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 |
|---|---|---|---|---|
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | not published | not published | not published | 0 |
| Gi trc img intral esophagus CPT 91111 | not published | not published | not published | 0 |
| Gi wireless capsule measure CPT 91112 | not published | not published | not published | 0 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $875.95 | $1,327.20 | $51.22 – $370.94 | 16 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | $790.52 | $1,197.75 | $51.22 – $322.32 | 16 |
| Glucagon plasma - sendout CPT 82943 | $50.16 | $76.00 | $13.88 – $32.15 | 16 |
| Glucose 1 hr post dose CPT 82950 | $72.60 | $110.00 | $4.75 – $10.69 | 16 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $15.84 | $24.00 | $3.28 – $7.38 | 16 |
| Glucose blood quantitative CPT 82947 | $24.42 | $37.00 | $3.93 – $8.84 | 16 |
| Glucose body fluid CPT 82945 | $43.56 | $66.00 | $3.93 – $8.84 | 16 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $89.76 | $136.00 | $12.87 – $28.96 | 16 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $25.08 | $38.00 | $3.92 – $8.82 | 16 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $32.99 | $49.98 | $0.63 – $0.78 | 5 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $117.48 | $178.00 | $18.58 – $41.81 | 16 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $117.48 | $178.00 | $18.52 – $41.67 | 16 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $60.72 | $92.00 | $51.39 – $273.42 | 11 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $3,316.90 | $5,025.60 | $52.89 – $273.42 | 11 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $193.38 | $293.00 | $103.75 – $273.42 | 16 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $58.08 | $88.00 | $78.69 – $273.42 | 11 |
| Great toe with reduction 28495 CPT 28495 | $568.26 | $861.00 | $95.40 – $541.95 | 14 |
| Grfg autol fat lipo 50 cc/< CPT 15771 | not published | not published | not published | 0 |
| Grfg autol fat lipo ea addl CPT 15772 | not published | not published | not published | 0 |
| G-tube reposition CPT 43761 | $830.28 | $1,258.00 | $171.97 – $548.94 | 16 |
| Gu dilat ureter/urethra s&i CPT 74485 | $2,366.10 | $3,585.00 | $89.39 – $4,592.75 | 16 |
| Guided cath fluid drainage 10030 CPT 10030 | $1,186.68 | $1,798.00 | $474.26 – $1,555.83 | 14 |
| Guide wire threaded 1.4x150mm HCPCS C1769 | $3,056.46 | $4,631.00 | $31.42 – $31.42 | 1 |
| Guide worley csg 9fx50cm std HCPCS C1892 | $102.96 | $156.00 | $85.80 – $85.80 | 1 |
| Guid loc target vol rad tx CPT 77387 | $407.88 | $618.00 | $53.11 – $618.00 | 10 |
| Gw stiffened micro access kit HCPCS C1894 | $1,378.08 | $2,088.00 | $67.10 – $67.10 | 1 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $32.34 | $49.00 | $1.20 – $1.97 | 5 |
| Hand X-ray CPT 73130 | $388.74 | $589.00 | $24.82 – $456.60 | 16 |
| Haptoglobin quantitative CPT 83010 | $81.18 | $123.00 | $12.58 – $28.31 | 16 |
