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 |
|---|---|---|---|---|
| Revision of arm nerve(s) CPT 64713 | not published | not published | $5,865.36 – $5,865.36 | 1 |
| Revision of big toe CPT 28310 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Revision of bladder neck CPT 52500 | $740.80 | $926.00 | $10,458.39 – $10,458.39 | 1 |
| Revision of calf tendon CPT 27687 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Revision of cervix CPT 57720 | $501.60 | $627.00 | $9,225.99 – $9,225.99 | 1 |
| Revision of cervix CPT 59320 | $222.40 | $278.00 | $9,225.99 – $9,225.99 | 1 |
| Revision of collar bone CPT 23480 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Revision of collar bone CPT 23485 | $1,400.80 | $1,751.00 | $42,576.18 – $42,576.18 | 1 |
| Revision of colostomy CPT 44340 | $925.60 | $1,157.00 | $10,614.75 – $10,614.75 | 1 |
| Revision of cornea CPT 65600 | not published | not published | $6,898.76 – $6,898.76 | 1 |
| Revision of cranial nerve CPT 64716 | not published | not published | $5,865.36 – $5,865.36 | 1 |
| Revision of eyelid CPT 67880 | not published | not published | $6,898.76 – $6,898.76 | 1 |
| Revision of eyelid CPT 67882 | not published | not published | $6,898.76 – $6,898.76 | 1 |
| Revision of eyelid CPT 67950 | not published | not published | $6,898.76 – $6,898.76 | 1 |
| Revision of eyelid CPT 67961 | not published | not published | $6,898.76 – $6,898.76 | 1 |
| Revision of eyelid CPT 67966 | not published | not published | $6,898.76 – $6,898.76 | 1 |
| Revision of foot CPT 28116 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Revision of foot and ankle CPT 28262 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Revision of foot bones CPT 28737 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Revision of foot fascia 28250 CPT 28250 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Revision of foot tendon CPT 28238 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Revision of foot tendon CPT 28261 | not published | not published | $4,680.86 – $4,680.86 | 1 |
| Revision of hip tendon CPT 27097 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Revision of ileostomy; simple 44312 CPT 44312 | not published | not published | $10,614.75 – $10,614.75 | 1 |
| Revision of infusion pump CPT 36261 | not published | not published | $10,934.15 – $10,934.15 | 1 |
| Revision of iris CPT 66761 | not published | not published | $1,731.92 – $1,731.92 | 1 |
| Revision of iris CPT 66762 | not published | not published | $1,731.92 – $1,731.92 | 1 |
| Revision of jaw muscle/bone CPT 21295 | not published | not published | $4,529.52 – $4,529.52 | 1 |
| Revision of jaw muscle/bone CPT 21296 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Revision of knee joint CPT 27440 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Revision of knee joint CPT 27441 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Revision of knee joint CPT 27442 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Revision of knee joint CPT 27443 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Revision of knee joint CPT 27446 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Revision of larynx CPT 31400 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Revision of leg vein 37780 CPT 37780 | not published | not published | $9,720.46 – $9,720.46 | 1 |
| Revision of neck muscle CPT 21700 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Revision of neck muscle CPT 21720 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Revision of neck muscle CPT 21725 | not published | not published | $2,117.62 – $2,117.62 | 1 |
| Revision of nose CPT 30120 | not published | not published | $9,283.38 – $9,283.38 | 1 |
| Revision of nose CPT 30430 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Revision of nose CPT 30435 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Revision of nose CPT 30450 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Revision of nose CPT 30460 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Revision of nose CPT 30462 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Revision of penis CPT 54300 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Revision of penis CPT 54304 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Revision of penis CPT 54420 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Revision of penis CPT 54435 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Revision of pharyngeal walls CPT 42892 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Revision of radius CPT 25350 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Revision of radius CPT 25355 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Revision of sciatic nerve CPT 64712 | not published | not published | $5,865.36 – $5,865.36 | 1 |
