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 |
|---|---|---|---|---|
| Chest 2 vws w oblique CPT 71048 | $355.08 | $538.00 | $24.82 – $456.60 | 16 |
| Chest apical lordotic proj CPT 71047 | $275.88 | $418.00 | $24.82 – $418.00 | 16 |
| Chest CT scan (with and without contrast) CPT 71270 | $1,818.96 | $2,756.00 | $68.51 – $1,215.09 | 16 |
| Chest CT scan (with contrast) CPT 71260 | $1,539.12 | $2,332.00 | $68.51 – $1,215.09 | 16 |
| Chest CT scan (without contrast) CPT 71250 | $1,264.56 | $1,916.00 | $47.18 – $1,215.09 | 16 |
| Chest X-ray CPT 71046 | $275.88 | $418.00 | $24.82 – $418.00 | 16 |
| Chest X-ray (single view) CPT 71045 | $259.38 | $393.00 | $24.82 – $393.00 | 16 |
| Chg pr pul rehab for copd patients CPT 94626 | $137.94 | $209.00 | $15.09 – $129.61 | 14 |
| Chimerism anal no cell selec CPT 81267 | $450.12 | $682.00 | $207.46 – $466.79 | 16 |
| Chlamydia culture CPT 87110 | $131.34 | $199.00 | $19.60 – $44.10 | 16 |
| Chlamydia trachomatis ag if CPT 87270 | $96.36 | $146.00 | $11.98 – $26.96 | 16 |
| Chlamydia type CPT 87140 | $49.50 | $75.00 | $5.57 – $12.53 | 16 |
| Chloride CPT 82435 | $54.12 | $82.00 | $4.60 – $10.35 | 16 |
| Chloride 24 hour urine CPT 82436 | $38.94 | $59.00 | $5.75 – $12.94 | 16 |
| Chloroprocaine hcl injection HCPCS J2401 | $0.26 | $0.39 | $0.05 – $0.07 | 5 |
| Cholangiogram percutaneous compl CPT 47532 | $4,076.16 | $6,176.00 | $393.37 – $7,866.44 | 16 |
| Cholangiography and/or pancreatography intraoperative supervision & interpretation CPT 74300 | $691.02 | $1,047.00 | $89.39 – $495.60 | 11 |
| Cholecystostomy complete w/supervision & interpretation CPT 47490 | $4,076.16 | $6,176.00 | $979.32 – $7,866.44 | 14 |
| Cholesterol CPT 82465 | $51.48 | $78.00 | $4.35 – $9.79 | 16 |
| Cholesterol body fluid CPT 84999 | $199.32 | $302.00 | $4.30 – $94.20 | 9 |
| Cholesterol (Lipid) Test CPT 80061 | $89.10 | $135.00 | $13.39 – $30.13 | 16 |
| Chrom analysis CPT 88273 | $398.64 | $604.00 | $34.81 – $78.32 | 16 |
| Chromatography CPT 83021 | $152.46 | $231.00 | $18.06 – $40.64 | 16 |
| Chromogenic substrate assay CPT 85130 | $444.84 | $674.00 | $11.89 – $26.75 | 16 |
| Chromo high res and frag x - sendout CPT 81243 | $237.60 | $360.00 | $54.46 – $128.34 | 16 |
| Chromosome analys amniotic CPT 88269 | $737.22 | $1,117.00 | $173.66 – $390.74 | 16 |
| Chromosome analysis 100 CPT 88249 | $339.24 | $514.00 | $173.17 – $389.63 | 16 |
| Chromosome analysis 15-20 cell count CPT 88262 | $611.16 | $926.00 | $125.49 – $282.35 | 16 |
| Chromosome analysis 50-100 CPT 88248 | $225.72 | $342.00 | $173.17 – $389.63 | 16 |
| Chromosome count additional CPT 88285 | $46.86 | $71.00 | $26.72 – $60.55 | 16 |
| Chromosome karyotype study CPT 88280 | $217.14 | $329.00 | $33.47 – $75.31 | 16 |
| Chromosome study additional CPT 88289 | $240.24 | $364.00 | $34.43 – $77.47 | 16 |
| Chronic urticaria - sendout CPT 86343 | $163.68 | $248.00 | $12.46 – $28.04 | 16 |
| Chylomicron screen, bf - sendout CPT 82664 | $180.18 | $273.00 | $48.31 – $138.38 | 16 |
| Cine/video x-rays CPT 76120 | $335.94 | $509.00 | $24.82 – $456.60 | 16 |
| Ciprofloxacin 400 mg/200 ml in 5 % dextrose intravenous piggyback HCPCS J0744 | $27.26 | $41.30 | $3.15 – $3.58 | 5 |
