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 |
|---|---|---|---|---|
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets CPT 87506 | $535.26 | $811.00 | $232.94 – $591.73 | 16 |
| Infectious agent nucleic acid quantification bk virus CPT 87799 | $287.76 | $436.00 | $42.84 – $96.39 | 16 |
| Infectious agent nucleic acid quantification hepatitis b CPT 87517 | $327.36 | $496.00 | $42.84 – $96.39 | 16 |
| Infectious agent nucleic acid quantification hepatitis c CPT 87522 | $287.76 | $436.00 | $42.84 – $96.39 | 16 |
| Infectious agent nucleic acid quantification hiv-1 CPT 87536 | $287.76 | $436.00 | $85.10 – $191.48 | 16 |
| Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets CPT 87631 | $425.70 | $645.00 | $140.78 – $320.92 | 16 |
| Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis CPT 94642 | $234.96 | $356.00 | $25.49 – $481.11 | 16 |
| Initiation & management bipap/cpap initial day CPT 94660 | $428.34 | $649.00 | $58.79 – $481.11 | 16 |
| Inj acetaminophen -fresenius HCPCS J0134 | $0.47 | $0.71 | $0.08 – $0.11 | 5 |
| Inj, bupivacaine liposome HCPCS J0666 | $7.30 | $11.06 | $1.44 – $3.24 | 11 |
| Inj cefazolin sodium, hikma HCPCS J0688 | $7.13 | $10.80 | $1.45 – $1.80 | 5 |
| Inj cefazolin (wg crit care) HCPCS J0687 | $5.39 | $8.17 | $1.45 – $1.58 | 4 |
| Inj. cefepime hcl (baxter) HCPCS J0701 | $56.96 | $86.30 | $9.67 – $10.69 | 5 |
| Inj ceftolozane tazobactam HCPCS J0695 | $28.66 | $43.42 | $8.95 – $51.22 | 16 |
| Inj cntr knee arthro incl ct/mri CPT 27369 | $583.44 | $884.00 | $76.14 – $495.60 | 11 |
| Inj disk cerv-thor ea lev CPT 62291 | $1,087.68 | $1,648.00 | $144.81 – $495.60 | 11 |
| Inj dx for sinogram CPT 20501 | $413.82 | $627.00 | $69.13 – $495.60 | 11 |
| Injection arthrography hip without anesthesia (both sides) CPT 27093 | $611.16 | $926.00 | $128.68 – $495.60 | 11 |
| Injection during cath supravalvular aortography CPT 93567 | $696.96 | $1,056.00 | $144.81 – $153.50 | 7 |
| Injection epidural blood patch or clot CPT 62273 | $1,087.02 | $1,647.00 | $337.74 – $1,550.88 | 14 |
| Injection for arthrography wrist (both sides) CPT 25246 | $611.16 | $926.00 | $138.91 – $495.60 | 11 |
| Injection for bladder x-ray CPT 51600 | $557.04 | $844.00 | $82.33 – $495.60 | 11 |
| Injection for hip x-ray CPT 27095 | $611.16 | $926.00 | $144.81 – $495.60 | 11 |
| Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides) CPT 23350 | $611.16 | $926.00 | $94.67 – $495.60 | 11 |
| Injection for ureter x-ray CPT 50690 | $568.92 | $862.00 | $133.46 – $495.60 | 11 |
| Injection,onabotulinumtoxina HCPCS J0585 | $16.24 | $24.61 | $6.51 – $200.85 | 16 |
| Injection radioactive tracer sentinel node (both sides) CPT 38792 | $787.38 | $1,193.00 | $162.47 – $878.33 | 14 |
| Injection(s) anesthetic agent(s) and/or steroid femoral nerve left CPT 64447 | $739.86 | $1,121.00 | $565.72 – $1,550.88 | 14 |
| Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides) CPT 64450 | $799.92 | $1,212.00 | $176.37 – $1,550.88 | 14 |
| Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides) CPT 64483 | $1,779.36 | $2,696.00 | $337.74 – $1,943.26 | 14 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level CPT 64493 | $2,281.62 | $3,457.00 | $337.74 – $1,943.26 | 14 |
| Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance CPT 62321 | $1,878.36 | $2,846.00 | $337.74 – $1,550.88 | 14 |
| Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance CPT 62323 | $1,704.78 | $2,583.00 | $337.74 – $1,550.88 | 14 |
