HSHS St. Mary's Hospital Medical Center
1726 SHAWANO AVE, GREEN BAY, WI · Hshs · · NPI 1649246877
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 |
|---|---|---|---|---|
| Emg needle test 4-extremities CPT 95864 | $711.48 | $1,078.00 | $58.61 – $885.08 | 16 |
| Encephalitis, california igg/igm CPT 86651 | $49.50 | $75.00 | $8.17 – $29.68 | 16 |
| Encephalitis, st louis igg/igm CPT 86653 | $60.72 | $92.00 | $8.17 – $29.68 | 16 |
| Encephalitis, western equine igg/igm CPT 86654 | $60.06 | $91.00 | $8.17 – $29.68 | 16 |
| Endo abl/incom vein/ext/rad fre/#1 36475 CPT 36475 | $4,123.68 | $6,248.00 | $1,202.51 – $6,937.25 | 14 |
| Endo cath bile duct s&i CPT 74328 | $925.32 | $1,402.00 | $44.69 – $495.60 | 11 |
| Endo cath panc duct s&i CPT 74329 | $925.32 | $1,402.00 | $44.69 – $495.60 | 11 |
| Endo cholangiopancreatograph CPT 43261 | not published | not published | not published | 0 |
| Endo cholangiopancreatograph CPT 43262 | not published | not published | not published | 0 |
| Endoluminal bx biliary tree CPT 47543 | $2,098.80 | $3,180.00 | $266.58 – $2,540.86 | 11 |
| Endoluminal bx urtr rnl plvs CPT 50606 | $434.28 | $658.00 | $658.00 – $3,012.50 | 7 |
| Endoluminl ivus oct c 1st CPT 92978 | $2,194.50 | $3,325.00 | $89.39 – $94.75 | 7 |
| Endoluminl ivus oct c ea CPT 92979 | $1,696.20 | $2,570.00 | $89.39 – $94.75 | 7 |
| Endoscopic pancreatoscopy CPT 43273 | not published | not published | not published | 0 |
| Endoscopic Ultrasound exam esoph CPT 43237 | not published | not published | not published | 0 |
| Endoscopy bowel pouch/biop CPT 44386 | not published | not published | not published | 0 |
| Endoscopy of bowel pouch 44385 CPT 44385 | not published | not published | not published | 0 |
| Endoscpy nsl/sns w/cntrl nsl hmrrgh CPT 31238 | $2,168.76 | $3,286.00 | $832.12 – $3,910.59 | 14 |
| Endovasc prosth delayed 33886 CPT 33886 | $17,216.76 | $26,086.00 | $7,257.52 – $7,692.97 | 7 |
| Endovasc rpr a-biiliac endogft 34705 CPT 34705 | $17,216.76 | $26,086.00 | $7,257.52 – $7,692.97 | 7 |
| Endovas iliac a device addon CPT 34808 | $336.60 | $510.00 | $510.00 – $7,257.52 | 7 |
| Enoxaparin 30 mg/0.3 ml subcutaneous syringe HCPCS J1650 | $10.78 | $16.33 | $0.87 – $0.99 | 5 |
| Enzyme histochemistry CPT 88319 | $943.80 | $1,430.00 | $58.17 – $1,770.15 | 16 |
| Ep & ablate supravent arrhyt CPT 93653 | $17,666.22 | $26,767.00 | $7,726.98 – $57,427.06 | 14 |
| Ep & ablate ventric tachy CPT 93654 | $17,666.22 | $26,767.00 | $7,726.98 – $57,427.06 | 14 |
| Epidural/lumbar/sacral/ea add level64484 CPT 64484 | $829.62 | $1,257.00 | $337.74 – $358.00 | 7 |
| Epinephrine 0.1 mg/ml injection syringe HCPCS J0168 | $6.69 | $10.14 | $4.95 – $5.37 | 4 |
| Epinephrine 1 mg/ml im kit - adult HCPCS J0169 | $7.29 | $11.05 | $2.28 – $2.47 | 4 |
| Epinephrine hcl (pf) 1 mg/ml (1 ml) injection solution HCPCS J0166 | $6.47 | $9.80 | $1.83 – $1.99 | 4 |
| Epoetin alfa-epbx 40,000 unit/ml injection solution HCPCS Q5106 | $3.62 | $5.49 | $5.49 – $83.22 | 16 |
| Epstein barr early antigen antibody CPT 86663 | $89.10 | $135.00 | $13.12 – $29.52 | 16 |
| Epstein barr nuclear antigen antibody CPT 86664 | $99.00 | $150.00 | $15.29 – $34.40 | 16 |
| Epstein barr viral capsid antigen antibody igm CPT 86665 | $118.14 | $179.00 | $18.14 – $40.82 | 16 |