| Circum 28 days or older CPT 54161 | not published | not published | not published | 0 |
| Circumcision (newborn) CPT 54150 | $1,364.88 | $2,068.00 | $871.34 – $4,592.75 | 14 |
| C-kit mutation liquid tumor - sendout CPT 81272 | $495.00 | $750.00 | $195.07 – $741.40 | 16 |
| Clamp isol transpolr 5mmx6.5cm transpolar HCPCS C1733 | $14,685.00 | $22,250.00 | $4,891.15 – $4,891.15 | 1 |
| Clearance of airways CPT 31720 | $234.96 | $356.00 | $25.49 – $481.11 | 14 |
| Clindamycin 600 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J0736 | $40.35 | $61.13 | $3.15 – $4.06 | 5 |
| Clonidine (pf) 1,000 mcg/10 ml (100 mcg/ml) epidural solution HCPCS J0735 | $126.85 | $192.20 | $28.43 – $30.84 | 5 |
| Closed carpo/metacarpal disl thumb w/manip CPT 26641 | $638.88 | $968.00 | $203.37 – $541.95 | 14 |
| Closed carpo/metacarpal fx disl thumb w/manip CPT 26645 | $1,848.66 | $2,801.00 | $203.37 – $3,532.89 | 14 |
| Closed tx humerus fx with manip 23605 CPT 23605 | $3,575.88 | $5,418.00 | $203.37 – $3,532.89 | 14 |
| Closed tx humerus fx w/manip 24505 CPT 24505 | $1,848.66 | $2,801.00 | $203.37 – $3,532.89 | 14 |
| Closed tx metatarsophalangeal jnt disl without anes CPT 28630 | $593.34 | $899.00 | $203.37 – $541.95 | 14 |
| Closed tx post hip arthroplasty disloc w/anes 27266 CPT 27266 | $1,848.66 | $2,801.00 | $426.70 – $3,532.89 | 14 |
| Close lac/mouth vest/2.5 cm or < 40830 CPT 40830 | $583.44 | $884.00 | $74.89 – $520.38 | 14 |
| Clos txnose fx without stablz 21315 CPT 21315 | $2,895.42 | $4,387.00 | $203.37 – $3,408.96 | 14 |
| Closure intestinal cutaneous fistula 44640 CPT 44640 | $203.28 | $308.00 | $308.00 – $1,687.54 | 7 |
| Closure laceration vestibule mouth > 2.5 cm cmplx CPT 40831 | $1,121.34 | $1,699.00 | $526.64 – $1,184.95 | 14 |
| Clot factor xii hageman CPT 85280 | $108.90 | $165.00 | $19.35 – $43.54 | 16 |
| Clot factor xiii fibrin scrn CPT 85291 | $49.50 | $75.00 | $9.11 – $20.50 | 16 |
| Clot factor xiii fibrin stab CPT 85290 | $106.26 | $161.00 | $16.34 – $36.77 | 16 |
| Clsd/shoulder dislo/manip/no anest 23650 CPT 23650 | $819.72 | $1,242.00 | $203.37 – $541.95 | 14 |
| Clsd tx carpo/metacarpl disl thmb manip ea without anes CPT 26670 | $510.18 | $773.00 | $203.37 – $541.95 | 14 |
| Clsd tx/dis phalan fx without manip/ea 26750 CPT 26750 | not published | not published | not published | 0 |
| Clsd tx dist fib fx w/manip 27788 CPT 27788 | $503.58 | $763.00 | $203.37 – $541.95 | 14 |
| Clsd tx elbow dislocation child 24640 CPT 24640 | $483.78 | $733.00 | $203.37 – $541.95 | 14 |
| Clsd tx/fem shaft fx/manipulation 27502 CPT 27502 | $3,729.00 | $5,650.00 | $203.37 – $3,532.89 | 14 |
| Clsd tx/fx/phalanx/phalang/manip 28515 CPT 28515 | $568.26 | $861.00 | $203.37 – $541.95 | 14 |
| Clsd tx fx radius/ulna dist without manip 25600 CPT 25600 | $551.10 | $835.00 | $203.37 – $541.95 | 14 |
| Clsd tx fx radius/ulna dist w/manip 25605 CPT 25605 | $1,607.10 | $2,435.00 | $203.37 – $3,532.89 | 14 |
| Clsd tx fx radius/ulna w/manip 25565 CPT 25565 | $1,607.10 | $2,435.00 | $101.68 – $1,766.45 | 14 |
| Clsd tx hip disloc without anes 27265 CPT 27265 | $780.78 | $1,183.00 | $203.37 – $541.95 | 14 |
