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 |
|---|---|---|---|---|
| Claviculectomy partial CPT 23120 | $868.80 | $1,086.00 | $9,712.92 – $9,712.92 | 1 |
| Claviculectomy total CPT 23125 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Clean out mastoid cavity CPT 69222 | $322.40 | $403.00 | $1,490.61 – $1,490.61 | 1 |
| Clearance of airways CPT 31720 | not published | not published | $624.86 – $624.86 | 1 |
| Clearance of tear duct CPT 68530 | not published | not published | $863.77 – $863.77 | 1 |
| C-lens fitg corneosclrl lens CPT 92313 | not published | not published | $378.88 – $378.88 | 1 |
| C-lens fitg tech aphakia 1 CPT 92315 | not published | not published | $378.88 – $378.88 | 1 |
| C-lens fitg tech aphakia ou CPT 92316 | not published | not published | $378.88 – $378.88 | 1 |
| C-lens fitg tech corneosclrl CPT 92317 | not published | not published | $110.81 – $110.81 | 1 |
| Clindamycin 600 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J0736 | $75.06 | $93.82 | $3.76 – $5.16 | 2 |
| Clitoroplasty intersex state CPT 56805 | not published | not published | $9,225.99 – $9,225.99 | 1 |
| Clofarabine 1 mg/ml intravenous solution HCPCS J9027 | not published | not published | $33.12 – $45.43 | 2 |
| Clonidine (pf) 1,000 mcg/10 ml (100 mcg/ml) epidural solution HCPCS J0735 | $125.82 | $157.28 | $39.76 – $54.55 | 2 |
| Closed carpo/metacarpal disl thumb w/manip CPT 26641 | not published | not published | $675.49 – $675.49 | 1 |
| Closed carpo/metacarpal fx disl thumb w/manip CPT 26645 | not published | not published | $4,680.86 – $4,680.86 | 1 |
| Closed tx/acetabululm without manip 27220 CPT 27220 | not published | not published | $675.49 – $675.49 | 1 |
| Closed tx humerus fx with manip 23605 CPT 23605 | $2,181.60 | $2,727.00 | $4,680.86 – $4,680.86 | 1 |
| Closed tx humerus fx without manip 23600 CPT 23600 | $498.40 | $623.00 | $675.49 – $675.49 | 1 |
| Closed tx humerus fx w/manip 24505 CPT 24505 | $783.20 | $979.00 | $4,680.86 – $4,680.86 | 1 |
| Closed tx metatarsophalangeal jnt disl without anes CPT 28630 | $288.80 | $361.00 | $675.49 – $675.49 | 1 |
| Closed tx nose/jaw fx CPT 21345 | not published | not published | $4,529.52 – $4,529.52 | 1 |
| Closed tx orbit without manipulj CPT 21400 | not published | not published | $1,490.61 – $1,490.61 | 1 |
| Closed tx orbit w/manipulj CPT 21401 | not published | not published | $4,529.52 – $4,529.52 | 1 |
| Closed tx post hip arthroplasty disloc w/anes 27266 CPT 27266 | $2,021.60 | $2,527.00 | $4,680.86 – $4,680.86 | 1 |
| Closed tx septal&nose fx CPT 21337 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Closed tx sesamoid fx 28530 CPT 28530 | not published | not published | $675.49 – $675.49 | 1 |
| Closed tx/talus fracture without manip 28430 CPT 28430 | not published | not published | $675.49 – $675.49 | 1 |
| Closed tx vert fx w/manj CPT 22315 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Close lac/mouth vest/2.5 cm or < 40830 CPT 40830 | not published | not published | $678.14 – $678.14 | 1 |
| Close mastoid fistula CPT 69700 | not published | not published | $4,529.52 – $4,529.52 | 1 |
| Close tear duct opening CPT 68760 | not published | not published | $863.77 – $863.77 | 1 |
| Close tear duct opening CPT 68761 | not published | not published | $863.77 – $863.77 | 1 |
| Close tear system fistula CPT 68770 | not published | not published | $6,898.76 – $6,898.76 | 1 |
