HSHS St. Vincent Hospital
835 S. Van Buren St., Green Bay, WI · Hshs · · NPI 1114908001
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 |
|---|---|---|---|---|
| Sulfonylurea screen qn-sendout CPT 80377 | $157.74 | $239.00 | $5.17 – $143.40 | 10 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $58.48 | $88.60 | $37.20 – $81.20 | 2 |
| Support clav 29.6-40.5in med HCPCS L3650 | $115.50 | $175.00 | $99.48 – $223.83 | 9 |
| Surg dx exam anorectal CPT 45990 | not published | not published | not published | 0 |
| Surgery to stop leg growth CPT 27475 | not published | not published | not published | 0 |
| Surgery to stop leg growth CPT 27485 | not published | not published | not published | 0 |
| Surgical pathology level 1 gross examination only CPT 88300 | $97.02 | $147.00 | $14.77 – $88.20 | 16 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $198.66 | $301.00 | $14.77 – $180.60 | 16 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $248.16 | $376.00 | $14.77 – $225.60 | 16 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $297.66 | $451.00 | $14.77 – $270.60 | 16 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $974.16 | $1,476.00 | $60.31 – $885.60 | 16 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $1,391.94 | $2,109.00 | $60.31 – $1,760.81 | 16 |
| Surg tx anal fistula 2nd stage 46285 CPT 46285 | not published | not published | not published | 0 |
| Susceptibility agar dilution per agent CPT 87181 | $68.64 | $104.00 | $4.75 – $10.69 | 16 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $49.50 | $75.00 | $4.75 – $10.69 | 16 |
| Susceptibility mic per plate CPT 87186 | $356.40 | $540.00 | $8.65 – $19.46 | 16 |
| Suscept studies macrobroth dilution ea CPT 87188 | $143.88 | $218.00 | $6.64 – $14.94 | 16 |
| Svc venogram s&i CPT 75827 | $2,383.26 | $3,611.00 | $128.86 – $3,440.31 | 16 |
| Sweat collection by iontophoresis CPT 89230 | $155.76 | $236.00 | $4.52 – $141.60 | 16 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $42.24 | $64.00 | $4.40 – $9.90 | 16 |
| T3 (triiodothyronine) free CPT 84481 | $143.88 | $218.00 | $16.62 – $38.12 | 16 |
| T3 (triiodothyronine) total CPT 84480 | $89.76 | $136.00 | $14.18 – $31.91 | 16 |
| T4 (thyroxine) free CPT 84439 | $54.12 | $82.00 | $9.02 – $20.30 | 16 |
| T4 (thyroxine) total CPT 84436 | $31.68 | $48.00 | $6.87 – $15.46 | 16 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $10.02 | $15.18 | $0.33 – $0.41 | 5 |
| Tacrolimus therapeutic drug level CPT 80197 | $77.88 | $118.00 | $13.73 – $30.89 | 16 |
| Target gsa panel hmtlmph neop CPT 81450 | $1,954.92 | $2,962.00 | $607.62 – $1,708.94 | 16 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | $4,368.54 | $6,619.00 | $2,335.68 – $6,569.10 | 16 |
| Tarlatamab-dlle 10 mg intravenous solution HCPCS J9026 | $2,862.29 | $4,336.80 | $1,566.59 – $3,524.82 | 11 |
| Tavr perq femoral CPT 33361 | $10,479.48 | $15,878.00 | $6,613.46 – $7,010.27 | 7 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | $997.66 | $1,511.60 | $0.25 – $91.46 | 16 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $295.02 | $447.00 | $90.12 – $225.00 | 16 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $415.14 | $629.00 | $61.98 – $139.46 | 16 |