| Injection(s) tendon sheath/ligament aponeurosis single (both sides) CPT 20550 | $341.22 | $517.00 | $73.68 – $674.40 | 16 |
| Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s) CPT 20552 | $355.08 | $538.00 | $70.36 – $674.40 | 16 |
| Injection(s) trigger point(s) single/multiple >= 3 muscle(s) CPT 20553 | $395.34 | $599.00 | $79.99 – $674.40 | 16 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug CPT 96375 | $143.88 | $218.00 | $18.29 – $102.88 | 14 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug CPT 96376 | $143.88 | $218.00 | $20.47 – $21.70 | 7 |
| Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug CPT 96374 | $205.92 | $312.00 | $20.47 – $467.33 | 14 |
| Injection therapeutic/prophylactic/diagnostic subcutaneous/im CPT 96372 | $105.60 | $160.00 | $20.47 – $158.19 | 14 |
| Inject sacroiliac joint CPT 27096 | $1,318.02 | $1,997.00 | $202.86 – $215.03 | 7 |
| Inj epidural sgl cerv-thor without img CPT 62320 | $1,186.68 | $1,798.00 | $337.74 – $1,550.88 | 14 |
| Inj epidural sgl lumb-sacral without img CPT 62322 | $1,186.68 | $1,798.00 | $337.74 – $1,943.26 | 14 |
| Inj for ext venography CPT 36005 | $576.18 | $873.00 | $86.74 – $495.60 | 11 |
| Inj for mammo ductogram CPT 19030 | $290.40 | $440.00 | $144.81 – $153.50 | 7 |
| Inj, gadopiclenol, 1 ml HCPCS A9573 | $19.25 | $29.16 | $5.45 – $6.65 | 5 |
| Inj hrt cath w/s&i nonsel p-art angrp CPT 93568 | $1,028.94 | $1,559.00 | $144.81 – $153.50 | 7 |
| Inj hrt cath w/s&i sel left vent CPT 93565 | $793.32 | $1,202.00 | $144.81 – $153.50 | 7 |
| Inj hrt cath w/s&i sel right vent CPT 93566 | $856.68 | $1,298.00 | $144.81 – $153.50 | 7 |
| Inj labetalol hcl hikma, 5mg HCPCS J1921 | $8.09 | $12.25 | $1.80 – $3.62 | 5 |
| Inj, lidocaine w epinephrine HCPCS J2004 | $1.80 | $2.72 | $0.07 – $0.07 | 1 |
| Inj mepivacaine hcl/10 ml HCPCS J0670 | $30.13 | $45.65 | $5.75 – $6.71 | 5 |
| Inj multihance HCPCS A9577 | $10.10 | $15.30 | $2.97 – $3.22 | 5 |
| Inj nephrosto/ureterogram w/img exstng access CPT 50431 | $809.82 | $1,227.00 | $125.44 – $1,532.02 | 16 |
| Inj peritoneal venous shunt CPT 49427 | $453.42 | $687.00 | $72.37 – $495.60 | 11 |
| Inj proc ankle arthr CPT 27648 | $611.16 | $926.00 | $96.76 – $495.60 | 11 |
| Inj proc elbow arthro CPT 24220 | $611.16 | $926.00 | $126.28 – $495.60 | 11 |
| Inj proc lumbr disk ea lvl CPT 62290 | $1,760.88 | $2,668.00 | $144.81 – $495.60 | 11 |
| Inj proc myelogram lumbar CPT 62284 | $859.98 | $1,303.00 | $144.81 – $495.60 | 11 |
| Inj proc sialogram CPT 42550 | $395.34 | $599.00 | $116.52 – $495.60 | 11 |
| Inj retro urethrocysto CPT 51610 | $528.00 | $800.00 | $122.69 – $495.60 | 11 |
| Inj scleros sol mult veins CPT 36471 | $461.34 | $699.00 | $280.77 – $893.15 | 14 |
| Inj vancomycin (xellia) 10mg HCPCS J3375 | $0.90 | $1.37 | $0.21 – $0.23 | 4 |
| Inj w/fluor eval cv device CPT 36598 | $583.44 | $884.00 | $67.10 – $467.33 | 16 |
| Ins cath ren art 1st bi CPT 36252 | $3,635.28 | $5,508.00 | $456.60 – $6,937.25 | 16 |
| Ins cath ren art 1st uni CPT 36251 | $3,004.98 | $4,553.00 | $456.60 – $6,937.25 | 16 |
| Ins cath ren art 2nd+ uni CPT 36253 | $6,243.60 | $9,460.00 | $1,954.15 – $12,225.64 | 14 |
| Insert cath pleura with image CPT 32557 | $2,046.00 | $3,100.00 | $281.30 – $3,458.55 | 16 |
| Insert cath pleura without image CPT 32556 | $2,191.20 | $3,320.00 | $440.45 – $4,216.00 | 14 |
