HSHS St. Nicholas Hospital
3100 SUPERIOR AVE, SHEBOYGAN, WI · Hshs · · NPI 1730184342
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 |
|---|---|---|---|---|
| Intraventricular pacing CPT 93612 | $8,764.14 | $13,279.00 | $2,816.70 – $17,162.33 | 14 |
| Intrinsic factor antibody CPT 86340 | $99.00 | $150.00 | $14.28 – $33.93 | 16 |
| Intro cath dialysis circuit CPT 36901 | $3,098.04 | $4,694.00 | $748.38 – $3,463.76 | 14 |
| Intro cath dialysis circuit w/pta CPT 36902 | $10,883.40 | $16,490.00 | $1,628.87 – $12,523.68 | 14 |
| Intro cath dialysis circuit w/stent plcmnt CPT 36903 | $20,413.80 | $30,930.00 | $4,729.17 – $25,401.76 | 14 |
| Intro catheter aorta CPT 36200 | $1,450.68 | $2,198.00 | $302.34 – $320.48 | 7 |
| Intro cath svc/ivc CPT 36010 | $1,139.16 | $1,726.00 | $302.34 – $320.48 | 7 |
| Intro long gi tube CPT 44500 | $518.76 | $786.00 | $36.00 – $1,995.72 | 16 |
| Intro long gi tube w/mult fluo CPT 74340 | $537.24 | $814.00 | $89.39 – $495.60 | 11 |
| Intubation endotracheal emergency procedure CPT 31500 | $1,094.94 | $1,659.00 | $231.63 – $521.16 | 14 |
| Ionm in operatng room 15 min CPT 95940 | $209.22 | $317.00 | $175.00 – $175.00 | 3 |
| Iopamidol 250 mg iodine/ml (51 %) intravenous solution HCPCS Q9966 | $11.01 | $16.68 | $0.60 – $0.72 | 5 |
| Iopamidol 300 mg iodine/ml (61 %) intravenous solution HCPCS Q9967 | $9.75 | $14.77 | $0.23 – $0.27 | 4 |
| Iron CPT 83540 | $39.60 | $60.00 | $6.47 – $14.56 | 16 |
| Iron binding capacity CPT 83550 | $62.04 | $94.00 | $8.74 – $19.67 | 16 |
| Iron sucrose 20 mg iron/ml intravenous solution (wrapper) HCPCS J1756 | $3.07 | $4.65 | $0.39 – $0.43 | 5 |
| Irradiation of blood product each unit reference CPT 86945 | $88.44 | $134.00 | $36.53 – $82.19 | 16 |
| Irrigation implantable venous access device for drug delivery systems CPT 96523 | $127.38 | $193.00 | $20.47 – $129.81 | 14 |
| Ivc venogram s&i CPT 75825 | $3,635.28 | $5,508.00 | $120.38 – $6,947.70 | 16 |
| IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour CPT 96367 | $145.86 | $221.00 | $28.17 – $158.43 | 14 |
| IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 | $207.24 | $314.00 | $130.24 – $138.05 | 7 |
| IV infusion therapy/prophylaxis/diagnosis each additional 1 hour CPT 96366 | $143.88 | $218.00 | $18.32 – $216.25 | 14 |
| IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour CPT 96365 | $439.56 | $666.00 | $83.21 – $468.03 | 14 |
| Ivp w/wo kub w/wo tomography CPT 74400 | $747.78 | $1,133.00 | $52.32 – $456.60 | 16 |
| Jak2 targeted sequence analysis CPT 81279 | $421.74 | $639.00 | $148.16 – $416.70 | 16 |
| John cunningham antibody CPT 86711 | $1,585.32 | $2,402.00 | $15.79 – $38.00 | 16 |
| Ketamine and metabolite screen - quest CPT 80357 | $44.88 | $68.00 | $4.99 – $40.80 | 10 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $44.22 | $67.00 | $8.17 – $18.38 | 16 |
| Ketorolac 15 mg/ml injection (wrapper) HCPCS J1885 | $32.34 | $49.00 | $0.33 – $0.75 | 11 |
| Kidney endoscopy CPT 50553 | $5,871.36 | $8,896.00 | $422.00 – $11,798.06 | 16 |
| Kidney img w/bldflw sgl without rx CPT 78707 | $1,682.34 | $2,549.00 | $162.47 – $1,246.46 | 16 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $566.28 | $858.00 | $40.90 – $521.52 | 16 |
| Kit gene analys d816 variant CPT 81273 | $683.10 | $1,035.00 | $73.92 – $280.96 | 16 |
| Knee Arthroscopy (Cartilage Repair) CPT 29877 | not published | not published | not published | 0 |
| Knee arthroscopy dx CPT 29870 | not published | not published | not published | 0 |
| Knee Arthroscopy (Meniscus Repair) CPT 29881 | not published | not published | not published | 0 |
| Knee arthroscopy/surgery CPT 29874 | not published | not published | not published | 0 |
| Knee arthroscopy/surgery CPT 29875 | not published | not published | not published | 0 |
| Knee arthroscopy/surgery CPT 29879 | not published | not published | not published | 0 |
| Knee arthroscopy/surgery CPT 29880 | not published | not published | not published | 0 |
| Knee arthroscopy/surgery CPT 29882 | not published | not published | not published | 0 |
| Knee arthroscopy/surgery CPT 29883 | not published | not published | not published | 0 |
| Knee arthroscopy/surgery CPT 29888 | not published | not published | not published | 0 |
| Knee MRI (with and without contrast) CPT 73723 | $2,669.70 | $4,045.00 | $179.97 – $1,444.47 | 16 |
| Knee MRI (with contrast) CPT 73722 | $2,542.32 | $3,852.00 | $179.97 – $1,724.93 | 16 |
| Knee MRI (without contrast) CPT 73721 | $2,420.88 | $3,668.00 | $106.68 – $1,444.47 | 16 |
| Knee X-ray CPT 73564 | $363.00 | $550.00 | $24.82 – $456.60 | 16 |
| Kras gene variants exon 2 CPT 81275 | $931.26 | $1,411.00 | $157.98 – $434.81 | 16 |
