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 |
|---|---|---|---|---|
| Suspension of testis CPT 54620 | $446.40 | $558.00 | $10,458.39 – $10,458.39 | 1 |
| Svc venogram s&i CPT 75827 | not published | not published | $4,854.90 – $4,854.90 | 1 |
| Sweat collection by iontophoresis CPT 89230 | not published | not published | $163.59 – $163.59 | 1 |
| Sympathectomy cervical CPT 64802 | not published | not published | $5,865.36 – $5,865.36 | 1 |
| Sympathectomy digital artery CPT 64820 | not published | not published | $5,865.36 – $5,865.36 | 1 |
| Sympathectomy supfc palmar CPT 64823 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Synch audio-only est high 40 CPT 98015 | $200.80 | $251.00 | not published | 0 |
| Synch audio-only est low 20 CPT 98013 | $94.40 | $118.00 | not published | 0 |
| Synch audio-only est mod 30 CPT 98014 | $138.40 | $173.00 | not published | 0 |
| Synch audio-only est sf 10 CPT 98012 | $54.40 | $68.00 | not published | 0 |
| Synch audio-only new high 60 CPT 98011 | $243.20 | $304.00 | not published | 0 |
| Synch audio-only new low 30 CPT 98009 | $120.80 | $151.00 | not published | 0 |
| Synch audio-only new mod 45 CPT 98010 | $187.20 | $234.00 | not published | 0 |
| Synch audio-only new sf 15 CPT 98008 | $72.80 | $91.00 | not published | 0 |
| Synojoynt, inj., 1 mg HCPCS J7331 | not published | not published | $12.63 – $17.33 | 2 |
| Synthetic sentence id test CPT 92576 | not published | not published | $110.81 – $110.81 | 1 |
| Synvisc or synvisc-one HCPCS J7325 | $1,742.98 | $2,178.72 | $20.45 – $28.06 | 2 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | not published | not published | $5.50 – $13.58 | 2 |
| T3 (triiodothyronine) free CPT 84481 | $178.40 | $223.00 | $21.18 – $52.29 | 2 |
| T3 (triiodothyronine) total CPT 84480 | $91.20 | $114.00 | $17.73 – $43.77 | 2 |
| T4 (thyroxine) free CPT 84439 | $127.20 | $159.00 | $11.28 – $27.84 | 2 |
| T4 (thyroxine) total CPT 84436 | $94.40 | $118.00 | $8.59 – $21.21 | 2 |
| Tacrol astagraf ex rel oral HCPCS J7508 | not published | not published | $1.32 – $1.81 | 2 |
| Tacrol envarsus ex rel oral HCPCS J7503 | not published | not published | $4.12 – $5.66 | 2 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $10.70 | $13.37 | $0.35 – $0.48 | 2 |
| Tacrolimus 5 mg/ml intravenous solution HCPCS J7525 | not published | not published | $590.02 – $809.50 | 2 |
| Tacrolimus therapeutic drug level CPT 80197 | $196.80 | $246.00 | $17.16 – $42.38 | 2 |
| Tafasitamab-cxix 200 mg intravenous solution HCPCS J9349 | not published | not published | $31.67 – $43.45 | 2 |
| Talimogene laherparepvec 10exp6 (1 million) pfu/ml susp for injection HCPCS J9325 | not published | not published | $165.48 – $227.04 | 2 |
| Talquetamab-tgvs 2 mg/ml subcutaneous solution HCPCS J3055 | not published | not published | $162.89 – $223.49 | 2 |
| Talymed HCPCS Q4127 | not published | not published | $154.10 – $211.42 | 2 |
| Target gsa panel hmtlmph neop CPT 81450 | not published | not published | $949.41 – $2,344.67 | 2 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | not published | not published | $3,649.50 – $9,012.81 | 2 |
| Target gsa panel organ neop CPT 81445 | not published | not published | $747.39 – $1,845.75 | 2 |
| Tarlatamab-dlle 10 mg intravenous solution HCPCS J9026 | not published | not published | $3,526.86 – $4,838.85 | 2 |
| Tattooing/intraderm 6.1-20.0 sq cm 11921 CPT 11921 | not published | not published | $1,895.66 – $1,895.66 | 1 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | not published | not published | $0.66 – $0.91 | 2 |
| Tbp gene detc abnor alleles CPT 81344 | not published | not published | $171.25 – $422.92 | 2 |
| Tbs techl calculation only CPT 77091 | not published | not published | $283.48 – $283.48 | 1 |
| Tbs techl prep&transmis data CPT 77090 | not published | not published | $283.48 – $283.48 | 1 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | not published | not published | $125.00 – $308.70 | 2 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $289.60 | $362.00 | $77.48 – $191.33 | 2 |
| Tca peel dermal 15789 CPT 15789 | $776.80 | $971.00 | $1,895.66 – $1,895.66 | 1 |
| Tcd emboli detect w/inj CPT 93893 | not published | not published | $348.75 – $348.75 | 1 |
| Tcd emboli detect without inj CPT 93892 | not published | not published | $348.75 – $348.75 | 1 |
| Tcd vasoreactivity study CPT 93890 | not published | not published | $761.98 – $761.98 | 1 |
| T-cell depletion of harvest CPT 38210 | not published | not published | $1,330.51 – $1,330.51 | 1 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $163.20 | $204.00 | $58.73 – $145.03 | 2 |
| T cells absolute cd 4 count CPT 86361 | $117.60 | $147.00 | $33.48 – $82.67 | 2 |
| T cells total count CPT 86359 | $156.80 | $196.00 | $47.16 – $116.47 | 2 |
