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 |
|---|---|---|---|---|
| Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector HCPCS J2506 | not published | not published | $131.40 – $180.28 | 2 |
| Pegfilgrastim-apgf 6 mg/0.6 ml subcutaneous syringe HCPCS Q5122 | not published | not published | $297.09 – $407.60 | 2 |
| Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe HCPCS Q5111 | not published | not published | $306.10 – $419.97 | 2 |
| Pegfilgrastim-fpgk 6 mg/0.6 ml subcutaneous syringe HCPCS Q5127 | not published | not published | $515.50 – $707.27 | 2 |
| Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe HCPCS Q5108 | $1,906.24 | $2,382.80 | $233.34 – $320.14 | 2 |
| Pegfilgrastim-pbbk 6 mg/0.6 ml subcutaneous syringe HCPCS Q5130 | not published | not published | $335.73 – $460.62 | 2 |
| Pegloticase 8 mg/ml intravenous solution HCPCS J2507 | not published | not published | $8,187.44 – $11,233.17 | 2 |
| Pegunigalsidase alfa-iwxj HCPCS J2508 | not published | not published | $518.13 – $710.87 | 2 |
| Pelvic CT scan (with and without contrast) CPT 72194 | $1,828.80 | $2,286.00 | $588.44 – $588.44 | 1 |
| Pelvic CT scan (with contrast) CPT 72193 | $1,429.60 | $1,787.00 | $588.44 – $588.44 | 1 |
| Pelvic CT scan (without contrast) CPT 72192 | $1,332.80 | $1,666.00 | $348.75 – $348.75 | 1 |
| Pelvic MRI (with and without contrast) CPT 72197 | $3,043.20 | $3,804.00 | $1,202.18 – $1,202.18 | 1 |
| Pelvic MRI (with contrast) CPT 72196 | $1,944.00 | $2,430.00 | $1,202.18 – $1,202.18 | 1 |
| Pelvic MRI (without contrast) CPT 72195 | $1,888.80 | $2,361.00 | $761.98 – $761.98 | 1 |
| Pelvic ring fracture uni/bil HCPCS G0413 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Pelvic Ultrasound (complete) CPT 76856 | $561.60 | $702.00 | $348.75 – $348.75 | 1 |
| Pelvic Ultrasound (limited) CPT 76857 | $281.60 | $352.00 | $348.75 – $348.75 | 1 |
| Pembrolizumab 25 mg/ml intravenous solution HCPCS J9271 | $7,900.99 | $9,876.24 | $131.76 – $180.78 | 2 |
| Pemetrexed disodium 100 mg intravenous powder for solution HCPCS J9305 | $4,893.27 | $6,116.59 | $8.40 – $11.53 | 2 |
| Peng benzathine/procaine inj HCPCS J0558 | not published | not published | $39.08 – $53.62 | 2 |
| Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe HCPCS J0561 | $517.78 | $647.23 | $65.93 – $90.45 | 2 |
| Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr HCPCS J2540 | $92.30 | $115.37 | $1.98 – $2.71 | 2 |
| Penile injection CPT 54235 | $137.60 | $172.00 | $701.12 – $701.12 | 1 |
| Penile vascular study CPT 93980 | not published | not published | $348.75 – $348.75 | 1 |
| Penile vascular study CPT 93981 | $230.40 | $288.00 | $348.75 – $348.75 | 1 |
| Penile venous occlusion CPT 37790 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Penis plastic surgery CPT 54360 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Penis study CPT 54240 | not published | not published | $913.84 – $913.84 | 1 |
| Pentamidine non-comp unit HCPCS J2545 | not published | not published | $185.33 – $254.28 | 2 |
| Pentostatin 10 mg intravenous solution HCPCS J9268 | not published | not published | $5,723.76 – $7,853.00 | 2 |
| Perc cryo ablate renal tum CPT 50593 | not published | not published | $29,652.07 – $29,652.07 | 1 |
