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 |
|---|---|---|---|---|
| Treat toe fracture CPT 28525 | not published | not published | not published | 0 |
| Treat ulnar fracture CPT 24685 | not published | not published | not published | 0 |
| Treat vaginal bleeding CPT 57180 | $1,052.04 | $1,594.00 | $197.42 – $444.19 | 14 |
| Treat wrist bone fracture CPT 25635 | not published | not published | not published | 0 |
| Treat wrist dislocation CPT 25675 | $1,022.34 | $1,549.00 | $203.37 – $541.95 | 14 |
| Treponema pallidum antibody CPT 86780 | $38.28 | $58.00 | $11.13 – $29.79 | 16 |
| Trg gene rearrangement anal CPT 81342 | $465.30 | $705.00 | $201.50 – $453.38 | 16 |
| Triamcinolone acetonide 40 mg/ml suspension for injection HCPCS J3301 | $11.58 | $17.54 | $1.22 – $1.75 | 5 |
| Trichinella antibody CPT 86784 | $96.36 | $146.00 | $8.17 – $28.26 | 16 |
| #tricyclicantidprssnt CPT 80337 | $91.08 | $138.00 | $4.99 – $82.80 | 10 |
| Triglycerides CPT 84478 | $35.64 | $54.00 | $5.74 – $12.92 | 16 |
| Trim nondyst nails CPT 11719 | $118.14 | $179.00 | $29.40 – $129.61 | 14 |
| Trnscath plc stent crv crtd without prtct CPT 37216 | $5,088.60 | $7,710.00 | $6,215.80 – $6,588.75 | 7 |
| Trnscath plc stent crv crtd w/prtct CPT 37215 | $7,128.66 | $10,801.00 | $6,215.80 – $6,588.75 | 7 |
| Trnscath plc stnt ante carotid art CPT 37218 | $823.02 | $1,247.00 | $456.60 – $6,215.80 | 11 |
| Trnscath plc vas stent w/s&i ea addl artery CPT 37237 | $4,891.26 | $7,411.00 | $4,729.17 – $5,012.92 | 7 |
| Trnscath plc vas stent w/s&i ea addl vein CPT 37239 | $3,367.98 | $5,103.00 | $4,729.17 – $5,012.92 | 7 |
| Trnscath plc vas stent w/s&i ini vein CPT 37238 | $13,098.36 | $19,846.00 | $4,729.17 – $25,363.55 | 14 |
| Trnscath retrv pq vasc fb w/guide CPT 37197 | $2,682.90 | $4,065.00 | $1,628.87 – $6,937.25 | 14 |
| Trnscath tx thromblytc artery non-intracrn ini day CPT 37211 | $6,243.60 | $9,460.00 | $1,628.87 – $12,225.64 | 14 |
| Trnscath tx thromblytc art/ven sbsq day CPT 37213 | $3,635.28 | $5,508.00 | $1,628.87 – $6,937.25 | 14 |
| Trnscath tx thromblytc cath rmv sbsq day CPT 37214 | $3,635.28 | $5,508.00 | $1,628.87 – $6,937.25 | 14 |
| Trnscath tx thromblytc vein ini day CPT 37212 | $3,635.28 | $5,508.00 | $1,628.87 – $6,937.25 | 14 |
| Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm CPT 14301 | not published | not published | not published | 0 |
| Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/< CPT 14302 | not published | not published | not published | 0 |
| Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/< CPT 14060 | not published | not published | not published | 0 |
| Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm CPT 14001 | not published | not published | not published | 0 |
| Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/< CPT 14000 | not published | not published | not published | 0 |
| Troponin quantitative CPT 84484 | $84.48 | $128.00 | $12.47 – $28.06 | 16 |
| Trurl dstrj prst8 tiss rf wv CPT 53854 | not published | not published | not published | 0 |
| Tte w or without fol w/con,stres HCPCS C8928 | $1,657.92 | $2,512.00 | $95.73 – $861.17 | 16 |
| Tx atrial fib pulm vein isol CPT 93656 | $17,666.22 | $26,767.00 | $7,726.98 – $57,427.06 | 14 |
