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 |
|---|---|---|---|---|
| Xray place dist ext thor ao CPT 75959 | $3,833.94 | $5,809.00 | $89.39 – $495.60 | 10 |
| Xray place prox ext thor ao CPT 75958 | $3,833.94 | $5,809.00 | $89.39 – $495.60 | 10 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $708.84 | $1,074.00 | $52.32 – $766.50 | 16 |
| X-ray ribs 2 views left CPT 71100 | $322.74 | $489.00 | $24.82 – $456.60 | 16 |
| X-ray ribs 3 views bilateral CPT 71110 | $391.38 | $593.00 | $24.82 – $456.60 | 16 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $477.18 | $723.00 | $24.82 – $456.60 | 16 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $498.30 | $755.00 | $24.82 – $456.60 | 16 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $363.00 | $550.00 | $24.82 – $456.60 | 16 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $330.00 | $500.00 | $24.82 – $456.60 | 16 |
| X-ray scapula complete (both sides) CPT 73010 | $353.10 | $535.00 | $24.82 – $456.60 | 16 |
| X-ray sella turcica CPT 70240 | $315.48 | $478.00 | $24.82 – $456.60 | 16 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $315.48 | $478.00 | $24.82 – $456.60 | 16 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $391.38 | $593.00 | $24.82 – $456.60 | 16 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $687.72 | $1,042.00 | $52.32 – $1,200.52 | 16 |
| X-ray skull < 4 views CPT 70250 | $326.70 | $495.00 | $24.82 – $456.60 | 16 |
| X-ray skull > 4 views complete CPT 70260 | $391.38 | $593.00 | $24.82 – $456.60 | 16 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | $597.96 | $906.00 | $52.32 – $456.60 | 16 |
| X-ray small intestine follow-through study CPT 74248 | $139.92 | $212.00 | $52.32 – $212.00 | 11 |
| X-ray spine single view CPT 72020 | $333.96 | $506.00 | $24.82 – $456.60 | 16 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $315.48 | $478.00 | $24.82 – $456.60 | 16 |
| X-ray sternum > 2 views CPT 71120 | $333.96 | $506.00 | $24.82 – $456.60 | 16 |
| X-ray surgical specimen CPT 76098 | $397.98 | $603.00 | $52.32 – $1,200.52 | 16 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | $523.38 | $793.00 | $52.32 – $456.60 | 16 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | $315.48 | $478.00 | $24.82 – $456.60 | 16 |
| X-ray thoracic spine 2 views CPT 72070 | $329.34 | $499.00 | $24.82 – $456.60 | 16 |
| X-ray thoracic spine 3 views CPT 72072 | $380.82 | $577.00 | $24.82 – $456.60 | 16 |
| X-ray thoracolumbar spine >=2 views CPT 72080 | $432.96 | $656.00 | $24.82 – $456.60 | 16 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $315.48 | $478.00 | $24.82 – $456.60 | 16 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views CPT 72082 | $380.82 | $577.00 | $24.82 – $456.60 | 16 |
| X-ray tibia/fibula 2 views (both sides) CPT 73590 | $330.00 | $500.00 | $12.41 – $456.60 | 16 |
| X-ray toe(s) > 2 views (both sides) CPT 73660 | $478.00 | $478.00 | $24.82 – $456.60 | 16 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 | $798.60 | $1,210.00 | $52.32 – $456.60 | 16 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 | $514.14 | $779.00 | $52.32 – $456.60 | 16 |
| X-ray wrist 2 views (both sides) CPT 73100 | $315.48 | $478.00 | $12.41 – $456.60 | 16 |
| Xylose absorption test blood &/or urine CPT 84620 | $124.74 | $189.00 | $12.91 – $29.05 | 16 |
| Zika virus dna/rna amp probe CPT 87662 | $495.00 | $750.00 | $50.68 – $115.45 | 16 |
| Ziprasidone 20 mg/ml (final concentration) intramuscular solution HCPCS J3486 | $114.48 | $173.45 | $13.74 – $16.38 | 5 |
| Zoledronic acid 4 mg/5 ml intravenous solution HCPCS J3489 | $574.03 | $869.74 | $8.38 – $9.74 | 5 |
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.