| Hba1/hba2 full gene sequence CPT 81259 | $698.94 | $1,059.00 | $480.00 – $1,350.00 | 16 |
| Hba1/hba2 gene dup/del vrnts CPT 81269 | $684.42 | $1,037.00 | $161.92 – $455.40 | 16 |
| Hbb full gene sequence CPT 81364 | $374.88 | $568.00 | $259.66 – $730.31 | 16 |
| Hbb gene dup/del variants CPT 81363 | $641.52 | $972.00 | $161.92 – $455.40 | 16 |
| Hcg qualitative CPT 84703 | $62.04 | $94.00 | $7.52 – $16.92 | 16 |
| Hcg quantitative CPT 84702 | $91.08 | $138.00 | $15.05 – $33.86 | 16 |
| Hc metata joint dislocation anes CPT 28635 | $2,799.06 | $4,241.00 | $426.70 – $3,532.89 | 14 |
| Head CT scan (with and without contrast) CPT 70470 | $1,818.96 | $2,756.00 | $134.40 – $1,215.09 | 16 |
| Head CT scan (with contrast) CPT 70460 | $1,770.12 | $2,682.00 | $134.40 – $1,215.09 | 16 |
| Head CT scan (without contrast) CPT 70450 | $1,259.28 | $1,908.00 | $102.09 – $1,215.09 | 16 |
| Heart infarct image CPT 78466 | $951.06 | $1,441.00 | $162.47 – $1,246.46 | 16 |
| Helicobacter pylori antibody igm CPT 86677 | $79.86 | $121.00 | $8.17 – $37.91 | 16 |
| Hematocrit CPT 85014 | $15.84 | $24.00 | $2.37 – $5.33 | 16 |
| Hemodialysis one evaluation CPT 90935 | $510.18 | $773.00 | $343.55 – $1,507.89 | 16 |
| Hemoglobin CPT 85018 | $143.22 | $217.00 | $2.37 – $5.33 | 16 |
| Hemoglobin fetal qualitative CPT 83033 | $44.22 | $67.00 | $8.00 – $18.00 | 16 |
| Hemoglobin methemoglobin quantitative CPT 83050 | $54.12 | $82.00 | $4.12 – $18.45 | 16 |
| Hemoglobin plasma CPT 83051 | $20.46 | $31.00 | $4.90 – $16.45 | 16 |
| Hemolysins/agglutinins auto CPT 86940 | $73.92 | $112.00 | $8.77 – $19.73 | 16 |
| Hemophilus influenza antibdy CPT 86684 | $138.60 | $210.00 | $15.84 – $35.64 | 16 |
| Hemorrhoidectomy intrnl lig rbbr band ligations CPT 46221 | $1,940.40 | $2,940.00 | $635.82 – $2,043.19 | 14 |
| Heparin assay CPT 85520 | $167.64 | $254.00 | $13.09 – $29.45 | 16 |
| Heparin bolus from bag HCPCS J1644 | $32.34 | $49.00 | $0.30 – $0.39 | 5 |
| Heparin, porcine (pf) 10 unit/ml flush (wrapper) HCPCS J1642 | $0.17 | $0.25 | $0.03 – $0.04 | 5 |
| Hepatitis a antibody igm CPT 86709 | $138.60 | $210.00 | $11.26 – $25.34 | 16 |
| Hepatitis b core antibody igm CPT 86705 | $147.84 | $224.00 | $11.77 – $26.48 | 16 |
| Hepatitis b core antibody total CPT 86704 | $87.12 | $132.00 | $12.05 – $27.11 | 16 |
| Hepatitis b surface antibody CPT 86706 | $68.64 | $104.00 | $10.74 – $24.17 | 16 |
| Hepatitis c antibody CPT 86803 | $99.00 | $150.00 | $14.27 – $32.11 | 16 |
| Hepatobiliary system imaging CPT 78226 | $1,663.20 | $2,520.00 | $162.47 – $1,246.46 | 16 |
| Hernia Repair (Inguinal) CPT 49505 | not published | not published | not published | 0 |
| Herpes simplex 1 ag if CPT 87274 | $75.24 | $114.00 | $11.98 – $26.96 | 16 |
| Herpes simplex 2 ag if CPT 87273 | $75.24 | $114.00 | $11.98 – $26.96 | 16 |
| Herpes simplex type 1 antibody igg CPT 86695 | $85.80 | $130.00 | $13.19 – $29.68 | 16 |
