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 |
|---|---|---|---|---|
| X-ray ankle 2 views (both sides) CPT 73600 | $179.20 | $224.00 | $283.48 – $283.48 | 1 |
| X-ray arthrogram shoulder supervision & interpretation (both sides) CPT 73040 | $636.80 | $796.00 | $1,202.18 – $1,202.18 | 1 |
| X-ray assay calculus CPT 82370 | not published | not published | $15.65 – $38.65 | 2 |
| X-ray bone age studies CPT 77072 | $293.60 | $367.00 | $348.75 – $348.75 | 1 |
| X-ray bone length studies CPT 77073 | $541.60 | $677.00 | $348.75 – $348.75 | 1 |
| X-ray bone survey complete CPT 77075 | $902.40 | $1,128.00 | $348.75 – $348.75 | 1 |
| X-ray bone survey infant CPT 77076 | $218.40 | $273.00 | $348.75 – $348.75 | 1 |
| X-ray cervical spine 2-3 views CPT 72040 | $241.60 | $302.00 | $283.48 – $283.48 | 1 |
| X-ray cervical spine 4-5 views CPT 72050 | $359.20 | $449.00 | $348.75 – $348.75 | 1 |
| X-ray cervical spine >= 6 views CPT 72052 | $423.20 | $529.00 | $348.75 – $348.75 | 1 |
| X-ray clavicle complete (both sides) CPT 73000 | $172.80 | $216.00 | $283.48 – $283.48 | 1 |
| X-ray colon abdominal radiograph(s) & delayed images single contrast study CPT 74270 | $760.80 | $951.00 | $588.44 – $588.44 | 1 |
| X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study CPT 74280 | $1,031.20 | $1,289.00 | $588.44 – $588.44 | 1 |
| X-ray elbow 2 views (both sides) CPT 73070 | $192.00 | $240.00 | $283.48 – $283.48 | 1 |
| X-ray elbow >= 3 views (both sides) CPT 73080 | $193.60 | $242.00 | $283.48 – $283.48 | 1 |
| X-ray esophogram chest radiograph(s) & delayed images single contrast study CPT 74220 | $386.40 | $483.00 | $588.44 – $588.44 | 1 |
| X-ray exam entire spi 4/5 vw CPT 72083 | $558.40 | $698.00 | $348.75 – $348.75 | 1 |
| X-ray exam entire spi 6/> vw CPT 72084 | $558.40 | $698.00 | $348.75 – $348.75 | 1 |
| X-ray exam of arm infant CPT 73092 | $193.60 | $242.00 | $348.75 – $348.75 | 1 |
| X-ray exam of eye sockets CPT 70200 | $181.60 | $227.00 | $348.75 – $348.75 | 1 |
| X-ray exam of femur 1 CPT 73551 | $178.40 | $223.00 | $283.48 – $283.48 | 1 |
| X-ray exam of jaw joint CPT 70328 | $137.60 | $172.00 | $283.48 – $283.48 | 1 |
| X-ray exam of jaw joint CPT 70332 | $619.20 | $774.00 | $761.98 – $761.98 | 1 |
| X-ray exam of mastoids CPT 70120 | not published | not published | $348.75 – $348.75 | 1 |
| X-ray exam of middle ear CPT 70134 | not published | not published | $1,641.72 – $1,641.72 | 1 |
| X-ray exam of penis CPT 74445 | not published | not published | $348.75 – $348.75 | 1 |
| X-ray exam of perineum CPT 74775 | not published | not published | $761.98 – $761.98 | 1 |
| X-ray exam of salivary gland CPT 70380 | not published | not published | $283.48 – $283.48 | 1 |
| X-ray exam of sinuses CPT 70210 | $196.00 | $245.00 | $283.48 – $283.48 | 1 |
| X-ray exam of tear duct CPT 70170 | not published | not published | $761.98 – $761.98 | 1 |
| X-ray exam of teeth CPT 70300 | not published | not published | $283.48 – $283.48 | 1 |
| X-ray exam of teeth CPT 70310 | not published | not published | $761.98 – $761.98 | 1 |
| X-ray exam si joints CPT 72200 | $204.80 | $256.00 | $348.75 – $348.75 | 1 |
