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 |
|---|---|---|---|---|
| Mayo bordetella pertussis antibody igg CPT 86615 | $255.20 | $319.00 | $16.49 – $40.72 | 2 |
| Mayo brcmg brucella antibody igm CPT 86622 | $136.00 | $170.00 | $11.16 – $27.57 | 2 |
| Mayo c1 esterase inhibitor CPT 83883 | $89.60 | $112.00 | $17.00 – $41.98 | 2 |
| Mayo cannabinoids natural definitive assay thc confirmation urine CPT 80349 | $71.20 | $89.00 | not published | 0 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $69.60 | $87.00 | $21.09 – $52.08 | 2 |
| Mayo cd20b mononuclear cell antigen nos quantitative each CPT 86356 | not published | not published | $33.48 – $82.67 | 2 |
| Mayo cdcom hla class ii typing low resolution one locus each CPT 81376 | $509.60 | $637.00 | $152.78 – $377.29 | 2 |
| Mayo ceruloplasmin CPT 82390 | $98.40 | $123.00 | $13.43 – $33.15 | 2 |
| Mayo chemiluminescent parathyroid related peptide CPT 82397 | $55.20 | $69.00 | $17.65 – $43.59 | 2 |
| Mayo chikv chikungunya antibodies igg CPT 86790 | $215.20 | $269.00 | $16.10 – $39.76 | 2 |
| Mayo chlap chlamydia pneumoniae antibody igg CPT 86631 | $48.80 | $61.00 | $14.78 – $36.49 | 2 |
| Mayo chlap chlamydia pneumoniae antibody igm CPT 86632 | $102.40 | $128.00 | $15.85 – $39.14 | 2 |
| Mayo chrcb tissue culture non-neoplastic disorders lymphocyte CPT 88230 | $525.60 | $657.00 | $145.61 – $359.60 | 2 |
| Mayo chromium CPT 82495 | $68.80 | $86.00 | $25.35 – $62.60 | 2 |
| Mayo coccidioides antibody CPT 86635 | $120.00 | $150.00 | $14.34 – $35.41 | 2 |
| Mayo cocou cortisone urine CPT 82542 | $414.40 | $518.00 | $30.11 – $74.37 | 2 |
| Mayo cortisol free CPT 82530 | $127.20 | $159.00 | $20.89 – $51.58 | 2 |
| Mayo covid-19 antibody nucleocapsid total CPT 86769 | $92.00 | $115.00 | $52.66 – $130.06 | 2 |
| Mayo coxiella brunetii (q fever) igg antibody CPT 86638 | $72.80 | $91.00 | $15.15 – $37.41 | 2 |
| Mayo cyanide CPT 82600 | $96.00 | $120.00 | $24.25 – $59.89 | 2 |
| Mayo cytopathology in situ hybridization urinary tract 3-5 probes each specimen manual CPT 88120 | not published | not published | $513.12 – $513.12 | 1 |
| Mayo deoxyribonuclease antibody titer CPT 86215 | $44.00 | $55.00 | $16.56 – $40.90 | 2 |
| Mayo dhea (dehydroepiandrosterone) CPT 82626 | $153.60 | $192.00 | $31.59 – $78.01 | 2 |
| Mayo dihydrotestosterone CPT 82642 | not published | not published | $36.60 – $90.39 | 2 |
| Mayo dipstick analyte single step qualitative/semiqualitative synovial fluid CPT 83518 | not published | not published | $12.05 – $29.76 | 2 |
| Mayo efpo chloride stool CPT 82438 | $109.60 | $137.00 | $6.25 – $15.44 | 2 |
| Mayo estriol CPT 82677 | $56.80 | $71.00 | $30.23 – $74.64 | 2 |
| Mayo estrone CPT 82679 | $68.80 | $86.00 | $31.19 – $77.02 | 2 |
| Mayo ethosuximide therapeutic drug level CPT 80168 | $171.20 | $214.00 | $20.43 – $50.44 | 2 |
| Mayo everolimus therapeutic drug level CPT 80169 | not published | not published | $17.16 – $42.38 | 2 |
| Mayo factor ii CPT 85210 | $176.00 | $220.00 | $16.23 – $40.07 | 2 |
| Mayo factor v CPT 85220 | $310.40 | $388.00 | $22.06 – $54.49 | 2 |
| Mayo factor vii CPT 85230 | $239.20 | $299.00 | $22.38 – $55.26 | 2 |
| Mayo factor viii vw factor antigen CPT 85246 | $199.20 | $249.00 | $28.68 – $70.82 | 2 |
| Mayo factor viii vw factor multimetric analysis CPT 85247 | $397.60 | $497.00 | $28.68 – $70.82 | 2 |
