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 |
|---|---|---|---|---|
| Decompression of leg CPT 27893 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Decompression of leg CPT 27894 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Decompression of lower leg CPT 27600 | $604.80 | $756.00 | $9,712.92 – $9,712.92 | 1 |
| Decompression of lower leg CPT 27601 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Decompression of thigh/knee CPT 27496 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Decompression of thigh/knee CPT 27497 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Decompression of thigh/knee CPT 27498 | not published | not published | $4,680.86 – $4,680.86 | 1 |
| Decompression of thigh/knee CPT 27499 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Decompression of tibia nerve CPT 28035 | $793.60 | $992.00 | $5,865.36 – $5,865.36 | 1 |
| Decompression unspecified nerve 64722 CPT 64722 | not published | not published | $5,865.36 – $5,865.36 | 1 |
| Decompress optic nerve CPT 67570 | not published | not published | $11,405.88 – $11,405.88 | 1 |
| Decompres spinal cord;thoracic 63055 CPT 63055 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Decompress spinal cord lmbr CPT 63056 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Decompress spinal cord thrc CPT 63064 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Deep muscle biopsy 20205 CPT 20205 | $456.80 | $571.00 | $8,429.22 – $8,429.22 | 1 |
| Deferoxamine 500 mg solution for injection HCPCS J0895 | not published | not published | $20.29 – $27.83 | 2 |
| Degarelix 120 mg subcutaneous solution HCPCS J9155 | $2,151.47 | $2,689.34 | $9.80 – $13.45 | 2 |
| Delayed breast prosthesis 19342 CPT 19342 | not published | not published | $28,733.32 – $28,733.32 | 1 |
| Delay flap arms/legs CPT 15610 | not published | not published | $5,631.53 – $5,631.53 | 1 |
| Delay flap eye/nos/ear/lip CPT 15630 | not published | not published | $5,631.53 – $5,631.53 | 1 |
| Delay flap fccnaxghf 15620 CPT 15620 | not published | not published | $5,631.53 – $5,631.53 | 1 |
| Delay flap trunk 15600 CPT 15600 | not published | not published | $10,614.75 – $10,614.75 | 1 |
| Delivery of placenta 59414 CPT 59414 | $132.00 | $165.00 | $9,225.99 – $9,225.99 | 1 |
| Demonstrate use home inr mon HCPCS G0248 | not published | not published | $394.38 – $394.38 | 1 |
| Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device CPT 94664 | $27.20 | $34.00 | $624.86 – $624.86 | 1 |
| Denervation of hip joint CPT 27035 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution HCPCS J0897 | $8,516.62 | $10,645.78 | $65.78 – $90.25 | 2 |
| Dentoalveolar/drain abs/cyst/hema 41800 CPT 41800 | $435.20 | $544.00 | $378.88 – $378.88 | 1 |
| Depo-estradiol cypionate inj HCPCS J1000 | not published | not published | $105.55 – $144.81 | 2 |
| Dermabrasion other than face CPT 15782 | $727.20 | $909.00 | $8,429.22 – $8,429.22 | 1 |
| Dermabrasion segmental face 15781 CPT 15781 | $783.20 | $979.00 | $2,117.62 – $2,117.62 | 1 |
| Dermabrasion suprfl any site CPT 15783 | $676.80 | $846.00 | $1,217.32 – $1,217.32 | 1 |
| Dermabrasion total face CPT 15780 | $1,264.00 | $1,580.00 | $8,429.22 – $8,429.22 | 1 |
| Derma-fat-fascia graft 15770 CPT 15770 | not published | not published | $10,614.75 – $10,614.75 | 1 |
