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 |
|---|---|---|---|---|
| Osmolality blood CPT 83930 | $40.26 | $61.00 | $6.61 – $14.87 | 16 |
| Osmolality urine CPT 83935 | $42.90 | $65.00 | $6.82 – $15.35 | 16 |
| Osteochondral knee allograft CPT 27415 | not published | not published | not published | 0 |
| Osteotomy/graft tarsal/calcaneus/talus 28305 CPT 28305 | not published | not published | not published | 0 |
| Ot evaluation high complexity patient/family CPT 97167 | $155.76 | $236.00 | $62.66 – $221.09 | 16 |
| Ot evaluation low complexity patient/family CPT 97165 | $155.76 | $236.00 | $62.66 – $221.09 | 16 |
| Ot evaluation moderate complexity patient/family CPT 97166 | $155.76 | $236.00 | $62.66 – $221.09 | 16 |
| Oth resp proc, group HCPCS G0239 | $167.64 | $254.00 | $15.09 – $90.89 | 16 |
| Oth resp proc, indiv HCPCS G0238 | $84.48 | $128.00 | $15.09 – $90.89 | 16 |
| Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes CPT 97763 | $80.52 | $122.00 | $28.15 – $122.00 | 16 |
| Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes CPT 97760 | $85.14 | $129.00 | $16.89 – $129.00 | 16 |
| Ot manual therpy techniques >=1 region each 15 minutes CPT 97140 | $80.52 | $122.00 | $16.89 – $122.00 | 16 |
| Ot re-evaluation patient/family CPT 97168 | $104.94 | $159.00 | $62.66 – $150.14 | 16 |
| Ot therapeutic activities direct patient contact each 15 minutes CPT 97530 | $95.70 | $145.00 | $16.89 – $145.00 | 16 |
| Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes CPT 97130 | $71.94 | $109.00 | $18.01 – $109.00 | 16 |
| Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes CPT 97129 | $71.94 | $109.00 | $18.86 – $109.00 | 16 |
| Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes CPT 97110 | $80.52 | $122.00 | $16.89 – $122.00 | 16 |
| Ot therapeutic procedure neuromuscular reeducate each 15 minutes CPT 97112 | $93.72 | $142.00 | $16.89 – $142.00 | 16 |
| Ot training self care/home management direct contact each 15 minutes CPT 97535 | $89.10 | $135.00 | $14.19 – $135.00 | 16 |
| Oxytocin 10 unit/ml injection solution HCPCS J2590 | $32.34 | $49.00 | $1.29 – $4.44 | 2 |
| Palb2 gene full gene seq CPT 81307 | $892.32 | $1,352.00 | $226.30 – $1,522.13 | 16 |
| Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr HCPCS J2470 | $32.34 | $49.00 | $14.34 – $14.34 | 1 |
| Papaverin hcl injection HCPCS J2440 | $182.66 | $276.75 | $53.55 – $75.80 | 2 |
| Parathormone (pth) intact CPT 83970 | $252.12 | $382.00 | $41.28 – $92.88 | 16 |
| Parathyrd planar w/spect&ct CPT 78072 | $1,755.60 | $2,660.00 | $162.47 – $1,246.46 | 16 |
| Parathyroid planar imaging CPT 78070 | $1,170.18 | $1,773.00 | $389.13 – $1,246.46 | 16 |
| Parathyroid planar img w/tomo spect CPT 78071 | $1,609.74 | $2,439.00 | $162.47 – $1,246.46 | 16 |
| Parial mast w/lymph removal 19302 CPT 19302 | not published | not published | not published | 0 |
| Paring/cutting benign hyperkeratotic lesion single CPT 11055 | $199.98 | $303.00 | $72.99 – $440.81 | 14 |
| Partial excision bone tars/metatars exc talus/calcaneus (both sides) (rest meth ii cah) CPT 28122 | not published | not published | not published | 0 |
| Partial removal finger bone CPT 26236 | $3,032.04 | $4,594.00 | $576.77 – $3,532.89 | 14 |