| Mayo factor viii vw factor ristocetin cofactor CPT 85245 | $199.20 | $249.00 | $28.68 – $70.82 | 2 |
| Mayo factor x CPT 85260 | $98.40 | $123.00 | $22.38 – $55.26 | 2 |
| Mayo factor xi CPT 85270 | $267.20 | $334.00 | $22.38 – $55.26 | 2 |
| Mayo fat/lipids feces quantitative CPT 82710 | $132.80 | $166.00 | $21.00 – $51.86 | 2 |
| Mayo fbl culture fungi blood CPT 87103 | $152.00 | $190.00 | $25.58 – $63.16 | 2 |
| Mayo fdp/fsp paracoagulation CPT 85366 | $125.60 | $157.00 | $100.58 – $248.38 | 2 |
| Mayo ffspg allergen clam igg CPT 86001 | $512.80 | $641.00 | $9.78 – $24.14 | 2 |
| Mayo fibrinogen antigen CPT 85385 | not published | not published | $18.08 – $44.64 | 2 |
| Mayo gabapentin bld/srm/plasma therapeutic drug level CPT 80171 | $83.20 | $104.00 | $27.09 – $66.90 | 2 |
| Mayo gamma-globin full gene sequencing CPT 81479 | $428.80 | $536.00 | not published | 0 |
| Mayo hemosiderin qualitative urine CPT 83070 | $124.00 | $155.00 | $5.94 – $14.66 | 2 |
| Mayo hip12 infectious agent nucleic acid amplified probe hiv-1 rna qualitative CPT 87535 | not published | not published | $43.86 – $108.32 | 2 |
| Mayo hip12 infectious agent nucleic acid amplified probe hiv-2 CPT 87538 | not published | not published | $43.86 – $108.32 | 2 |
| Mayo hiser histoplasma antibodies immunodiffusion CPT 86698 | $84.80 | $106.00 | $17.24 – $42.57 | 2 |
| Mayo hla typing a/b/c single antigen CPT 86812 | $184.00 | $230.00 | $32.26 – $79.68 | 2 |
| Mayo hvdip HIV 1 antibody CPT 86701 | $188.00 | $235.00 | $11.11 – $27.44 | 2 |
| Mayo hvdip HIV 2 antibody CPT 86702 | $136.00 | $170.00 | $16.90 – $41.74 | 2 |
| Mayo hydroxyprogesterone 17-d CPT 83498 | $124.00 | $155.00 | $33.96 – $83.87 | 2 |
| Mayo immunoassay c1 esterase inhibitor antibody quantitative CPT 83520 | $382.40 | $478.00 | $21.59 – $53.31 | 2 |
| Mayo immunoassay infectious agent antibody quantitative diptheria igg CPT 86317 | $84.80 | $106.00 | $18.74 – $46.27 | 2 |
| Mayo immunoassay tumor antigen quantitative ca 27.29 CPT 86300 | $140.80 | $176.00 | $26.01 – $64.24 | 2 |
| Mayo immunoassay tumor antigen quantitative chromogranin a CPT 86316 | $432.00 | $540.00 | $26.01 – $64.24 | 2 |
| Mayo inf agt nucleic acid amp prb helicobacter pylori clarithromycin resistance CPT 87513 | not published | not published | $43.86 – $108.32 | 2 |
| Mayo infectious agent antigen immunoassay direct optical observation cryptococcus CPT 87899 | $144.80 | $181.00 | $20.09 – $49.61 | 2 |
| Mayo infectious agent antigen immunoassay ql/sq multi step aspergillus bal CPT 87305 | $235.20 | $294.00 | $14.98 – $36.98 | 2 |
| Mayo infectious agent nucleic acid amplified probe enterovirus CPT 87498 | $145.60 | $182.00 | $43.86 – $108.32 | 2 |
| Mayo infectious agent nucleic acid amplified probe mycoplasma genitalium urine CPT 87563 | not published | not published | $43.86 – $108.32 | 2 |
| Mayo infectious agent nucleic acid amplified probe mycoplasma pneumoniae CPT 87581 | $243.20 | $304.00 | $43.86 – $108.32 | 2 |
| Mayo infectious agent nucleic acid amplified probe pneumocystis jirovecii CPT 87594 | not published | not published | $43.86 – $108.32 | 2 |
| Mayo infectious agent nucleic acid quantification cytomegalovirus CPT 87497 | $586.40 | $733.00 | $53.55 – $132.25 | 2 |
| Mayo infectious disease hepatitis c chronic six biochemical assays CPT 81596 | not published | not published | $90.24 – $222.85 | 2 |
