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 |
|---|---|---|---|---|
| Hydralazine 20 mg/ml injection solution HCPCS J0360 | $83.03 | $125.80 | $6.99 – $7.86 | 5 |
| Hydration IV infusion each additional hour CPT 96361 | $143.88 | $218.00 | $18.29 – $216.25 | 14 |
| Hydration IV infusion initial 31minutes - 1 hour CPT 96360 | $375.54 | $569.00 | $83.08 – $467.33 | 14 |
| Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J1720 | $117.25 | $177.65 | $33.75 – $39.49 | 5 |
| Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper) HCPCS J1171 | $16.17 | $24.50 | $0.23 – $0.25 | 4 |
| Hydroxyzine hcl 50 mg/ml intramuscular solution HCPCS J3410 | $82.10 | $124.40 | $21.45 – $24.65 | 5 |
| Hydrxycorticsterds 17- (17-ohcs) CPT 83491 | $100.32 | $152.00 | $17.90 – $40.28 | 16 |
| #hypersens-actinomyces ab CPT 86602 | $91.08 | $138.00 | $8.17 – $22.91 | 16 |
| Hysterosalpingography s&i CPT 74740 | $626.34 | $949.00 | $52.32 – $524.23 | 16 |
| Hysteroscopy biopsy CPT 58558 | not published | not published | not published | 0 |
| Iaadi respiratory synctial virus CPT 87280 | $99.00 | $150.00 | $13.42 – $30.20 | 16 |
| Ia infect ag ab qual/semiquant sgl step CPT 86318 | $118.14 | $179.00 | $18.09 – $40.70 | 16 |
| Ibutilide fumarate 0.1 mg/ml intravenous solution HCPCS J1742 | $2,726.86 | $4,131.60 | $51.22 – $446.64 | 16 |
| I&d abscss rtrphryngl/paraphryngl intraorl apprch CPT 42720 | not published | not published | not published | 0 |
| Idh1 common variants CPT 81120 | $712.80 | $1,080.00 | $154.60 – $434.81 | 16 |
| I&d intramural/intramuscular/submuc abscess transanal anes CPT 46045 | not published | not published | not published | 0 |
| Igh@/bcl2 translocation alys CPT 81278 | $284.46 | $431.00 | $165.85 – $466.45 | 16 |
| Igh gene rearrange amp meth CPT 81261 | $1,604.46 | $2,431.00 | $197.99 – $445.48 | 16 |
| Igh@ var region somatic mutation analy CPT 81263 | $683.76 | $1,036.00 | $294.52 – $662.67 | 16 |
| Igk rearrangeabn clonal pop CPT 81264 | $1,604.46 | $2,431.00 | $162.98 – $388.64 | 16 |
| Ihc/icc per specimen each additional single antibody stain CPT 88341 | $342.54 | $519.00 | $14.25 – $69.00 | 11 |
| Ihc/icc per specimen initial single antibody stain CPT 88342 | $297.00 | $450.00 | $58.17 – $374.32 | 16 |
| Iliac/fem angio cath insert HCPCS G0278 | $726.66 | $1,101.00 | $24.29 – $1,954.15 | 11 |
| Iliac revasc add-on 37222 CPT 37222 | $4,341.48 | $6,578.00 | $4,729.17 – $5,012.92 | 7 |
| Immobilizer shldr cntor adlt HCPCS L3670 | $115.50 | $175.00 | $136.72 – $307.62 | 9 |
| Immobilizer shldr dlx str 24-36in med HCPCS L1830 | $141.90 | $215.00 | $99.60 – $224.10 | 9 |
| Immt breast prosthesis 19340 CPT 19340 | not published | not published | not published | 0 |
| Immune complex assay CPT 86332 | $166.32 | $252.00 | $24.37 – $54.83 | 16 |
| Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution HCPCS J1568 | $288.47 | $437.07 | $47.39 – $557.49 | 16 |
| Immunoassay tumor antigen quantitative ca 125 CPT 86304 | $138.60 | $210.00 | $20.81 – $46.82 | 16 |
| Immunoassay tumor antigen quantitative ca 19-9 CPT 86301 | $139.92 | $212.00 | $20.81 – $46.82 | 16 |
| Immunodiff gel qual ea antigen/ab CPT 86331 | $85.80 | $130.00 | $11.98 – $26.96 | 16 |
| Immunodiffusion nes CPT 86329 | $96.36 | $146.00 | $14.05 – $31.61 | 16 |
| Immunofixation electrophoresis serum CPT 86334 | $207.90 | $315.00 | $22.34 – $50.27 | 16 |