| Partial removal foot fascia CPT 28060 | not published | not published | not published | 0 |
| Partial removal of fibula CPT 27641 | not published | not published | not published | 0 |
| Partial removal of foot bone CPT 28288 | not published | not published | not published | 0 |
| Partial removal of tibia CPT 27640 | not published | not published | not published | 0 |
| Partial removal of toe CPT 28160 | not published | not published | not published | 0 |
| Partial removal of tongue CPT 41120 | not published | not published | not published | 0 |
| Partial removal of ulna CPT 25240 | not published | not published | not published | 0 |
| Part removal of metatarsal CPT 28110 | not published | not published | not published | 0 |
| Part removal of metatarsal 28112 CPT 28112 | not published | not published | not published | 0 |
| Passy muir valve metal trach HCPCS L8501 | $203.94 | $309.00 | $180.10 – $405.23 | 9 |
| Path clin consltj sf 5-20 CPT 80503 | $107.58 | $163.00 | $17.07 – $114.49 | 16 |
| Pca3/klk3 antigen CPT 81313 | $1,189.32 | $1,802.00 | $59.04 – $573.86 | 16 |
| Pelvic CT scan (with and without contrast) CPT 72194 | $1,818.96 | $2,756.00 | $134.40 – $1,215.09 | 16 |
| Pelvic CT scan (with contrast) CPT 72193 | $1,539.12 | $2,332.00 | $134.40 – $1,215.09 | 16 |
| Pelvic CT scan (without contrast) CPT 72192 | $1,259.28 | $1,908.00 | $47.18 – $1,215.09 | 16 |
| Pelvic MRI (with and without contrast) CPT 72197 | $2,893.44 | $4,384.00 | $136.27 – $1,444.47 | 16 |
| Pelvic MRI (with contrast) CPT 72196 | $2,504.70 | $3,795.00 | $179.97 – $1,444.47 | 16 |
| Pelvic MRI (without contrast) CPT 72195 | $2,277.00 | $3,450.00 | $93.20 – $1,444.47 | 16 |
| Pelvic Ultrasound (complete) CPT 76856 | $615.12 | $932.00 | $74.44 – $521.52 | 16 |
| Pelvic Ultrasound (limited) CPT 76857 | $482.46 | $731.00 | $40.83 – $521.52 | 16 |
| Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe HCPCS J0561 | $101.09 | $153.16 | $31.97 – $71.92 | 16 |
| Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr HCPCS J2540 | $11.31 | $17.13 | $1.29 – $1.58 | 5 |
| Penile injection CPT 54235 | $711.48 | $1,078.00 | $38.07 – $548.94 | 14 |
| Perc d-e cor revasc chro add HCPCS C9608 | $8,915.28 | $13,508.00 | $3,625.53 – $3,843.06 | 7 |
| Perc d-e cor revasc chro sin HCPCS C9607 | $13,249.50 | $20,075.00 | $3,625.53 – $40,276.14 | 14 |
| Perc d-e cor revasc t cabg b HCPCS C9605 | $5,539.38 | $8,393.00 | $3,625.53 – $3,843.06 | 7 |
| Perc d-e cor revasc t cabg s HCPCS C9604 | $11,482.68 | $17,398.00 | $3,625.53 – $25,363.55 | 14 |
| Perc d-e cor stent ather br HCPCS C9603 | $10,730.28 | $16,258.00 | $3,625.53 – $3,843.06 | 7 |
| Perc d-e cor stent ather s HCPCS C9602 | $20,739.84 | $31,424.00 | $3,625.53 – $40,276.14 | 14 |
| Perc drug-el cor stent bran HCPCS C9601 | $8,234.16 | $12,476.00 | $3,625.53 – $3,843.06 | 7 |
| Perc drug-el cor stent sing HCPCS C9600 | $9,716.52 | $14,722.00 | $3,625.53 – $25,363.55 | 14 |
| Percut ablate liver rf CPT 47382 | $6,738.60 | $10,210.00 | $1,215.09 – $13,282.53 | 16 |
| Perflutren lipid microspheres 1.1 mg/ml intravenous suspension HCPCS Q9957 | $315.66 | $478.28 | $66.35 – $71.98 | 5 |
| Pericardiocentesis wwo imaging CPT 33016 | $1,794.54 | $2,719.00 | $440.45 – $3,458.55 | 14 |
