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 |
|---|---|---|---|---|
| Assay of leflunomide CPT 80193 | $144.80 | $181.00 | $48.21 – $119.07 | 2 |
| Assay of lrh hormone CPT 83727 | not published | not published | $21.49 – $53.07 | 2 |
| Assay of methemalbumin CPT 83857 | not published | not published | $13.43 – $33.15 | 2 |
| Assay of neonatal thyroxine CPT 84437 | not published | not published | $8.09 – $19.97 | 2 |
| Assay of osteocalcin CPT 83937 | not published | not published | $37.31 – $92.15 | 2 |
| Assay of phenylketones CPT 84035 | not published | not published | $4.98 – $12.29 | 2 |
| Assay of pregnanediol CPT 84135 | not published | not published | $26.59 – $65.66 | 2 |
| Assay of pregnanetriol CPT 84138 | not published | not published | $26.31 – $64.98 | 2 |
| Assay of procainamide w/metab CPT 80192 | $224.80 | $281.00 | $20.94 – $51.71 | 2 |
| Assay of progesterone CPT 84234 | not published | not published | $81.10 – $200.28 | 2 |
| Assay of prostaglandin CPT 84150 | not published | not published | $52.21 – $128.94 | 2 |
| Assay of PSA complexed CPT 84152 | not published | not published | $22.99 – $56.77 | 2 |
| Assay of quinine CPT 84228 | not published | not published | $14.54 – $35.90 | 2 |
| Assay of rbc pg6d enzyme CPT 84085 | not published | not published | $11.80 – $29.14 | 2 |
| Assay of salicylate CPT 80179 | $106.40 | $133.00 | $23.30 – $57.54 | 2 |
| Assay of semen fructose CPT 82757 | not published | not published | $21.68 – $53.53 | 2 |
| Assay of sialic acid CPT 84275 | not published | not published | $16.80 – $41.49 | 2 |
| Assay of silica CPT 84285 | not published | not published | $31.51 – $77.82 | 2 |
| Assay of somatostatin CPT 84307 | not published | not published | $22.85 – $56.43 | 2 |
| Assay of thiocyanate CPT 84430 | $48.80 | $61.00 | $14.54 – $35.90 | 2 |
| Assay of troponin qual CPT 84512 | not published | not published | $12.61 – $31.15 | 2 |
| Assay of tyrosine CPT 84510 | not published | not published | $13.29 – $32.81 | 2 |
| Assay of urine sulfate CPT 84392 | $20.00 | $25.00 | $6.86 – $16.95 | 2 |
| Assay of urine urobilinogen CPT 84580 | not published | not published | $11.94 – $29.48 | 2 |
| Assay of urine urobilinogen CPT 84583 | not published | not published | $7.56 – $18.68 | 2 |
| Assay phosphatidylglycerol CPT 84081 | $68.80 | $86.00 | $20.65 – $51.00 | 2 |
| Assay phosphohexose enzymes CPT 84087 | not published | not published | $13.41 – $33.12 | 2 |
| Assay rbc glutathione CPT 82979 | not published | not published | $11.80 – $29.14 | 2 |
| Assay toxin or antitoxin CPT 87230 | $98.40 | $123.00 | $24.68 – $60.94 | 2 |
| Assess aphasia/interp/rpt/per hr 96105 CPT 96105 | $135.20 | $169.00 | not published | 0 |
| Assess care plan pt w/cog impair 99483 CPT 99483 | $408.80 | $511.00 | $247.51 – $247.51 | 1 |
| Assess cyst contrast inject CPT 49424 | $655.20 | $819.00 | not published | 0 |
| Assessment leukocyte fecal qualitative/semiquantitative CPT 89055 | $48.80 | $61.00 | $5.34 – $13.18 | 2 |
| Asses tinnit/pitch/loud/match/mask 92625 CPT 92625 | not published | not published | $474.53 – $474.53 | 1 |
| Assistive tech assessment, ot CPT 97755 | $16.00 | $20.00 | not published | 0 |
| Assist oocyte fertilization CPT 89280 | not published | not published | $2,533.78 – $2,533.78 | 1 |