| Eptifibatide 0.75 mg/ml intravenous solution HCPCS J1327 | $54.80 | $83.03 | $3.52 – $16.82 | 16 |
| Ercp biliary & pancreas CPT 74330 | $1,215.06 | $1,841.00 | $44.69 – $495.60 | 11 |
| Ercp bil/panc duct; each stent plcmt 43274 CPT 43274 | $6,875.22 | $10,417.00 | $456.60 – $13,338.27 | 16 |
| Ercp ea duct/ampulla dilate CPT 43277 | not published | not published | not published | 0 |
| Ercp lesion ablate w/dilate 43278 CPT 43278 | not published | not published | not published | 0 |
| Ercp lithotripsy calculi CPT 43265 | not published | not published | not published | 0 |
| Ercp remove duct calculi 43264 CPT 43264 | not published | not published | not published | 0 |
| Ercp remove forgn body duct 43275 CPT 43275 | not published | not published | not published | 0 |
| Ercp stent exchange w/dilate CPT 43276 | not published | not published | not published | 0 |
| Ercp w/specimen collection CPT 43260 | not published | not published | not published | 0 |
| Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr HCPCS J1335 | $192.41 | $291.53 | $15.11 – $18.26 | 5 |
| ER Visit (level 1, minor) CPT 99281 | $136.62 | $207.00 | $82.34 – $185.27 | 9 |
| ER Visit (level 2) CPT 99282 | $273.24 | $414.00 | $149.93 – $337.35 | 9 |
| ER Visit (level 3) CPT 99283 | $839.52 | $1,272.00 | $266.56 – $599.75 | 9 |
| ER Visit (level 4) CPT 99284 | $1,259.28 | $1,908.00 | $407.45 – $916.76 | 9 |
| ER Visit (level 5, high severity) CPT 99285 | $1,723.92 | $2,612.00 | $581.53 – $1,308.43 | 9 |
| Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr HCPCS J1364 | $360.72 | $546.55 | $33.26 – $118.64 | 5 |
| Escharotomy ea addl incision CPT 16036 | $207.24 | $314.00 | $168.77 – $178.90 | 7 |
| Esmolol 2,500 mg/250 ml (10 mg/ml) in sterile water intravenous soln HCPCS J1806 | $3.25 | $4.93 | $0.68 – $0.73 | 5 |
| Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only HCPCS J1805 | $8.09 | $12.25 | $0.35 – $0.44 | 5 |
| Esophagoscop stent placement CPT 43212 | not published | not published | not published | 0 |
| Esophagoscop ultrasound exam CPT 43231 | not published | not published | not published | 0 |
| Esophagoscopy flex remove fb CPT 43215 | not published | not published | not published | 0 |
| Esophagoscopy lesion ablate CPT 43229 | not published | not published | not published | 0 |
| Esophagoscopy w/us needle bx CPT 43232 | not published | not published | not published | 0 |
| Esoph egd dilation <30 mm CPT 43249 | not published | not published | not published | 0 |
| Esoph endoscopy dilation CPT 43226 | not published | not published | not published | 0 |
| Establish access to artery CPT 36100 | $1,450.68 | $2,198.00 | $302.34 – $320.48 | 7 |
| Established Patient Office Visit (level 1) CPT 99211 | $191.40 | $290.00 | $95.40 – $154.00 | 3 |
| Established Patient Office Visit (level 2) CPT 99212 | $199.32 | $302.00 | $95.40 – $154.00 | 3 |
| Established Patient Office Visit (level 3) CPT 99213 | $243.54 | $369.00 | $95.40 – $154.00 | 3 |
| Established Patient Office Visit (level 4) CPT 99214 | $268.62 | $407.00 | $95.40 – $154.00 | 3 |
| Established Patient Office Visit (level 5) CPT 99215 | $339.24 | $514.00 | $95.40 – $154.00 | 3 |
| Estradiol total CPT 82670 | $170.94 | $259.00 | $27.94 – $62.87 | 16 |
