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 |
|---|---|---|---|---|
| Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback HCPCS J1450 | $64.25 | $97.35 | $4.17 – $8.02 | 5 |
| Fluidotherapy charges pt CPT 97022 | $77.22 | $117.00 | $14.19 – $117.00 | 16 |
| Fluorescent antibody titer dna CPT 86256 | $297.00 | $450.00 | $12.05 – $27.11 | 16 |
| Fluoroguide for spine inject 77003-26 CPT 77003 | $568.92 | $862.00 | $89.39 – $495.60 | 11 |
| Fluoroguide needle placement CPT 77002 | $517.44 | $784.00 | $0.01 – $89.39 | 11 |
| Fluoro polarize fetal lung CPT 83663 | $434.94 | $659.00 | $13.65 – $42.55 | 16 |
| Fluoroscopy up to 1 hour CPT 76000 | $517.44 | $784.00 | $52.32 – $524.23 | 16 |
| Fna bx w/ct gdn 1st les CPT 10009 | $1,087.02 | $1,647.00 | $301.92 – $1,555.83 | 14 |
| Fna bx w/ct gdn ea addl CPT 10010 | $543.84 | $824.00 | $301.92 – $320.04 | 7 |
| Folic acid CPT 82746 | $89.76 | $136.00 | $14.70 – $33.08 | 16 |
| Folic acid 5 mg/ml injection solution HCPCS J1808 | $3.23 | $4.90 | $0.08 – $0.09 | 4 |
| Follow-up angiography CPT 75898 | $3,161.40 | $4,790.00 | $86.90 – $6,937.25 | 16 |
| Fo nontorsion joint cf HCPCS L3935 | $170.28 | $258.00 | $249.26 – $560.83 | 9 |
| Foot arch support remov prem HCPCS L3030 | $118.80 | $180.00 | $111.02 – $249.79 | 9 |
| Foot drp splt w/exp heel lg HCPCS L4398 | $118.80 | $180.00 | $111.94 – $251.86 | 9 |
| Foot X-ray CPT 73630 | $335.94 | $509.00 | $24.82 – $456.60 | 16 |
| Foreskn manip w/lss preputial ads+stretching 54450 CPT 54450 | $711.48 | $1,078.00 | $178.39 – $548.94 | 14 |
| Fosaprepitant 150 mg intravenous powder for solution HCPCS J1453 | $6.98 | $10.57 | $0.18 – $0.29 | 5 |
| Fosphenytoin 50 mg pe/ml injection (wrapper) HCPCS Q2009 | $95.36 | $144.48 | $1.34 – $3.02 | 11 |
| Fragmenting of kidney stone CPT 50590 | not published | not published | not published | 0 |
| Frenectomy 41115 CPT 41115 | not published | not published | not published | 0 |
| Fresh frozen plasma 8-24 hours collection each unit HCPCS P9059 | $1,226.28 | $1,858.00 | $55.39 – $165.98 | 14 |
| Fresh frozen plasma frozen within 8 hours of collection each unit HCPCS P9017 | $188.76 | $286.00 | $38.65 – $193.46 | 14 |
| Fresh frozen plasma thawing ea un CPT 86927 | $198.00 | $300.00 | $30.87 – $374.32 | 16 |
| Fructosamine glycated protein CPT 82985 | $72.60 | $110.00 | $16.62 – $37.71 | 16 |
| Full thick gft/nose/ear/lid/lip/20sqcm or< 15260 CPT 15260 | not published | not published | not published | 0 |
| Full thick gft w/close donor fccmnaghf <=20sqcm 15240 CPT 15240 | not published | not published | not published | 0 |
| Furosemide 10 mg/ml injection solution HCPCS J1938 | $1.62 | $2.45 | $0.03 – $0.04 | 4 |
| Fusion of ankle joint open CPT 27870 | not published | not published | not published | 0 |
| Fusion of big toe joint CPT 28750 | not published | not published | not published | 0 |
| Fusion of big toe joint CPT 28755 | not published | not published | not published | 0 |
| Fusion of finger joint CPT 26860 | not published | not published | not published | 0 |
| Fusion of finger tendons CPT 26471 | not published | not published | not published | 0 |
