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 |
|---|---|---|---|---|
| Myelography l-s spine CPT 72265 | $1,922.58 | $2,913.00 | $136.08 – $1,722.34 | 16 |
| Myelography via inj w/s&i 2+ regions CPT 62305 | $3,280.20 | $4,970.00 | $232.59 – $1,722.34 | 16 |
| Myelography via inj w/s&i cervical CPT 62302 | $2,624.82 | $3,977.00 | $226.55 – $1,722.34 | 16 |
| Myelography via inj w/s&i lumbosacral CPT 62304 | $2,100.12 | $3,182.00 | $223.82 – $1,722.34 | 16 |
| Myelography via inj w/s&i thoracic CPT 62303 | $1,679.70 | $2,545.00 | $226.98 – $1,722.34 | 16 |
| Myeloperoxidase ab multi step qualitative/semiquantitative CPT 83516 | $82.50 | $125.00 | $11.53 – $25.94 | 16 |
| Nafcillin 2 gram solution for injection HCPCS J2290 | $0.61 | $0.92 | $0.10 – $0.11 | 4 |
| Naloxone 0.4 mg/ml injection (wrapper) HCPCS J2312 | $1.45 | $2.19 | $0.12 – $0.13 | 4 |
| Nasopharyngoscopy w/endoscope CPT 92511 | $248.82 | $377.00 | $74.89 – $438.55 | 14 |
| Natriuretic peptide CPT 83880 | $207.24 | $314.00 | $39.26 – $88.34 | 16 |
| Natural killer cells total count CPT 86357 | $256.74 | $389.00 | $37.73 – $84.89 | 16 |
| Ndl emg musc 1 xtr/non-limb CPT 95870 | $207.24 | $314.00 | $58.61 – $314.00 | 16 |
| Neck (Cervical Spine) CT scan (with and without contrast) CPT 72127 | $1,818.96 | $2,756.00 | $134.40 – $1,215.09 | 16 |
| Neck (Cervical Spine) CT scan (with contrast) CPT 72126 | $1,539.12 | $2,332.00 | $134.40 – $1,215.09 | 16 |
| Neck (Cervical Spine) CT scan (without contrast) CPT 72125 | $1,357.62 | $2,057.00 | $47.18 – $1,215.09 | 16 |
| Neck (Cervical Spine) MRI (with and without contrast) CPT 72156 | $2,001.12 | $3,032.00 | $136.27 – $1,444.47 | 16 |
| Neck (Cervical Spine) MRI (with contrast) CPT 72142 | $1,906.08 | $2,888.00 | $179.97 – $1,444.47 | 16 |
| Neck (Cervical Spine) MRI (without contrast) CPT 72141 | $1,815.00 | $2,750.00 | $53.34 – $1,444.47 | 16 |
| Neck MRA (blood vessel MRI, with and without contrast) CPT 70549 | $2,080.98 | $3,153.00 | $217.39 – $1,444.47 | 16 |
| Neck MRA (blood vessel MRI, with contrast) CPT 70548 | $1,801.80 | $2,730.00 | $217.39 – $1,444.47 | 16 |
| Neck MRA (blood vessel MRI, without contrast) CPT 70547 | $1,716.00 | $2,600.00 | $217.39 – $1,444.47 | 16 |
| Neostigmine methylsulfate 1 mg/ml injection (wrapper) HCPCS J2710 | $4.05 | $6.13 | $1.19 – $2.33 | 2 |
| Nerve conduction 7-8 studies CPT 95910 | $1,049.40 | $1,590.00 | $58.61 – $885.08 | 16 |
| Nerve conduction studies 11-12 CPT 95912 | $2,577.30 | $3,905.00 | $58.61 – $885.08 | 16 |
| Nerve conduction studies 1-2 CPT 95907 | $343.20 | $520.00 | $58.61 – $520.00 | 16 |
| Nerve conduction studies 13+ CPT 95913 | $2,290.86 | $3,471.00 | $58.61 – $885.08 | 16 |
| Nerve conduction studies 3-4 CPT 95908 | $543.18 | $823.00 | $58.61 – $823.00 | 16 |
| Nerve conduction studies 5-6 CPT 95909 | $753.72 | $1,142.00 | $58.61 – $885.08 | 16 |
| Nerve conduction studies 9-10 CPT 95911 | $1,908.72 | $2,892.00 | $58.61 – $885.08 | 16 |
| Nerve repair w/allograft CPT 64910 | not published | not published | not published | 0 |
| Neurolysis celiac plexus CPT 64680 | $1,582.02 | $2,397.00 | $565.72 – $1,943.26 | 16 |
| Neuroplasty digital 1/both same digit CPT 64702 | not published | not published | not published | 0 |
