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 |
|---|---|---|---|---|
| CT angio pelvis CPT 72191 | $1,818.96 | $2,756.00 | $164.22 – $1,215.09 | 16 |
| Cta upper extremity w &/or without contrast left CPT 73206 | $1,818.96 | $2,756.00 | $164.22 – $1,215.09 | 16 |
| CT colonography dx CPT 74261 | $1,119.36 | $1,696.00 | $47.18 – $1,215.09 | 16 |
| CT guidance for needle placement CPT 77012 | $1,263.24 | $1,914.00 | $36.40 – $1,273.00 | 11 |
| CT guidance for percutaneous drain w/catheter placement supervision & interpretation CPT 75989 | $1,215.06 | $1,841.00 | $89.39 – $495.60 | 11 |
| CT guid cryo ablat intramuscular CPT 20999 | not published | not published | not published | 0 |
| CT guid parench tis ablat CPT 77013 | $1,189.32 | $1,802.00 | $36.40 – $1,273.00 | 11 |
| CT hrt c+ strux cgen hrt ds CPT 75573 | $1,259.28 | $1,908.00 | $134.40 – $1,215.09 | 16 |
| CT hrt w/3d image CPT 75572 | $1,448.04 | $2,194.00 | $134.40 – $1,308.14 | 16 |
| CT limited or localized follow-up study CPT 76380 | $769.56 | $1,166.00 | $47.18 – $1,166.00 | 16 |
| CT lower extremity w/contrast (both sides) CPT 73701 | $1,574.76 | $2,386.00 | $134.40 – $1,215.09 | 16 |
| CT lower extremity without contrast (both sides) CPT 73700 | $1,430.88 | $2,168.00 | $47.18 – $1,215.09 | 16 |
| CT lwr extremity w/o&w/dye CPT 73702 | $1,818.96 | $2,756.00 | $134.40 – $1,215.09 | 16 |
| CT neck soft tissue w/contrast CPT 70491 | $1,595.22 | $2,417.00 | $134.40 – $1,215.09 | 16 |
| CT neck soft tissue without contrast CPT 70490 | $1,259.28 | $1,908.00 | $47.18 – $1,215.09 | 16 |
| CT neck soft tissue without & w/contrast CPT 70492 | $2,091.54 | $3,169.00 | $134.40 – $1,215.09 | 16 |
| CT orbit/sella/fossa w/wo contrast CPT 70482 | $1,818.96 | $2,756.00 | $134.40 – $1,215.09 | 16 |
| CT orbit/sella/ or posterior outer inner or middle ear w/contrast CPT 70481 | $1,770.12 | $2,682.00 | $134.40 – $1,215.09 | 16 |
| CT orbit/sella/ or posterior outer inner or middle ear without contrast CPT 70480 | $1,351.02 | $2,047.00 | $47.18 – $1,215.09 | 16 |
| Ctrl nosebld postir subsq 30906 CPT 30906 | $322.74 | $489.00 | $74.89 – $520.38 | 14 |
| CT scan for localization CPT 77011 | $1,189.32 | $1,802.00 | $36.40 – $1,273.00 | 11 |
| CT scan for therapy guide CPT 77014 | $1,189.32 | $1,802.00 | $36.40 – $1,273.00 | 11 |
| CT Scan of Abdomen and Pelvis (with and without contrast) CPT 74178 | $3,550.14 | $5,379.00 | $134.40 – $1,215.09 | 16 |
| CT Scan of Abdomen and Pelvis (with contrast) CPT 74177 | $3,016.86 | $4,571.00 | $67.20 – $1,215.09 | 16 |
| CT Scan of Abdomen and Pelvis (without contrast) CPT 74176 | $2,544.96 | $3,856.00 | $93.20 – $1,215.09 | 16 |
| CT thoracic spine w/contrast CPT 72129 | $1,539.12 | $2,332.00 | $134.40 – $1,215.09 | 16 |
| CT thoracic spine without contrast CPT 72128 | $1,448.04 | $2,194.00 | $47.18 – $1,215.09 | 16 |
| CT thorax low dose for lung screening without contrast CPT 71271 | $769.56 | $1,166.00 | $40.83 – $1,166.00 | 16 |
| CT t-spine w /wo contrast CPT 72130 | $1,818.96 | $2,756.00 | $134.40 – $1,215.09 | 16 |
| CT upper extremity w/contrast (both sides) CPT 73201 | $1,770.12 | $2,682.00 | $134.40 – $1,215.09 | 16 |
| CT upper extremity without contrast (both sides) CPT 73200 | $1,335.18 | $2,023.00 | $47.18 – $1,215.09 | 16 |
