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 |
|---|---|---|---|---|
| Ghs layer closure 2.5cm or less - 12051 CPT 12051 | $421.60 | $527.00 | $1,217.32 – $1,217.32 | 1 |
| Ghs layer closure 2.6 - 5.0 cm - 12052 CPT 12052 | $468.00 | $585.00 | $1,217.32 – $1,217.32 | 1 |
| Ghs layer closure 2.6 - 7.5 cm - 12042 CPT 12042 | $524.80 | $656.00 | $1,217.32 – $1,217.32 | 1 |
| Ghs layer closure 5.1 - 7.5 cm - 12053 CPT 12053 | $540.80 | $676.00 | $1,217.32 – $1,217.32 | 1 |
| Ghs layer closure 7.6 - 12.5 cm - 12034 CPT 12034 | $496.00 | $620.00 | $1,217.32 – $1,217.32 | 1 |
| Ghs layer closure 7.6 - 12.5 cm - 12044 CPT 12044 | $826.40 | $1,033.00 | $1,895.66 – $1,895.66 | 1 |
| Ghs layer closure 7.6 - 12.5 cm - 12054 CPT 12054 | $573.60 | $717.00 | $1,217.32 – $1,217.32 | 1 |
| Ghs layered repair 12.6 - 20.0 cm -12045 CPT 12045 | $826.40 | $1,033.00 | $1,895.66 – $1,895.66 | 1 |
| Ghs layered repair 12.6 - 20.0 cm -12055 CPT 12055 | $385.60 | $482.00 | $1,217.32 – $1,217.32 | 1 |
| Ghs layered repair 20.1 - 30.0 cm -12046 CPT 12046 | $828.00 | $1,035.00 | $1,895.66 – $1,895.66 | 1 |
| Ghs layered repair 20.1 - 30.0 cm -12056 CPT 12056 | $385.60 | $482.00 | $1,217.32 – $1,217.32 | 1 |
| Ghs layered repair over 30.0 cm -12047 CPT 12047 | not published | not published | $5,631.53 – $5,631.53 | 1 |
| Ghs layered repair over 3.0 cm -12057 CPT 12057 | $900.00 | $1,125.00 | $1,217.32 – $1,217.32 | 1 |
| Ghs leukocyte alkaline phos (mayo) CPT 85540 | $153.60 | $192.00 | $10.75 – $26.55 | 2 |
| Ghs mbp CPT 83873 | $120.80 | $151.00 | $21.50 – $53.10 | 2 |
| Ghs moderate sedation < 5 yr, 30 min CPT 99151 | $298.40 | $373.00 | not published | 0 |
| Ghs moderate sedation < 5 yr, 30 min, other CPT 99155 | $298.40 | $373.00 | not published | 0 |
| Ghs moderate sedation, > 5 yr, 30 min, other CPT 99156 | $298.40 | $373.00 | not published | 0 |
| Ghs moderate sedation ea addtl 15 min CPT 99153 | $148.80 | $186.00 | not published | 0 |
| Ghs moderate sedation ea addtl 15 min, other CPT 99157 | $148.80 | $186.00 | not published | 0 |
| Ghs musc test done w/n test comp CPT 95886 | $139.20 | $174.00 | not published | 0 |
| Ghs musc tst done w/nerv tst lim CPT 95885 | $88.80 | $111.00 | not published | 0 |
| Ghs musc tst done w/n tst non ext CPT 95887 | $121.60 | $152.00 | not published | 0 |
| Ghs myocardial strain img spckl track CPT 93356 | $54.40 | $68.00 | not published | 0 |
| Ghs nailbed repair/nail removal CPT 11760 | $280.00 | $350.00 | $1,895.66 – $1,895.66 | 1 |
| Ghs nerve blk intercostal, ea addtl level CPT 64421 | $444.00 | $555.00 | $2,780.68 – $2,780.68 | 1 |
| Ghs nerve blk intercostal, single level CPT 64420 | $144.00 | $180.00 | $2,102.48 – $2,102.48 | 1 |
| Ghs nerve block axillary nerve CPT 64417 | $112.00 | $140.00 | $2,780.68 – $2,780.68 | 1 |
| Ghs nerve block brachial plexus CPT 64415 | $542.40 | $678.00 | $2,780.68 – $2,780.68 | 1 |
| Ghs nerve block celiac plexus CPT 64530 | not published | not published | $2,780.68 – $2,780.68 | 1 |
| Ghs nerve block interscaline CPT 64510 | not published | not published | $2,780.68 – $2,780.68 | 1 |
| Ghs nerve block lumbar or thoracic symp CPT 64520 | not published | not published | $2,780.68 – $2,780.68 | 1 |
