grf CPT 15860 | not published | not published | $1,232.01 – $1,232.01 | 1 |
| Ivp w/nephrotomography CPT 74415 | not published | not published | $588.44 – $588.44 | 1 |
| Ivp w/wo kub w/wo tomography CPT 74400 | not published | not published | $588.44 – $588.44 | 1 |
| Ixabepilone 15 mg intravenous solution HCPCS J9207 | not published | not published | $312.01 – $428.08 | 2 |
| Jak2 targeted sequence analysis CPT 81279 | not published | not published | $231.50 – $571.71 | 2 |
| Jaw arthroscopy/surgery CPT 29800 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Jaw arthroscopy/surgery CPT 29804 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Jejunstmy tube plcmt CPT 44372 | not published | not published | $5,682.83 – $5,682.83 | 1 |
| John cunningham antibody CPT 86711 | $47.20 | $59.00 | $21.11 – $52.14 | 2 |
| J-tube placement CPT 44015 | $208.80 | $261.00 | not published | 0 |
| Keratoprosthesis CPT 65770 | not published | not published | $23,550.98 – $23,550.98 | 1 |
| Ketogenic steroids fract CPT 83582 | not published | not published | $19.34 – $47.76 | 2 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $84.80 | $106.00 | $10.21 – $25.22 | 2 |
| Ketorolac 15 mg/ml injection (wrapper) HCPCS J1885 | $70.04 | $87.55 | $0.78 – $1.07 | 2 |
| Kidney endoscopy CPT 50551 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Kidney endoscopy CPT 50553 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Kidney endoscopy CPT 50570 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Kidney endoscopy CPT 50575 | $1,047.20 | $1,309.00 | $15,343.31 – $15,343.31 | 1 |
| Kidney endoscopy & biopsy CPT 50555 | not published | not published | $27,923.42 – $27,923.42 | 1 |
| Kidney endoscopy & biopsy CPT 50574 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Kidney endoscopy & treatment CPT 50557 | not published | not published | $27,923.42 – $27,923.42 | 1 |
| Kidney endoscopy & treatment CPT 50561 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Kidney endoscopy & treatment CPT 50576 | not published | not published | $27,923.42 – $27,923.42 | 1 |
| Kidney endoscopy & treatment CPT 50580 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Kidney function study CPT 78725 | not published | not published | $1,268.29 – $1,268.29 | 1 |
| Kidney imaging morphology CPT 78700 | not published | not published | $1,268.29 – $1,268.29 | 1 |
| Kidney imag w/bld flow multi CPT 78709 | not published | not published | $1,646.19 – $1,646.19 | 1 |
| Kidney img w/bldflw sgl without rx CPT 78707 | not published | not published | $1,646.19 – $1,646.19 | 1 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $626.40 | $783.00 | $348.75 – $348.75 | 1 |
| Kit cast tcc 3in w/2reg boots total contact cast HCPCS Q4038 | $62.40 | $78.00 | not published | 0 |
| Kit gene analys d816 variant CPT 81273 | $382.40 | $478.00 | $156.09 – $385.47 | 2 |
| Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm HCPCS Q4105 | not published | not published | $58.70 – $80.53 | 2 |
| Knee Arthroscopy (Cartilage Repair) CPT 29877 | $917.60 | $1,147.00 | $9,712.92 – $9,712.92 | 1 |
| Knee arthroscopy/drainage CPT 29871 | $787.20 | $984.00 | $9,712.92 – $9,712.92 | 1 |
| Knee arthroscopy dx CPT 29870 | $841.60 | $1,052.00 | $9,712.92 – $9,712.92 | 1 |
| Knee Arthroscopy (Meniscus Repair) CPT 29881 | $960.00 | $1,200.00 | $9,712.92 – $9,712.92 | 1 |
| Knee arthroscopy/surgery CPT 29850 | not published | not published | $4,680.86 – $4,680.86 | 1 |
