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 pborb infectious agent nucleic acid amplified probe borrelia burgdorferi (lyme) CPT 87476 | $40.80 | $51.00 | $43.86 – $108.32 | 2 |
| Mayo phospholipid neutralization hexagonal lupus anticoagulant CPT 85598 | $96.80 | $121.00 | $22.48 – $55.50 | 2 |
| Mayo pntft phenytoin free therapeutic drug level CPT 80186 | $38.40 | $48.00 | $17.20 – $42.48 | 2 |
| Mayo pqnu porphobilinogen urine quantitative 24 hour urine CPT 84110 | $112.00 | $140.00 | $10.55 – $26.05 | 2 |
| Mayo pregnenolone CPT 84140 | $75.20 | $94.00 | $25.84 – $63.81 | 2 |
| Mayo prmb primidone therapeutic drug level CPT 80188 | $115.20 | $144.00 | $20.74 – $51.21 | 2 |
| Mayo proinsulin CPT 84206 | $196.00 | $245.00 | $33.36 – $82.39 | 2 |
| Mayo psaft prostate specific antigen free CPT 84154 | $149.60 | $187.00 | $22.99 – $56.77 | 2 |
| Mayo radioimmunoassay procollagen i intact n-terminal antibody quantitative CPT 83519 | $611.20 | $764.00 | $23.00 – $56.80 | 2 |
| Mayo rbcme osmotic fragility rbc incubated CPT 85557 | $52.00 | $65.00 | $16.70 – $41.24 | 2 |
| Mayo receptor assay transferrin soluble CPT 84238 | not published | not published | $45.71 – $112.89 | 2 |
| Mayo renin CPT 84244 | $188.00 | $235.00 | $27.49 – $67.88 | 2 |
| Mayo repu protein electrophoresis urine CPT 84166 | $121.60 | $152.00 | $22.29 – $55.04 | 2 |
| Mayo selenium CPT 84255 | $100.00 | $125.00 | $31.91 – $78.81 | 2 |
| Mayo semb semen analysis volume/count/motility/differential strict morphologic criteria CPT 89322 | $71.20 | $89.00 | $19.38 – $47.85 | 2 |
| Mayo serotonin CPT 84260 | $153.60 | $192.00 | $38.73 – $95.64 | 2 |
| Mayo sfgp rickettsia rickettsii antibody igg CPT 86757 | $181.60 | $227.00 | $24.19 – $59.73 | 2 |
| Mayo sirolimus therapeutic drug level CPT 80195 | $62.40 | $78.00 | $17.16 – $42.38 | 2 |
| Mayo syphilis test non-treponemal antibody qualitative vdrl CPT 86592 | $79.20 | $99.00 | $5.34 – $13.18 | 2 |
| Mayo tcgr analysis gene rearrangement trb@ abnormal clonal population(s) amplification CPT 81340 | not published | not published | $261.15 – $644.94 | 2 |
| Mayo tgrp testosterone free CPT 84402 | $120.80 | $151.00 | $31.84 – $78.63 | 2 |
| Mayo tgrp testosterone total CPT 84403 | $173.60 | $217.00 | $32.26 – $79.68 | 2 |
| Mayo thiopurine s-methyltransferase CPT 84433 | $111.20 | $139.00 | $27.71 – $68.44 | 2 |
| Mayo thyroglobulin CPT 84432 | $140.00 | $175.00 | $20.08 – $49.58 | 2 |
| Mayo ticks anaplasma phagocytophilum antibody igg CPT 86666 | $56.80 | $71.00 | $12.73 – $31.43 | 2 |
| Mayo ticks babesia microti antibody igg CPT 86753 | $55.20 | $69.00 | $15.49 – $38.25 | 2 |
| Mayo ttfb testosterone bioavailable direct CPT 84410 | $1,268.00 | $1,585.00 | $64.10 – $158.30 | 2 |
| Mayo tulab francisella tularensis antibody igg CPT 86668 | $56.80 | $71.00 | $17.70 – $43.71 | 2 |
| Mayo valpg valproic acid free therapeutic drug level CPT 80165 | not published | not published | $16.93 – $41.80 | 2 |
| Mayo vasoactive intestinal peptide CPT 84586 | $261.60 | $327.00 | $44.16 – $109.06 | 2 |
| Mayo vitamin b-2 (riboflavin) CPT 84252 | not published | not published | $25.30 – $62.48 | 2 |
| Mayo vitamin b3 (niacin) CPT 84591 | $196.00 | $245.00 | $21.33 – $52.66 | 2 |
| Mayo vitamin k CPT 84597 | $122.40 | $153.00 | $17.15 – $42.35 | 2 |
| Mayo zonisamide therapeutic drug level CPT 80203 | $149.60 | $187.00 | $16.56 – $40.90 | 2 |