| Insert hepatic shunt (tips) CPT 37182 | $11,864.82 | $17,977.00 | $4,729.17 – $40,276.14 | 14 |
| Insertion catheter bladder non indwelling CPT 51701 | $215.82 | $327.00 | $38.07 – $292.32 | 14 |
| Insertion catheter bladder temporary simple CPT 51702 | $215.82 | $327.00 | $38.07 – $292.32 | 14 |
| Insertion catheter pleural indwelling tunneled with cuff CPT 32550 | $4,434.54 | $6,719.00 | $440.45 – $7,866.44 | 14 |
| Insertion intra aortic balloon assist device percutaneous CPT 33967 | $1,571.46 | $2,381.00 | $2,381.00 – $3,478.75 | 7 |
| Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance CPT 37191 | $7,679.10 | $11,635.00 | $405.43 – $12,225.64 | 16 |
| Insertion nontunneled centrally inserted central venous catheter >= 5 years old CPT 36556 | $3,161.40 | $4,790.00 | $485.09 – $6,937.25 | 14 |
| Insertion of catheter vein CPT 36481 | $1,367.52 | $2,072.00 | $302.34 – $320.48 | 7 |
| Insertion of catheter vein CPT 36500 | $925.32 | $1,402.00 | $302.34 – $320.48 | 7 |
| Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular CPT 33208 | $7,330.62 | $11,107.00 | $3,478.75 – $22,963.91 | 14 |
| Insertion of new/replacement ppm w/transvenous electrode(s) ventricular CPT 33207 | $12,087.24 | $18,314.00 | $3,478.75 – $22,963.91 | 14 |
| Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator CPT 33225 | $5,838.36 | $8,846.00 | $3,478.75 – $3,687.48 | 7 |
| Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years CPT 36569 | $1,560.24 | $2,364.00 | $485.09 – $3,458.55 | 14 |
| Insertion picc without port or pump with imaging guidance=>5y CPT 36573 | $3,082.86 | $4,671.00 | $485.09 – $3,458.55 | 14 |
| Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber CPT 33249 | $15,899.40 | $24,090.00 | $9,799.05 – $68,963.96 | 14 |
| Insertion/replacement temporary single chamber electrode/pacemaker catheter CPT 33210 | $9,558.78 | $14,483.00 | $693.47 – $18,181.72 | 14 |
| Insertion single tranvenous electrode/ppm/implantable defibrillator CPT 33216 | $9,558.78 | $14,483.00 | $693.47 – $18,181.72 | 14 |
| Insertion subcutaneous cardiac rhythm monitor CPT 33285 | $5,034.48 | $7,628.00 | $3,955.89 – $18,181.72 | 14 |
| Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides) CPT 36561 | $5,794.80 | $8,780.00 | $936.84 – $6,937.25 | 14 |
| Insert multi-comp penis pros CPT 54405 | not published | not published | not published | 0 |
| Insert picvad cath CPT 36570 | $6,232.38 | $9,443.00 | $485.09 – $6,937.25 | 14 |
| Insert pm/icd lead dual CPT 33217 | $9,769.32 | $14,802.00 | $693.47 – $18,181.72 | 14 |
| Insert/repl sq defib w/eltrd CPT 33270 | $20,743.80 | $31,430.00 | $9,799.05 – $68,963.96 | 14 |
| Insert sq defib electrode CPT 33271 | $10,827.96 | $16,406.00 | $693.47 – $18,181.72 | 14 |
| Insert swan-ganz cath CPT 93503 | $1,871.10 | $2,835.00 | $485.09 – $3,458.55 | 14 |
| Insert tunneled cv 2cath 2sits without port/pmp 36565 CPT 36565 | $5,840.34 | $8,849.00 | $936.84 – $6,937.25 | 14 |
| Insert tunneled cv cath CPT 36560 | $4,350.06 | $6,591.00 | $936.84 – $6,937.25 | 14 |
| Insert tunneled cv cath CPT 36563 | $3,954.06 | $5,991.00 | $936.84 – $12,225.64 | 14 |
| Insert uro/ves nck sphincter CPT 53445 | not published | not published | not published | 0 |
| Ins icd gen exist mlt leads CPT 33231 | $11,388.96 | $17,256.00 | $9,799.05 – $68,963.96 | 14 |
| Ins icd gen exist sgl lead CPT 33240 | $25,925.46 | $39,281.00 | $9,799.05 – $48,871.00 | 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.