| Fusion of foot bones CPT 28730 | not published | not published | not published | 0 |
| Fusion of foot bones CPT 28735 | not published | not published | not published | 0 |
| Fusion of foot bones CPT 28740 | not published | not published | not published | 0 |
| Fusion of knuckle CPT 26850 | not published | not published | not published | 0 |
| Fusion of tendons at wrist CPT 25301 | not published | not published | not published | 0 |
| Fusion of tibiofibular joint CPT 27871 | not published | not published | not published | 0 |
| Gabapentin non-blood CPT 80355 | $36.30 | $55.00 | $4.99 – $39.00 | 10 |
| Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution HCPCS A9581 | $24.18 | $36.63 | $24.34 – $26.40 | 5 |
| Galac-1-phosphate uridyltran - sendout CPT 82775 | $224.40 | $340.00 | $21.07 – $47.41 | 16 |
| Galectin-3 CPT 82777 | $147.84 | $224.00 | $24.14 – $99.56 | 16 |
| Gallbladder Removal (Laparoscopic) CPT 47562 | not published | not published | not published | 0 |
| Gammaglobulin iga CPT 82784 | $54.12 | $82.00 | $9.30 – $20.93 | 16 |
| Gammaglobulin ige CPT 82785 | $99.00 | $150.00 | $16.46 – $37.04 | 16 |
| Gamma glutamyltransferase CPT 82977 | $44.22 | $67.00 | $7.20 – $16.20 | 16 |
| Gastroesophageal reflux test CPT 91034 | $790.68 | $1,198.00 | $171.97 – $819.86 | 14 |
| Gastro/jejuno tube, std HCPCS B4087 | $40.92 | $62.00 | $32.74 – $34.10 | 2 |
| General health panel CPT 80050 | $300.30 | $455.00 | $3.25 – $273.00 | 11 |
| Genetic tstg severe inh cond CPT 81443 | $3,915.78 | $5,933.00 | $2,448.56 – $5,509.26 | 16 |
| Genome sequence analysis CPT 81425 | $5,811.30 | $8,805.00 | $835.31 – $11,320.20 | 16 |
| Genome sequence analysis CPT 81426 | $3,129.72 | $4,742.00 | $835.31 – $6,097.39 | 16 |
| Gentamicin 10 mg/ml liquid compound - enteral use only HCPCS J1580 | $158.24 | $239.75 | $3.52 – $3.88 | 5 |
| Gentamicin peak therapeutic drug level CPT 80170 | $138.60 | $210.00 | $16.38 – $36.86 | 16 |
| G-esoph reflx tst w/electrod CPT 91035 | not published | not published | not published | 0 |
| Ghs abscess perianal iandd CPT 46050 | $1,087.02 | $1,647.00 | $635.82 – $2,043.19 | 14 |
| Ghs abscess postoperative iandd complex CPT 10180 | $6,540.60 | $9,910.00 | $95.40 – $6,381.90 | 14 |
| Ghs alpha thalasemia, 7 deletions CPT 81257 | $554.40 | $840.00 | $102.26 – $230.09 | 16 |
| Ghs antibodies (torch) igm CPT 86694 | $97.68 | $148.00 | $14.39 – $32.38 | 16 |
| Ghs aspiration bladder - needle CPT 51100 | $365.64 | $554.00 | $73.78 – $548.94 | 16 |
| Ghs bladder cath - complex-foley CPT 51703 | $335.94 | $509.00 | $38.07 – $282.71 | 14 |
| Ghs bleeding time (ivy) CPT 85002 | $114.18 | $173.00 | $4.77 – $10.85 | 16 |
| Ghs central line insert < age 5, failed CPT 36555 | $3,635.28 | $5,508.00 | $485.09 – $6,937.25 | 14 |
| Ghs change cysto/gastrost CPT 43762 | $701.58 | $1,063.00 | $171.97 – $548.94 | 14 |
| Ghs chemo IV push, ea addtl CPT 96411 | $287.76 | $436.00 | $20.47 – $436.00 | 16 |
| Ghs chlamydia pneumoniae by pcr (arup) (306630) CPT 87486 | $198.66 | $301.00 | $35.09 – $78.95 | 16 |
| Ghs closd tx interphalang jt disloc w/ma CPT 26770 | $780.78 | $1,183.00 | $203.37 – $541.95 | 14 |