| Tc-99m non-heu per study dose HCPCS Q9969 | $11.88 | $18.00 | $16.50 – $16.50 | 1 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $316.80 | $480.00 | $46.98 – $105.71 | 16 |
| T cells absolute cd 4 count CPT 86361 | $172.92 | $262.00 | $26.78 – $60.26 | 16 |
| T cells total count CPT 86359 | $268.62 | $407.00 | $37.73 – $84.89 | 16 |
| Team conf without pat by hc pro CPT 99368 | $112.86 | $171.00 | $52.84 – $171.00 | 5 |
| Team conf w/pat by hc prof CPT 99366 | $112.86 | $171.00 | $52.84 – $171.00 | 5 |
| Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution HCPCS J9274 | $39,522.98 | $59,883.30 | $222.21 – $7,661.98 | 16 |
| Telehealth original site facility fee HCPCS Q3014 | $197.34 | $299.00 | $6.46 – $71.66 | 14 |
| Telethx isodose plan cplx CPT 77307 | $2,457.84 | $3,724.00 | $85.50 – $2,025.50 | 16 |
| Telethx isodose plan simple CPT 77306 | $580.80 | $880.00 | $55.06 – $880.00 | 16 |
| Temozolomide HCPCS J8700 | $32.46 | $49.18 | $0.39 – $0.97 | 5 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $322.00 | $487.88 | $186.97 – $487.88 | 16 |
| Terbutaline 1 mg/ml subcutaneous solution HCPCS J3105 | $95.96 | $145.40 | $4.08 – $6.22 | 5 |
| Tert gene targeted seq alys CPT 81345 | $1,178.76 | $1,786.00 | $185.20 – $416.70 | 16 |
| Test stress cardiovascular tracing only CPT 93017 | $990.66 | $1,501.00 | $37.98 – $795.27 | 16 |
| Test urine urobilinogen CPT 84578 | $20.46 | $31.00 | $4.47 – $10.06 | 16 |
| Tetanus immune globulin inj HCPCS J1670 | $1,619.54 | $2,453.85 | $86.29 – $1,324.22 | 16 |
| Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe HCPCS J2356 | $40.37 | $61.17 | $17.82 – $61.17 | 16 |
| Tgsap so/hl 51/< rna alys CPT 81456 | $4,899.18 | $7,423.00 | $866.06 – $6,569.10 | 16 |
| Tgsap so neo 5-50 rna alys CPT 81449 | $2,178.00 | $3,300.00 | $597.91 – $1,345.30 | 16 |
| Theophylline therapeutic drug level CPT 80198 | $69.30 | $105.00 | $14.14 – $31.82 | 16 |
| Therapeutic procd strg endur HCPCS G0237 | $79.20 | $120.00 | $15.65 – $90.89 | 16 |
| Ther fx nasal inf turbinate CPT 30930 | not published | not published | not published | 0 |
| Ther nma rdctj intus/obstrcj CPT 74283 | $704.22 | $1,067.00 | $54.25 – $456.60 | 16 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | $32.34 | $49.00 | $2.99 – $3.30 | 5 |
| Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides) CPT 32555 | $1,364.88 | $2,068.00 | $206.23 – $1,370.97 | 16 |
| Thoracotomy with cardiac massage CPT 32160 | $2,088.24 | $3,164.00 | $2,314.78 – $2,453.67 | 7 |
| Thor rib belt custom fabrica HCPCS L0220 | $128.04 | $194.00 | $165.81 – $373.07 | 9 |
| Throat x-ray & fluoroscopy CPT 70370 | $616.44 | $934.00 | $25.74 – $456.60 | 16 |
| Thrombectmy crnry perq mechanical CPT 92973 | $3,218.82 | $4,877.00 | $3,759.01 – $3,984.55 | 7 |
| Thrombectomy/inf pq dialysis circuit CPT 36904 | $10,075.56 | $15,266.00 | $1,688.84 – $12,438.90 | 14 |
| Thrombectomy/inf pq dialysis circuit w/pta CPT 36905 | $20,413.80 | $30,930.00 | $2,832.02 – $25,229.80 | 14 |
| Thrombectomy/inf pq dialysis circuit w/stent plcmnt CPT 36906 | $32,652.84 | $49,474.00 | $4,903.29 – $40,063.76 | 14 |