| New Patient Office Visit (level 2) CPT 99202 | $208.56 | $316.00 | $95.40 – $154.00 | 3 |
| New Patient Office Visit (level 3) CPT 99203 | $252.12 | $382.00 | $95.40 – $154.00 | 3 |
| New Patient Office Visit (level 4) CPT 99204 | $287.10 | $435.00 | $95.40 – $154.00 | 3 |
| New Patient Office Visit (level 5) CPT 99205 | $347.82 | $527.00 | $95.40 – $154.00 | 3 |
| Nicardipine 25 mg/10 ml intravenous solution HCPCS J2404 | $2.09 | $3.16 | $0.12 – $42.87 | 11 |
| N-invas est c ffr sw aly cta CPT 75580 | $3,977.16 | $6,026.00 | $829.56 – $1,886.72 | 16 |
| Nipple/areola reconst 19350 CPT 19350 | not published | not published | not published | 0 |
| Nitroglycerin 50 mg/250 ml (200 mcg/ml) in 5 % dextrose intravenous HCPCS J2305 | $13.00 | $19.70 | $2.28 – $2.72 | 5 |
| Njx interlaminar lmbr/sac CPT 62326 | $1,186.68 | $1,798.00 | $337.74 – $1,943.26 | 14 |
| Njx interlaminar lmbr/sac CPT 62327 | $1,482.36 | $2,246.00 | $337.74 – $1,943.26 | 14 |
| Njx px nfrosgrm &/urtrgrm CPT 50430 | $1,865.16 | $2,826.00 | $178.39 – $1,532.02 | 14 |
| Nm imaging bone/joint 3 phase study CPT 78315 | $1,665.18 | $2,523.00 | $162.47 – $1,246.46 | 16 |
| Nm imaging bone/joint whole body CPT 78306 | $1,389.96 | $2,106.00 | $162.47 – $1,246.46 | 16 |
| Nm imaging cardiac blood pooling planar single study at rest or stress CPT 78472 | $1,620.96 | $2,456.00 | $162.47 – $1,246.46 | 16 |
| Nm imaging gastric emptying study CPT 78264 | $1,302.84 | $1,974.00 | $162.47 – $1,246.46 | 16 |
| Nm imaging gastrointestinal acute blood loss CPT 78278 | $1,316.70 | $1,995.00 | $389.13 – $1,246.46 | 16 |
| Nm imaging hepatobiliary system w/pharmacologic intervention CPT 78227 | $1,587.96 | $2,406.00 | $162.47 – $1,246.46 | 16 |
| Nm imaging kidney morphology vascular flow/function single study w/pharmacological intervention CPT 78708 | $1,722.60 | $2,610.00 | $162.47 – $1,246.46 | 16 |
| Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s) CPT 78014 | $1,097.58 | $1,663.00 | $162.47 – $1,246.46 | 16 |
| Nm radiopharmaceutical therapy oral administration CPT 79005 | $951.06 | $1,441.00 | $120.16 – $1,246.46 | 16 |
| Noninv pace analysis CPT 93724 | $1,801.80 | $2,730.00 | $62.97 – $674.81 | 14 |
| Npm1 gene CPT 81310 | $507.54 | $769.00 | $197.71 – $554.67 | 16 |
| Nras gene variants exon 2&3 CPT 81311 | $673.86 | $1,021.00 | $175.10 – $665.53 | 16 |
| Nr lnr acclrtr tx max 5 sessions CPT 77373 | $7,421.70 | $11,245.00 | $629.03 – $3,928.50 | 16 |
| Nrv rpr w/nrv algrft 1st CPT 64912 | not published | not published | not published | 0 |
| Nrv rpr w/nrv algrft ea addl CPT 64913 | not published | not published | not published | 0 |
| Ntrk translocation analysis CPT 81194 | $1,342.44 | $2,034.00 | $414.62 – $1,166.13 | 16 |
| Ntsty modul rad tx dlvr cplx CPT 77386 | $2,904.66 | $4,401.00 | $208.99 – $2,044.10 | 10 |
| Ntsty modul rad tx dlvr smpl CPT 77385 | $2,533.08 | $3,838.00 | $208.99 – $2,044.10 | 10 |
| Nuclear Stress Test (Heart) CPT 78452 | $3,365.34 | $5,099.00 | $389.13 – $2,844.45 | 16 |
| Observation direct referral from physician office for admission HCPCS G0379 | $643.50 | $975.00 | not published | 0 |
| Observation per hour HCPCS G0378 | $182.82 | $277.00 | not published | 0 |
| Obstetric panel inc HIV tstg CPT 80081 | $356.40 | $540.00 | $74.86 – $168.44 | 16 |
| Obstetrics panel CPT 80055 | $256.74 | $389.00 | $18.84 – $107.57 | 16 |