| Perc d-e cor revasc chro sin HCPCS C9607 | not published | not published | $56,050.90 – $56,050.90 | 1 |
| Perc d-e cor revasc t cabg s HCPCS C9604 | not published | not published | $34,638.00 – $34,638.00 | 1 |
| Perc d-e cor stent ather s HCPCS C9602 | not published | not published | $56,050.90 – $56,050.90 | 1 |
| Perc drug-el cor stent sing HCPCS C9600 | not published | not published | $34,638.00 – $34,638.00 | 1 |
| Perc rf ablate renal tumor CPT 50592 | not published | not published | $17,007.37 – $17,007.37 | 1 |
| Percut ablate liver rf CPT 47382 | not published | not published | $17,007.37 – $17,007.37 | 1 |
| Perflutren lipid microspheres 1.1 mg/ml intravenous suspension HCPCS Q9957 | not published | not published | $92.70 – $127.18 | 2 |
| Pericardial drain w/cath pq w/ct guid CPT 33019 | $313.60 | $392.00 | not published | 0 |
| Pericardiocentesis wwo imaging CPT 33016 | $3,137.60 | $3,922.00 | $4,854.90 – $4,854.90 | 1 |
| Peri-implt capslc brst compl CPT 19371 | not published | not published | $11,217.60 – $11,217.60 | 1 |
| Perineoplasty rpr per nonob CPT 56810 | not published | not published | $9,225.99 – $9,225.99 | 1 |
| Peripheral vascular rehab CPT 93668 | not published | not published | $187.55 – $187.55 | 1 |
| Peri-proc device eval icd CPT 93287 | $76.80 | $96.00 | not published | 0 |
| Peri-proc device eval pm CPT 93286 | $66.40 | $83.00 | not published | 0 |
| Peritoneal cath sub q resv per CPT 49419 | not published | not published | $16,771.14 – $16,771.14 | 1 |
| Peritoneogram rs&i CPT 74190 | not published | not published | $1,641.72 – $1,641.72 | 1 |
| Perit-vens shunt pat tst CPT 78291 | not published | not published | $1,268.29 – $1,268.29 | 1 |
| Perq dev breast 1st mr guide CPT 19287 | $343.20 | $429.00 | $2,117.62 – $2,117.62 | 1 |
| Perq dev breast 1st strtctc CPT 19283 | $343.20 | $429.00 | $2,117.62 – $2,117.62 | 1 |
| Perq nl/pl lithotrp cplx>2cm CPT 50081 | not published | not published | $27,923.42 – $27,923.42 | 1 |
| Perq nl/pl lithotrp smpl<2cm CPT 50080 | not published | not published | $27,923.42 – $27,923.42 | 1 |
| Perq p-art revsc 1 abnor bi CPT 33903 | not published | not published | $34,638.00 – $34,638.00 | 1 |
| Perq p-art revsc 1 abnor uni CPT 33902 | not published | not published | $56,050.90 – $56,050.90 | 1 |
| Perq p-art revsc 1 nm nt bi CPT 33901 | not published | not published | $34,638.00 – $34,638.00 | 1 |
| Perq p-art revsc 1 nm nt uni CPT 33900 | not published | not published | $34,638.00 – $34,638.00 | 1 |
| Perq plmt bile duct stent CPT 47538 | not published | not published | $17,007.37 – $17,007.37 | 1 |
| Perq plmt bile duct stent CPT 47539 | not published | not published | $17,007.37 – $17,007.37 | 1 |
| Perq plmt bile duct stent CPT 47540 | not published | not published | $17,007.37 – $17,007.37 | 1 |
| Perq rplcmt g-tube req revsn gstrst trk CPT 43763 | $524.80 | $656.00 | $701.12 – $701.12 | 1 |
| Perq skel fix rad/uln dislc CPT 25671 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Perq skel fix ulnar styld fx CPT 25651 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Perq transcath closure pda CPT 93582 | not published | not published | $56,050.90 – $56,050.90 | 1 |
| Perq transcath cls aortic CPT 93591 | not published | not published | $56,050.90 – $56,050.90 | 1 |