| Ghs closed reduction ankle dislocation CPT 27840 | $543.84 | $824.00 | $203.37 – $541.95 | 14 |
| Ghs closed tx bimalleolar fracture w/manip CPT 27810 | $1,607.10 | $2,435.00 | $203.37 – $3,532.89 | 14 |
| Ghs closed tx radiocarpal disloc w manip CPT 25660 | $593.34 | $899.00 | $203.37 – $541.95 | 14 |
| Ghs closure surg wound/dehiscence-13160 CPT 13160 | $4,621.32 | $7,002.00 | $448.99 – $7,785.86 | 14 |
| Ghs clsd red med malleolus fx w manip CPT 27762 | $4,391.64 | $6,654.00 | $203.37 – $3,532.89 | 14 |
| Ghs clsd tx frac distal tibia w/manipulation CPT 27825 | $4,012.14 | $6,079.00 | $203.37 – $3,532.89 | 14 |
| Ghs cl tx knee disl; wo anesth CPT 27550 | $549.78 | $833.00 | $203.37 – $541.95 | 14 |
| Ghs cl tx metacarpophal disloc without anes CPT 26700 | $701.58 | $1,063.00 | $203.37 – $541.95 | 14 |
| Ghs conjunctiva foreign body-embed bil CPT 65210 | $460.68 | $698.00 | $33.30 – $981.49 | 14 |
| Ghs conjunctiva foreign body-superf bil CPT 65205 | $352.44 | $534.00 | $16.65 – $146.16 | 14 |
| Ghs corneal fb without slit lamp bilat CPT 65220 | $460.68 | $698.00 | $33.30 – $981.49 | 14 |
| Ghs corneal fb with slit lamp bilat CPT 65222 | $372.90 | $565.00 | $33.30 – $292.32 | 14 |
| Ghs cricothyroidotomy CPT 31605 | $1,202.52 | $1,822.00 | $231.28 – $963.45 | 14 |
| Ghs diphtheria toxoid ab igg CPT 86648 | $79.86 | $121.00 | $8.17 – $34.22 | 16 |
| Ghs dislocation elbow closed treatment CPT 24600 | $529.32 | $802.00 | $101.68 – $270.97 | 14 |
| Ghs ed peritoneal lavage w guidance if performed CPT 49084 | $892.32 | $1,352.00 | $318.99 – $1,992.72 | 14 |
| Ghs ed rmvl or bivalving cast CPT 29700 | $217.14 | $329.00 | $79.49 – $614.51 | 14 |
| Ghs ed therapeutic lp, drain csf w fluoro CPT 62329 | $1,186.68 | $1,798.00 | $337.74 – $1,550.88 | 14 |
| Ghs eeg cont rec w/video by tec min 8 chnls CPT 95700 | $2,522.52 | $3,822.00 | $146.51 – $474.40 | 16 |
| Ghs excision ingrown nail CPT 11765 | $461.34 | $699.00 | $29.40 – $893.15 | 14 |
| Ghs eyelid foreign body-embedded - bil CPT 67938 | $486.42 | $737.00 | $127.74 – $697.37 | 14 |
| Ghs fb removal foot - deep - left CPT 28192 | not published | not published | not published | 0 |
| Ghs fb removal - incisional CPT 10121 | not published | not published | not published | 0 |
| Ghs febrile agglutinns(mayo) CPT 86000 | $38.28 | $58.00 | $6.98 – $15.71 | 16 |
| Ghs fish cytogen CPT 88271 | $607.20 | $920.00 | $20.36 – $48.20 | 16 |
| Ghs fish hybrid in situ 100-300 CPT 88275 | $477.84 | $724.00 | $51.19 – $115.18 | 16 |
| Ghs gastric intub aspiration lavage CPT 43753 | $583.44 | $884.00 | $210.85 – $474.40 | 9 |
| Ghs hepatitis c virus (hcv riba) CPT 86804 | $144.54 | $219.00 | $15.49 – $34.85 | 16 |
| Ghs hgb stability-thal CPT 83068 | $97.02 | $147.00 | $9.47 – $21.31 | 16 |
| Ghs histoplasma antigen CPT 87385 | $129.36 | $196.00 | $13.25 – $29.81 | 16 |
| Ghs HIV antibody CPT 86703 | $89.10 | $135.00 | $13.71 – $30.85 | 16 |
| Ghs i and d abscess/hematoma scrotum CPT 54700 | $2,366.10 | $3,585.00 | $1,046.14 – $4,592.75 | 14 |
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.