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 |
|---|---|---|---|---|
| Cytotoxic antibody screening CPT 86808 | $76.56 | $116.00 | $29.68 – $66.78 | 16 |
| Cytp urine 3-5 probes cmptr CPT 88121 | $522.06 | $791.00 | $65.34 – $474.60 | 16 |
| Daptomycin 500 mg/10 ml intravenous solution HCPCS J0878 | $2.22 | $3.37 | $0.03 – $0.05 | 5 |
| Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe HCPCS J0881 | $1,158.60 | $1,755.45 | $3.02 – $212.90 | 16 |
| Dch glucoscan CPT 82948 | $13.86 | $21.00 | $4.45 – $11.34 | 16 |
| Dcm pq ndl dsk sgl/mlt lv lmbr w/guide CPT 62287 | $7,118.76 | $10,786.00 | $456.60 – $4,290.30 | 16 |
| Deamidated gliadin antibody iga CPT 86258 | $28.38 | $43.00 | $11.53 – $27.11 | 16 |
| Debridement (>20 cm) charge pt CPT 97598 | $180.84 | $274.00 | $35.14 – $274.00 | 15 |
| Debridement bone <= 20 sq cm CPT 11044 | not published | not published | not published | 0 |
| Debridement subcutaneous tissue <= 20 sq cm CPT 11042 | $533.28 | $808.00 | $95.40 – $893.15 | 14 |
| Debride skin bone at fx site CPT 11012 | not published | not published | not published | 0 |
| Debride/subq tissue/ea add 20sq cm 11045 CPT 11045 | not published | not published | not published | 0 |
| Debr musc/fascia 20sq cm/< 11043 CPT 11043 | $988.02 | $1,497.00 | $95.40 – $1,623.80 | 14 |
| Decalcification CPT 88311 | $79.86 | $121.00 | $10.16 – $72.60 | 11 |
| Declotting thrombolytic agent implanted vas access device 36 CPT 36593 | $583.44 | $884.00 | $95.40 – $725.71 | 14 |
| Delayed breast prosthesis 19342 CPT 19342 | not published | not published | not published | 0 |
| Delivery of placenta 59414 CPT 59414 | $3,672.24 | $5,564.00 | $748.81 – $7,112.24 | 14 |
| Delivery transcath fxtn dvc to endogrft w/s&i CPT 34712 | $748.44 | $1,134.00 | $1,134.00 – $7,257.52 | 7 |
| Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution HCPCS J0897 | $60.65 | $91.90 | $29.46 – $408.31 | 16 |
| Dentoalveolar/drain abs/cyst/hema 41800 CPT 41800 | $384.78 | $583.00 | $74.89 – $292.32 | 14 |
| Descend thora aorta rpr/lt sub art 33880 CPT 33880 | $17,216.76 | $26,086.00 | $7,257.52 – $7,692.97 | 7 |
| Design mlc device for imrt CPT 77338 | $2,045.34 | $3,099.00 | $82.46 – $2,025.50 | 16 |
| Desmopressin 4 mcg/ml injection solution HCPCS J2597 | $98.82 | $149.73 | $5.63 – $54.29 | 11 |
| Desoxycorticosterone CPT 82633 | $184.14 | $279.00 | $30.98 – $69.71 | 16 |
| Des thora aorta/ea add prox prosth 33884 CPT 33884 | $2,769.36 | $4,196.00 | $4,196.00 – $7,257.52 | 7 |
| Des thora aorta rpr without left sub art 33881 CPT 33881 | $17,216.76 | $26,086.00 | $7,257.52 – $7,692.97 | 7 |
| Des thor aorta/prox ext prosth/ini 33883 CPT 33883 | $2,469.72 | $3,742.00 | $3,742.00 – $7,257.52 | 7 |
| Device ablt adv novasure HCPCS C1886 | $3,335.64 | $5,054.00 | $244.75 – $244.75 | 1 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $544.50 | $825.00 | $33.99 – $456.60 | 16 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $1.76 | $2.67 | $0.02 – $0.11 | 5 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $8.09 | $12.25 | $0.18 – $0.20 | 5 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | $69.96 | $106.00 | $9.98 – $12.75 | 2 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $69.96 | $106.00 | $2.86 – $3.13 | 5 |