| Perq transcath cls mitral CPT 93590 | not published | not published | $56,050.90 – $56,050.90 | 1 |
| Perq tx big toe fracture w/manip 28496 CPT 28496 | $664.80 | $831.00 | $9,712.92 – $9,712.92 | 1 |
| Perq tx malar fracture CPT 21355 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Perq tx mndblr fx xtrnl fixj CPT 21452 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Perq tx nasoethmoid fx CPT 21340 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Pertussis ag if CPT 87265 | not published | not published | $14.98 – $36.98 | 2 |
| Pertuzumab 30 mg/ml desensitization HCPCS J9306 | $8,958.03 | $11,197.54 | $38.01 – $52.15 | 2 |
| Pertuzu, trastuzu, 10 mg HCPCS J9316 | not published | not published | $142.62 – $195.68 | 2 |
| Pessary 3.5 in 7 vag sil rng fold HCPCS A4562 | $63.20 | $79.00 | not published | 0 |
| Pet CT skull-mid thgh initial CPT 78815 | not published | not published | $4,859.78 – $4,859.78 | 1 |
| Pet CT whole body initial CPT 78816 | not published | not published | $4,859.78 – $4,859.78 | 1 |
| Pet fdg brain metoblic eval sb CPT 78608 | not published | not published | $4,859.78 – $4,859.78 | 1 |
| Pet image full body CPT 78813 | not published | not published | $4,859.78 – $4,859.78 | 1 |
| Pet image ltd area CPT 78811 | not published | not published | $4,330.91 – $4,330.91 | 1 |
| Pet image skull-thigh CPT 78812 | not published | not published | $4,859.78 – $4,859.78 | 1 |
| Pet image w/ct lmtd CPT 78814 | not published | not published | $4,859.78 – $4,859.78 | 1 |
| Pet not otherwise specified HCPCS G0235 | not published | not published | $1,268.29 – $1,268.29 | 1 |
| Ph1 assmt&mgmt nqhp 11-20 CPT 98967 | $36.80 | $46.00 | not published | 0 |
| Ph1 assmt&mgmt nqhp 21-30 CPT 98968 | $51.20 | $64.00 | not published | 0 |
| Ph1 assmt&mgmt nqhp 5-10 CPT 98966 | $20.00 | $25.00 | not published | 0 |
| Phalangectomy ea toe 28150 CPT 28150 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Pharmacologic management w/psytx CPT 90863 | $37.60 | $47.00 | not published | 0 |
| Ph body fluid CPT 83986 | $117.60 | $147.00 | $4.48 – $11.05 | 2 |
| Phencyclidine (pcp) CPT 83992 | $60.80 | $76.00 | not published | 0 |
| Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr HCPCS J2560 | $115.03 | $143.79 | $61.56 – $84.47 | 2 |
| Phenobarbital therapeutic drug level CPT 80184 | $158.40 | $198.00 | $19.13 – $47.23 | 2 |
| Phentolaine mesylate inj HCPCS J2760 | $1,206.14 | $1,507.67 | $982.14 – $1,347.50 | 2 |
| Phenylephrine 10 mg/ml injection solution HCPCS J2371 | $100.14 | $125.18 | $0.01 – $0.01 | 1 |
| Phenytoin in ns IV syringe 5 mg/ml (neo/ped) - cnr HCPCS J1165 | $67.13 | $83.91 | $1.48 – $2.03 | 2 |
| Phenytoin total therapeutic drug level CPT 80185 | $142.40 | $178.00 | $16.56 – $40.90 | 2 |
| Phlebotomy therapeutic CPT 99195 | $253.60 | $317.00 | $378.88 – $378.88 | 1 |
| Phleb veins 1 extrm 10-20 stab CPT 37765 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Phleb veins 1 extrm >20 stab CPT 37766 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Phosphorus CPT 84100 | $35.20 | $44.00 | $5.93 – $14.63 | 2 |
| Phosphorus 24 hour urine CPT 84105 | $89.60 | $112.00 | $7.23 – $17.84 | 2 |
| Photchmtx tar&uvb/ptrltm&uvb CPT 96910 | not published | not published | $187.55 – $187.55 | 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.