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 |
|---|---|---|---|---|
| Laser treatment of retina CPT 67039 | not published | not published | $13,037.66 – $13,037.66 | 1 |
| Laser treatment of retina CPT 67040 | not published | not published | $13,037.66 – $13,037.66 | 1 |
| Lateral canthopexy CPT 21282 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Lat retinacular release open CPT 27425 | $672.80 | $841.00 | $9,712.92 – $9,712.92 | 1 |
| Lavage cannulation maxillary sinus CPT 31000 | $276.00 | $345.00 | $678.14 – $678.14 | 1 |
| Lavh >250 gms 58553 CPT 58553 | not published | not published | $29,652.07 – $29,652.07 | 1 |
| Lb with mastopexy 15839 CPT 15839 | $1,313.60 | $1,642.00 | $8,429.22 – $8,429.22 | 1 |
| Lead capillary CPT 83655 | $112.80 | $141.00 | $15.14 – $37.38 | 2 |
| Lefort i-1 piece without graft CPT 21141 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Lefort i-2 piece without graft CPT 21142 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Lefort i-3/> piece without graft CPT 21143 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Lefort ii anterior intrusion CPT 21150 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Legion pneumo dna dir prob CPT 87540 | not published | not published | $25.06 – $61.89 | 2 |
| Legion pneumo dna quant CPT 87542 | not published | not published | $52.20 – $128.91 | 2 |
| Leg vein fusion 34530 CPT 34530 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $932.00 | $1,165.00 | $761.98 – $761.98 | 1 |
| Leishmania antibody CPT 86717 | not published | not published | $15.31 – $37.82 | 2 |
| Lengthening of hand tendon CPT 26478 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Lengthening of palate CPT 42227 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Lengthening of palate+pharyngeal flap 42226 CPT 42226 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Lengthening of thigh tendon CPT 27393 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Lengthening of thigh tendons CPT 27394 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Lengthening of thigh tendons CPT 27395 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Lengthen metacarpal/finger CPT 26568 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Lengthen radius or ulna CPT 25391 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Lengthen radius & ulna CPT 25393 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $161.66 | $202.07 | $8.88 – $12.18 | 2 |
| Leukacyte transfusion CPT 86950 | not published | not published | $513.12 – $513.12 | 1 |
| Leukocyte phagocytosis CPT 86344 | not published | not published | $12.99 – $32.07 | 2 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $2,000.21 | $2,500.26 | $349.69 – $479.78 | 2 |
| Leuprolide 3.75 mg intramuscular syringe kit HCPCS J1950 | $10,680.33 | $13,350.41 | $3,908.47 – $5,362.42 | 2 |
| Leuprolide depot cipla 7.5mg HCPCS J1954 | not published | not published | $496.67 – $681.43 | 2 |
| Leuprolide inj, camcevi, 1mg HCPCS J1952 | not published | not published | $115.66 – $158.69 | 2 |
| Lev 1 hosp type b ed visit HCPCS G0380 | not published | not published | $199.59 – $199.59 | 1 |
| Lev 2 hosp type b ed visit HCPCS G0381 | not published | not published | $363.60 – $363.60 | 1 |
| Lev 3 hosp type b ed visit HCPCS G0382 | not published | not published | $635.36 – $635.36 | 1 |
| Lev 4 hosp type b ed visit HCPCS G0383 | not published | not published | $912.72 – $912.72 | 1 |
| Lev 5 hosp type b ed visit HCPCS G0384 | not published | not published | $1,126.19 – $1,126.19 | 1 |
| Levalbuterol non-comp con HCPCS J7612 | not published | not published | $0.68 – $0.93 | 2 |
| Levalbuterol non-comp unit HCPCS J7614 | not published | not published | $0.20 – $0.27 | 2 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $75.24 | $94.05 | $0.11 – $0.15 | 2 |
| Levetiracetam therapeutic drug level CPT 80177 | $129.60 | $162.00 | $16.56 – $40.90 | 2 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $79.34 | $99.17 | $4.41 – $6.05 | 2 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | $267.31 | $334.14 | $17.32 – $23.76 | 2 |
| L hrt cath chd nm/abn nt cnj CPT 93595 | not published | not published | $9,653.52 – $9,653.52 | 1 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $75.17 | $93.96 | not published | 0 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | $53.13 | $66.41 | $0.01 – $0.01 | 2 |
| Lidocaine therapeutic drug level CPT 80176 | $255.20 | $319.00 | $18.36 – $45.35 | 2 |
| Ligate leg veins open CPT 37761 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Ligate leg veins radical 37760 CPT 37760 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Ligate oviduct(s) add-on 58611 CPT 58611 | $111.20 | $139.00 | not published | 0 |