| Clostridium toxin a w/optic CPT 87803 | not published | not published | $20.00 – $49.39 | 2 |
| Clos txnose fx without stablz 21315 CPT 21315 | $2,246.40 | $2,808.00 | $4,529.52 – $4,529.52 | 1 |
| Closure enterostomy lg/sm intestine 44620 CPT 44620 | $1,272.80 | $1,591.00 | not published | 0 |
| Closure enterostomy lg/sm intestine oth/thn 44625 CPT 44625 | $1,484.80 | $1,856.00 | not published | 0 |
| Closure laceration vestibule mouth > 2.5 cm cmplx CPT 40831 | $462.40 | $578.00 | $1,490.61 – $1,490.61 | 1 |
| Closure of eyelid by suture CPT 67875 | not published | not published | $2,847.45 – $2,847.45 | 1 |
| Closure of salivary fistula CPT 42600 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Closure of windpipe lesion 31820 CPT 31820 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Closure paravalvlr leak pq CPT 33999 | not published | not published | $1,887.67 – $1,887.67 | 1 |
| Clot factor fletcher fact CPT 85292 | not published | not published | $23.66 – $58.44 | 2 |
| Clot factor viii reltd antgn CPT 85244 | not published | not published | $25.53 – $63.04 | 2 |
| Clot factor wght kininogen CPT 85293 | not published | not published | $23.66 – $58.44 | 2 |
| Clot factor xii hageman CPT 85280 | $281.60 | $352.00 | $24.19 – $59.73 | 2 |
| Clot factor xiii fibrin scrn CPT 85291 | $76.00 | $95.00 | $11.39 – $28.12 | 2 |
| Clot factor xiii fibrin stab CPT 85290 | not published | not published | $20.43 – $50.44 | 2 |
| Clsd/shoulder dislo/manip/no anest 23650 CPT 23650 | $488.80 | $611.00 | $675.49 – $675.49 | 1 |
| Clsd tx bimalleol ank fx without manip 27808 CPT 27808 | not published | not published | $675.49 – $675.49 | 1 |
| Clsd tx carpo/metacarpl disl thmb manip ea without anes CPT 26670 | not published | not published | $675.49 – $675.49 | 1 |
| Clsd tx clav dislc without manip 23520 CPT 23520 | not published | not published | $4,680.86 – $4,680.86 | 1 |
| Clsd tx clavicle dislocation without manip 23540 CPT 23540 | not published | not published | $675.49 – $675.49 | 1 |
| Clsd tx clavicle fracture w/manip 23505 CPT 23505 | not published | not published | $4,680.86 – $4,680.86 | 1 |
| Clsd tx/clavicular fx without manip 23500 CPT 23500 | not published | not published | $675.49 – $675.49 | 1 |
| Clsd tx coccygeal fracture 27200 CPT 27200 | not published | not published | $675.49 – $675.49 | 1 |
| Clsd tx/dis phalan fx without manip/ea 26750 CPT 26750 | $287.20 | $359.00 | $675.49 – $675.49 | 1 |
| Clsd tx dist fib fx w/manip 27788 CPT 27788 | $633.60 | $792.00 | $675.49 – $675.49 | 1 |
| Clsd tx/dis tib/wt bear no manip 27824 CPT 27824 | $493.60 | $617.00 | $675.49 – $675.49 | 1 |
| Clsd tx elbow dislocation child 24640 CPT 24640 | $332.00 | $415.00 | $675.49 – $675.49 | 1 |
| Clsd tx/fem shaft fx/manipulation 27502 CPT 27502 | $1,121.60 | $1,402.00 | $4,680.86 – $4,680.86 | 1 |
| Clsd tx finger tendon w/wo perq pin 26432 CPT 26432 | not published | not published | $4,680.86 – $4,680.86 | 1 |
| Clsd tx fracture of radius 25500 CPT 25500 | $425.60 | $532.00 | $675.49 – $675.49 | 1 |
| Clsd tx/fx grt toe/phalanx/phalang 28490 CPT 28490 | not published | not published | $675.49 – $675.49 | 1 |
| Clsd tx/fx/phalanx/phalang/manip 28515 CPT 28515 | $240.80 | $301.00 | $675.49 – $675.49 | 1 |
| Clsd tx fx radius/ulna dist without manip 25600 CPT 25600 | $505.60 | $632.00 | $675.49 – $675.49 | 1 |
| Clsd tx fx radius/ulna dist w/manip 25605 CPT 25605 | $805.60 | $1,007.00 | $4,680.86 – $4,680.86 | 1 |