| Tx closed distal humerus fx CPT 24999 | not published | not published | not published | 0 |
| Tx closed hip disl traumatic without anes CPT 27250 | $662.64 | $1,004.00 | $203.37 – $541.95 | 14 |
| Tx closed tib fx proximal w/w/o manip w/skel trac CPT 27532 | $6,407.94 | $9,709.00 | $203.37 – $7,188.86 | 14 |
| Tx l/r atrial fib addl CPT 93657 | $3,003.00 | $4,550.00 | $4,550.00 – $7,726.98 | 7 |
| Tx open dstl phlngl fx f/t internal fixation ea CPT 26765 | not published | not published | not published | 0 |
| Tx open iphlngl jt disl internal fixation sngl CPT 26785 | not published | not published | not published | 0 |
| Tx phalangeal shaft fx open prox/middle ea CPT 26735 | not published | not published | not published | 0 |
| Ugt1a1 gene analy common variants CPT 81350 | $619.08 | $938.00 | $234.00 – $526.50 | 16 |
| Ultrasound abdomen aorta screening study aaa CPT 76706 | $386.76 | $586.00 | $40.83 – $521.52 | 16 |
| Ultrasound breast complete CPT 76641 | $546.48 | $828.00 | $48.32 – $521.52 | 16 |
| Ultrasound breast unilateral limited (both sides) CPT 76642 | $392.70 | $595.00 | $48.32 – $521.52 | 16 |
| Ultrasound chest CPT 76604 | $405.24 | $614.00 | $40.83 – $521.52 | 16 |
| Ultrasound doppler velocimetry fetal umbilical artery CPT 76820 | $292.38 | $443.00 | $41.37 – $443.00 | 16 |
| Ultrasound encephalogram CPT 76506 | $629.64 | $954.00 | $48.32 – $521.52 | 16 |
| Ultrasound exam k transpl w/doppler CPT 76776 | $573.54 | $869.00 | $48.32 – $521.52 | 16 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | $398.64 | $604.00 | $44.52 – $521.52 | 16 |
| Ultrasound guidance for vascular access CPT 76937 | $370.26 | $561.00 | $47.89 – $561.00 | 11 |
| Ultrasound guided needle placement supervision & interpretation CPT 76942 | $699.60 | $1,060.00 | $49.70 – $574.00 | 11 |
| Ultrasound guide intraoperative CPT 76998 | $839.52 | $1,272.00 | $49.70 – $574.00 | 11 |
| Ultrasound hips infant dynamic CPT 76885 | $377.52 | $572.00 | $48.32 – $521.52 | 16 |
| Ultrasound joint complete left CPT 76881 | $566.28 | $858.00 | $21.12 – $521.52 | 16 |
| Ultrasound joint/nonvascular extremity limited left CPT 76882 | $384.78 | $583.00 | $40.83 – $521.52 | 16 |
| Ultrasound pregnant uterus < 14 weeks each additional gestation CPT 76802 | $251.46 | $381.00 | $41.14 – $381.00 | 11 |
| Ultrasound pregnant uterus detailed fetal exam single/1st gestation CPT 76811 | $650.10 | $985.00 | $44.52 – $524.23 | 16 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | $321.42 | $487.00 | $44.52 – $487.00 | 16 |
| Ultrasound pregnant uterus limited >= 1 fetuses CPT 76815 | $335.28 | $508.00 | $44.52 – $508.00 | 16 |
| Ultrasound pregnant uterus transvaginal CPT 76817 | $440.22 | $667.00 | $44.52 – $521.52 | 16 |
| Ultrasound retroperitoneal limited CPT 76775 | $517.44 | $784.00 | $40.83 – $521.52 | 16 |
| Ultrasound scrotum and contents CPT 76870 | $578.16 | $876.00 | $40.83 – $521.52 | 16 |
| Ultrasound spinal canal and contents CPT 76800 | $349.80 | $530.00 | $48.32 – $521.52 | 16 |
| Ultrasound transabd ea addl gest CPT 76812 | $297.00 | $450.00 | $44.52 – $450.00 | 11 |
| Ultrasound transvaginal non obstetric CPT 76830 | $531.30 | $805.00 | $24.16 – $521.52 | 16 |