| Dermal filler injection(s) HCPCS G0429 | not published | not published | $5,631.53 – $5,631.53 | 1 |
| Derm autograft face/nck/hf/g CPT 15135 | not published | not published | $10,614.75 – $10,614.75 | 1 |
| Derm autograft trnk/arm/leg CPT 15130 | not published | not published | $5,631.53 – $5,631.53 | 1 |
| Design custom breast implant CPT 19396 | not published | not published | $11,217.60 – $11,217.60 | 1 |
| Design mlc device for imrt CPT 77338 | not published | not published | $1,170.51 – $1,170.51 | 1 |
| Desmopressin 4 mcg/ml injection solution HCPCS J2597 | $78.02 | $97.52 | $8.76 – $12.02 | 2 |
| Desoxycorticosterone CPT 82633 | not published | not published | $38.73 – $95.64 | 2 |
| Dest mal lesion feenlm <0.5cm 17280 CPT 17280 | $205.60 | $257.00 | $589.25 – $589.25 | 1 |
| Dest mal lesion feenlm 0.6-1cm 17281 CPT 17281 | $264.80 | $331.00 | $1,217.32 – $1,217.32 | 1 |
| Dest mal lesion feenlm 1.1 - 2.0 cm 17282 CPT 17282 | $302.40 | $378.00 | $1,217.32 – $1,217.32 | 1 |
| Dest mal lesion snhfg <0.5cm 17270 CPT 17270 | $224.80 | $281.00 | $589.25 – $589.25 | 1 |
| Dest mal lesion snhfg 0.6-1cm 17271 CPT 17271 | $244.00 | $305.00 | $589.25 – $589.25 | 1 |
| Dest mal lesion snhfg 1.1-2cm 17272 CPT 17272 | $278.40 | $348.00 | $589.25 – $589.25 | 1 |
| Dest mal lesion tal <0.5 17260 CPT 17260 | $147.20 | $184.00 | $589.25 – $589.25 | 1 |
| Dest mal lesion tal 0.6-1.0cm 17261 CPT 17261 | $217.60 | $272.00 | $589.25 – $589.25 | 1 |
| Dest mal lesion tal 1.1-2.0cm 17262 CPT 17262 | $263.20 | $329.00 | $589.25 – $589.25 | 1 |
| Dest mal lesion tal 2.1-3.0cm 17263 CPT 17263 | $288.00 | $360.00 | $589.25 – $589.25 | 1 |
| Destroy cervthor facet jnt 64633 CPT 64633 | not published | not published | $5,865.36 – $5,865.36 | 1 |
| Destroy internal hemorrhoids destroy 46930 CPT 46930 | $330.40 | $413.00 | $3,533.55 – $3,533.55 | 1 |
| Destroy premlg lesns;1st lesn 17000 CPT 17000 | $99.20 | $124.00 | $589.25 – $589.25 | 1 |
| Destroy vulva lesion extensive 56515 CPT 56515 | $415.20 | $519.00 | $5,631.53 – $5,631.53 | 1 |
| Destroy vulva lesion simple 56501 CPT 56501 | $289.60 | $362.00 | $5,631.53 – $5,631.53 | 1 |
| Destruct ben lesion 15/> 17111 CPT 17111 | $196.00 | $245.00 | $589.25 – $589.25 | 1 |
| Destruct cut vasl lesions 10-50cm 17107 CPT 17107 | $673.60 | $842.00 | $1,895.66 – $1,895.66 | 1 |
| Destruct cut vasl lesions <10cm 17106 CPT 17106 | $518.40 | $648.00 | $1,217.32 – $1,217.32 | 1 |
| Destruct cut vasl lesions >50cm 17108 CPT 17108 | $955.20 | $1,194.00 | $5,631.53 – $5,631.53 | 1 |
| Destruction 2-14 lesions 17003 CPT 17003 | $10.40 | $13.00 | not published | 0 |
| Destruction anal lesion(s) CPT 46910 | not published | not published | $5,631.53 – $5,631.53 | 1 |
| Destruction anal lesion(s) CPT 46924 | $828.00 | $1,035.00 | $8,384.23 – $8,384.23 | 1 |
| Destruction anal lesion(s) smpl chem 46900 CPT 46900 | $362.40 | $453.00 | $1,217.32 – $1,217.32 | 1 |
| Destruction benign lesions < 14 lesions CPT 17110 | $167.20 | $209.00 | $589.25 – $589.25 | 1 |
| Destruction by injection tx of nerve 64630 CPT 64630 | not published | not published | $2,780.68 – $2,780.68 | 1 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | not published | not published | $5,865.36 – $5,865.36 | 1 |