| Clsd tx fx radius/ulna without manip 25560 CPT 25560 | $433.60 | $542.00 | $675.49 – $675.49 | 1 |
| Clsd tx fx radius/ulna w/manip 25565 CPT 25565 | $775.20 | $969.00 | $4,680.86 – $4,680.86 | 1 |
| Clsd tx/grt hum tube fx without manip 23620 CPT 23620 | not published | not published | $675.49 – $675.49 | 1 |
| Clsd tx hip disloc without anes 27265 CPT 27265 | $609.60 | $762.00 | $675.49 – $675.49 | 1 |
| Clsd tx humeral fract without manip 24530 CPT 24530 | $570.40 | $713.00 | $675.49 – $675.49 | 1 |
| Clsd tx humerus fract without manip 24500 CPT 24500 | not published | not published | $675.49 – $675.49 | 1 |
| Clsd tx iphal jnt disl w/manip req anes CPT 26775 | $586.40 | $733.00 | $782.84 – $782.84 | 1 |
| Clsd tx mandibular fx without manip 21450 CPT 21450 | not published | not published | $1,490.61 – $1,490.61 | 1 |
| Clsd tx/metacar/interphal artic fx 26740 CPT 26740 | not published | not published | $675.49 – $675.49 | 1 |
| Clsd tx/metacarpal fx/sg without manip 26600 CPT 26600 | $449.60 | $562.00 | $675.49 – $675.49 | 1 |
| Clsd tx/metacarpal fx/sng/w manip 26605 CPT 26605 | $495.20 | $619.00 | $675.49 – $675.49 | 1 |
| Clsd tx metacarp fx w/manip&ext fix ea bone 26607 CPT 26607 | $773.60 | $967.00 | $9,712.92 – $9,712.92 | 1 |
| Clsd tx metatarsal fracture w/manip 28475 CPT 28475 | $402.40 | $503.00 | $675.49 – $675.49 | 1 |
| Clsd tx/metatarsal fx without manip 28470 CPT 28470 | $338.40 | $423.00 | $675.49 – $675.49 | 1 |
| Clsd tx/nasal bone fx/stabilize 21320 CPT 21320 | $325.60 | $407.00 | $9,283.38 – $9,283.38 | 1 |
| Clsd tx of ankle fracture w/manip 28435 CPT 28435 | $549.60 | $687.00 | $4,680.86 – $4,680.86 | 1 |
| Clsd tx patella disloc without anes 27560 CPT 27560 | $551.20 | $689.00 | $675.49 – $675.49 | 1 |
| Clsd tx/patellar fx without manip 27520 CPT 27520 | $512.00 | $640.00 | $675.49 – $675.49 | 1 |
| Clsd tx pelvic ring fx CPT 27197 | $332.00 | $415.00 | $675.49 – $675.49 | 1 |
| Clsd tx pelvic ring fx CPT 27198 | $469.60 | $587.00 | $675.49 – $675.49 | 1 |
| Clsd tx prox fib/shaft fx w/manip 27781 CPT 27781 | not published | not published | $4,680.86 – $4,680.86 | 1 |
| Clsd tx/prox/mid phalnx fx/no manp 26720 CPT 26720 | $320.00 | $400.00 | $675.49 – $675.49 | 1 |
| Clsd tx/radial head/neck fx/no manip 24650 CPT 24650 | not published | not published | $675.49 – $675.49 | 1 |
| Clsd tx radius fracture w/manip 24655 CPT 24655 | $1,820.80 | $2,276.00 | $4,680.86 – $4,680.86 | 1 |
| Clsd tx/scapular fx without manip 23570 CPT 23570 | not published | not published | $675.49 – $675.49 | 1 |
| Clsd tx shoulder dislc/fx 23665 CPT 23665 | $647.20 | $809.00 | $4,680.86 – $4,680.86 | 1 |
| Clsd tx shoulder disloc w/anatom neck fx w/manip 23675 CPT 23675 | $2,312.80 | $2,891.00 | $4,680.86 – $4,680.86 | 1 |
| Clsd tx/shoulder dislo/manip/anest 23655 CPT 23655 | $1,820.80 | $2,276.00 | $4,680.86 – $4,680.86 | 1 |
| Clsd tx/talotarsal dislocat/anes 28575 CPT 28575 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Clsd tx temporomandibular dislocat 21480 CPT 21480 | not published | not published | $675.49 – $675.49 | 1 |
| Clsd tx toe dislocation without anes28660 CPT 28660 | $181.60 | $227.00 | $675.49 – $675.49 | 1 |
| Clsd tx trimall ankle fx without manip 27816 CPT 27816 | $494.40 | $618.00 | $675.49 – $675.49 | 1 |
| Clsd tx trimall ankle fx w/manip 27818 CPT 27818 | $1,614.40 | $2,018.00 | $4,680.86 – $4,680.86 | 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.