| Thromb/endar/neck inc/car/vert/subc35301 CPT 35301 | not published | not published | not published | 0 |
| Thrombin time CPT 85670 | $89.10 | $135.00 | $1.65 – $12.98 | 16 |
| Thromboplastin inhibition CPT 85705 | $49.50 | $75.00 | $8.17 – $21.67 | 16 |
| Thromboplastin time partial (ptt) substitution fractions each CPT 85732 | $68.64 | $104.00 | $6.47 – $14.56 | 16 |
| Thyroglobulin antibody CPT 86800 | $108.90 | $165.00 | $15.91 – $35.80 | 16 |
| Thyroid imaging CPT 78013 | $694.98 | $1,053.00 | $168.45 – $1,053.00 | 16 |
| Thyroid mets imag whole body CPT 78018 | $1,493.58 | $2,263.00 | $168.45 – $1,246.46 | 16 |
| Thyroid met uptake CPT 78020 | $365.64 | $554.00 | $168.45 – $554.00 | 10 |
| Thyroid (TSH) Test CPT 84443 | $99.00 | $150.00 | $16.80 – $37.80 | 16 |
| Thyroid Ultrasound CPT 76536 | $552.42 | $837.00 | $25.05 – $521.52 | 16 |
| Thyroid uptake measurement CPT 78012 | $463.98 | $703.00 | $168.45 – $873.70 | 16 |
| Thyrotropin alfa 0.9 mg intramuscular solution HCPCS J3240 | $3,923.73 | $5,945.05 | $443.32 – $4,782.68 | 16 |
| Thyroxine binding globulin (tbg) CPT 84442 | $65.34 | $99.00 | $14.78 – $33.26 | 16 |
| Tib/per revasc stent & ather 37231 CPT 37231 | $20,739.84 | $31,424.00 | $4,903.29 – $5,197.49 | 7 |
| Tib/per revasc stnt & ather CPT 37235 | $8,332.50 | $12,625.00 | $4,903.29 – $5,197.49 | 7 |
| Tib/per revasc w/ather add-on 37233 CPT 37233 | $5,332.80 | $8,080.00 | $4,903.29 – $5,197.49 | 7 |
| Tilt table study CPT 93660 | $1,745.04 | $2,644.00 | $75.96 – $815.54 | 14 |
| Tisotumab vedotin-tftv 40 mg intravenous solution HCPCS J9273 | $349.04 | $528.85 | $196.07 – $528.85 | 16 |
| Tissue culture placenta CPT 88235 | $483.78 | $733.00 | $70.04 – $338.18 | 16 |
| Tissue culture skin/biopsy CPT 88233 | $735.24 | $1,114.00 | $70.04 – $316.64 | 16 |
| Tissue culture tumor CPT 88239 | $520.74 | $789.00 | $70.04 – $331.92 | 16 |
| Tissue exam koh skin/hair/nails CPT 87220 | $47.52 | $72.00 | $4.27 – $9.61 | 16 |
| Tissue matrix xcm thk 20x30cm -cost per sq cm HCPCS Q4142 | $444.99 | $674.22 | $120.88 – $271.97 | 9 |
| Tissue transglutaminase iga CPT 86364 | $32.34 | $49.00 | $11.53 – $25.94 | 16 |
| Tixagev and cilgav inj HCPCS M0220 | $80.52 | $122.00 | $122.00 – $129.32 | 7 |
| Tlh uterus 250 g or less CPT 58570 | not published | not published | not published | 0 |
| Tlh uterus over 250 g CPT 58572 | not published | not published | not published | 0 |
| Tlh w/t/o 250 g or less CPT 58571 | not published | not published | not published | 0 |
| Tlh w/t/o uterus over 250 g CPT 58573 | not published | not published | not published | 0 |
| Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr HCPCS J3260 | $32.34 | $49.00 | $3.42 – $4.06 | 5 |
| Tobramycin peak therapeutic drug level CPT 80200 | $77.88 | $118.00 | $16.13 – $36.29 | 16 |
| Tocilizumab 162 mg/0.9 ml subcutaneous pen injector HCPCS J3262 | $17.88 | $27.09 | $5.61 – $27.09 | 16 |
| Tongue biopsy; posterior one-third 41105 CPT 41105 | not published | not published | not published | 0 |
| Tonsillectomy (age 12+) CPT 42826 | 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.