| Peri-implt capslc brst compl CPT 19371 | not published | not published | not published | 0 |
| Peripheral vascular rehab CPT 93668 | $92.40 | $140.00 | $13.81 – $140.00 | 16 |
| Peri-proc device eval icd CPT 93287 | $204.60 | $310.00 | $15.99 – $16.95 | 7 |
| Peri-proc device eval pm CPT 93286 | $181.50 | $275.00 | $15.99 – $16.95 | 7 |
| Peritoneal cath sub q resv per CPT 49419 | $6,243.60 | $9,460.00 | $1,616.01 – $12,225.64 | 14 |
| Peritoneogram rs&i CPT 74190 | $551.76 | $836.00 | $52.32 – $1,200.52 | 16 |
| Perq dev breast 1st mr guide CPT 19287 | $2,034.78 | $3,083.00 | $476.00 – $1,555.83 | 16 |
| Perq dev breast 1st strtctc CPT 19283 | $1,202.52 | $1,822.00 | $187.60 – $1,555.83 | 16 |
| Perq plmt bile duct stent CPT 47538 | $7,612.44 | $11,534.00 | $979.32 – $13,282.53 | 14 |
| Perq plmt bile duct stent CPT 47539 | $6,738.60 | $10,210.00 | $456.60 – $13,282.53 | 16 |
| Perq plmt bile duct stent CPT 47540 | $9,251.88 | $14,018.00 | $2,397.03 – $13,282.53 | 14 |
| Perq rplcmt g-tube req revsn gstrst trk CPT 43763 | $924.66 | $1,401.00 | $171.97 – $548.94 | 14 |
| Perq tx big toe fracture w/manip 28496 CPT 28496 | not published | not published | not published | 0 |
| Pet CT skull-mid thgh initial CPT 78815 | $5,121.60 | $7,760.00 | $589.87 – $3,928.74 | 16 |
| Pet CT whole body initial CPT 78816 | $5,121.60 | $7,760.00 | $589.87 – $3,928.74 | 16 |
| Pet fdg brain metoblic eval sb CPT 78608 | $4,901.82 | $7,427.00 | $589.87 – $3,928.74 | 16 |
| Pet image w/ct lmtd CPT 78814 | $4,901.82 | $7,427.00 | $589.87 – $3,928.74 | 16 |
| Ph body fluid CPT 83986 | $25.08 | $38.00 | $3.58 – $8.06 | 16 |
| Phencyclidine (pcp) CPT 83992 | $89.76 | $136.00 | $20.67 – $59.57 | 11 |
| Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr HCPCS J2560 | $166.58 | $252.40 | $47.98 – $55.71 | 5 |
| Phenobarbital therapeutic drug level CPT 80184 | $77.88 | $118.00 | $15.30 – $34.43 | 16 |
| Phentolaine mesylate inj HCPCS J2760 | $1,222.35 | $1,852.05 | $51.22 – $946.26 | 16 |
| Phenylephrine 10 mg/ml injection solution HCPCS J2371 | $1.29 | $1.96 | $0.02 – $0.02 | 2 |
| Phenytoin total therapeutic drug level CPT 80185 | $77.88 | $118.00 | $13.25 – $29.81 | 16 |
| Phlebotomy therapeutic CPT 99195 | $227.70 | $345.00 | $33.22 – $292.32 | 16 |
| Phosphorus CPT 84100 | $29.04 | $44.00 | $4.74 – $10.67 | 16 |
| Phosphorus 24 hour urine CPT 84105 | $31.68 | $48.00 | $5.78 – $13.01 | 16 |
| Phytonadione (vitamin k1) 10 mg/ml injection solution HCPCS J3430 | $20.84 | $31.57 | $4.64 – $5.03 | 5 |
| Pik3ca gene trgt seq alys CPT 81309 | $365.64 | $554.00 | $219.86 – $618.37 | 16 |
| Pin finger dislocation CPT 26776 | not published | not published | not published | 0 |
| Pinworm exam CPT 87172 | $23.76 | $36.00 | $4.27 – $9.61 | 16 |
| Piperacillin-tazobactam 3.375 gram intravenous solution HCPCS J2543 | $39.75 | $60.23 | $1.80 – $2.01 | 5 |
| Place cath intracranial art CPT 36228 | $2,486.22 | $3,767.00 | $1,954.15 – $2,071.40 | 7 |
| Place cath xtrnl carotid CPT 36227 | $2,445.30 | $3,705.00 | $1,954.15 – $2,071.40 | 7 |
| Place cecostomy tube perc CPT 49442 | $2,768.04 | $4,194.00 | $392.66 – $2,629.12 | 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.