| X-ray exam thorac spine4/>vw CPT 72074 | $304.80 | $381.00 | $348.75 – $348.75 | 1 |
| X-ray eye detection foreign body (both sides) CPT 70030 | $371.20 | $464.00 | $283.48 – $283.48 | 1 |
| X-ray facial bones complete > 3 views CPT 70150 | $455.20 | $569.00 | $348.75 – $348.75 | 1 |
| X-ray femur >=2 views (both sides) CPT 73552 | $178.40 | $223.00 | $283.48 – $283.48 | 1 |
| X-ray finger(s) >= 2 views (both sides) CPT 73140 | $236.00 | $295.00 | $283.48 – $283.48 | 1 |
| X-ray foot 2 views (both sides) CPT 73620 | $172.80 | $216.00 | $283.48 – $283.48 | 1 |
| X-ray forearm 2 views (both sides) CPT 73090 | $203.20 | $254.00 | $283.48 – $283.48 | 1 |
| X-ray hand 2 views (both sides) CPT 73120 | $169.60 | $212.00 | $348.75 – $348.75 | 1 |
| X-ray head for orthodontia CPT 70350 | not published | not published | $283.48 – $283.48 | 1 |
| X-ray heel/calcaneus > 2 views (both sides) CPT 73650 | $179.20 | $224.00 | $283.48 – $283.48 | 1 |
| X-ray hip uni w/wo pelvis min 4 views CPT 73503 | $294.40 | $368.00 | $348.75 – $348.75 | 1 |
| X-ray hip with pelvis when performed bilateral 2 views CPT 73521 | $294.40 | $368.00 | $348.75 – $348.75 | 1 |
| X-ray hip with pelvis when performed bilateral 3-4 views CPT 73522 | $294.40 | $368.00 | $348.75 – $348.75 | 1 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | $558.40 | $698.00 | $348.75 – $348.75 | 1 |
| X-ray hip with pelvis when performed unilateral 1 view left CPT 73501 | $160.80 | $201.00 | $283.48 – $283.48 | 1 |
| X-ray humerus >= 2 views left CPT 73060 | $193.60 | $242.00 | $283.48 – $283.48 | 1 |
| X-ray joint survey 1 view CPT 77077 | $121.60 | $152.00 | $348.75 – $348.75 | 1 |
| X-ray knee 1-2 views (both sides) CPT 73560 | $192.00 | $240.00 | $283.48 – $283.48 | 1 |
| X-ray knee 3 views (both sides) CPT 73562 | $193.60 | $242.00 | $283.48 – $283.48 | 1 |
| X-ray knee ap standing bilateral CPT 73565 | $153.60 | $192.00 | $283.48 – $283.48 | 1 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $193.60 | $242.00 | $283.48 – $283.48 | 1 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $309.60 | $387.00 | $348.75 – $348.75 | 1 |
| X-ray lumbosacral spine >= 4 views CPT 72110 | $330.40 | $413.00 | $348.75 – $348.75 | 1 |
| X-ray lumbosacral spine complete including bending views >= 6 views CPT 72114 | $492.80 | $616.00 | $348.75 – $348.75 | 1 |
| X-ray male genital tract CPT 74440 | not published | not published | $761.98 – $761.98 | 1 |
| X-ray mandible complete > 4 views CPT 70110 | $458.40 | $573.00 | $348.75 – $348.75 | 1 |
| X-ray mandible ltd <4 views CPT 70100 | $278.40 | $348.00 | $283.48 – $283.48 | 1 |
| X-ray measurement of pelvis CPT 74710 | not published | not published | $283.48 – $283.48 | 1 |
| X-ray nasal bones complete > 3 views CPT 70160 | $208.80 | $261.00 | $283.48 – $283.48 | 1 |
| X-ray neck soft tissue CPT 70360 | $224.80 | $281.00 | $283.48 – $283.48 | 1 |
| X-ray nose to rectum for foreign body child CPT 76010 | $141.60 | $177.00 | $283.48 – $283.48 | 1 |
| X-ray of mammary ducts CPT 77054 | not published | not published | $761.98 – $761.98 | 1 |
| X-ray optic foramina CPT 70190 | not published | not published | $283.48 – $283.48 | 1 |