| CT uppr extremity w/o&w/dye CPT 73202 | $1,846.68 | $2,798.00 | $134.40 – $1,215.09 | 16 |
| Culture aerobic additional method definitive id each CPT 87077 | $59.40 | $90.00 | $8.08 – $18.18 | 16 |
| Culture afb any source CPT 87116 | $143.22 | $217.00 | $10.80 – $24.30 | 16 |
| Culture anaerobic additional method definitive id each CPT 87076 | $59.40 | $90.00 | $8.08 – $18.18 | 16 |
| Culture anaerobic except blood CPT 87075 | $89.10 | $135.00 | $9.47 – $21.31 | 16 |
| Culture bact stool aero addl path ea CPT 87046 | $59.40 | $90.00 | $3.40 – $21.24 | 16 |
| Culture body fluid CPT 87070 | $237.60 | $360.00 | $8.62 – $19.40 | 16 |
| Culture fungi definitive id mold CPT 87107 | $68.64 | $104.00 | $10.32 – $23.22 | 16 |
| Culture fungi definitive id yeast CPT 87106 | $117.48 | $178.00 | $10.32 – $23.22 | 16 |
| Culture fungi other (except blood) CPT 87102 | $68.64 | $104.00 | $8.41 – $18.92 | 16 |
| Culture fungi skin/hair/nail CPT 87101 | $118.14 | $179.00 | $7.71 – $17.35 | 16 |
| Culture mycobacteria definitive id each isolate CPT 87118 | $138.60 | $210.00 | $14.61 – $32.87 | 16 |
| Culture mycoplasma any source CPT 87109 | $79.86 | $121.00 | $14.01 – $34.63 | 16 |
| Culture screening strep group a CPT 87081 | $49.50 | $75.00 | $6.63 – $14.92 | 16 |
| Culture typing glc/hplc CPT 87143 | $97.68 | $148.00 | $12.52 – $28.17 | 16 |
| Culture typing immunologic CPT 87147 | $117.48 | $178.00 | $5.18 – $11.66 | 16 |
| Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets CPT 87154 | $483.78 | $733.00 | $12.05 – $490.64 | 16 |
| Culture typing nucleic acid probe amplified per culture/isolate each organism CPT 87150 | $219.78 | $333.00 | $35.09 – $78.95 | 16 |
| Culture urine each isolate CPT 87088 | $59.40 | $90.00 | $8.09 – $18.20 | 16 |
| Cutter lead HCPCS C1773 | $390.72 | $592.00 | $325.60 – $325.60 | 1 |
| Cv line/pic reposition CPT 36597 | $1,878.36 | $2,846.00 | $325.87 – $3,458.55 | 14 |
| Cyanocobalamin unsat binding capacity CPT 82608 | $13.20 | $20.00 | $14.32 – $32.22 | 16 |
| Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution HCPCS J3420 | $35.51 | $53.80 | $1.06 – $1.89 | 5 |
| Cyclic citrullinated peptide antibody CPT 86200 | $89.10 | $135.00 | $12.95 – $29.14 | 16 |
| Cyclosporine 2 hour CPT 80158 | $69.96 | $106.00 | $18.05 – $40.61 | 16 |
| Cyclosporine modified 25 mg capsule HCPCS J7515 | $5.28 | $8.00 | $0.87 – $1.36 | 5 |
| Cyp2d6 gene com variants CPT 81226 | $1,585.32 | $2,402.00 | $128.83 – $1,014.55 | 16 |
| Cystatin c CPT 82610 | $99.00 | $150.00 | $18.52 – $41.67 | 16 |
| Cystine urine quantitative CPT 82131 | $136.62 | $207.00 | $21.01 – $51.71 | 16 |
| Cystogram >= 3 views supervision & interpretation CPT 74430 | $785.40 | $1,190.00 | $51.15 – $766.50 | 16 |
| Cysto rx balo cath urtl strx CPT 52284 | not published | not published | not published | 0 |
| Cystoscopy and treatment CPT 52234 | not published | not published | not published | 0 |
| Cystoscopy and treatment CPT 52235 | not published | not published | not published | 0 |
| Cystoscopy and treatment CPT 52240 | not published | not published | not published | 0 |
| Cystoscopy and treatment CPT 52276 | not published | not published | not published | 0 |
| Cystoscopy and treatment CPT 52310 | $3,036.66 | $4,601.00 | $688.39 – $4,592.75 | 14 |
