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 |
|---|---|---|---|---|
| Insitu hybridization (fish) CPT 88366 | $493.68 | $748.00 | $58.17 – $448.80 | 16 |
| Insitu hybridization manual CPT 88368 | $894.30 | $1,355.00 | $58.17 – $787.54 | 16 |
| In situ hybridization per specimen each additional single probe stain CPT 88364 | $493.68 | $748.00 | $14.25 – $448.80 | 11 |
| In situ hybridization per specimen initial single probe stain CPT 88365 | $493.68 | $748.00 | $58.17 – $374.32 | 16 |
| Insj biomechanical device CPT 22859 | not published | not published | not published | 0 |
| Insj biomechanical device 22853 CPT 22853 | not published | not published | not published | 0 |
| Insj stablj dev without dcmprn CPT 22869 | not published | not published | not published | 0 |
| Ins lv lead exist pm/icd CPT 33224 | $12,087.24 | $18,314.00 | $3,478.75 – $22,963.91 | 14 |
| Ins mark abd/pel for right perq CPT 49411 | $3,070.32 | $4,652.00 | $470.57 – $3,041.05 | 16 |
| Ins picad w subq port 5yr> CPT 36571 | $6,688.44 | $10,134.00 | $485.09 – $6,937.25 | 14 |
| Ins picc wo subq prt/pmp w image guidnc <5yr CPT 36572 | $2,620.86 | $3,971.00 | $485.09 – $1,378.24 | 14 |
| Ins pm gen exist dual lead CPT 33230 | $10,565.94 | $16,009.00 | $9,799.05 – $48,871.00 | 14 |
| Ins pq tunnld ip cath w/img CPT 49418 | $6,031.08 | $9,138.00 | $1,616.01 – $7,866.44 | 14 |
| Ins/rplc spi npg/rcvr pocket CPT 63685 | not published | not published | not published | 0 |
| Ins/rpl ldless pm right vent w img & eval CPT 33274 | $6,978.18 | $10,573.00 | $422.82 – $42,319.55 | 14 |
| Ins/rpl pm gen exist dual lead CPT 33213 | $12,087.24 | $18,314.00 | $3,478.75 – $22,963.91 | 14 |
| Ins/rpl pm gen exist sgl lead CPT 33212 | $9,558.78 | $14,483.00 | $3,478.75 – $18,181.72 | 14 |
| Ins/rpl pm w/tv ld atrl CPT 33206 | $5,539.38 | $8,393.00 | $3,478.75 – $22,963.91 | 14 |
| Inst fibrinolysis agent ini day CPT 32561 | $714.12 | $1,082.00 | $126.55 – $1,378.24 | 16 |
| Inst fibrinolysis agent sbsq d CPT 32562 | $714.12 | $1,082.00 | $113.24 – $1,378.24 | 16 |
| Instillation anticarcinogenic agent bladder CPT 51720 | not published | not published | not published | 0 |
| Ins tun cvad 2 cath w/subq port(s) CPT 36566 | $8,823.54 | $13,369.00 | $936.84 – $12,225.64 | 14 |
| Ins tun cv cath wo subq prt/pm CPT 36557 | $4,125.00 | $6,250.00 | $936.84 – $12,225.64 | 14 |
| Ins tun cv cath wo subq prt/pm CPT 36558 | $4,888.62 | $7,407.00 | $936.84 – $6,937.25 | 14 |
| Ins tun intraperit dia cath CPT 49421 | $4,306.50 | $6,525.00 | $1,616.01 – $7,866.44 | 14 |
| Insulin total CPT 83525 | $62.70 | $95.00 | $11.43 – $25.72 | 16 |
| Interdiscal perq aspir dx CPT 62267 | $1,384.02 | $2,097.00 | $337.74 – $1,555.83 | 14 |
| Internal nerve revision 64727 CPT 64727 | not published | not published | not published | 0 |
| Interrog evl pm/ldls pm ip CPT 93288 | $113.52 | $172.00 | $15.99 – $82.00 | 14 |
| Intra-atrial recording CPT 93602 | $8,764.14 | $13,279.00 | $2,816.70 – $17,136.51 | 14 |
| Intracard echo interv w/s&i CPT 93662 | $3,218.82 | $4,877.00 | $191.46 – $202.95 | 7 |
| Intraventricular pacing CPT 93612 | $8,764.14 | $13,279.00 | $2,816.70 – $17,136.51 | 14 |