| Tcranial magn stim tx deli CPT 90868 | not published | not published | $913.84 – $913.84 | 1 |
| Tcranial magn stim tx plan CPT 90867 | not published | not published | $913.84 – $913.84 | 1 |
| Tcran magn stim redetemine CPT 90869 | not published | not published | $913.84 – $913.84 | 1 |
| Team conf without pat by hc pro CPT 99368 | $52.00 | $65.00 | not published | 0 |
| Team conf without pat by phys CPT 99367 | $79.20 | $99.00 | not published | 0 |
| Team conf w/pat by hc prof CPT 99366 | $60.80 | $76.00 | not published | 0 |
| Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution HCPCS J9274 | not published | not published | $488.45 – $670.15 | 2 |
| Tee w or without fol w/cont,cong HCPCS C8926 | $1,011.20 | $1,264.00 | $2,417.07 – $2,417.07 | 1 |
| Tee w or without fol w/cont, mon HCPCS C8927 | not published | not published | $2,417.07 – $2,417.07 | 1 |
| Telavancin injection HCPCS J3095 | not published | not published | $16.80 – $23.05 | 2 |
| Telehealth original site facility fee HCPCS Q3014 | $31.20 | $39.00 | not published | 0 |
| Telethx isodose plan cplx CPT 77307 | not published | not published | $1,170.51 – $1,170.51 | 1 |
| Telethx isodose plan simple CPT 77306 | not published | not published | $1,170.51 – $1,170.51 | 1 |
| Temozolomide HCPCS J8700 | not published | not published | $0.81 – $1.11 | 2 |
| Temozolomide 100 mg intravenous solution HCPCS J9328 | not published | not published | $23.39 – $32.09 | 2 |
| Temperature gradient studies CPT 93740 | not published | not published | $474.53 – $474.53 | 1 |
| Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln HCPCS J9330 | $2,420.99 | $3,026.24 | $72.64 – $99.67 | 2 |
| Tendon lengthening CPT 26476 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Tendon lngth upr a/e ea tdn CPT 24305 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Tendon shortening CPT 26477 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Tendon transfer with graft CPT 26492 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $20,393.69 | $25,492.11 | $386.86 – $530.77 | 2 |
| Tenodesis biceps tdn at elbw CPT 24340 | $915.20 | $1,144.00 | $21,583.67 – $21,583.67 | 1 |
| Tenolysis extensor tendon hand/finger each CPT 26445 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Tenolysis triceps CPT 24332 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Tenoplasty elbow to sho 1 CPT 24320 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Tenosynovectomy radic 26145 CPT 26145 | $794.40 | $993.00 | $4,680.86 – $4,680.86 | 1 |
| Tenotomy length/rls abductor hallucis musc 28240 CPT 28240 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Tenotomy open tndn flxr toe sgl tndn spx CPT 28232 | $556.80 | $696.00 | $4,680.86 – $4,680.86 | 1 |
| Terbutaline 1 mg/ml subcutaneous solution HCPCS J3105 | $69.99 | $87.49 | $6.17 – $8.46 | 2 |
| Tert gene targeted seq alys CPT 81345 | not published | not published | $231.50 – $571.71 | 2 |
| Test for chlorohydrocarbons CPT 82441 | not published | not published | $7.51 – $18.55 | 2 |
| Test for porphobilinogen CPT 84106 | not published | not published | $7.28 – $17.97 | 2 |
| Test for urine cystines CPT 82615 | $34.40 | $43.00 | $11.94 – $29.48 | 2 |
| Testicular imaging w/vasc flow CPT 78761 | not published | not published | $1,268.29 – $1,268.29 | 1 |
| Testosterone response panel CPT 80414 | not published | not published | $64.55 – $159.41 | 2 |
| Testosterone undecanoate 1mg HCPCS J3145 | not published | not published | $4.48 – $6.15 | 2 |
| Test pathogen(s) for platelets reference HCPCS P9100 | not published | not published | $187.55 – $187.55 | 1 |
| Test stress cardiovascular tracing only CPT 93017 | $403.20 | $504.00 | $913.84 – $913.84 | 1 |
| Test urine for lactose CPT 83633 | not published | not published | $14.06 – $34.73 | 2 |
| Test urine for porphyrins CPT 84119 | not published | not published | $16.70 – $41.24 | 2 |
| Test urine urobilinogen CPT 84578 | not published | not published | $5.59 – $13.80 | 2 |
| Tetanus immune globulin inj HCPCS J1670 | $1,461.98 | $1,827.48 | $1,298.35 – $1,781.34 | 2 |
| Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe HCPCS J2356 | not published | not published | $41.18 – $56.50 | 2 |
| Tgfbi gene common variants CPT 81333 | not published | not published | $171.25 – $422.92 | 2 |
| Tgsap hl neo 5-50 rna alys CPT 81451 | not published | not published | $949.41 – $2,344.67 | 2 |
| Tgsap so/hl 51/< rna alys CPT 81456 | not published | not published | $3,649.50 – $9,012.81 | 2 |
| Tgsap so neo 5-50 rna alys CPT 81449 | not published | not published | $747.39 – $1,845.75 | 2 |
| Thaw cryoprsvrd reprod tiss CPT 89354 | not published | not published | $513.12 – $513.12 | 1 |
| Thawing cryopresrved embryo CPT 89352 | not published | not published | $513.12 – $513.12 | 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.