| Herpes simplex type 2 antibody igg CPT 86696 | $129.36 | $196.00 | $19.35 – $43.54 | 16 |
| Heterophile antibodies screening CPT 86308 | $68.64 | $104.00 | $5.18 – $11.66 | 16 |
| Hhv-6 dna quant CPT 87533 | $436.92 | $662.00 | $41.76 – $93.96 | 16 |
| Hip arthro acetabuloplasty CPT 29915 | not published | not published | not published | 0 |
| Hip arthro w/fb removal CPT 29861 | not published | not published | not published | 0 |
| Hip arthro w/femoroplasty CPT 29914 | not published | not published | not published | 0 |
| Hip arthro w/labral repair CPT 29916 | not published | not published | not published | 0 |
| Hip X-ray CPT 73502 | $363.66 | $551.00 | $24.82 – $456.60 | 16 |
| Histamine CPT 83088 | $170.94 | $259.00 | $29.53 – $66.44 | 16 |
| Histochemical stains add-on CPT 88314 | $168.96 | $256.00 | $14.25 – $153.60 | 11 |
| Hiv-1 ag ia CPT 87390 | $124.74 | $189.00 | $24.06 – $54.14 | 16 |
| Hla class i high defin qual CPT 86832 | $802.56 | $1,216.00 | $139.23 – $728.44 | 16 |
| Hla ii typing 1 loc hr CPT 81382 | $284.46 | $431.00 | $123.68 – $278.28 | 16 |
| Hla ii typing ag equiv lr CPT 81375 | $436.92 | $662.00 | $220.74 – $496.67 | 16 |
| Hla i low res one antigen equiv ea CPT 81374 | $161.70 | $245.00 | $74.33 – $167.24 | 16 |
| Hla i typing low res one locus ea CPT 81373 | $277.20 | $420.00 | $121.54 – $286.72 | 16 |
| Hla typing a b or c CPT 86813 | $522.06 | $791.00 | $58.00 – $130.50 | 16 |
| Hocm 350-399mg/ml iodine,1ml HCPCS Q9963 | $1.37 | $2.08 | $0.36 – $0.39 | 5 |
| Homocysteine CPT 83090 | $107.58 | $163.00 | $17.92 – $40.32 | 16 |
| Homovanillic acid (hva) CPT 83150 | $89.76 | $136.00 | $19.62 – $50.42 | 16 |
| Hpa-15 genotyping CPT 81112 | $281.82 | $427.00 | $120.71 – $275.00 | 16 |
| Hpa-1 genotyping CPT 81105 | $281.82 | $427.00 | $120.71 – $275.00 | 16 |
| Hpa-2 genotyping CPT 81106 | $281.82 | $427.00 | $120.71 – $275.00 | 16 |
| Hpa-3 genotyping CPT 81107 | $281.82 | $427.00 | $120.71 – $275.00 | 16 |
| Hpa-4 genotyping CPT 81108 | $281.82 | $427.00 | $120.71 – $275.00 | 16 |
| Hpa-5 genotyping CPT 81109 | $281.82 | $427.00 | $120.71 – $275.00 | 16 |
| Hpa-6 genotyping CPT 81110 | $281.82 | $427.00 | $120.71 – $275.00 | 16 |
| Hpa-9 genotyping CPT 81111 | $281.82 | $427.00 | $120.71 – $275.00 | 16 |
| Hpv types 16 & 18 only CPT 87625 | $138.60 | $210.00 | $38.30 – $91.24 | 16 |
| H pylori (c-13) breath CPT 83013 | $220.44 | $334.00 | $67.36 – $151.56 | 16 |
| Hrdtry perph neurphy panel CPT 81448 | $2,079.00 | $3,150.00 | $128.83 – $1,316.03 | 16 |
| Htt gene detc abnor alleles CPT 81271 | $390.72 | $592.00 | $109.60 – $308.25 | 16 |
| Human epididymis protein 4 (he4) CPT 86305 | $254.76 | $386.00 | $20.81 – $46.82 | 16 |
| Human prothrombin complex concentrate (pcc)-lans 500 unit (400-640 unit) IV solution HCPCS J7165 | $5.74 | $8.69 | $1.71 – $3.84 | 9 |
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.