| Mayo infliximab therapeutic drug level CPT 80230 | not published | not published | $48.21 – $119.07 | 2 |
| Mayo inhab inhibin a CPT 86336 | $133.60 | $167.00 | $19.49 – $48.13 | 2 |
| Mayo insft insulin free CPT 83527 | $54.40 | $68.00 | $16.19 – $39.98 | 2 |
| Mayo insulin antibodies CPT 86337 | $90.40 | $113.00 | $26.76 – $66.09 | 2 |
| Mayo iodine CPT 83789 | $337.60 | $422.00 | $30.14 – $74.43 | 2 |
| Mayo itraconazole therapeutic drug level CPT 80189 | $125.60 | $157.00 | $33.89 – $83.69 | 2 |
| Mayo lacosamide therapeutic drug level CPT 80235 | not published | not published | $33.89 – $83.69 | 2 |
| Mayo lamotrigine therapeutic drug level CPT 80175 | $93.60 | $117.00 | $16.56 – $40.90 | 2 |
| Mayo ld_i lactate dehydrogenase isoenzymes CPT 83625 | $132.80 | $166.00 | $15.99 – $39.48 | 2 |
| Mayo legionella antibody CPT 86713 | $94.40 | $118.00 | $19.13 – $47.23 | 2 |
| Mayo leptospira antibody igm CPT 86720 | $128.00 | $160.00 | $20.25 – $50.01 | 2 |
| Mayo lipoprotein electrophoresis CPT 83700 | not published | not published | $14.08 – $34.76 | 2 |
| Mayo lywb borrelia burgdorferi (lyme disease) antibody igg confirmatory CPT 86617 | $56.80 | $71.00 | $19.36 – $47.82 | 2 |
| Mayo manganese CPT 83785 | $112.00 | $140.00 | $33.31 – $82.27 | 2 |
| Mayo metanephrines plasma CPT 83835 | $174.40 | $218.00 | $21.18 – $52.29 | 2 |
| Mayo methadone definitive assay confirmation urine CPT 80358 | $132.00 | $165.00 | not published | 0 |
| Mayo mgle voltage-gated calcium channel antibody each CPT 86596 | not published | not published | $15.06 – $37.20 | 2 |
| Mayo mgrm acetylcholine receptor binding antibody CPT 86041 | not published | not published | $23.00 – $56.80 | 2 |
| Mayo microsomal antibody liver-kidney CPT 86376 | $120.80 | $151.00 | $18.19 – $44.92 | 2 |
| Mayo mitotane (lysodren) therapeutic drug level CPT 80299 | $468.00 | $585.00 | $23.30 – $57.54 | 2 |
| Mayo molecular pathology procedure level 2 apoe genotype CPT 81401 | $424.80 | $531.00 | $171.25 – $422.92 | 2 |
| Mayo mpl sequence analysis exon 10 CPT 81339 | not published | not published | $231.50 – $571.71 | 2 |
| Mayo muramidase CPT 85549 | $101.60 | $127.00 | $23.44 – $57.88 | 2 |
| Mayo muscle-specific kinase (musk) antibody CPT 86366 | not published | not published | $23.00 – $56.80 | 2 |
| Mayo mycophenolic acid therapeutic drug level CPT 80180 | $91.20 | $114.00 | $22.56 – $55.72 | 2 |
| Mayo myoglobin CPT 83874 | $188.80 | $236.00 | $16.15 – $39.88 | 2 |
| Mayo nickel CPT 83885 | not published | not published | $30.64 – $75.66 | 2 |
| Mayo opatu opioid/analogs definitive assay 1 or 2 CPT 80362 | $48.00 | $60.00 | not published | 0 |
| Mayo organic acid methylmalonic single quantitative CPT 83921 | $271.20 | $339.00 | $26.51 – $65.48 | 2 |
| Mayo organic acids qualitative each specimen CPT 83919 | $540.80 | $676.00 | $20.56 – $50.78 | 2 |
| Mayo oxalate 24 hour urine CPT 83945 | $109.60 | $137.00 | $18.06 – $44.61 | 2 |
| Mayo pancreatic elastase fecal qualitative or semi quantitative CPT 82656 | $48.00 | $60.00 | $14.41 – $35.59 | 2 |
| Mayo parvs parvovirus b19 antibody igg CPT 86747 | $96.00 | $120.00 | $18.79 – $46.40 | 2 |
| Mayo paval fluorescent antibody screen agna type 1 CPT 86255 | $544.80 | $681.00 | $15.06 – $37.20 | 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.