| Knee arthroscopy/surgery CPT 29851 | $1,368.00 | $1,710.00 | $4,680.86 – $4,680.86 | 1 |
| Knee arthroscopy/surgery CPT 29873 | $795.20 | $994.00 | $9,712.92 – $9,712.92 | 1 |
| Knee arthroscopy/surgery CPT 29874 | $792.00 | $990.00 | $9,712.92 – $9,712.92 | 1 |
| Knee arthroscopy/surgery CPT 29875 | $733.60 | $917.00 | $9,712.92 – $9,712.92 | 1 |
| Knee arthroscopy/surgery CPT 29876 | $964.00 | $1,205.00 | $9,712.92 – $9,712.92 | 1 |
| Knee arthroscopy/surgery CPT 29879 | $976.00 | $1,220.00 | $9,712.92 – $9,712.92 | 1 |
| Knee arthroscopy/surgery CPT 29880 | $830.40 | $1,038.00 | $9,712.92 – $9,712.92 | 1 |
| Knee arthroscopy/surgery CPT 29882 | $1,016.00 | $1,270.00 | $9,712.92 – $9,712.92 | 1 |
| Knee arthroscopy/surgery CPT 29883 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Knee arthroscopy/surgery CPT 29884 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Knee arthroscopy/surgery CPT 29886 | $972.80 | $1,216.00 | $9,712.92 – $9,712.92 | 1 |
| Knee arthroscopy/surgery CPT 29887 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Knee arthroscopy/surgery CPT 29888 | $1,438.40 | $1,798.00 | $21,583.67 – $21,583.67 | 1 |
| Knee arthroscopy/surgery CPT 29889 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Knee MRI (with and without contrast) CPT 73723 | $2,171.20 | $2,714.00 | $1,202.18 – $1,202.18 | 1 |
| Knee MRI (with contrast) CPT 73722 | $1,732.80 | $2,166.00 | $2,417.07 – $2,417.07 | 1 |
| Knee MRI (without contrast) CPT 73721 | $1,724.00 | $2,155.00 | $761.98 – $761.98 | 1 |
| Knee X-ray CPT 73564 | $260.80 | $326.00 | $348.75 – $348.75 | 1 |
| Kras gene addl variants CPT 81276 | not published | not published | $241.56 – $596.56 | 2 |
| Kras gene variants exon 2 CPT 81275 | $603.20 | $754.00 | $241.56 – $596.56 | 2 |
| Kyleena, 19.5 mg HCPCS J7296 | $1,008.00 | $1,260.00 | not published | 0 |
| Lab draw < 3 yrs fem/jugular 36400 CPT 36400 | $49.60 | $62.00 | not published | 0 |
| Labetalol 5 mg/ml IV (wrapper) HCPCS J1920 | $75.96 | $94.95 | $0.88 – $1.20 | 2 |
| Labioplasty 56800 CPT 56800 | $373.60 | $467.00 | $9,225.99 – $9,225.99 | 1 |
| Lactate dehydrogenase (ldh) CPT 83615 | $52.80 | $66.00 | $7.55 – $18.65 | 2 |
| Lactated ringers intravenous solution HCPCS J7120 | $36.28 | $45.35 | $5.54 – $7.60 | 2 |
| Lactic acid CPT 83605 | $118.40 | $148.00 | $14.46 – $35.72 | 2 |
| Lactoferrin fecal qualitative CPT 83630 | $83.20 | $104.00 | $24.63 – $60.81 | 2 |
| Lactoferrin fecal quant CPT 83631 | not published | not published | $24.54 – $60.60 | 2 |
| Lam facetec & foramot crv CPT 63045 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Lam facetec & foramot lumbar CPT 63047 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Lam facetec & foramot thrc CPT 63046 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Lamie excise intrspinl lesion thrc 63266 CPT 63266 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Laminotomy single cervical CPT 63040 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Laminotomy single lumbar CPT 63042 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Lanreotide 120 mg/0.5 ml subcutaneous syringe HCPCS J1930 | not published | not published | $82.48 – $113.16 | 2 |
| Laparo ablate liver tumor rf CPT 47370 | not published | not published | $29,652.07 – $29,652.07 | 1 |
| Laparo ablate renal cyst CPT 50541 | not published | not published | $17,007.37 – $17,007.37 | 1 |
| Laparo ablate renal mass CPT 50542 | not published | not published | $29,652.07 – $29,652.07 | 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.