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 |
|---|---|---|---|---|
| Low cost skin substitute app HCPCS C5273 | not published | not published | $5,631.53 – $5,631.53 | 1 |
| Low cost skin substitute app HCPCS C5275 | not published | not published | $1,895.66 – $1,895.66 | 1 |
| Low cost skin substitute app HCPCS C5277 | not published | not published | $1,895.66 – $1,895.66 | 1 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $1,824.80 | $2,281.00 | $588.44 – $588.44 | 1 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $1,600.00 | $2,000.00 | $1,202.18 – $1,202.18 | 1 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $1,314.40 | $1,643.00 | $348.75 – $348.75 | 1 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $2,889.60 | $3,612.00 | $1,202.18 – $1,202.18 | 1 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $2,448.80 | $3,061.00 | $1,202.18 – $1,202.18 | 1 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $1,956.80 | $2,446.00 | $761.98 – $761.98 | 1 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $260.80 | $326.00 | $348.75 – $348.75 | 1 |
| Lower jaw bone graft CPT 21215 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Low frequency non-thermal Ultrasound CPT 97610 | not published | not published | $589.25 – $589.25 | 1 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | $17,007.37 – $17,007.37 | 1 |
| Lsh uterus above 250 g CPT 58543 | not published | not published | $29,652.07 – $29,652.07 | 1 |
| Lsh w/t/o ut 250 g or less CPT 58542 | $1,228.00 | $1,535.00 | $29,652.07 – $29,652.07 | 1 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | $29,652.07 – $29,652.07 | 1 |
| L/s ratio fetal lung CPT 83661 | $255.20 | $319.00 | $27.49 – $67.88 | 2 |
| Lumbar diskogram s&i CPT 72295 | not published | not published | $5,865.36 – $5,865.36 | 1 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | $71,452.46 – $71,452.46 | 1 |
| Lumizyme injection HCPCS J0221 | not published | not published | $464.88 – $637.82 | 2 |
| Lung function test (mbc/mvv) CPT 94200 | $148.80 | $186.00 | $187.55 – $187.55 | 1 |
| Lung Function Test (Spirometry) CPT 94010 | $178.40 | $223.00 | $474.53 – $474.53 | 1 |
| Lung perfusion imaging CPT 78580 | not published | not published | $1,268.29 – $1,268.29 | 1 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | not published | not published | $463.78 – $636.31 | 2 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | $32,228.43 | $40,285.54 | $94.41 – $129.54 | 2 |
| Lw ntsty Ultrasound stimj bone healg CPT 20979 | $81.60 | $102.00 | $81.43 – $81.43 | 1 |
| Lyme dis dna dir probe CPT 87475 | not published | not published | $25.06 – $61.89 | 2 |
| Lymphatics/lymph node imaging CPT 78195 | not published | not published | $1,646.19 – $1,646.19 | 1 |
| Lymphocyte culture mixed CPT 86821 | not published | not published | $45.70 – $112.86 | 2 |
| Lymphocyte transformation mitogen CPT 86353 | $903.20 | $1,129.00 | $61.29 – $151.36 | 2 |
| Lymphocytotoxicity assay CPT 86805 | not published | not published | $236.89 – $585.02 | 2 |
| Lymphocytotoxicity assay CPT 86806 | not published | not published | $59.49 – $146.91 | 2 |
| Lymph vessel x-ray arm/leg CPT 75801 | not published | not published | $1,887.67 – $1,887.67 | 1 |
| Lymph vessel x-ray arms/legs CPT 75803 | not published | not published | $4,854.90 – $4,854.90 | 1 |
| Lymph vessel x-ray trunk CPT 75805 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Lymph vessel x-ray trunk CPT 75807 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Lysis intranasal synechia 30560 CPT 30560 | not published | not published | $1,490.61 – $1,490.61 | 1 |
| Lysis of labial adhesions CPT 56441 | $272.00 | $340.00 | $9,225.99 – $9,225.99 | 1 |
| Lysis penil circumic lesion CPT 54162 | $379.20 | $474.00 | $6,052.50 – $6,052.50 | 1 |
| Lyumjev for insulin pump use HCPCS J1813 | not published | not published | $34.36 – $47.14 | 2 |
| Macroscopic exam arthropod CPT 87168 | $77.60 | $97.00 | $5.34 – $13.18 | 2 |
| Macroscopic exam parasite CPT 87169 | $51.20 | $64.00 | $5.39 – $13.30 | 2 |
| Magnesium CPT 83735 | $112.00 | $140.00 | $8.38 – $20.68 | 2 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $70.84 | $88.55 | $1.12 – $1.54 | 2 |
| Magnetic image bone marrow CPT 77084 | not published | not published | $761.98 – $761.98 | 1 |
| Makena, 10 mg HCPCS J1726 | $31.20 | $39.00 | not published | 0 |
| Malaria antibody CPT 86750 | not published | not published | $16.49 – $40.72 | 2 |
| Male sling procedure CPT 53440 | not published | not published | $39,247.87 – $39,247.87 | 1 |
| Manipulate finger w/anesth CPT 26340 | not published | not published | $4,680.86 – $4,680.86 | 1 |