| Immunofluorescence per specimen each additional single antibody stain CPT 88350 | $188.76 | $286.00 | $14.25 – $185.95 | 11 |
| Immunofluorescence per specimen initial single antibody stain CPT 88346 | $172.26 | $261.00 | $58.17 – $374.32 | 16 |
| Immunoglobulin assay CPT 86023 | $89.10 | $135.00 | $12.46 – $28.04 | 16 |
| Immunology procedure CPT 86849 | $142.56 | $216.00 | $4.14 – $50.40 | 9 |
| Implant neuroelectrodes CPT 63655 | not published | not published | not published | 0 |
| Implant ureth bulk agent HCPCS L8606 | $1,442.10 | $2,185.00 | $158.03 – $167.51 | 7 |
| Implnt bio implnt for soft tiss reinforcement 15777 CPT 15777 | not published | not published | not published | 0 |
| Incision & drainage hematoma/seroma/fluid collection CPT 10140 | $2,046.00 | $3,100.00 | $474.26 – $3,628.70 | 14 |
| Incision of achilles tendon CPT 27605 | not published | not published | not published | 0 |
| Incision of achilles tendon CPT 27606 | not published | not published | not published | 0 |
| Incision of breast lesion CPT 19020 | $2,460.48 | $3,728.00 | $588.15 – $3,628.70 | 14 |
| Incision of burn scab initi CPT 16035 | $461.34 | $699.00 | $168.77 – $893.15 | 14 |
| Incision of finger tendon CPT 26455 | not published | not published | not published | 0 |
| Incision of foot fascia CPT 28008 | not published | not published | not published | 0 |
| Incision of foot tendon 28234 CPT 28234 | not published | not published | not published | 0 |
| Incision of heel bone CPT 28300 | not published | not published | not published | 0 |
| Incision of metatarsal CPT 28306 | not published | not published | not published | 0 |
| Incision of metatarsal CPT 28308 | not published | not published | not published | 0 |
| Incision of midfoot bones CPT 28304 | not published | not published | not published | 0 |
| Incision of palm tendon CPT 26450 | not published | not published | not published | 0 |
| Incision of spinal nerve 64772 CPT 64772 | not published | not published | not published | 0 |
| Incision of tendon & muscle CPT 23405 | not published | not published | not published | 0 |
| Incision of tendon sheath CPT 25000 | not published | not published | not published | 0 |
| Incision of thigh tendon CPT 27306 | not published | not published | not published | 0 |
| Incision of urethra CPT 53020 | $6,256.80 | $9,480.00 | $1,266.65 – $4,592.75 | 14 |
| Incision tendon sheath CPT 26055 | not published | not published | not published | 0 |
| Incisn of toe tndn CPT 28010 | not published | not published | not published | 0 |
| Infect ag drug suscept pheno predict CPT 87900 | $143.22 | $217.00 | $130.35 – $293.29 | 16 |
| Infect ag eia influenza a or b ea CPT 87400 | $71.94 | $109.00 | $8.66 – $31.79 | 16 |
| Infect ag genotype na hiv-1 revr trn/prt CPT 87901 | $86.46 | $131.00 | $131.00 – $294.75 | 16 |
| Infect ag ia optc obs influenza CPT 87804 | $85.14 | $129.00 | $16.55 – $37.24 | 16 |
| Infect ag if ea plyvlnt antsrm CPT 87300 | $75.24 | $114.00 | $8.66 – $26.96 | 16 |
| Infect ag if influenza a CPT 87276 | $96.36 | $146.00 | $16.07 – $36.16 | 16 |
| Infect ag if influenza b CPT 87275 | $96.36 | $146.00 | $12.25 – $27.56 | 16 |
| Infect ag if legionella pneumophila CPT 87278 | $59.40 | $90.00 | $15.60 – $35.10 | 16 |
| Infect ag if pneumocystis carinii CPT 87281 | $99.00 | $150.00 | $11.98 – $26.96 | 16 |