| Assist oocyte fertilization CPT 89281 | not published | not published | $513.12 – $513.12 | 1 |
| Ast/sgot CPT 84450 | $35.20 | $44.00 | $6.48 – $15.99 | 2 |
| Atezolizumab 60 mg/ml intravenous solution (wrapper) HCPCS J9022 | $15,221.47 | $19,026.84 | $204.80 – $280.98 | 2 |
| Athrectomy fem/pop/unilateral 37225 CPT 37225 | not published | not published | $34,638.00 – $34,638.00 | 1 |
| Athrectomy tib/pero/unilat/ini ves 37229 CPT 37229 | not published | not published | $56,050.90 – $56,050.90 | 1 |
| Atomic absorption CPT 82190 | not published | not published | $19.88 – $49.08 | 2 |
| Atropine 0.1 mg/ml injection syringe HCPCS J0461 | $89.01 | $111.26 | $0.15 – $0.20 | 2 |
| Attach ocular implant CPT 65140 | not published | not published | $11,405.88 – $11,405.88 | 1 |
| Attn at delivery+ 1 stabilization of newborn 99464 CPT 99464 | $107.20 | $134.00 | not published | 0 |
| Aud brainstem implt programg CPT 92640 | not published | not published | $474.53 – $474.53 | 1 |
| Audiometry air + bone CPT 92553 | not published | not published | $474.53 – $474.53 | 1 |
| Auditory function 60 min CPT 92620 | not published | not published | $474.53 – $474.53 | 1 |
| Augmentation cheek bone CPT 21270 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Augmentation lower jaw bone CPT 21125 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Augmentation lower jaw bone CPT 21127 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Augmentation of facial bones CPT 21208 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Augumentation percutaneous vertebral inc cavity creation ea addl thoracic/lumbar vertebral body CPT 22515 | $4,585.60 | $5,732.00 | not published | 0 |
| Augumentation percutaneous vertebral including cavity creation 1 vertebral body thoracic CPT 22513 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Autgrft implnt knee w/scope CPT 29866 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Autochondrocyte implant knee CPT 27412 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Autoimmune rheumatoid arthr anl 12 mrk ia CPT 81490 | $700.00 | $875.00 | $1,050.81 – $2,595.09 | 2 |
| Autologous blood op salvage CPT 86891 | not published | not published | $2,533.78 – $2,533.78 | 1 |
| Autologous blood process CPT 86890 | not published | not published | $513.12 – $513.12 | 1 |
| Autolog prp diab wound ulcer HCPCS G0465 | not published | not published | $5,631.53 – $5,631.53 | 1 |
| Autolog prp not diab ulcer HCPCS G0460 | not published | not published | $5,631.53 – $5,631.53 | 1 |
| Automated diff wbc count CPT 85004 | not published | not published | $8.09 – $19.97 | 2 |
| Autonomic nrv adrenrg inervj CPT 95922 | not published | not published | $378.88 – $378.88 | 1 |
| Autonomic nrv parasym inervj CPT 95921 | not published | not published | $474.53 – $474.53 | 1 |
| Autonomic nrv syst funj test CPT 95923 | $175.20 | $219.00 | $378.88 – $378.88 | 1 |
| Avelumab 20 mg/ml intravenous solution HCPCS J9023 | $2,644.50 | $3,305.62 | $225.67 – $309.62 | 2 |
| Av fistula revision CPT 36833 | not published | not published | $16,771.14 – $16,771.14 | 1 |
| Av fuse uppr arm basilic CPT 36819 | not published | not published | $16,771.14 – $16,771.14 | 1 |