| Cystoscopy and treatment CPT 52315 | not published | not published | not published | 0 |
| Cystoscopy and treatment CPT 52320 | not published | not published | not published | 0 |
| Cystoscopy (Bladder Scope) CPT 52000 | $1,171.50 | $1,775.00 | $95.40 – $1,532.02 | 14 |
| Cystoscopy chemodenervation CPT 52287 | not published | not published | not published | 0 |
| Cystoscopy removal of clots CPT 52001 | not published | not published | not published | 0 |
| Cystoscopy & ureter catheter CPT 52005 | not published | not published | not published | 0 |
| Cystostomy cystotomy w/drainage 51040 CPT 51040 | not published | not published | not published | 0 |
| Cystouretero & or pyeloscope CPT 52351 | not published | not published | not published | 0 |
| Cystouretero w/biopsy CPT 52354 | not published | not published | not published | 0 |
| Cystouretero w/excise tumor CPT 52355 | not published | not published | not published | 0 |
| Cysto/uretero w/lithotripsy CPT 52356 | not published | not published | not published | 0 |
| Cystouretero w/stone remove CPT 52352 | not published | not published | not published | 0 |
| Cystourethroscop/calib/dilat stric 52281 CPT 52281 | $3,641.22 | $5,517.00 | $688.39 – $4,592.75 | 14 |
| Cystourethroscopy w/biopsy(s) 52204 CPT 52204 | not published | not published | not published | 0 |
| Cytogenetics 25-99 CPT 88274 | $173.58 | $263.00 | $42.38 – $95.36 | 16 |
| Cytogenetics 3-5 CPT 88272 | $262.68 | $398.00 | $35.62 – $91.58 | 16 |
| Cytogenomic neo microra alys CPT 81277 | $3,093.42 | $4,687.00 | $928.00 – $2,610.00 | 16 |
| Cytogenom microarray copy nmbr var CPT 81228 | $2,001.78 | $3,033.00 | $516.91 – $2,025.00 | 16 |
| Cytomegalovirus (cmv) antibody igg CPT 86644 | $99.00 | $150.00 | $14.39 – $32.38 | 16 |
| Cytomegalovirus (cmv) antibody igm CPT 86645 | $89.10 | $135.00 | $8.17 – $37.91 | 16 |
| Cytopath c/v index add-on CPT 88155 | $40.26 | $61.00 | $8.42 – $32.96 | 16 |
| Cytopath c/v manual CPT 88150 | $71.94 | $109.00 | $14.86 – $41.72 | 16 |
| Cytopathology cellular enhancement technique non-gyn CPT 88112 | $168.30 | $255.00 | $11.76 – $153.00 | 16 |
| Cytopathology cervical/vaginal thin layer manual screening CPT 88142 | $139.26 | $211.00 | $20.26 – $45.59 | 16 |
| Cytopathology concentration technique smears & interpretation CPT 88108 | $217.80 | $330.00 | $11.76 – $198.00 | 16 |
| Cytopathology fluids/washings/brushings smears with interpretation CPT 88104 | $148.50 | $225.00 | $11.76 – $135.00 | 16 |
| Cytopathology fna adequacy evaluation each separate additional episode same site CPT 88177 | $89.76 | $136.00 | $9.76 – $81.60 | 11 |
| Cytopathology fna adequacy evaluation first episode each site CPT 88172 | $198.00 | $300.00 | $64.25 – $374.32 | 16 |
| Cytopathology fna adequacy evaluation first episode each site interp/rpt CPT 88173 | $357.72 | $542.00 | $36.94 – $325.20 | 16 |
| Cytopath smear other source CPT 88160 | $168.30 | $255.00 | $11.76 – $153.00 | 16 |
| Cytopath smear other source CPT 88162 | $248.16 | $376.00 | $11.76 – $225.60 | 16 |
| Cytopath tbs c/v manual CPT 88164 | $61.38 | $93.00 | $14.86 – $41.72 | 16 |
| Cytotoxic antibody screening CPT 86807 | $357.72 | $542.00 | $55.65 – $176.96 | 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.