| Infect ag if varicella zoster CPT 87290 | $96.36 | $146.00 | $13.42 – $30.20 | 16 |
| Infect ag na herpes simplex quant CPT 87530 | $178.86 | $271.00 | $42.84 – $96.39 | 16 |
| Infect ag na hpv high-risk types CPT 87624 | $138.60 | $210.00 | $35.09 – $78.95 | 16 |
| Infect ag na orthopoxvirus amp prb each CPT 87593 | $87.12 | $132.00 | $15.36 – $115.45 | 16 |
| Infect ag na resp virus 12-25 targets CPT 87633 | $911.46 | $1,381.00 | $416.78 – $937.76 | 16 |
| Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin CPT 87324 | $96.36 | $146.00 | $11.98 – $26.96 | 16 |
| Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans CPT 87327 | $96.36 | $146.00 | $13.42 – $30.20 | 16 |
| Infectious agent antigen immunoassay ql/sq multi step cryptosporidium CPT 87328 | $42.90 | $65.00 | $13.82 – $31.10 | 16 |
| Infectious agent antigen immunoassay ql/sq multi step giardia CPT 87329 | $59.40 | $90.00 | $11.98 – $26.96 | 16 |
| Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool CPT 87338 | $118.14 | $179.00 | $14.38 – $32.36 | 16 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn CPT 87340 | $68.64 | $104.00 | $10.33 – $23.24 | 16 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization CPT 87341 | $68.64 | $104.00 | $10.33 – $23.24 | 16 |
| Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies CPT 87389 | $99.00 | $150.00 | $24.08 – $54.18 | 16 |
| Infectious agent antigen immunoassay ql/sq multi step legionella urine CPT 87449 | $316.80 | $480.00 | $11.98 – $26.96 | 16 |
| Infectious agent antigen immunoassay ql/sq multi step rotavirus CPT 87425 | $68.64 | $104.00 | $11.98 – $26.96 | 16 |
| Infectious agent nucleic acid amplified probe CPT 87798 | $495.00 | $750.00 | $35.09 – $78.95 | 16 |
| Infectious agent nucleic acid amplified probe chlamydia trachomatis CPT 87491 | $217.14 | $329.00 | $35.09 – $78.95 | 16 |
| Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s) CPT 87493 | $237.60 | $360.00 | $37.27 – $83.86 | 16 |
| Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets CPT 87483 | $1,684.32 | $2,552.00 | $333.42 – $937.76 | 16 |
| Infectious agent nucleic acid amplified probe hsv-1 CPT 87529 | $158.40 | $240.00 | $35.09 – $78.95 | 16 |
| Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus CPT 87641 | $199.32 | $302.00 | $35.09 – $78.95 | 16 |
| Infectious agent nucleic acid amplified probe mycobacteria tuberculosis CPT 87556 | $198.00 | $300.00 | $41.68 – $93.78 | 16 |
| Infectious agent nucleic acid amplified probe neisseria gonorrhoeae CPT 87591 | $237.60 | $360.00 | $35.09 – $78.95 | 16 |
| Infectious agent nucleic acid amplified probe sars-cov-2/covid-19 CPT 87635 | $126.06 | $191.00 | $51.31 – $115.45 | 16 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b CPT 87636 | $317.46 | $481.00 | $142.63 – $320.92 | 16 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv CPT 87637 | $363.00 | $550.00 | $142.63 – $320.92 | 16 |
| Infectious agent nucleic acid amplified probe streptococcus group a CPT 87651 | $219.12 | $332.00 | $35.09 – $78.95 | 16 |
| Infectious agent nucleic acid amplified probe trichomonas vaginalis CPT 87661 | $150.48 | $228.00 | $35.09 – $78.95 | 16 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets CPT 87507 | $833.58 | $1,263.00 | $416.78 – $937.76 | 16 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets CPT 87505 | $388.08 | $588.00 | $128.29 – $288.65 | 16 |
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.