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 |
|---|---|---|---|---|
| Oph Ultrasound dx quan a-scan only CPT 76511 | not published | not published | $348.75 – $348.75 | 1 |
| Opn impltj crnl nrv nea&pg CPT 64568 | not published | not published | $95,797.36 – $95,797.36 | 1 |
| Opn impltj nea neuromuscular CPT 64580 | not published | not published | $70,205.09 – $70,205.09 | 1 |
| Opn impltj nea perph nerve CPT 64575 | not published | not published | $39,001.55 – $39,001.55 | 1 |
| Opn impltj nea sacral nerve CPT 64581 | not published | not published | $21,548.51 – $21,548.51 | 1 |
| Opn mpltj hpglsl nstm ary pg CPT 64582 | not published | not published | $95,797.36 – $95,797.36 | 1 |
| Opn tx complx malar fx CPT 21365 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Opn tx complx malar w/grft CPT 21366 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Opn tx dprsd zygomatic arch CPT 21356 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Opn tx nasomax fx multple CPT 21347 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Opn tx nasomax fx w/fixj CPT 21346 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Opn tx orbit fx combined CPT 21387 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Opn tx orbit fx periorbital CPT 21386 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Opn tx orbit fx transantral CPT 21385 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Opn tx orbit fx w/bone grft CPT 21408 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Opn tx orbit fx w/implant CPT 21407 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Opn tx orbit fx without impl 21406 CPT 21406 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Opn tx orbit periorbtl implt CPT 21390 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Opn tx orbit periorbt w/grft CPT 21395 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Opps service,sched team conf HCPCS G0175 | not published | not published | $1,245.22 – $1,245.22 | 1 |
| Opscpy extnd on/mac draw CPT 92202 | not published | not published | $187.55 – $187.55 | 1 |
| Opscpy extnd rta draw uni/bi CPT 92201 | not published | not published | $187.55 – $187.55 | 1 |
| Optx acrclv dslc aq/chrn grf CPT 23552 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Optx acromclv dislc aqt/chrn CPT 23550 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Optx acute shoulder dislc CPT 23660 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Optx carpl scphd fx int fixj CPT 25628 | $1,063.20 | $1,329.00 | $21,583.67 – $21,583.67 | 1 |
| Optx clavicular fx w/int fix CPT 23515 | $1,063.20 | $1,329.00 | $21,583.67 – $21,583.67 | 1 |
| Optx complicated mndblr fx CPT 21470 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Optx crpl fx oth/thn scph ea CPT 25645 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Optx gr hmrl tbrs fx int fix CPT 23630 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Optx lunate dislocation CPT 25695 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Optx medial ankle fx CPT 27766 | $893.60 | $1,117.00 | $21,583.67 – $21,583.67 | 1 |
| Optx mndblr cndylr fx CPT 21465 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Optx mndblr fx wo ntrdntl CPT 21461 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Optx mndblr fx xtrnl fixj CPT 21454 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Optx mndblr/max alv ridge fx CPT 21445 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Optx palatal/max fracture CPT 21422 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Optx partclr fx&/dslc elbw w CPT 24587 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Optx post ankle fx CPT 27769 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Optx prox humrl fx w/int fix CPT 23615 | $1,303.20 | $1,629.00 | $42,576.18 – $42,576.18 | 1 |
| Optx prx hmrl fx fix rpr rpl CPT 23616 | $1,860.00 | $2,325.00 | $71,452.46 – $71,452.46 | 1 |
| Optx radial shaft fracture CPT 25515 | $989.60 | $1,237.00 | $21,583.67 – $21,583.67 | 1 |
| Optx rad/uln dislc aqt/chrnc CPT 25676 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Optx rdcrpl/ntrcrpl dislc 1+ CPT 25670 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Optx rdl shft fx&cltx rad/ul CPT 25525 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Optx rdl shft fx&dstl rad/ul CPT 25526 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Optx rdl&uln shft fx rds&uln CPT 25575 | $1,333.60 | $1,667.00 | $21,583.67 – $21,583.67 | 1 |