| Ob Ultrasound nuchal meas 1 gest CPT 76813 | $293.70 | $445.00 | $44.52 – $445.00 | 16 |
| Ob Ultrasound nuchal meas add-on CPT 76814 | $230.34 | $349.00 | $44.52 – $349.00 | 11 |
| Octreotide acetate 100 mcg/ml injection (wrapper) HCPCS J2354 | $12.10 | $18.34 | $1.09 – $1.53 | 5 |
| Olanzapine 10 mg intramuscular solution HCPCS J2359 | $4.66 | $7.06 | $1.34 – $1.67 | 5 |
| Ondansetron hcl (pf) 2 mg/ml injection (wrapper) HCPCS J2405 | $8.09 | $12.25 | $0.15 – $0.16 | 5 |
| Open aortic tube prosth repair 34830 CPT 34830 | $29,942.88 | $45,368.00 | $4,212.26 – $4,465.00 | 7 |
| Open aortofemor prosth repr CPT 34832 | $29,942.88 | $45,368.00 | $4,212.26 – $4,465.00 | 7 |
| Open aortoiliac prosth repr 34831 CPT 34831 | $29,942.88 | $45,368.00 | $4,212.26 – $4,465.00 | 7 |
| Open bx/exc inguinofem nodes CPT 38531 | not published | not published | not published | 0 |
| Open periprosthetic breast capsule 19370 CPT 19370 | not published | not published | not published | 0 |
| Opioids & opiate analogs 3/4 CPT 80363 | $23.10 | $35.00 | $4.99 – $35.00 | 10 |
| Opn ax/subcla art expos CPT 34715 | $5,988.18 | $9,073.00 | $1,766.63 – $1,872.63 | 7 |
| Opps service,sched team conf HCPCS G0175 | $491.70 | $745.00 | $50.97 – $916.76 | 12 |
| Optx carpl scphd fx int fixj CPT 25628 | not published | not published | not published | 0 |
| Optx clavicular fx w/int fix CPT 23515 | not published | not published | not published | 0 |
| Optx crpl fx oth/thn scph ea CPT 25645 | not published | not published | not published | 0 |
| Optx medial ankle fx CPT 27766 | not published | not published | not published | 0 |
| Optx post ankle fx CPT 27769 | not published | not published | not published | 0 |
| Optx prox humrl fx w/int fix CPT 23615 | not published | not published | not published | 0 |
| Optx scapular fx w/int fixj CPT 23585 | not published | not published | not published | 0 |
| Optx ulnar shft fx int fixj CPT 25545 | not published | not published | not published | 0 |
| Optx ulnar styloid fracture CPT 25652 | not published | not published | not published | 0 |
| Oral aprepitant HCPCS J8501 | $29.03 | $43.98 | $4.57 – $5.78 | 5 |
| Orchiopexy ingun/scrot appr CPT 54640 | not published | not published | not published | 0 |
| Organic acids total quant ea spec CPT 83918 | $531.30 | $805.00 | $23.14 – $53.10 | 16 |
| Orphenadrine citrate 30 mg/ml injection solution HCPCS J2360 | $76.00 | $115.15 | $10.54 – $15.45 | 5 |
| Ortho elbow without jnt cstm w/fit&adj HCPCS L3702 | $349.80 | $530.00 | $364.38 – $819.85 | 9 |
| Ortho ewh rgd without jnt cstm w/fit&adj HCPCS L3763 | $552.42 | $837.00 | $836.99 – $1,883.23 | 9 |
| Ortho hnd/fngr without jnt cstm w/fit&adj HCPCS L3913 | $371.58 | $563.00 | $354.92 – $798.57 | 9 |
| Ortho hnd/fngr w/jnt cstm w/fit&adj HCPCS L3921 | $283.80 | $430.00 | $232.21 – $840.20 | 14 |
| Ortho hnd without jnt w/fit&adj HCPCS L3919 | $208.56 | $316.00 | $305.52 – $687.42 | 9 |
| Orthopantogram CPT 70355 | $315.48 | $478.00 | $16.54 – $456.60 | 16 |
| Ortho whf rigd without jnt cstm w/fit&adj HCPCS L3808 | $485.76 | $736.00 | $465.94 – $1,048.37 | 9 |
| Oscillation chest wall mechanical per session CPT 94669 | $526.02 | $797.00 | $25.49 – $481.11 | 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.