| Ligate/strip long leg vein CPT 37722 | $684.00 | $855.00 | $9,720.46 – $9,720.46 | 1 |
| Ligate/strip short leg vein CPT 37718 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Ligate/transect fallopian tubes 58600 CPT 58600 | $556.00 | $695.00 | $9,225.99 – $9,225.99 | 1 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | $468.00 | $585.00 | $4,893.07 – $4,893.07 | 1 |
| Ligation/divis of long saph vein 37700 CPT 37700 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Ligation external carotid artery 37600 CPT 37600 | $1,117.60 | $1,397.00 | $9,720.46 – $9,720.46 | 1 |
| Ligation internal/common carotid artery 37605 CPT 37605 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Ligation internal jugular vein 37565 CPT 37565 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Ligation major artery neck CPT 37615 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Ligation nasal sinus artery CPT 30915 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Ligation of femoral vein CPT 37650 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Ligation of inf vena cava CPT 37619 | not published | not published | $16,771.14 – $16,771.14 | 1 |
| Ligation of neck artery CPT 37606 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Ligation of salivary duct CPT 42665 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Ligation upper jaw artery CPT 30920 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Ligation vericose vein cluster(s) 1 leg CPT 37785 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Lig/band angioaccess av fistula CPT 37607 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Lig&div&compl strpg saph vn CPT 37735 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Liletta, 52 mg HCPCS J7297 | $812.00 | $1,015.00 | not published | 0 |
| Limb exercise test CPT 95875 | not published | not published | $474.53 – $474.53 | 1 |
| Limited visual field xm CPT 92081 | not published | not published | $187.55 – $187.55 | 1 |
| Lincomycin injection HCPCS J2010 | not published | not published | $12.62 – $17.32 | 2 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $313.50 | $391.87 | $7.81 – $10.71 | 2 |
| Lipase CPT 83690 | $73.60 | $92.00 | $8.61 – $21.27 | 2 |
| Lip exc/transverse wedge/w closure 40510 CPT 40510 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Lipoprotein blood high res frac & quant CPT 83701 | $103.20 | $129.00 | $42.33 – $104.53 | 2 |
| Lipoprotein blood quant CPT 83704 | $89.60 | $112.00 | $42.74 – $105.54 | 2 |
| Lipoprotein direct measurement hdl CPT 83718 | $79.20 | $99.00 | $10.24 – $25.28 | 2 |
| Lipoprotein direct measurement ldl CPT 83721 | $63.20 | $79.00 | $13.13 – $32.41 | 2 |
| Lipoprtn dir meas sd ldl chl CPT 83722 | not published | not published | $42.74 – $105.54 | 2 |
| Lip surgery procedure CPT 40799 | not published | not published | $678.14 – $678.14 | 1 |
| Lisocabtagene mara car pos t HCPCS Q2054 | not published | not published | $1,218,680.23 – $1,672,029.27 | 2 |
| Listeria monocytogenes CPT 86723 | not published | not published | $16.49 – $40.72 | 2 |
| Lithium therapeutic drug level CPT 80178 | $68.00 | $85.00 | $8.26 – $20.41 | 2 |
| Liver ds alys 3 bmrk srm alg CPT 81517 | not published | not published | $220.24 – $543.90 | 2 |
| Liver elastography 91200 CPT 91200 | not published | not published | $474.53 – $474.53 | 1 |
| Liver Function Test CPT 80076 | $76.80 | $96.00 | $10.21 – $25.22 | 2 |
| Liver imaging CPT 78201 | not published | not published | $1,646.19 – $1,646.19 | 1 |
| Liver imag w/vasclr flow CPT 78202 | not published | not published | $1,646.19 – $1,646.19 | 1 |
| Liver/spleen imag static only CPT 78215 | not published | not published | $1,268.29 – $1,268.29 | 1 |
| Liver/spleen imag w/vasclr flow CPT 78216 | not published | not published | $1,268.29 – $1,268.29 | 1 |
| Lmtd oph exam general anes CPT 92019 | not published | not published | $6,898.76 – $6,898.76 | 1 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | not published | not published | $4.05 – $5.56 | 2 |
| Loncastuximab tesirine-lpyl 10 mg intravenous solution HCPCS J9359 | not published | not published | $487.67 – $669.09 | 2 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $45.56 | $56.95 | $2.96 – $4.06 | 2 |
| Loudness balance test CPT 92562 | not published | not published | $474.53 – $474.53 | 1 |
| Low back disk surgery CPT 63030 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Low cost skin substitute app HCPCS C5271 | not published | not published | $1,895.66 – $1,895.66 | 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.