| Optx rdl&uln shft fx rds/uln CPT 25574 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Optx scapular fx w/int fixj CPT 23585 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Optx sho dislc fx CPT 23670 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Optx sho dislc neck fx fixj CPT 23680 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Optx strclv dslc aq/chrn grf CPT 23532 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Optx strnclav dislc aqt/chrn CPT 23530 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Optx tmprmand dislocation CPT 21490 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Optx trns-scphprlnr fx dislc CPT 25685 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Optx ulnar shft fx int fixj CPT 25545 | $924.00 | $1,155.00 | $21,583.67 – $21,583.67 | 1 |
| Optx ulnar styloid fracture CPT 25652 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Oral aprepitant HCPCS J8501 | not published | not published | $6.12 – $8.39 | 2 |
| Oral everolimus HCPCS J7527 | not published | not published | $4.47 – $6.13 | 2 |
| Oral hiv-1/hiv-2 screen HCPCS G0435 | not published | not published | $14.98 – $36.98 | 2 |
| Oral methotrexate (jylamvo) HCPCS J8611 | not published | not published | $41.69 – $57.20 | 2 |
| Oral methotrexate (xatmep) HCPCS J8612 | not published | not published | $50.98 – $69.95 | 2 |
| Oral netupitant, palonosetro HCPCS J8655 | not published | not published | $921.42 – $1,264.19 | 2 |
| Orchiectomy partial CPT 54522 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Orchiopexy (fowler-stephens) CPT 54650 | not published | not published | $11,557.38 – $11,557.38 | 1 |
| Orchiopexy ingun/scrot appr CPT 54640 | not published | not published | $11,557.38 – $11,557.38 | 1 |
| Organic acids total quant ea spec CPT 83918 | $68.80 | $86.00 | $29.50 – $72.85 | 2 |
| Oritavancin 1,200 mg intravenous solution HCPCS J2406 | not published | not published | $93.16 – $127.81 | 2 |
| Oritavancin 400 mg intravenous solution HCPCS J2407 | not published | not published | $64.17 – $88.04 | 2 |
| Oropharyngeal biopsy 42800 CPT 42800 | $235.20 | $294.00 | $4,529.52 – $4,529.52 | 1 |
| Orphenadrine citrate 30 mg/ml injection solution HCPCS J2360 | not published | not published | $21.26 – $29.17 | 2 |
| Ortho elbow without jnt cstm w/fit&adj HCPCS L3702 | $253.60 | $317.00 | not published | 0 |
| Ortho ewhf rigd without jnt cstm w HCPCS L3765 | $320.00 | $400.00 | not published | 0 |
| Ortho ewh rgd without jnt cstm w/fit&adj HCPCS L3763 | $476.80 | $596.00 | not published | 0 |
| Ortho hnd/fngr without jnt cstm w/fit&adj HCPCS L3913 | $220.80 | $276.00 | not published | 0 |
| Ortho hnd/fngr w/jnt cstm w/fit&adj HCPCS L3921 | $268.00 | $335.00 | not published | 0 |
| Ortho hnd without jnt w/fit&adj HCPCS L3919 | $196.00 | $245.00 | not published | 0 |
| Orthopantogram CPT 70355 | not published | not published | $283.48 – $283.48 | 1 |
| Orthop traing supvj phys/qhp CPT 92066 | not published | not published | $187.55 – $187.55 | 1 |
| Orthovisc inj per dose HCPCS J7324 | not published | not published | $219.82 – $301.59 | 2 |
| Ortho whf rigd without jnt cstm w/fit&adj HCPCS L3808 | $271.20 | $339.00 | not published | 0 |
| Ortho wrst/hnd w/jnt cstm w/fit&adj HCPCS L3905 | $731.20 | $914.00 | not published | 0 |
| Oscillation chest wall mechanical per session CPT 94669 | $249.60 | $312.00 | $624.86 – $624.86 | 1 |
| Osmolality blood CPT 83930 | $80.00 | $100.00 | $8.26 – $20.41 | 2 |
| Osmolality urine CPT 83935 | $80.00 | $100.00 | $8.53 – $21.05 | 2 |
| Ostectomy complete 1st metatarsal head 28111 CPT 28111 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Ostectomy scapula partial CPT 23190 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Osteochondral knee allograft CPT 27415 | $2,016.80 | $2,521.00 | $42,576.18 – $42,576.18 | 1 |
| Osteochondral knee autograft CPT 27416 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Osteochondral talus autogrft CPT 28446 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Osteopath manip tx/5-6 body region 98927 CPT 98927 | $85.60 | $107.00 | $81.52 – $81.52 | 1 |
| Osteopath manip tx/7-8 body region 98928 CPT 98928 | $104.80 | $131.00 | $81.52 – $81.52 | 1 |
| Osteopath manip tx/9-10 body region98929 CPT 98929 | $125.60 | $157.00 | $81.52 – $81.52 | 1 |
| Osteoplasty humerus CPT 24420 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Osteot humerus w/wo int fixj CPT 24400 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Osteotomy/graft tarsal/calcaneus/talus 28305 CPT 28305 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Ot evaluation high complexity patient/family CPT 97167 | $153.60 | $192.00 | not published | 0 |
| Ot evaluation low complexity patient/family CPT 97165 | $154.40 | $193.00 | not published | 0 |
| Ot evaluation moderate complexity patient/family CPT 97166 | $123.20 | $154.00 | not published | 0 |
| Other immunoelectrophoresis CPT 86325 | not published | not published | $28.91 – $71.40 | 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.