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 |
|---|---|---|---|---|
| Laryngeal function studies CPT 92520 | $267.30 | $405.00 | $61.57 – $259.68 | 16 |
| Laryngoscopy w/biopsy CPT 31535 | not published | not published | not published | 0 |
| Laryngoscopy w/fb removal CPT 31530 | not published | not published | not published | 0 |
| Lead capillary CPT 83655 | $72.60 | $110.00 | $12.11 – $27.25 | 16 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $1,058.64 | $1,604.00 | $74.44 – $524.23 | 16 |
| Lengthening or shortening - tibia and fibula 27715 CPT 27715 | not published | not published | not published | 0 |
| Leukacyte transfusion CPT 86950 | $1,306.14 | $1,979.00 | $37.44 – $1,187.40 | 16 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $3.11 | $4.71 | $0.07 – $0.10 | 5 |
| Levetiracetam therapeutic drug level CPT 80177 | $77.22 | $117.00 | $13.25 – $29.81 | 16 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $49.63 | $75.20 | $1.60 – $3.87 | 5 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | $34.71 | $52.59 | $9.87 – $10.70 | 4 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $1.62 | $2.45 | $0.08 – $0.08 | 1 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | $4.10 | $6.21 | $0.02 – $0.02 | 1 |
| Lidocaine therapeutic drug level CPT 80176 | $155.76 | $236.00 | $14.69 – $33.05 | 16 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | not published | not published | not published | 0 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $80.67 | $122.23 | $4.45 – $4.90 | 5 |
| Lipase CPT 83690 | $143.88 | $218.00 | $6.89 – $15.50 | 16 |
| Lipoprotein blood high res frac & quant CPT 83701 | $147.84 | $224.00 | $32.56 – $76.19 | 16 |
| Lipoprotein blood quant CPT 83704 | $217.80 | $330.00 | $34.19 – $76.93 | 16 |
| Lipoprotein direct measurement hdl CPT 83718 | $54.12 | $82.00 | $8.19 – $18.43 | 16 |
| Lipoprotein direct measurement ldl CPT 83721 | $62.70 | $95.00 | $10.50 – $23.63 | 16 |
| Lithium therapeutic drug level CPT 80178 | $39.60 | $60.00 | $6.61 – $14.87 | 16 |
| Lithotripsy transluminal coronary percutaneous CPT 92972 | $9,848.52 | $14,922.00 | $3,625.53 – $3,843.06 | 7 |
| Liver Function Test CPT 80076 | $68.64 | $104.00 | $8.17 – $18.38 | 16 |
| Liver/spleen imag static only CPT 78215 | $951.06 | $1,441.00 | $389.13 – $1,246.46 | 16 |
| Liver/spleen imag w/vasclr flow CPT 78216 | $1,243.44 | $1,884.00 | $389.13 – $1,246.46 | 16 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | not published | 0 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $188.76 | $286.00 | $2.23 – $2.52 | 5 |
| Low back disk surgery CPT 63030 | not published | not published | not published | 0 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $1,818.96 | $2,756.00 | $134.40 – $1,215.09 | 16 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $1,562.88 | $2,368.00 | $134.40 – $1,215.09 | 16 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $1,359.60 | $2,060.00 | $47.18 – $1,215.09 | 16 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $2,700.06 | $4,091.00 | $179.97 – $1,444.47 | 16 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $2,571.36 | $3,896.00 | $179.97 – $1,444.47 | 16 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $2,337.72 | $3,542.00 | $53.34 – $1,444.47 | 16 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $363.66 | $551.00 | $24.82 – $456.60 | 16 |
| Lumbar diskogram s&i CPT 72295 | $2,484.90 | $3,765.00 | $141.29 – $4,290.30 | 16 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | not published | 0 |
| Lung Function Test (Spirometry) CPT 94010 | $363.00 | $550.00 | $25.49 – $550.00 | 16 |
| Lung perfusion imaging CPT 78580 | $1,226.28 | $1,858.00 | $389.13 – $1,246.46 | 16 |
| Lymphatics/lymph node imaging CPT 78195 | $1,463.22 | $2,217.00 | $389.13 – $1,246.46 | 16 |
| Lymphocyte transformation mitogen CPT 86353 | $267.30 | $405.00 | $49.03 – $110.32 | 16 |
| Lymph vessel x-ray arms/legs CPT 75803 | $2,072.40 | $3,140.00 | $448.11 – $3,458.55 | 16 |
| Lymph vessel x-ray trunk CPT 75807 | $3,635.28 | $5,508.00 | $456.60 – $6,937.25 | 16 |
| Lysis penil circumic lesion CPT 54162 | not published | not published | not published | 0 |
| Macroscopic exam arthropod CPT 87168 | $68.64 | $104.00 | $4.27 – $9.61 | 16 |
| Macroscopic exam parasite CPT 87169 | $68.64 | $104.00 | $4.31 – $9.70 | 16 |
| Magnesium CPT 83735 | $48.84 | $74.00 | $6.70 – $15.08 | 16 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $30.29 | $45.90 | $0.68 – $0.85 | 5 |
| Male sling procedure CPT 53440 | not published | not published | not published | 0 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $129.36 | $196.00 | $25.49 – $292.32 | 16 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $137.94 | $209.00 | $25.49 – $292.32 | 16 |