| Dextrose 5 % IV bolus HCPCS J7070 | $69.96 | $106.00 | $4.85 – $5.71 | 5 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $134.64 | $204.00 | $22.23 – $50.02 | 16 |
| Diabetes (HbA1c) Test CPT 83036 | $62.70 | $95.00 | $9.71 – $21.85 | 16 |
| Diag laparo separate proc 49320 CPT 49320 | not published | not published | not published | 0 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $160.38 | $243.00 | $129.92 – $292.32 | 14 |
| Diagnostic laryngoscopy 31505 CPT 31505 | $344.52 | $522.00 | $74.89 – $438.55 | 14 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $224.40 | $340.00 | $74.89 – $438.55 | 14 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $369.60 | $560.00 | $21.09 – $237.33 | 14 |
| Diagnostic Mammogram (one breast) CPT 77065 | $310.20 | $470.00 | $21.09 – $185.27 | 14 |
| Diagnostic radio unlisted proc CPT 76499 | $212.52 | $322.00 | $24.82 – $322.00 | 16 |
| Dialysis circuit perm vascular embolization 36909 CPT 36909 | $6,662.04 | $10,094.00 | $4,729.17 – $5,012.92 | 7 |
| Dialysis one evaluation CPT 90945 | $489.72 | $742.00 | $343.55 – $916.76 | 14 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | $0.32 | $0.48 | $0.12 – $0.13 | 5 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $59.95 | $90.83 | $9.27 – $11.98 | 5 |
| Dicyclomine injection HCPCS J0500 | $197.90 | $299.85 | $18.69 – $34.56 | 5 |
| Diffusing capacity CPT 94729 | $286.44 | $434.00 | $25.49 – $434.00 | 10 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $670.86 | $1,016.45 | $12.19 – $17.13 | 5 |
| Digoxin total therapeutic drug level CPT 80162 | $114.18 | $173.00 | $13.28 – $29.88 | 16 |
| Dilate biliary duct/ampulla CPT 47542 | $2,312.64 | $3,504.00 | $252.19 – $2,540.86 | 11 |
| Dilate esophagus CPT 43453 | not published | not published | not published | 0 |
| Dilate esophagus 1/mult pass CPT 43450 | not published | not published | not published | 0 |
| Dilate urethra stricture CPT 53600 | $492.36 | $746.00 | $38.07 – $548.94 | 14 |
| Dilator fascial 10fx20cm HCPCS C2627 | $147.84 | $224.00 | $123.20 – $123.20 | 1 |
| Dilat xst trc ndurlgc px CPT 50436 | $8,539.08 | $12,938.00 | $647.32 – $7,744.68 | 14 |
| Dilat xst trc new access rcs CPT 50437 | $8,714.64 | $13,204.00 | $647.32 – $7,744.68 | 14 |
| Diltiazem 5 mg/ml intravenous solution HCPCS J1163 | $0.65 | $0.98 | $0.05 – $0.05 | 4 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $32.34 | $49.00 | $1.17 – $1.55 | 5 |
| Disability dlco CPT 94727 | $276.54 | $419.00 | $25.49 – $474.40 | 16 |
| Disaccharidases CPT 82657 | $207.24 | $314.00 | $22.17 – $49.88 | 16 |
| Discography cerv/thor spine CPT 72285 | $1,911.36 | $2,896.00 | $150.43 – $4,290.30 | 16 |
| Dlyd plmt xtn prosth ea addl CPT 34711 | $2,469.72 | $3,742.00 | $3,742.00 – $7,257.52 | 7 |
| Dmd dup/delet analysis CPT 81161 | $368.28 | $558.00 | $140.01 – $627.75 | 16 |
| Dmpk gene detc abnor allele CPT 81234 | $368.94 | $559.00 | $109.60 – $308.25 | 16 |
| Dna antibody native/double stranded CPT 86225 | $89.10 | $135.00 | $13.74 – $30.92 | 16 |
| Dna gardnerella CPT 87510 | $138.60 | $210.00 | $20.05 – $45.11 | 16 |