| Mcoln1 gene CPT 81290 | not published | not published | $49.14 – $121.35 | 2 |
| Mcp joint arthroscopy dx CPT 29900 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Mcp joint arthroscopy surg CPT 29901 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Mcp joint arthroscopysurg 29902 CPT 29902 | not published | not published | $4,680.86 – $4,680.86 | 1 |
| Mdfc flap w/prsrv vasc pedcl CPT 15730 | not published | not published | $10,614.75 – $10,614.75 | 1 |
| Md service required for pmd HCPCS G0372 | $13.60 | $17.00 | not published | 0 |
| Meas lung vol thru 2 yrs CPT 94013 | not published | not published | $1,577.43 – $1,577.43 | 1 |
| Measure kidney pressure CPT 50396 | not published | not published | $2,040.48 – $2,040.48 | 1 |
| Measurement post void urine by ultrasound CPT 51798 | $151.20 | $189.00 | $187.55 – $187.55 | 1 |
| Measure ureter pressure CPT 50686 | not published | not published | $474.53 – $474.53 | 1 |
| Mecp2 gene dup/delet variant CPT 81304 | not published | not published | $187.50 – $463.05 | 2 |
| Mecp2 gene full seq CPT 81302 | not published | not published | $659.84 – $1,629.53 | 2 |
| Mecp2 gene known variant CPT 81303 | not published | not published | $150.00 – $370.44 | 2 |
| Medial canthopexy CPT 21280 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Mediastinoscpy w/lmph nod bx CPT 39402 | not published | not published | $17,007.37 – $17,007.37 | 1 |
| Mediastinoscpy w/medstnl bx 39401 CPT 39401 | not published | not published | $17,007.37 – $17,007.37 | 1 |
| Med physic dos eval rad exps CPT 76145 | not published | not published | $1,577.43 – $1,577.43 | 1 |
| Medroxyprogesterone 150 mg/ml im injection (wrapper) HCPCS J1050 | $324.70 | $405.87 | not published | 0 |
| Meg evoked single CPT 95966 | not published | not published | $3,048.91 – $3,048.91 | 1 |
| Meg spontaneous CPT 95965 | not published | not published | $3,048.91 – $3,048.91 | 1 |
| Membrane affinity fresh amniotic 2.5x2.5cm -cost per sq cm HCPCS Q4159 | not published | not published | $529.14 – $725.98 | 2 |
| Membrane amnioband 2x2cm -cost per sq cm HCPCS Q4151 | not published | not published | $308.68 – $423.51 | 2 |
| Membrane amnio clarix 4x3cm 1k -cost per sq cm HCPCS Q4155 | not published | not published | $61.45 – $84.31 | 2 |
| Membrane amniotic barrier 4x4cm-q4163-cost per sq cm HCPCS Q4163 | not published | not published | $409.91 – $562.39 | 2 |
| Membrane placenta tiss biodfence g3 2x2cm-4sqcm-q4116-cost per sq cm HCPCS Q4140 | not published | not published | $370.88 – $508.85 | 2 |
| Membrane placenta tiss enverse sheet 2x3cm-cost per sq cm HCPCS Q4258 | not published | not published | $185.43 – $254.41 | 2 |
| Memoderm/derma/tranz/integup HCPCS Q4126 | not published | not published | $134.57 – $184.64 | 2 |
| Meniscal trnspl knee w/scpe CPT 29868 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Meperidine (pf) 25 mg/ml injection (wrapper) HCPCS J2175 | $45.56 | $56.95 | $35.31 – $48.45 | 2 |
| Mepolizumab 100 mg/ml subcutaneous auto-injector HCPCS J2182 | not published | not published | $70.48 – $96.70 | 2 |
| Meropenem 1 gram intravenous solution HCPCS J2185 | $85.15 | $106.44 | $0.98 – $1.35 | 2 |
| Mesna 100 mg/ml intravenous solution HCPCS J9209 | not published | not published | $3.00 – $4.12 | 2 |
| Metabolic Blood Panel (Basic) CPT 80048 | $85.60 | $107.00 | $10.58 – $26.12 | 2 |
| Metabolic Blood Panel (Comprehensive) CPT 80053 | $113.60 | $142.00 | $13.20 – $32.60 | 2 |