| Intrinsic factor antibody CPT 86340 | $99.00 | $150.00 | $14.28 – $33.93 | 16 |
| Intro cath dialysis circuit CPT 36901 | $3,098.04 | $4,694.00 | $748.38 – $3,458.55 | 14 |
| Intro cath dialysis circuit w/pta CPT 36902 | $10,883.40 | $16,490.00 | $1,628.87 – $12,504.84 | 14 |
| Intro cath dialysis circuit w/stent plcmnt CPT 36903 | $20,413.80 | $30,930.00 | $4,729.17 – $25,363.55 | 14 |
| Intro catheter aorta CPT 36200 | $1,450.68 | $2,198.00 | $302.34 – $320.48 | 7 |
| Intro cath svc/ivc CPT 36010 | $1,139.16 | $1,726.00 | $302.34 – $320.48 | 7 |
| Intro long gi tube CPT 44500 | $518.76 | $786.00 | $36.00 – $1,992.72 | 16 |
| Intro long gi tube w/mult fluo CPT 74340 | $537.24 | $814.00 | $89.39 – $495.60 | 11 |
| Intubation endotracheal emergency procedure CPT 31500 | $1,094.94 | $1,659.00 | $231.28 – $520.38 | 14 |
| Ionm in operatng room 15 min CPT 95940 | $209.22 | $317.00 | $317.00 – $317.00 | 3 |
| Ionm remote/>1 pt or per hr CPT 95941 | $591.36 | $896.00 | $455.52 – $496.70 | 3 |
| Iopamidol 300 mg iodine/ml (61 %) intravenous solution HCPCS Q9967 | $9.75 | $14.77 | $0.23 – $0.27 | 4 |
| Iron CPT 83540 | $39.60 | $60.00 | $6.47 – $14.56 | 16 |
| Iron binding capacity CPT 83550 | $62.04 | $94.00 | $8.74 – $19.67 | 16 |
| Iron sucrose 20 mg iron/ml intravenous solution (wrapper) HCPCS J1756 | $3.07 | $4.65 | $0.39 – $0.43 | 5 |
| Irradiation of blood product each unit reference CPT 86945 | $88.44 | $134.00 | $36.47 – $82.06 | 16 |
| Irrigation implantable venous access device for drug delivery systems CPT 96523 | $127.38 | $193.00 | $20.47 – $129.61 | 14 |
| Ivc venogram s&i CPT 75825 | $3,635.28 | $5,508.00 | $120.38 – $6,937.25 | 16 |
| IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour CPT 96367 | $145.86 | $221.00 | $28.12 – $158.19 | 14 |
| IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 | $207.24 | $314.00 | $130.24 – $138.05 | 7 |
| IV infusion therapy/prophylaxis/diagnosis each additional 1 hour CPT 96366 | $143.88 | $218.00 | $18.29 – $216.25 | 14 |
| IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour CPT 96365 | $439.56 | $666.00 | $83.08 – $467.33 | 14 |
| Ivp w/wo kub w/wo tomography CPT 74400 | $747.78 | $1,133.00 | $52.32 – $456.60 | 16 |
| Jak2 targeted sequence analysis CPT 81279 | $421.74 | $639.00 | $148.16 – $416.70 | 16 |
| Jejunstmy tube plcmt CPT 44372 | not published | not published | not published | 0 |
| John cunningham antibody CPT 86711 | $1,585.32 | $2,402.00 | $15.79 – $38.00 | 16 |
| Ketamine and metabolite screen - quest CPT 80357 | $44.88 | $68.00 | $4.99 – $40.80 | 10 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $44.22 | $67.00 | $8.17 – $18.38 | 16 |
| Ketorolac 15 mg/ml injection (wrapper) HCPCS J1885 | $32.34 | $49.00 | $0.33 – $0.75 | 11 |
| Kidney endoscopy CPT 50553 | $5,871.36 | $8,896.00 | $456.60 – $11,780.32 | 16 |
| Kidney img w/bldflw sgl without rx CPT 78707 | $1,682.34 | $2,549.00 | $162.47 – $1,246.46 | 16 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $566.28 | $858.00 | $40.83 – $521.52 | 16 |
| Kit gene analys d816 variant CPT 81273 | $683.10 | $1,035.00 | $73.92 – $280.96 | 16 |