| Estrogens total-sendout CPT 82672 | $134.64 | $204.00 | $21.70 – $48.83 | 16 |
| Ethylene glycol -sendout CPT 82693 | $321.42 | $487.00 | $7.95 – $33.53 | 16 |
| Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen CPT 84112 | $396.00 | $600.00 | $90.57 – $220.75 | 16 |
| Evaluation heart device CPT 93640 | $2,523.84 | $3,824.00 | $1,308.14 – $2,985.70 | 10 |
| Evaluation of speech fluency 92521 CPT 92521 | $181.50 | $275.00 | $103.44 – $293.85 | 16 |
| Evaluation psychiatric diagnostic CPT 90791 | $379.50 | $575.00 | $109.80 – $389.97 | 14 |
| Evasc prlng admn rx agnt 1st CPT 61650 | $1,701.48 | $2,578.00 | $2,578.00 – $6,215.80 | 7 |
| Evasc prlng admn rx agnt add CPT 61651 | $866.58 | $1,313.00 | $1,313.00 – $6,215.80 | 7 |
| Evasc repair of iliac artery; endograft 34718 CPT 34718 | $17,216.76 | $26,086.00 | $7,257.52 – $7,692.97 | 7 |
| Evasc rpr a-ao ndgft 34701 CPT 34701 | $17,216.76 | $26,086.00 | $7,257.52 – $7,692.97 | 7 |
| Evasc rpr a-ao ndgft rpt 34702 CPT 34702 | $23,954.04 | $36,294.00 | $7,257.52 – $7,692.97 | 7 |
| Evasc rpr a-biiliac ndgft rptr CPT 34706 | $23,954.04 | $36,294.00 | $7,257.52 – $7,692.97 | 7 |
| Evasc rpr a-iliac ndgft 34717 CPT 34717 | $7,485.72 | $11,342.00 | $7,257.52 – $7,692.97 | 7 |
| Evasc rpr a-unilac ndgft 34703 CPT 34703 | $17,216.76 | $26,086.00 | $7,257.52 – $7,692.97 | 7 |
| Evasc rpr a-unilac ndgft rpt CPT 34704 | $23,954.04 | $36,294.00 | $7,257.52 – $7,692.97 | 7 |
| Evasc rpr ilio-iliac ndgft CPT 34707 | $17,216.76 | $26,086.00 | $7,257.52 – $7,692.97 | 7 |
| Evasc rpr ilio-iliac rpt CPT 34708 | $23,954.04 | $36,294.00 | $7,257.52 – $7,692.97 | 7 |
| Event monitor CPT 93270 | $231.00 | $350.00 | $18.44 – $350.00 | 16 |
| Exc abd les sc 3 cm/> CPT 22903 | not published | not published | not published | 0 |
| Exc abdl tum deep 5 cm/> CPT 22901 | not published | not published | not published | 0 |
| Exc arm/elbo les sc >=3cm 24071 CPT 24071 | not published | not published | not published | 0 |
| Exc arm/elbo les sc <3cm 24075 CPT 24075 | not published | not published | not published | 0 |
| Exc back tum deep 5 cm/> CPT 21933 | not published | not published | not published | 0 |
| Exc benign snhfg 3.1-4.0cm 11424 CPT 11424 | not published | not published | not published | 0 |
| Exc benign tal 0.5 < cm 11400 CPT 11400 | $1,475.76 | $2,236.00 | $185.89 – $1,555.83 | 14 |
| Exc ben+marg excep skin tag snhfg 0.6-1cm 11421 CPT 11421 | not published | not published | not published | 0 |
| Exc ben+marg excep skin tag snhfg 2.1-3cm 11423 CPT 11423 | not published | not published | not published | 0 |
| Exc ben+marg excep skin tag snhfg >4cm 11426 CPT 11426 | not published | not published | not published | 0 |
| Exc ben+marg excep skin tag tal 0.6-1cm 11401 CPT 11401 | not published | not published | not published | 0 |
| Exc ben+marg excep skin tag tal 2.1-3/>cm 11403 CPT 11403 | not published | not published | not published | 0 |
| Exc breast duct fistula 19112 CPT 19112 | not published | not published | not published | 0 |
| Exc feenl mal+mrg 2.1-3 11643 CPT 11643 | not published | not published | not published | 0 |
| Exc foot/toe tum subq < 1.5 cm 28043 CPT 28043 | not published | not published | not published | 0 |
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.