| Av fuse uppr arm cephalic CPT 36818 | not published | not published | $16,771.14 – $16,771.14 | 1 |
| Av fusion direct any site CPT 36821 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Av fusion/forearm vein 36820 CPT 36820 | not published | not published | $16,771.14 – $16,771.14 | 1 |
| Avul nail plate addl CPT 11732 | $108.80 | $136.00 | not published | 0 |
| Avulsion nail plate partial/complete simple single nail plate CPT 11730 | $172.00 | $215.00 | $589.25 – $589.25 | 1 |
| Axicabtagene ciloleucel car+ HCPCS Q2041 | not published | not published | $1,199,422.07 – $1,645,607.08 | 2 |
| Axillary lymphadenect/superficial 38740 CPT 38740 | not published | not published | $17,007.37 – $17,007.37 | 1 |
| Azacitidine injection HCPCS J9025 | $1,793.51 | $2,241.89 | $0.47 – $0.65 | 2 |
| Azathioprine 50 mg tablet HCPCS J7500 | $3.52 | $4.40 | $4.82 – $6.61 | 2 |
| Azithromycin 500 mg intravenous solution HCPCS J0456 | $94.49 | $118.11 | $5.88 – $8.07 | 2 |
| Aztreonam 1 gram solution for injection HCPCS J0457 | $161.45 | $201.81 | $6.00 – $8.23 | 2 |
| Baclofen 2,000 mcg/ml intrathecal solution (wrapper) HCPCS J0475 | not published | not published | $395.59 – $542.75 | 2 |
| Baclofen 50 mcg/ml intrathecal solution (wrapper) HCPCS J0476 | not published | not published | $151.21 – $207.46 | 2 |
| Baclofen eval charges CPT 97750 | $45.60 | $57.00 | not published | 0 |
| Bacterial meningitis antigen CPT 86403 | $97.60 | $122.00 | $14.43 – $35.62 | 2 |
| Bacterial vaginosis pcr CPT 87801 | $163.20 | $204.00 | $87.75 – $216.71 | 2 |
| Bactericidal level serum CPT 87197 | not published | not published | $18.78 – $46.37 | 2 |
| #bac vag cand-c. albicans naa CPT 87481 | not published | not published | $43.86 – $108.32 | 2 |
| Bartholin gland cyst/marsupializat 56440 CPT 56440 | not published | not published | $9,225.99 – $9,225.99 | 1 |
| Bartonella dna pcr-sendout CPT 87471 | not published | not published | $43.86 – $108.32 | 2 |
| Basic vestibular evaluation CPT 92540 | not published | not published | $474.53 – $474.53 | 1 |
| Basiliximab HCPCS J0480 | not published | not published | $10,513.05 – $14,423.91 | 2 |
| B cells total count CPT 86355 | $156.80 | $196.00 | $47.16 – $116.47 | 2 |
| Bcg live 50 mg intravesical suspension HCPCS J9030 | not published | not published | $7.03 – $9.64 | 2 |
| Bckdhb gene CPT 81205 | not published | not published | $118.74 – $293.23 | 2 |
| Behavior counsel obesity 15min medicare g0447 HCPCS G0447 | $48.80 | $61.00 | $247.51 – $247.51 | 1 |
| Belatacept 250 mg intravenous solution HCPCS J0485 | not published | not published | $8.75 – $12.00 | 2 |
| Belimumab 120 mg intravenous solution HCPCS J0490 | not published | not published | $126.01 – $172.89 | 2 |
| Bendamustine 100 mg intravenous powder for solution HCPCS J9033 | $2,896.68 | $3,620.85 | $4.16 – $5.71 | 2 |
| Bendamustine 25 mg/ml intravenous solution (belrapzo) HCPCS J9036 | not published | not published | $26.98 – $37.02 | 2 |
| Bendamustine 25 mg/ml intravenous solution (bendeka) HCPCS J9034 | not published | not published | $29.52 – $40.50 | 2 |
| Bendamustine 25 mg/ml intravenous solution (vivimusta) HCPCS J9056 | not published | not published | $63.13 – $86.62 | 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.