| Revision of scrotum CPT 55175 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Revision of scrotum CPT 55180 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Revision of spinal shunt CPT 63744 | not published | not published | $20,161.06 – $20,161.06 | 1 |
| Revision of testis CPT 54660 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Revision of thigh muscles CPT 27430 | $1,097.60 | $1,372.00 | $21,583.67 – $21,583.67 | 1 |
| Revision of toe CPT 28312 | not published | not published | $9,712.92 – $9,712.92 | 1 |
| Revision of ulna CPT 25360 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Revision of unstable kneecap CPT 27420 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Revision of unstable kneecap CPT 27422 | $1,097.60 | $1,372.00 | $21,583.67 – $21,583.67 | 1 |
| Revision of urethra CPT 53450 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Revision of urethra CPT 53460 | not published | not published | $10,458.39 – $10,458.39 | 1 |
| Revision of urethra CPT 57220 | $520.00 | $650.00 | $15,124.47 – $15,124.47 | 1 |
| Revision open av fistula without thromb CPT 36832 | not published | not published | $16,771.14 – $16,771.14 | 1 |
| Revision orbitofacial bones CPT 21275 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Revision/removal of kneecap CPT 27424 | not published | not published | $21,583.67 – $21,583.67 | 1 |
| Revision tips CPT 37183 | not published | not published | $17,017.98 – $17,017.98 | 1 |
| Revis reconst shoulder joint CPT 23473 | not published | not published | $42,576.18 – $42,576.18 | 1 |
| Revita, per sq cm HCPCS Q4180 | not published | not published | $2,452.66 – $3,365.05 | 2 |
| Revj fem anast autog vn grf CPT 35884 | not published | not published | $16,771.14 – $16,771.14 | 1 |
| Revj fem anast nonautog grf CPT 35883 | not published | not published | $16,771.14 – $16,771.14 | 1 |
| Revj mstdc rsltg compl mstdc CPT 69601 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Revj mstdc rsltg tympanplsty CPT 69604 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Revj prior hypspad repair CPT 54352 | not published | not published | $15,343.31 – $15,343.31 | 1 |
| Rev mastoidectomy rsltg modf rad mstdc 69602 CPT 69602 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Rev-rem impl neurostim gen-rec CPT 63688 | not published | not published | $10,597.24 – $10,597.24 | 1 |
| Rev/rmv perph nstim eltrd ra CPT 64585 | not published | not published | $10,597.24 – $10,597.24 | 1 |
| Rev/rmv prph sac/gstr npg/r CPT 64595 | not published | not published | $10,597.24 – $10,597.24 | 1 |
| Rev/rplct hpglsl nstm ary pg CPT 64583 | not published | not published | $39,001.55 – $39,001.55 | 1 |
| Rezafungin 200 mg intravenous solution HCPCS J0349 | not published | not published | $23.89 – $32.77 | 2 |
| Rf abltj nrv nrvtg si jt CPT 64625 | not published | not published | $5,865.36 – $5,865.36 | 1 |
| Rheumatoid factor qualitative CPT 86430 | $94.40 | $118.00 | $7.68 – $18.95 | 2 |
| Rheumatoid factor quantitative CPT 86431 | $41.60 | $52.00 | $7.09 – $17.50 | 2 |
| Rh ig minidose im CPT 90385 | $23.20 | $29.00 | not published | 0 |
| Rhinp prim lat&alr crtlge&/elvtn nsl tip CPT 30400 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Rho(d) immune globulin 1,500 unit (300 mcg)/2 ml injection syringe HCPCS J2791 | not published | not published | $11.18 – $15.33 | 2 |
| Rho d immune globulin 50 mcg HCPCS J2788 | $153.62 | $192.02 | $62.68 – $86.00 | 2 |
| Rho(d) immune globulin h, sd HCPCS J2792 | not published | not published | $69.24 – $94.99 | 2 |
| Rho d immune globulin inj HCPCS J2790 | $377.85 | $472.31 | $185.45 – $254.44 | 2 |
| R hrt cath chd abnl nt cnj CPT 93594 | not published | not published | $9,653.52 – $9,653.52 | 1 |
| R hrt cath chd nml nt cnj CPT 93593 | not published | not published | $9,653.52 – $9,653.52 | 1 |
| Rhythm ecg with report CPT 93040 | $20.00 | $25.00 | not published | 0 |
| Rib cartilage graft CPT 21230 | not published | not published | $17,423.47 – $17,423.47 | 1 |
| Rifampin in ns IV syringe 3 mg/ml (neo/ped) - cnr HCPCS J2804 | not published | not published | $0.36 – $0.49 | 2 |
| Right ventric recording CPT 93603 | not published | not published | $3,645.00 – $3,645.00 | 1 |
| Risankizumab-rzaa 60 mg/ml intravenous solution HCPCS J2327 | not published | not published | $33.39 – $45.81 | 2 |
| Risperidone microspheres 12.5 mg/2 ml inj HCPCS J2794 | not published | not published | $24.62 – $33.77 | 2 |
| Rituximab 10 mg/ml concentrate,intravenous HCPCS J9312 | $6,169.81 | $7,712.26 | $170.84 – $234.40 | 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.