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 |
|---|---|---|---|---|
| Reconstr lwr jaw segment CPT 21198 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstr lwr jaw w/advance CPT 21199 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruct ankle joint CPT 27702 | not published | not published | $71,452.46 – $71,452.46 | 1 |
| Reconstruct cleft foot CPT 28360 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Reconstruct cleft palate CPT 42200 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruct cleft palate CPT 42205 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Reconstruct cleft palate CPT 42210 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruct cleft palate CPT 42215 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruct cleft palate CPT 42220 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruct cleft palate CPT 42225 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruct elbow joint CPT 24360 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Reconstruct elbow joint CPT 24361 | not published | not published | $71,452.46 – $71,452.46 | 1 |
| Reconstruct elbow joint CPT 24362 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Reconstruct elbow lat ligmnt CPT 24344 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Reconstruct elbow med ligmnt CPT 24346 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Reconstruct extra finger CPT 26587 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Reconstruct finger joint CPT 26545 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Reconstruct finger joint CPT 26548 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Reconstruct head of radius CPT 24365 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Reconstruct head of radius CPT 24366 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Reconstruction knee CPT 27427 | $1,050.40 | $1,313.00 | $21,583.67 – $21,583.67 | 1 |
| Reconstruction knee CPT 27428 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Reconstruction knee CPT 27429 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Reconstruction of anus CPT 46753 | not published | not published | $8,384.23 – $8,384.23 | 1 |
| Reconstruction of eyelid CPT 67971 | not published | not published | $6,898.76 – $6,898.76 | 1 |
| Reconstruction of eyelid CPT 67973 | not published | not published | $6,898.76 – $6,898.76 | 1 |
| Reconstruction of eyelid CPT 67974 | not published | not published | $11,405.88 – $11,405.88 | 1 |
| Reconstruction of eyelid CPT 67975 | not published | not published | $6,898.76 – $6,898.76 | 1 |
| Reconstruction of jaw CPT 21245 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruction of jaw CPT 21246 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruction of jaw CPT 21248 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruction of jaw CPT 21249 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruction of jaw joint CPT 21240 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruction of jaw joint CPT 21242 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruction of jaw joint CPT 21243 | not published | not published | $71,452.46 – $71,452.46 | 1 |
| Reconstruction of lower jaw CPT 21244 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruction of mouth CPT 40840 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruction of mouth CPT 40842 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruction of mouth CPT 40843 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruction of mouth CPT 40844 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruction of mouth CPT 40845 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruction of nail bed CPT 11762 | not published | not published | $5,631.53 – $5,631.53 | 1 |
| Reconstruction of nose CPT 30410 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruction of nose CPT 30420 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruction of orbit CPT 21256 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruction of throat CPT 42950 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruction of urethra CPT 53410 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Reconstruction of urethra CPT 53430 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Reconstruction of urethra CPT 54308 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Reconstruction of urethra CPT 54312 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Reconstruction of urethra CPT 54316 | not published | not published | $27,923.42 – $27,923.42 | 1 |
| Reconstruction of urethra CPT 54318 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Reconstruction of urethra CPT 54322 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Reconstruction of urethra CPT 54324 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Reconstruction of urethra CPT 54326 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Reconstruction tongue fold CPT 41520 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Reconstruct lip with flap CPT 40527 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruct lip w/local flap 40525 CPT 40525 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Reconstruct lower jaw bone CPT 21255 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruct orbit/forehead CPT 21172 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruct shoulder joint CPT 23470 | $1,764.00 | $2,205.00 | $42,576.18 – $42,576.18 | 1 |
| Reconstruct shoulder joint CPT 23472 | $1,916.80 | $2,396.00 | $42,576.18 – $42,576.18 | 1 |
| Reconstruct ulna/radioulnar CPT 25337 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Reconstruct upper jaw bone CPT 21206 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reconstruct urethra/bladder CPT 53431 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Reconstruct urethra stage 1 CPT 53420 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Reconstruct urethra stage 2 CPT 53425 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Rectal sensation test CPT 91120 | not published | not published | $913.84 – $913.84 | 1 |
| Red blood cells each unit HCPCS P9021 | $320.80 | $401.00 | $442.22 – $442.22 | 1 |
| Red blood cells frozen/deglycerolized/washed leukocytes reduced irradiated each unit HCPCS P9057 | not published | not published | $1,285.10 – $1,285.10 | 1 |
| Red blood cells leukocytes reduced cmv negative irradiated each unit HCPCS P9058 | $644.00 | $805.00 | $818.97 – $818.97 | 1 |
| Red blood cells leukocytes reduced each unit HCPCS P9016 | $320.80 | $401.00 | $617.40 – $617.40 | 1 |
| Red blood cells leukocytes reduced irradiated each unit HCPCS P9040 | $442.40 | $553.00 | $845.50 – $845.50 | 1 |
| Red blood cells washed each unit HCPCS P9022 | not published | not published | $1,291.44 – $1,291.44 | 1 |
| Red cell mass multiple CPT 78121 | not published | not published | $1,646.19 – $1,646.19 | 1 |
| Red cell mass single CPT 78120 | not published | not published | $1,268.29 – $1,268.29 | 1 |
| Red cell sequestration CPT 78140 | not published | not published | $1,268.29 – $1,268.29 | 1 |
| Red cell survival study CPT 78130 | not published | not published | $1,268.29 – $1,268.29 | 1 |
| Redo endovas vena cava filtr CPT 37192 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Reduce testis torsion CPT 54600 | $680.00 | $850.00 | $10,458.39 – $10,458.39 | 1 |
| Reduction of facial bones CPT 21209 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reduction of procidentia 45900 CPT 45900 | not published | not published | $2,711.70 – $2,711.70 | 1 |
| Re-explore parathyroids CPT 60502 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Refill maint impl spine pump CPT 95991 | not published | not published | $887.20 – $887.20 | 1 |
| Refill/maint pump/resvr syst CPT 96522 | not published | not published | $674.04 – $674.04 | 1 |
| Regadenoson 0.4 mg/5 ml intravenous syringe HCPCS J2785 | not published | not published | $6.51 – $8.93 | 2 |
| Reinforce clavicle CPT 23490 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Reinforce eye wall CPT 67250 | not published | not published | $6,898.76 – $6,898.76 | 1 |
| Reinforce/graft eye wall CPT 67255 | not published | not published | $7,046.29 – $7,046.29 | 1 |
| Reinforce shoulder bones CPT 23491 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Reinforce tibia CPT 27745 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Reinnervate larynx CPT 31590 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Reinsert ocular implant CPT 65155 | not published | not published | $11,405.88 – $11,405.88 | 1 |
| Release encircling material CPT 67115 | not published | not published | $13,037.66 – $13,037.66 | 1 |
| Release eye tissue CPT 67343 | not published | not published | $6,898.76 – $6,898.76 | 1 |
| Release facial nerve CPT 69720 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Release facial nerve CPT 69725 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Release facial nerve CPT 69955 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Release finger contracture CPT 26525 | not published | not published | $4,680.86 – $4,680.86 | 1 |
| Release forearm/hand tendon CPT 26449 | not published | not published | $9,712.92 – $9,712.92 | 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.