| Clsd tx/metacarpal fx/sg without manip 26600 CPT 26600 | $467.28 | $708.00 | $203.37 – $541.95 | 14 |
| Clsd tx/metacarpal fx/sng/w manip 26605 CPT 26605 | $613.14 | $929.00 | $203.37 – $541.95 | 14 |
| Clsd tx metatarsal fracture w/manip 28475 CPT 28475 | $549.78 | $833.00 | $203.37 – $541.95 | 14 |
| Clsd tx/nasal bone fx/stabilize 21320 CPT 21320 | not published | not published | not published | 0 |
| Clsd tx of ankle fracture w/manip 28435 CPT 28435 | $3,711.84 | $5,624.00 | $203.37 – $3,532.89 | 14 |
| Clsd tx patella disloc without anes 27560 CPT 27560 | $662.64 | $1,004.00 | $203.37 – $541.95 | 14 |
| Clsd tx shoulder dislc/fx 23665 CPT 23665 | $4,019.40 | $6,090.00 | $203.37 – $3,532.89 | 14 |
| Clsd tx/shoulder dislo/manip/anest 23655 CPT 23655 | $1,848.66 | $2,801.00 | $426.70 – $3,532.89 | 14 |
| Clsd tx temporomandibular dislocat 21480 CPT 21480 | $424.38 | $643.00 | $74.89 – $541.95 | 14 |
| Clsd tx toe dislocation without anes28660 CPT 28660 | $614.46 | $931.00 | $203.37 – $541.95 | 14 |
| Clsd tx trimall ankle fx w/manip 27818 CPT 27818 | $1,848.66 | $2,801.00 | $203.37 – $3,532.89 | 14 |
| Clsd tx wrist ulnar styloid fx 25650 CPT 25650 | $475.20 | $720.00 | $203.37 – $541.95 | 14 |
| Clsd/ulnar fx/prox end without manip 24670 CPT 24670 | $512.16 | $776.00 | $203.37 – $541.95 | 14 |
| Cltx lunate dislc w/mnpj CPT 25690 | $3,837.90 | $5,815.00 | $203.37 – $3,532.89 | 14 |
| Cltx mndblr fx ntrdntl fixj CPT 21453 | not published | not published | not published | 0 |
| Cltx tmprmand dislc comp CPT 21485 | $3,732.96 | $5,656.00 | $426.70 – $3,408.96 | 14 |
| C motor evoked lwr limbs CPT 95929 | $613.14 | $929.00 | $58.61 – $819.86 | 16 |
| C motor evoked upr&lwr limbs CPT 95939 | $1,034.88 | $1,568.00 | $58.61 – $1,886.72 | 16 |
| #cmvcul-virus inoculation shell CPT 87254 | $129.36 | $196.00 | $7.06 – $44.01 | 16 |
| Cmv pcr-sendout CPT 87496 | $256.74 | $389.00 | $35.09 – $78.95 | 16 |
| Cnbp gene detc abnor allele CPT 81187 | $368.94 | $559.00 | $109.60 – $308.25 | 16 |
| Co2 monitor per day CPT 94681 | $677.16 | $1,026.00 | $45.62 – $819.86 | 16 |
| Coagulation time activated teg CPT 85347 | $59.40 | $90.00 | $4.28 – $9.63 | 16 |
| Cold agglutinin screen (arc) CPT 86156 | $122.10 | $185.00 | $8.07 – $18.16 | 16 |
| Cold agglutinin titer CPT 86157 | $9.24 | $14.00 | $8.06 – $18.14 | 16 |
| Collar cerv 18.25x3.5in serp firm density sm HCPCS L0120 | $50.16 | $76.00 | $41.21 – $92.72 | 9 |
| Collar cerv adlt perfit ace extric HCPCS L0140 | $145.20 | $220.00 | $102.85 – $231.41 | 9 |
| Collar cerv ascend 172 reg HCPCS L0172 | $213.84 | $324.00 | $204.04 – $459.09 | 9 |
| Collar cerv patriot adlt HCPCS L0150 | $93.06 | $141.00 | $133.43 – $300.22 | 9 |
| Collection blood specimen from completely implantable venous access device CPT 36591 | $129.36 | $196.00 | $33.22 – $292.32 | 16 |
| Collection blood specimen using established central/peripheral catheter venous nos CPT 36592 | $129.36 | $196.00 | $33.22 – $292.32 | 16 |
| Collection of venous blood by venipuncture CPT 36415 | $33.00 | $50.00 | $1.19 – $21.02 | 16 |
| Colonoscopy (diagnostic) CPT 45378 | not published | not published | not published | 0 |
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.