| Mapping io sentinel lymph node CPT 38900 | not published | not published | not published | 0 |
| Map tachycard site(s) CPT 93609 | $2,641.98 | $4,003.00 | $4,003.00 – $7,726.98 | 7 |
| Mastectomy partial CPT 19301 | not published | not published | not published | 0 |
| Mast mod rad CPT 19307 | not published | not published | not published | 0 |
| Mastoids complete CPT 70130 | $315.48 | $478.00 | $24.82 – $456.60 | 16 |
| Mastopexy CPT 19316 | not published | not published | not published | 0 |
| Mast simple complete CPT 19303 | not published | not published | not published | 0 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $118.80 | $180.00 | $14.46 – $32.54 | 16 |
| Mayo aathr protein s free CPT 85306 | $118.14 | $179.00 | $15.32 – $34.47 | 16 |
| Mayo activated protein c resistance assay CPT 85307 | $118.14 | $179.00 | $15.32 – $34.47 | 16 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | $260.04 | $394.00 | $30.85 – $86.78 | 16 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | $122.76 | $186.00 | $4.99 – $111.60 | 10 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $174.90 | $265.00 | $4.99 – $159.00 | 10 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $89.76 | $136.00 | $14.78 – $33.26 | 16 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $142.56 | $216.00 | $4.99 – $129.60 | 10 |
| Mayo alpha 1 antitrypsin CPT 82103 | $81.18 | $123.00 | $13.44 – $30.24 | 16 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $95.70 | $145.00 | $15.08 – $33.93 | 16 |
| Mayo amphu amphetamines definitive assay 3 or 4 urine CPT 80325 | $124.08 | $188.00 | $4.99 – $112.80 | 10 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | $75.90 | $115.00 | $4.99 – $69.00 | 10 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $520.08 | $788.00 | $98.08 – $273.67 | 16 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $1,069.86 | $1,621.00 | $91.66 – $206.24 | 16 |
| Mayo analysis microarray cytogenomic copy number/snp variants CPT 81229 | $2,378.64 | $3,604.00 | $608.00 – $2,610.00 | 16 |
| Mayo androstenedione CPT 82157 | $180.18 | $273.00 | $29.28 – $65.88 | 16 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $89.76 | $136.00 | $14.60 – $32.85 | 16 |
| Mayo antithrombin iii antigen CPT 85301 | $89.10 | $135.00 | $10.81 – $24.32 | 16 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $51.48 | $78.00 | $8.17 – $33.86 | 16 |
| Mayo avwpr vw factor activity CPT 85397 | $254.76 | $386.00 | $30.86 – $69.44 | 16 |
| Mayo babpb infectious agent nucleic acid amplified probe babesia microti CPT 87469 | $99.66 | $151.00 | $35.09 – $78.95 | 16 |
| Mayo barbiturates definitive assay confirmation urine CPT 80345 | $71.28 | $108.00 | $4.99 – $39.00 | 10 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $50.82 | $77.00 | $8.17 – $22.91 | 16 |
| Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 | $910.80 | $1,380.00 | $144.84 – $325.89 | 16 |
| Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative CPT 81208 | $273.90 | $415.00 | $175.54 – $482.90 | 16 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $68.64 | $104.00 | $8.17 – $29.03 | 16 |
| Mayo bnzu sedative hypnotics definitive urine CPT 80368 | $39.60 | $60.00 | $4.99 – $39.00 | 10 |
| Mayo brcmg brucella antibody igm CPT 86622 | $59.40 | $90.00 | $8.17 – $20.09 | 16 |
| Mayo c1 esterase inhibitor CPT 83883 | $102.30 | $155.00 | $13.60 – $30.60 | 16 |
| Mayo cannabinoids natural definitive assay thc confirmation urine CPT 80349 | $102.30 | $155.00 | $4.99 – $93.00 | 10 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $342.54 | $519.00 | $16.87 – $37.96 | 16 |
| Mayo cd20b mononuclear cell antigen nos quantitative each CPT 86356 | $114.18 | $173.00 | $26.78 – $60.26 | 16 |
| Mayo cdcom hla class ii typing low resolution one locus each CPT 81376 | $281.82 | $427.00 | $122.22 – $275.00 | 16 |
| Mayo ceruloplasmin CPT 82390 | $62.70 | $95.00 | $10.74 – $24.17 | 16 |
| Mayo chemiluminescent parathyroid related peptide CPT 82397 | $89.76 | $136.00 | $14.12 – $31.77 | 16 |
| Mayo chikv chikungunya antibodies igg CPT 86790 | $99.00 | $150.00 | $4.14 – $28.98 | 16 |
| Mayo chlap chlamydia pneumoniae antibody igg CPT 86631 | $42.90 | $65.00 | $8.17 – $26.60 | 16 |
| Mayo chlap chlamydia pneumoniae antibody igm CPT 86632 | $48.84 | $74.00 | $8.17 – $28.53 | 16 |
| Mayo chrcb tissue culture non-neoplastic disorders lymphocyte CPT 88230 | $450.78 | $683.00 | $70.04 – $262.10 | 16 |
| Mayo chromium CPT 82495 | $99.00 | $150.00 | $10.23 – $45.63 | 16 |
| Mayo cocaine definitive assay confirmation urine CPT 80353 | $25.08 | $38.00 | $4.99 – $38.00 | 10 |
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.