| Lab draw < 3 yrs fem/jugular 36400 CPT 36400 | $157.08 | $238.00 | $1.19 – $1.26 | 7 |
| Lab draw <3 yrs scalp vein 36405 CPT 36405 | $41.58 | $63.00 | $1.19 – $1.26 | 7 |
| Labetalol 5 mg/ml IV (wrapper) HCPCS J1920 | $38.97 | $59.05 | $0.28 – $0.63 | 5 |
| Lactate dehydrogenase (ldh) CPT 83615 | $67.32 | $102.00 | $6.04 – $13.59 | 16 |
| Lactated ringers intravenous solution HCPCS J7120 | $69.96 | $106.00 | $3.93 – $4.26 | 5 |
| Lactic acid CPT 83605 | $72.60 | $110.00 | $11.57 – $26.03 | 16 |
| Lactoferrin fecal quant CPT 83631 | $114.18 | $173.00 | $19.63 – $44.17 | 16 |
| Lam facetc/frmt arthrd lum 1 CPT 63052 | not published | not published | not published | 0 |
| Lam facetec & foramot lumbar CPT 63047 | not published | not published | not published | 0 |
| Lam factc/frmt arthrd lum ea CPT 63053 | not published | not published | not published | 0 |
| Laminotomy single lumbar CPT 63042 | not published | not published | not published | 0 |
| Laparo cholecystectomy/explr CPT 47564 | not published | not published | not published | 0 |
| Laparo cholecystectomy/graph CPT 47563 | not published | not published | not published | 0 |
| Laparo partial nephrectomy CPT 50543 | not published | not published | not published | 0 |
| Laparo proc abdm/per/oment 49329 CPT 49329 | not published | not published | not published | 0 |
| Laparo radical nephrectomy CPT 50545 | not published | not published | not published | 0 |
| Laparo remove w/ureter CPT 50548 | not published | not published | not published | 0 |
| Laparoscopic myomectomy CPT 58545 | not published | not published | not published | 0 |
| Laparoscopy aspiration CPT 49322 | not published | not published | not published | 0 |
| Laparoscopy biopsy CPT 49321 | not published | not published | not published | 0 |
| Laparoscopy excise lesions CPT 58662 | not published | not published | not published | 0 |
| Laparoscopy fundoplasty CPT 43280 | not published | not published | not published | 0 |
| Laparoscopy lymphadenectomy CPT 38571 | not published | not published | not published | 0 |
| Laparoscopy pyeloplasty CPT 50544 | not published | not published | not published | 0 |
| Laparoscopy remove adnexa CPT 58661 | not published | not published | not published | 0 |
| Laparo-vag hyst incl t/o CPT 58552 | not published | not published | not published | 0 |
| Lap ing hernia repair init CPT 49650 | not published | not published | not published | 0 |
| Lap ing hernia repair recur CPT 49651 | not published | not published | not published | 0 |
| Lap paraesophag hern repair CPT 43281 | not published | not published | not published | 0 |
| Laps surg prst8ect rpbic rad CPT 55866 | not published | not published | not published | 0 |
| Laps surg prst8ect smpl stot CPT 55867 | not published | not published | not published | 0 |
| Largsc w/rmvl foreign bdy(s) CPT 31577 | $766.92 | $1,162.00 | $266.93 – $860.61 | 14 |
| Laryngoscopy w/bx & op scope CPT 31536 | not published | not published | not published | 0 |
| Larynscop w/tumr exc + scope CPT 31541 | not published | not published | not published | 0 |
| Lead capillary CPT 83655 | $72.60 | $110.00 | $12.11 – $27.25 | 16 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $1,058.64 | $1,604.00 | $74.44 – $525.02 | 16 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $28.91 | $43.81 | $6.34 – $7.53 | 5 |
| Leukacyte transfusion CPT 86950 | $1,306.14 | $1,979.00 | $37.44 – $1,187.40 | 16 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $1.02 | $1.55 | $0.07 – $0.10 | 5 |
| Levetiracetam therapeutic drug level CPT 80177 | $77.22 | $117.00 | $13.25 – $29.81 | 16 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $35.57 | $53.90 | $1.60 – $3.87 | 5 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | $34.70 | $52.58 | $9.87 – $10.70 | 4 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $2.16 | $3.27 | $0.08 – $0.08 | 1 |
| Lidocaine therapeutic drug level CPT 80176 | $155.76 | $236.00 | $14.69 – $33.05 | 16 |
| Ligate leg veins open CPT 37761 | not published | not published | not published | 0 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | not published | not published | not published | 0 |
| Lig/band angioaccess av fistula CPT 37607 | not published | not published | not published | 0 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $80.67 | $122.23 | $4.45 – $4.90 | 5 |
| Lipase CPT 83690 | $143.88 | $218.00 | $6.89 – $15.50 | 16 |
| Lipoprotein blood high res frac & quant CPT 83701 | $147.84 | $224.00 | $32.56 – $76.19 | 16 |
| Lipoprotein blood quant CPT 83704 | $217.80 | $330.00 | $34.19 – $76.93 | 16 |
| Lipoprotein direct measurement hdl CPT 83718 | $54.12 | $82.00 | $8.19 – $18.43 | 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.