| Metabolic panel ionized ca CPT 80047 | $57.60 | $72.00 | $17.16 – $42.38 | 2 |
| Methacholine chloride 0.0625 mg/ml nebulization soln HCPCS J7674 | not published | not published | $3.89 – $5.33 | 2 |
| Methadone injection HCPCS J1230 | not published | not published | $51.56 – $70.74 | 2 |
| Methocarbamol ivpb 250 mg in 50 ml ns - cnr (headpain) HCPCS J2800 | not published | not published | $10.77 – $14.77 | 2 |
| Methotrexate sodium 2.5 mg tablet HCPCS J8610 | $13.00 | $16.25 | $0.45 – $0.61 | 2 |
| Methotrexate sodium (pf) 1 gram solution for injection HCPCS J9260 | $31.42 | $39.27 | $5.09 – $6.99 | 2 |
| Methotrexate therapeutic drug level CPT 80204 | $60.80 | $76.00 | $48.21 – $119.07 | 2 |
| Methylene blue (antidote) 5 mg/ml intravenous solution HCPCS Q9968 | $608.14 | $760.18 | not published | 0 |
| Methylergonovine 0.2 mg/ml (1 ml) injection solution HCPCS J2210 | $110.27 | $137.84 | $49.63 – $68.09 | 2 |
| Methylnaltrexone 12 mg/0.6 ml subcutaneous injection (wrapper) HCPCS J2212 | $343.29 | $429.11 | not published | 0 |
| Methylprednisolone 4 mg tablet HCPCS J7509 | $9.40 | $11.75 | $0.52 – $0.72 | 2 |
| Methylprednisolone acetate 40 mg/ml suspension for injection HCPCS J1010 | $102.26 | $127.83 | $0.27 – $0.37 | 2 |
| Methylprednisolone sodium succinate 1,000 mg intravenous solution HCPCS J2919 | $279.21 | $349.01 | $0.58 – $0.80 | 2 |
| Metoclopramide in d5w IV syringe 0.2 mg/ml (neo/ped) - cnr HCPCS J2765 | $74.02 | $92.53 | $2.24 – $3.08 | 2 |
| Metoprolol tartrate 5 mg/5 ml intravenous (wrapper) HCPCS J0616 | not published | not published | $0.30 – $0.41 | 2 |
| Metronidazole 500 mg/100 ml in sodium chlor(iso) intravenous piggyback HCPCS J1836 | $45.56 | $56.95 | $0.07 – $0.09 | 2 |
| Metyrapone panel CPT 80436 | not published | not published | $113.95 – $281.41 | 2 |
| Mgmt promoter methylation analysis CPT 81287 | not published | not published | $155.80 – $384.76 | 2 |
| Micafungin 100 mg intravenous solution HCPCS J2248 | $299.54 | $374.43 | $0.69 – $0.95 | 2 |
| Microalbumin urine screen CPT 82044 | $73.60 | $92.00 | $7.79 – $19.23 | 2 |
| Microbe susceptible mlc CPT 87187 | not published | not published | $50.21 – $124.00 | 2 |
| Microfluid analy tears CPT 83861 | not published | not published | $28.10 – $69.40 | 2 |
| Microsatellite instability CPT 81301 | $1,206.40 | $1,508.00 | $435.70 – $1,076.00 | 2 |
| Microvolt t-wave assess CPT 93025 | not published | not published | $474.53 – $474.53 | 1 |
| Microwave bronch, 3d, ebus HCPCS C9751 | not published | not published | $12,237.96 – $12,237.96 | 1 |
| Midazolam 1 mg/ml injection solution HCPCS J2250 | $45.56 | $56.95 | $0.36 – $0.49 | 2 |
| Midazolam 1 mg/ml in sodium chloride IV infusion (wrapper) HCPCS J2251 | not published | not published | $0.38 – $0.52 | 2 |
| Middle cerebral artery echo CPT 76821 | $201.60 | $252.00 | $348.75 – $348.75 | 1 |
| Milrinone 20 mg/100 ml(200 mcg/ml) in 5 % dextrose intravenous piggybk HCPCS J2260 | not published | not published | $3.16 – $4.33 | 2 |
| Miroderm HCPCS Q4175 | not published | not published | $152.36 – $209.04 | 2 |
| Mirvetuximab soravtansine-gynx 5 mg/ml intravenous solution HCPCS J9063 | not published | not published | $156.42 – $214.61 | 2 |
| Mitochondrial gene CPT 81440 | not published | not published | $4,155.00 – $10,261.19 | 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.