| Knee Arthroscopy (Cartilage Repair) CPT 29877 | not published | not published | not published | 0 |
| Knee arthroscopy dx CPT 29870 | not published | not published | not published | 0 |
| Knee Arthroscopy (Meniscus Repair) CPT 29881 | not published | not published | not published | 0 |
| Knee arthroscopy/surgery CPT 29873 | not published | not published | not published | 0 |
| Knee arthroscopy/surgery CPT 29874 | not published | not published | not published | 0 |
| Knee arthroscopy/surgery CPT 29875 | not published | not published | not published | 0 |
| Knee arthroscopy/surgery CPT 29876 | not published | not published | not published | 0 |
| Knee arthroscopy/surgery CPT 29879 | not published | not published | not published | 0 |
| Knee arthroscopy/surgery CPT 29880 | not published | not published | not published | 0 |
| Knee arthroscopy/surgery CPT 29882 | not published | not published | not published | 0 |
| Knee arthroscopy/surgery CPT 29888 | not published | not published | not published | 0 |
| Knee MRI (with and without contrast) CPT 73723 | $2,669.70 | $4,045.00 | $179.97 – $1,444.47 | 16 |
| Knee MRI (with contrast) CPT 73722 | $2,542.32 | $3,852.00 | $179.97 – $1,722.34 | 16 |
| Knee MRI (without contrast) CPT 73721 | $2,420.88 | $3,668.00 | $106.68 – $1,444.47 | 16 |
| Knee X-ray CPT 73564 | $363.00 | $550.00 | $24.82 – $456.60 | 16 |
| Kras gene variants exon 2 CPT 81275 | $931.26 | $1,411.00 | $157.98 – $434.81 | 16 |
| Lab draw < 3 yrs fem/jugular 36400 CPT 36400 | $157.08 | $238.00 | $1.19 – $1.26 | 7 |
| Lab draw <3 yrs scalp vein 36405 CPT 36405 | $41.58 | $63.00 | $1.19 – $1.26 | 7 |
| Labetalol 5 mg/ml IV (wrapper) HCPCS J1920 | $32.34 | $49.00 | $0.28 – $0.63 | 5 |
| Lactate dehydrogenase (ldh) CPT 83615 | $67.32 | $102.00 | $6.04 – $13.59 | 16 |
| Lactated ringers intravenous solution HCPCS J7120 | $69.96 | $106.00 | $3.93 – $4.26 | 5 |
| Lactic acid CPT 83605 | $72.60 | $110.00 | $11.57 – $26.03 | 16 |
| Lactoferrin fecal quant CPT 83631 | $114.18 | $173.00 | $19.63 – $44.17 | 16 |
| Lam facetc/frmt arthrd lum 1 CPT 63052 | not published | not published | not published | 0 |
| Lam facetec & foramot lumbar CPT 63047 | not published | not published | not published | 0 |
| Lam factc/frmt arthrd lum ea CPT 63053 | not published | not published | not published | 0 |
| Laparo cholecystectomy/graph CPT 47563 | not published | not published | not published | 0 |
| Laparoscopy excise lesions CPT 58662 | not published | not published | not published | 0 |
| Laparoscopy fundoplasty CPT 43280 | not published | not published | not published | 0 |
| Laparoscopy remove adnexa CPT 58661 | not published | not published | not published | 0 |
| Lap ing hernia repair init CPT 49650 | not published | not published | not published | 0 |
| Lap ing hernia repair recur CPT 49651 | not published | not published | not published | 0 |
| Lap paraesophag hern repair CPT 43281 | not published | not published | not published | 0 |
| Lap sleeve gastrectomy CPT 43775 | $5,250.30 | $7,955.00 | $1,436.15 – $1,522.32 | 7 |
| Largsc w/rmvl foreign bdy(s) CPT 31577 | $766.92 | $1,162.00 | $266.93 – $859.32 | 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.