| X-ray pelvis 1-2 views CPT 72170 | $198.40 | $248.00 | $348.75 – $348.75 | 1 |
| X-ray pelvis complete > 3 views CPT 72190 | $223.20 | $279.00 | $348.75 – $348.75 | 1 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $621.60 | $777.00 | $1,202.18 – $1,202.18 | 1 |
| X-ray ribs 2 views left CPT 71100 | $308.80 | $386.00 | $283.48 – $283.48 | 1 |
| X-ray ribs 3 views bilateral CPT 71110 | $560.80 | $701.00 | $348.75 – $348.75 | 1 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $357.60 | $447.00 | $348.75 – $348.75 | 1 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $585.60 | $732.00 | $348.75 – $348.75 | 1 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $204.80 | $256.00 | $348.75 – $348.75 | 1 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $251.20 | $314.00 | $283.48 – $283.48 | 1 |
| X-ray scapula complete (both sides) CPT 73010 | $252.80 | $316.00 | $348.75 – $348.75 | 1 |
| X-ray sella turcica CPT 70240 | not published | not published | $283.48 – $283.48 | 1 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $220.00 | $275.00 | $283.48 – $283.48 | 1 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $290.40 | $363.00 | $283.48 – $283.48 | 1 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $632.80 | $791.00 | $1,641.72 – $1,641.72 | 1 |
| X-ray skull < 4 views CPT 70250 | $225.60 | $282.00 | $348.75 – $348.75 | 1 |
| X-ray skull > 4 views complete CPT 70260 | $330.40 | $413.00 | $348.75 – $348.75 | 1 |
| X-ray slg plne bdy sect without urogr CPT 76100 | not published | not published | $348.75 – $348.75 | 1 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | $660.00 | $825.00 | $588.44 – $588.44 | 1 |
| X-ray small intestine follow-through study CPT 74248 | $628.00 | $785.00 | not published | 0 |
| X-ray spine single view CPT 72020 | $165.60 | $207.00 | $283.48 – $283.48 | 1 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $250.40 | $313.00 | $283.48 – $283.48 | 1 |
| X-ray sternum > 2 views CPT 71120 | $276.80 | $346.00 | $283.48 – $283.48 | 1 |
| X-ray surgical specimen CPT 76098 | $770.40 | $963.00 | $1,641.72 – $1,641.72 | 1 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | $475.20 | $594.00 | $588.44 – $588.44 | 1 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | $336.80 | $421.00 | $283.48 – $283.48 | 1 |
| X-ray thoracic spine 2 views CPT 72070 | $165.60 | $207.00 | $348.75 – $348.75 | 1 |
| X-ray thoracic spine 3 views CPT 72072 | $239.20 | $299.00 | $348.75 – $348.75 | 1 |
| X-ray thoracolumbar spine >=2 views CPT 72080 | $223.20 | $279.00 | $283.48 – $283.48 | 1 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $178.40 | $223.00 | $283.48 – $283.48 | 1 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views CPT 72082 | $294.40 | $368.00 | $348.75 – $348.75 | 1 |
| X-ray tibia/fibula 2 views (both sides) CPT 73590 | $192.00 | $240.00 | $283.48 – $283.48 | 1 |
| X-ray toe(s) > 2 views (both sides) CPT 73660 | $148.00 | $185.00 | $283.48 – $283.48 | 1 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 | $652.00 | $815.00 | $588.44 – $588.44 | 1 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 | $602.40 | $753.00 | $588.44 – $588.44 | 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.