| Ghs nerve block sciatic nerve CPT 64445 | $114.40 | $143.00 | $2,102.48 – $2,102.48 | 1 |
| Ghs nerve block suprascapular CPT 64418 | $128.00 | $160.00 | $2,102.48 – $2,102.48 | 1 |
| Ghs ng placement w fluoro guidance CPT 43752 | $1,287.20 | $1,609.00 | $1,232.01 – $1,232.01 | 1 |
| Ghs o2 saturation CPT 82810 | $260.00 | $325.00 | $12.21 – $30.16 | 2 |
| Ghs o2 uptake rest & exercise CPT 94680 | not published | not published | $474.53 – $474.53 | 1 |
| Ghs o2 uptake rest & indirect CPT 94690 | not published | not published | $187.55 – $187.55 | 1 |
| Ghs ob unlisted IV or art inj or infusion CPT 96379 | not published | not published | $138.26 – $138.26 | 1 |
| Ghs opcc repair cvp without subq port CPT 36575 | not published | not published | $1,887.67 – $1,887.67 | 1 |
| Ghs opcc repair cvp w subq port CPT 36576 | not published | not published | $4,854.90 – $4,854.90 | 1 |
| Ghs optokenetic CPT 92544 | not published | not published | $474.53 – $474.53 | 1 |
| Ghs oscillating trac CPT 92545 | not published | not published | $913.84 – $913.84 | 1 |
| Ghs osteopathic manipulative tx, 1-2 regions CPT 98925 | $47.20 | $59.00 | $81.52 – $81.52 | 1 |
| Ghs osteopathic manipulative tx, 3-4 regions CPT 98926 | $68.00 | $85.00 | $81.52 – $81.52 | 1 |
| Ghs ot sensory integrative tech/15min CPT 97533 | $38.40 | $48.00 | not published | 0 |
| Ghs pacing - transcutaneous CPT 92953 | $468.00 | $585.00 | $1,919.11 – $1,919.11 | 1 |
| Ghs paravert facet/nerve cerv ea add bil CPT 64492 | $305.60 | $382.00 | not published | 0 |
| Ghs paravert facet/nerve lumb ea add bil CPT 64495 | $208.00 | $260.00 | not published | 0 |
| Ghs peritonsillar abscess i andd CPT 42700 | $286.40 | $358.00 | $678.14 – $678.14 | 1 |
| Ghs phenylketonurid CPT 84030 | $46.40 | $58.00 | $6.88 – $16.98 | 2 |
| Ghs picc line insert < 5 CPT 36568 | not published | not published | $4,854.90 – $4,854.90 | 1 |
| Ghs plngl fx pm cl CPT 26725 | $511.20 | $639.00 | $675.49 – $675.49 | 1 |
| Ghs plt ct-manual CPT 85032 | not published | not published | $5.39 – $13.30 | 2 |
| Ghs polysom <6 yrs 4/> parameters CPT 95782 | $890.40 | $1,113.00 | $3,048.91 – $3,048.91 | 1 |
| Ghs pos nystagmus CPT 92542 | not published | not published | $378.88 – $378.88 | 1 |
| Ghs ppd (tb intradermal) CPT 86580 | $80.00 | $100.00 | $81.43 – $81.43 | 1 |
| Ghs prostatic acid phosphatase (mayo) CPT 84066 | $94.40 | $118.00 | $12.08 – $29.82 | 2 |
| Ghs protein, misc fluid CPT 84160 | not published | not published | $7.01 – $17.32 | 2 |
| Ghs protoporphyrins fract CPT 84202 | $148.80 | $186.00 | $17.94 – $44.30 | 2 |
| Ghs pr without cont pulse ox CPT 94625 | not published | not published | $187.55 – $187.55 | 1 |
| Ghs pseudocholinesterase,dibucain-inhibi CPT 82638 | $103.20 | $129.00 | $15.31 – $37.82 | 2 |
| Ghs quinidine CPT 80194 | $208.00 | $260.00 | $18.25 – $45.07 | 2 |
| Ghs refill of implantable pump CPT 95990 | not published | not published | $1,085.34 – $1,085.34 | 1 |
| Ghs removal intranasal foreign body CPT 30300 | $315.20 | $394.00 | $378.88 – $378.88 | 1 |
| Ghs removal pharyngeal foreign body CPT 42809 | not published | not published | $1,232.01 – $1,232.01 | 1 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | $908.00 | $1,135.00 | $4,680.86 – $4,680.86 | 1 |
