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 |
|---|---|---|---|---|
| Upgrade pm system CPT 33214 | not published | not published | $33,703.02 – $33,703.02 | 1 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $2,889.60 | $3,612.00 | $1,202.18 – $1,202.18 | 1 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $1,895.20 | $2,369.00 | $1,202.18 – $1,202.18 | 1 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $1,821.60 | $2,277.00 | $761.98 – $761.98 | 1 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | $451.20 | $564.00 | $2,693.66 – $2,693.66 | 1 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | $577.60 | $722.00 | $2,693.66 – $2,693.66 | 1 |
| Uppr gi scope w/submuc inj CPT 43236 | not published | not published | $2,693.66 – $2,693.66 | 1 |
| Urachal cyst/sinus excision 51500 CPT 51500 | not published | not published | $17,007.37 – $17,007.37 | 1 |
| Urea nitrogen CPT 84520 | $52.80 | $66.00 | $4.94 – $12.19 | 2 |
| Urea nitrogen 24 hour urine CPT 84540 | $73.60 | $92.00 | $6.95 – $17.16 | 2 |
| Urea nitrogen clearance CPT 84545 | not published | not published | $9.00 – $22.23 | 2 |
| Urea nitrogen semi-quant CPT 84525 | not published | not published | $6.41 – $15.84 | 2 |
| Ureteral reflux study CPT 78740 | not published | not published | $1,268.29 – $1,268.29 | 1 |
| Ureter endoscopy CPT 50970 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Ureter endoscopy & biopsy CPT 50955 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Ureter endoscopy & biopsy CPT 50974 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Ureter endoscopy & catheter CPT 50972 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Ureter endoscopy & treatment CPT 50957 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Ureter endoscopy & treatment CPT 50961 | $579.20 | $724.00 | $15,343.31 – $15,343.31 | 1 |
| Ureter endoscopy & treatment CPT 50976 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Ureter endoscopy & treatment CPT 50980 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | not published | not published | $761.98 – $761.98 | 1 |
| Urethrlys transvag with scope CPT 53500 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Urethrocystography void s&i CPT 74455 | $957.60 | $1,197.00 | $761.98 – $761.98 | 1 |
| Uric acid blood CPT 84550 | $55.20 | $69.00 | $5.65 – $13.95 | 2 |
| Uric acid urine CPT 84560 | $42.40 | $53.00 | $6.35 – $15.68 | 2 |
| Urinalysis glass test CPT 81020 | not published | not published | $5.88 – $14.51 | 2 |
| Urinalysis microscopic only CPT 81015 | $47.20 | $59.00 | $3.81 – $9.42 | 2 |
| Urinalysis qual/semiquant excpt ia CPT 81005 | $84.00 | $105.00 | $2.71 – $6.70 | 2 |
| Urinalysis (with microscopy) CPT 81001 | $57.60 | $72.00 | $3.96 – $9.79 | 2 |
| Urinalysis (without microscopy) CPT 81003 | $44.00 | $55.00 | $2.81 – $6.95 | 2 |
| Urinary reflex study CPT 51792 | not published | not published | $187.55 – $187.55 | 1 |
| Urine Culture Test CPT 87086 | $88.00 | $110.00 | $10.09 – $24.91 | 2 |
| Urine flow measurement 51736 CPT 51736 | $20.80 | $26.00 | $378.88 – $378.88 | 1 |
| Urine pregnancy test CPT 81025 | $61.60 | $77.00 | $10.76 – $26.58 | 2 |
| Urine screen for bacteria CPT 81007 | not published | not published | $37.48 – $92.55 | 2 |
| Urine specimen collect mult HCPCS P9615 | not published | not published | $11.36 – $28.06 | 2 |
| Urography, antegrade CPT 74425 | $371.20 | $464.00 | $1,202.18 – $1,202.18 | 1 |
| Urography inf drip &/or bolus CPT 74410 | not published | not published | $588.44 – $588.44 | 1 |
| Use 1st target lesion CPT 76982 | not published | not published | $348.75 – $348.75 | 1 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | $5,701.18 | $7,126.48 | $29.90 – $41.03 | 2 |
| U/s trtmt, not leiomyomata HCPCS C9734 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | $233.47 | $291.84 | $363.72 – $499.02 | 2 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | $233.47 | $291.84 | $330.89 – $453.97 | 2 |
| Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im CPT 91320 | $209.76 | $262.20 | $350.76 – $481.25 | 2 |
| Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im CPT 91319 | $140.45 | $175.56 | $197.51 – $270.98 | 2 |
| Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im CPT 91318 | $104.58 | $130.72 | $147.49 – $202.35 | 2 |
| Vaccine dtap < 7 years im CPT 90700 | $157.21 | $196.51 | not published | 0 |
| Vaccine dtap-hep b-ipv im CPT 90723 | $88.00 | $110.00 | not published | 0 |
| Vaccine dtap-ipv 4-6 years im CPT 90696 | $235.06 | $293.83 | not published | 0 |
| Vaccine dtap-ipv-hib-hepb im CPT 90697 | $88.00 | $110.00 | not published | 0 |
| Vaccine dtap-ipv/hib im CPT 90698 | $61.60 | $77.00 | not published | 0 |
| Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 | $10.40 | $13.00 | not published | 0 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | $391.94 | $489.92 | $163.54 – $224.38 | 2 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im CPT 90633 | $24.80 | $31.00 | not published | 0 |
| Vaccine hepatitis b (hepb) adolescent 2 dose im CPT 90743 | not published | not published | $169.08 – $231.97 | 2 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | $40.00 | $50.00 | $158.35 – $217.25 | 2 |
| Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im CPT 90739 | not published | not published | $399.50 – $548.11 | 2 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | $16.00 | $20.00 | $71.26 – $97.77 | 2 |
| Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im CPT 90651 | $218.40 | $273.00 | not published | 0 |
| Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im CPT 90649 | $218.40 | $273.00 | not published | 0 |
| Vaccine influenza (iiv) preservative free antigen content im CPT 90662 | $55.20 | $69.00 | $187.86 – $257.74 | 2 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | $339.74 | $424.68 | $187.85 – $257.73 | 2 |
| Vaccine influenza nos 0.5ml dose im CPT 90658 | not published | not published | $49.18 – $67.48 | 2 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | $13.60 | $17.00 | $50.29 – $68.99 | 2 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im CPT 90686 | $18.40 | $23.00 | not published | 0 |
| Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im CPT 90682 | $59.20 | $74.00 | not published | 0 |
| Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im CPT 90661 | $163.34 | $204.18 | $82.91 – $113.75 | 2 |
| Vaccine influenza trivalent (iiv3) 0.25ml dose im CPT 90657 | not published | not published | $24.59 – $33.74 | 2 |
| Vaccine mengingoccocal serogroup b 2 dose im CPT 90620 | $147.20 | $184.00 | not published | 0 |
| Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im CPT 90619 | $96.00 | $120.00 | not published | 0 |
| Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im CPT 90734 | $96.00 | $120.00 | not published | 0 |
| Vaccine mmr live subcutaneous CPT 90707 | $74.40 | $93.00 | not published | 0 |
| Vaccine mmrv live subcutaneous CPT 90710 | $228.80 | $286.00 | not published | 0 |
| Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im CPT 90732 | $100.80 | $126.00 | $300.31 – $412.03 | 2 |
| Vaccine pneumococcal conjugate 13 valent (pcv13) im CPT 90670 | $192.80 | $241.00 | $580.48 – $796.41 | 2 |
| Vaccine pneumonococcal conjugate 15 valent (pcv15) im CPT 90671 | not published | not published | $587.58 – $806.16 | 2 |
| Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 | $634.68 | $793.35 | $704.03 – $965.93 | 2 |
| Vaccine polio (ipv) subcutaneous/im CPT 90713 | $212.80 | $266.00 | not published | 0 |
| Vaccine rabies im CPT 90675 | $1,683.17 | $2,103.96 | $702.07 – $963.24 | 2 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im CPT 90380 | $376.00 | $470.00 | not published | 0 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im CPT 90381 | $376.00 | $470.00 | not published | 0 |
| Vaccine rotavirus pentavalent (rv5) live 3 dose oral CPT 90680 | $72.00 | $90.00 | not published | 0 |
| Vaccine tdap >=7 years im CPT 90715 | $220.49 | $275.61 | $89.35 – $122.58 | 2 |
| Vaccine td preservative free >= 7 years im CPT 90714 | $20.80 | $26.00 | $81.82 – $112.26 | 2 |
| Vaccine typhoid vicps im CPT 90691 | $80.80 | $101.00 | not published | 0 |
| Vaccine varicella live subcutaneous CPT 90716 | $145.60 | $182.00 | not published | 0 |
| Vag hys/<250g/rmv tube/rpr entero 58263 CPT 58263 | $1,468.00 | $1,835.00 | $15,124.47 – $15,124.47 | 1 |
| Vag hyst incl t/o complex CPT 58291 | $1,837.60 | $2,297.00 | $15,124.47 – $15,124.47 | 1 |
| Vag hyst including t/o CPT 58262 | $1,369.60 | $1,712.00 | $15,124.47 – $15,124.47 | 1 |
| Vag hyst t/o & repair compl CPT 58292 | not published | not published | $22,598.24 – $22,598.24 | 1 |
| Vag hyst w/enterocele compl 58294 CPT 58294 | not published | not published | $15,124.47 – $15,124.47 | 1 |
| Vag hyst w/enterocele repair CPT 58270 | $1,324.00 | $1,655.00 | $15,124.47 – $15,124.47 | 1 |
| Vaginal bx CPT 58999 | not published | not published | $581.24 – $581.24 | 1 |
| Vaginal delivery after cesarean delivery 59612 CPT 59612 | $1,404.80 | $1,756.00 | $9,225.99 – $9,225.99 | 1 |
| Vaginal Delivery (full care) CPT 59400 | $2,908.80 | $3,636.00 | not published | 0 |
| Vaginal hysterectomy CPT 58260 | $1,240.00 | $1,550.00 | $15,124.47 – $15,124.47 | 1 |
| Vaginectomy partial w/nodes CPT 57109 | not published | not published | $9,225.99 – $9,225.99 | 1 |
| Valproic acid total therapeutic drug level CPT 80164 | $100.80 | $126.00 | $16.93 – $41.80 | 2 |
| Valrubicin injection HCPCS J9357 | not published | not published | $3,097.77 – $4,250.14 | 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.