| Destruction ciliary body CPT 66700 | not published | not published | $7,046.29 – $7,046.29 | 1 |
| Destruction ciliary body CPT 66720 | not published | not published | $6,898.76 – $6,898.76 | 1 |
| Destruction ciliary body CPT 66740 | not published | not published | $6,898.76 – $6,898.76 | 1 |
| Destruction cryosurgery anal lesion(s) simpl 46916 CPT 46916 | $388.00 | $485.00 | $589.25 – $589.25 | 1 |
| Destruction laser surgery anal lesions 46917 CPT 46917 | not published | not published | $8,384.23 – $8,384.23 | 1 |
| Destruction les conjunctiva CPT 68135 | not published | not published | $6,898.76 – $6,898.76 | 1 |
| Destruction mal lsn s/n/h/f/g 2.1-3cm CPT 17273 | $312.00 | $390.00 | $1,217.32 – $1,217.32 | 1 |
| Destruction mal lsn s/n/h/f/g 3.1-4cm CPT 17274 | $365.60 | $457.00 | $1,217.32 – $1,217.32 | 1 |
| Destruction mal lsn t/a/l 3.1-4cm CPT 17264 | $304.80 | $381.00 | $1,217.32 – $1,217.32 | 1 |
| Destruction mal lsn t/a/l >4cm CPT 17266 | $346.40 | $433.00 | $1,217.32 – $1,217.32 | 1 |
| Destruction penis lesion(s) chem 54050 CPT 54050 | $218.40 | $273.00 | $1,217.32 – $1,217.32 | 1 |
| Destruction penis lesion(s) exten 54065 CPT 54065 | $336.80 | $421.00 | $5,631.53 – $5,631.53 | 1 |
| Destruction premal lesions 15/> 17004 CPT 17004 | $248.00 | $310.00 | $1,217.32 – $1,217.32 | 1 |
| Destruction rectal tumor 45190 CPT 45190 | not published | not published | $8,384.23 – $8,384.23 | 1 |
| Destruction vag lesions complex 57065 CPT 57065 | not published | not published | $9,225.99 – $9,225.99 | 1 |
| Destruction vag lesions simple 57061 CPT 57061 | $3,815.20 | $4,769.00 | $9,225.99 – $9,225.99 | 1 |
| Destruct penis les/smp/electrodesi 54055 CPT 54055 | not published | not published | $5,631.53 – $5,631.53 | 1 |
| Detect agent nos dna dir CPT 87797 | not published | not published | $37.54 – $92.70 | 2 |
| Detect agnt mult dna direc CPT 87800 | not published | not published | $54.59 – $134.81 | 2 |
| Developmental screen/score/document 96110 CPT 96110 | $17.60 | $22.00 | not published | 0 |
| Devel tst phys/qhp 1st hr CPT 96112 | not published | not published | $913.84 – $913.84 | 1 |
| Device intraute mirena HCPCS J7298 | $1,008.00 | $1,260.00 | not published | 0 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $95.20 | $119.00 | $283.48 – $283.48 | 1 |
| Dexametha opth insert 0.1 mg HCPCS J1096 | not published | not published | $228.34 – $313.29 | 2 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $12.39 | $15.49 | $0.04 – $0.05 | 2 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $67.11 | $83.89 | $0.27 – $0.37 | 2 |
| Dexamethasone intra implant HCPCS J7312 | not published | not published | $461.87 – $633.69 | 2 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | $432.49 | $540.61 | $72.19 – $99.05 | 2 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | $70.84 | $88.55 | $3.05 – $4.18 | 2 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | $70.84 | $88.55 | not published | 0 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $77.92 | $97.40 | $4.56 – $6.25 | 2 |
| Dextrose 5 % IV bolus HCPCS J7070 | $70.84 | $88.55 | $6.84 – $9.39 | 2 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $102.40 | $128.00 | $27.79 – $68.62 | 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.