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | not published | not published | $19.86 – $49.05 | 2 |
| Ghs reticulocyte count CPT 85044 | $18.40 | $23.00 | $5.39 – $13.30 | 2 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | $147.20 | $184.00 | $17.39 – $42.94 | 2 |
| Ghs sedimentation rate CPT 85651 | $48.80 | $61.00 | $5.34 – $13.18 | 2 |
| Ghs semen analysis fert CPT 89320 | $263.20 | $329.00 | $15.39 – $38.00 | 2 |
| Ghs semen analysis, post-vas CPT 89300 | not published | not published | $12.30 – $30.38 | 2 |
| Ghs sensitivity (per antimicro) CPT 87184 | $91.20 | $114.00 | $9.35 – $23.09 | 2 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $262.40 | $328.00 | $1,217.32 – $1,217.32 | 1 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $524.80 | $656.00 | $1,217.32 – $1,217.32 | 1 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $306.40 | $383.00 | $1,217.32 – $1,217.32 | 1 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $228.80 | $286.00 | $1,217.32 – $1,217.32 | 1 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $212.80 | $266.00 | $589.25 – $589.25 | 1 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $227.20 | $284.00 | $589.25 – $589.25 | 1 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $255.20 | $319.00 | $589.25 – $589.25 | 1 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $344.80 | $431.00 | $589.25 – $589.25 | 1 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | $259.20 | $324.00 | $589.25 – $589.25 | 1 |
| Ghs sleep study unattended CPT 95800 | $317.60 | $397.00 | $474.53 – $474.53 | 1 |
| Ghs somatosensory testing lower extremit CPT 95926 | $209.60 | $262.00 | $913.84 – $913.84 | 1 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | not published | not published | $1,577.43 – $1,577.43 | 1 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $79.20 | $99.00 | not published | 0 |
| Ghs sphenopalatine ganglion block CPT 64505 | $218.40 | $273.00 | $887.20 – $887.20 | 1 |
| Ghs spont nystagmus CPT 92541 | not published | not published | $378.88 – $378.88 | 1 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $111.20 | $139.00 | not published | 0 |
| Ghs st - eval for alt comm CPT 92567 | $24.00 | $30.00 | $110.81 – $110.81 | 1 |
| Ghs strapping shoulder - 29240 CPT 29240 | $44.00 | $55.00 | $378.88 – $378.88 | 1 |
| Ghs subcutaneous infus, for therapy ea. add. hr CPT 96370 | not published | not published | $138.26 – $138.26 | 1 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | not published | not published | $674.04 – $674.04 | 1 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $752.00 | $940.00 | $1,895.66 – $1,895.66 | 1 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $263.20 | $329.00 | $1,217.32 – $1,217.32 | 1 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | not published | not published | $4,529.52 – $4,529.52 | 1 |
| Ghs trypsin (fecal) CPT 84488 | not published | not published | $9.13 – $22.54 | 2 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $478.40 | $598.00 | $675.49 – $675.49 | 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.