| Manipulate wrist w/anesthes CPT 25259 | not published | not published | $4,680.86 – $4,680.86 | 1 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $120.00 | $150.00 | $378.88 – $378.88 | 1 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $152.00 | $190.00 | $378.88 – $378.88 | 1 |
| Manipulation of hip joint CPT 27275 | not published | not published | $4,680.86 – $4,680.86 | 1 |
| Manipulation of spine CPT 22505 | not published | not published | $4,680.86 – $4,680.86 | 1 |
| Manipulat palm cord post inj CPT 26341 | $173.60 | $217.00 | $675.49 – $675.49 | 1 |
| Mannitol 12.5 gm/50 ml inj HCPCS J2150 | not published | not published | $5.03 – $6.90 | 2 |
| Manual diff wbc count b-coat CPT 85009 | not published | not published | $6.34 – $15.65 | 2 |
| Mapping io sentinel lymph node CPT 38900 | $202.40 | $253.00 | not published | 0 |
| Margetuximab-cmkb 25 mg/ml intravenous solution HCPCS J9353 | $3,511.61 | $4,389.51 | $113.51 – $155.74 | 2 |
| Marker biop eviva buckle ss HCPCS A4648 | $135.37 | $169.21 | not published | 0 |
| Mastectomy partial CPT 19301 | $979.20 | $1,224.00 | $11,217.60 – $11,217.60 | 1 |
| Mast mod rad CPT 19307 | $1,750.40 | $2,188.00 | $19,392.63 – $19,392.63 | 1 |
| Mastoidectomy CPT 69501 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Mastoidectomy complete 69502 CPT 69502 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Mastoids complete CPT 70130 | $412.00 | $515.00 | $348.75 – $348.75 | 1 |
| Mastoid surgery revision CPT 69603 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Mastopexy CPT 19316 | not published | not published | $19,392.63 – $19,392.63 | 1 |
| Mast radical CPT 19305 | $1,720.80 | $2,151.00 | not published | 0 |
| Mast simple complete CPT 19303 | $1,419.20 | $1,774.00 | $19,392.63 – $19,392.63 | 1 |
| Matrion 1 sq cm HCPCS Q4201 | not published | not published | $178.26 – $244.58 | 2 |
| Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm HCPCS Q4166 | not published | not published | $46.90 – $64.35 | 2 |
| M.avium-intra dna amp prob CPT 87561 | not published | not published | $43.86 – $108.32 | 2 |
| M.avium-intra dna dir prob CPT 87560 | $69.60 | $87.00 | $34.11 – $84.24 | 2 |
| M.avium-intra dna quant CPT 87562 | not published | not published | $53.55 – $132.25 | 2 |
| Maxillofacial fixation CPT 21100 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $96.00 | $120.00 | $18.08 – $44.64 | 2 |
| Mayo aathr protein s free CPT 85306 | $155.20 | $194.00 | $19.15 – $47.29 | 2 |
| Mayo activated protein c resistance assay CPT 85307 | $152.80 | $191.00 | $19.15 – $47.29 | 2 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | not published | not published | $48.21 – $119.07 | 2 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | $43.20 | $54.00 | not published | 0 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $60.80 | $76.00 | not published | 0 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $60.80 | $76.00 | $18.48 – $45.63 | 2 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $75.20 | $94.00 | not published | 0 |
| Mayo alpha 1 antitrypsin CPT 82103 | $127.20 | $159.00 | $16.80 – $41.49 | 2 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $183.20 | $229.00 | $18.85 – $46.55 | 2 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | not published | not published | $152.04 – $375.47 | 2 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $387.20 | $484.00 | $114.58 – $282.95 | 2 |
| Mayo analysis gene smn1 dosage/deletion CPT 81329 | not published | not published | $171.25 – $422.92 | 2 |
| Mayo analysis microarray cytogenomic copy number/snp variants CPT 81229 | not published | not published | $1,450.00 – $3,580.92 | 2 |
| Mayo androstenedione CPT 82157 | $145.60 | $182.00 | $36.60 – $90.39 | 2 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $112.80 | $141.00 | $18.25 – $45.07 | 2 |
| Mayo antithrombin iii antigen CPT 85301 | $116.00 | $145.00 | $13.51 – $33.37 | 2 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $92.80 | $116.00 | $18.81 – $46.46 | 2 |
| Mayo avwpr vw factor activity CPT 85397 | $238.40 | $298.00 | $38.58 – $95.26 | 2 |
| Mayo babpb infectious agent nucleic acid amplified probe babesia microti CPT 87469 | not published | not published | $43.86 – $108.32 | 2 |
| Mayo barbiturates definitive assay confirmation urine CPT 80345 | $116.00 | $145.00 | not published | 0 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $181.60 | $227.00 | $12.73 – $31.43 | 2 |
| Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 | $364.00 | $455.00 | $181.05 – $447.12 | 2 |
| Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative CPT 81208 | not published | not published | $268.28 – $662.53 | 2 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $80.00 | $100.00 | $16.13 – $39.82 | 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.