| Dna trichomonas CPT 87660 | $138.60 | $210.00 | $20.05 – $45.11 | 16 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $127.97 | $193.90 | $12.89 – $14.36 | 5 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | $9.75 | $14.78 | $1.32 – $1.43 | 5 |
| Doppler echo complete CPT 93320 | $456.06 | $691.00 | $191.46 – $567.70 | 10 |
| Doppler intravascular pressure flow initial vessel CPT 93571 | $1,496.88 | $2,268.00 | $748.38 – $793.28 | 7 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $582.12 | $882.00 | $73.27 – $474.40 | 16 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $410.52 | $622.00 | $24.16 – $472.83 | 16 |
| Doxycycline hyclate 100 mg intravenous powder for solution HCPCS J1271 | $1.23 | $1.86 | $0.17 – $0.18 | 4 |
| Dpyd gene common variants CPT 81232 | $822.36 | $1,246.00 | $59.04 – $393.32 | 16 |
| Drainage absc/cyst/hmtma/vestibule mouth smpl CPT 40800 | $1,663.86 | $2,521.00 | $528.96 – $1,555.83 | 14 |
| Drainage ext aud canal abscess 69020 CPT 69020 | $1,325.28 | $2,008.00 | $74.89 – $1,555.83 | 14 |
| Drainage external ear complex 69005 CPT 69005 | $1,871.10 | $2,835.00 | $618.42 – $3,628.70 | 14 |
| Drainage external ear simple 69000 CPT 69000 | $812.46 | $1,231.00 | $74.89 – $1,555.83 | 14 |
| Drainage mouth roof lesion CPT 42000 | $460.68 | $698.00 | $74.89 – $520.38 | 14 |
| Drainage of arm bursa 23931 CPT 23931 | $1,871.10 | $2,835.00 | $791.17 – $3,628.70 | 14 |
| Drainage of kidney lesion CPT 50390 | $1,384.02 | $2,097.00 | $178.39 – $1,555.83 | 16 |
| Drainage of mouth lesion CPT 41008 | $167.64 | $254.00 | $254.00 – $7,284.34 | 14 |
| Drainage of nose lesion int 30000 CPT 30000 | $345.84 | $524.00 | $74.89 – $520.38 | 14 |
| Drainage of pelvis lesion 26990 CPT 26990 | not published | not published | not published | 0 |
| Drainage of rectal abscess 45020 CPT 45020 | not published | not published | not published | 0 |
| Drainage of urethra abscess 53060 CPT 53060 | $2,366.10 | $3,585.00 | $1,266.65 – $4,592.75 | 14 |
| Drain blood from under nail 11740 CPT 11740 | $149.16 | $226.00 | $29.40 – $292.32 | 14 |
| Drain cath image guided peri/retroperitoneal transvag/transrectal CPT 49407 | $2,220.24 | $3,364.00 | $318.99 – $3,628.70 | 16 |
| Drain cath image guided visceral pq CPT 49405 | $1,871.10 | $2,835.00 | $318.99 – $3,628.70 | 16 |
| Drain cerebro spinal fluid 62272 CPT 62272 | $819.72 | $1,242.00 | $164.57 – $1,550.88 | 16 |
| Drain finger abscess;simple 26010 CPT 26010 | $395.34 | $599.00 | $72.99 – $440.81 | 14 |
| Drain neck/chest lesion 21501 CPT 21501 | $8,647.98 | $13,103.00 | $1,023.67 – $6,381.90 | 14 |
| Drain penis lesion CPT 54015 | not published | not published | not published | 0 |
| Drain thigh/knee lesion 27301 CPT 27301 | $5,360.52 | $8,122.00 | $791.17 – $6,381.90 | 14 |
| Dress/debride pt-tck burn/5-10% bs 16025 CPT 16025 | $434.28 | $658.00 | $80.58 – $440.81 | 14 |
| Dress/debride pt-thick burn/<5% bs 16020 CPT 16020 | $374.88 | $568.00 | $80.58 – $440.81 | 14 |
| Dress/debrid prtl-thick burn l 16030 CPT 16030 | $524.04 | $794.00 | $168.77 – $893.15 | 14 |
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.