| Unlisted CT procedure CPT 76497 | $331.98 | $503.00 | $47.18 – $503.00 | 16 |
| Unlisted cytogenetic study CPT 88299 | $372.90 | $565.00 | $16.71 – $339.00 | 16 |
| Unlisted dialysis procedure CPT 90999 | $510.18 | $773.00 | $343.55 – $773.00 | 10 |
| Unlisted laparoscopic liver biopy 47379 CPT 47379 | not published | not published | not published | 0 |
| Unlisted laparoscopic procedure 49659 CPT 49659 | not published | not published | not published | 0 |
| Unlisted laps px esoph CPT 43289 | not published | not published | not published | 0 |
| Unlisted mr procedure CPT 76498 | $2,233.44 | $3,384.00 | $84.98 – $1,444.47 | 16 |
| Unlisted procedure esophagus CPT 43499 | not published | not published | not published | 0 |
| Unlisted procedure pancreas CPT 48999 | not published | not published | not published | 0 |
| Unlisted px arthroscopy CPT 29999 | not published | not published | not published | 0 |
| Unlisted px casting/strpg CPT 29799 | $285.78 | $433.00 | $33.47 – $357.03 | 14 |
| Unlisted px foot/toes CPT 28899 | $545.82 | $827.00 | $203.37 – $541.95 | 14 |
| Unlisted px hands/fingers CPT 26989 | not published | not published | not published | 0 |
| Unlisted px leg/ankle CPT 27899 | not published | not published | not published | 0 |
| Unlisted px med radj physics CPT 77399 | $196.02 | $297.00 | $53.11 – $297.00 | 16 |
| Unlisted px pelvis/hip joint CPT 27299 | not published | not published | not published | 0 |
| Unlisted px small intestine CPT 44799 | $1,083.06 | $1,641.00 | $885.65 – $1,992.72 | 14 |
| Unlisted surgical path px CPT 88399 | $1,824.24 | $2,764.00 | $11.76 – $1,658.40 | 16 |
| Unlisted ultrasound procedure CPT 76999 | $293.70 | $445.00 | $48.32 – $445.00 | 16 |
| Unlisted urinalysis px CPT 81099 | $584.76 | $886.00 | $1.07 – $531.60 | 9 |
| Unlstd laps px sprmatic cord CPT 55559 | not published | not published | not published | 0 |
| Upgrade pm system CPT 33214 | $12,087.24 | $18,314.00 | $3,478.75 – $22,963.91 | 14 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $2,651.88 | $4,018.00 | $136.27 – $1,444.47 | 16 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $2,410.98 | $3,653.00 | $179.97 – $1,444.47 | 16 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $2,295.48 | $3,478.00 | $53.34 – $1,444.47 | 16 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | not published | not published | not published | 0 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | not published | not published | not published | 0 |
| Uppr gi scope w/submuc inj CPT 43236 | not published | not published | not published | 0 |
| Urea nitrogen CPT 84520 | $25.74 | $39.00 | $3.95 – $8.89 | 16 |
| Urea nitrogen 24 hour urine CPT 84540 | $54.12 | $82.00 | $5.56 – $12.51 | 16 |
| Urea nitrogen clearance CPT 84545 | $217.14 | $329.00 | $7.20 – $16.20 | 16 |
| Ureteral embolization/occl CPT 50705 | $369.60 | $560.00 | $560.00 – $3,012.50 | 7 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | $747.78 | $1,133.00 | $52.32 – $524.23 | 16 |
| Urethrocystography void s&i CPT 74455 | $747.78 | $1,133.00 | $52.32 – $524.23 | 16 |
| Uric acid blood CPT 84550 | $31.02 | $47.00 | $4.52 – $10.17 | 16 |
| Uric acid urine CPT 84560 | $31.02 | $47.00 | $5.08 – $11.43 | 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.