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 |
|---|---|---|---|---|
| Part removal of metatarsal CPT 28110 | not published | not published | not published | 0 |
| Part removal of metatarsal CPT 28113 | not published | not published | not published | 0 |
| Part removal of metatarsal 28112 CPT 28112 | not published | not published | not published | 0 |
| Passy muir valve metal trach HCPCS L8501 | $203.94 | $309.00 | $180.10 – $405.23 | 9 |
| Path clin consltj sf 5-20 CPT 80503 | $107.58 | $163.00 | $17.07 – $114.67 | 16 |
| Pca3/klk3 antigen CPT 81313 | $1,189.32 | $1,802.00 | $59.04 – $573.86 | 16 |
| Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe HCPCS Q5108 | $433.99 | $657.56 | $98.87 – $590.94 | 16 |
| Pelvic CT scan (with and without contrast) CPT 72194 | $1,818.96 | $2,756.00 | $134.40 – $1,215.09 | 16 |
| Pelvic CT scan (with contrast) CPT 72193 | $1,539.12 | $2,332.00 | $134.40 – $1,215.09 | 16 |
| Pelvic CT scan (without contrast) CPT 72192 | $1,259.28 | $1,908.00 | $47.18 – $1,215.09 | 16 |
| Pelvic MRI (with and without contrast) CPT 72197 | $2,893.44 | $4,384.00 | $136.47 – $1,444.47 | 16 |
| Pelvic MRI (with contrast) CPT 72196 | $2,504.70 | $3,795.00 | $179.97 – $1,444.47 | 16 |
| Pelvic MRI (without contrast) CPT 72195 | $2,277.00 | $3,450.00 | $93.34 – $1,444.47 | 16 |
| Pelvic Ultrasound (complete) CPT 76856 | $615.12 | $932.00 | $74.44 – $521.52 | 16 |
| Pelvic Ultrasound (limited) CPT 76857 | $482.46 | $731.00 | $40.90 – $521.52 | 16 |
| Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe HCPCS J0561 | $101.08 | $153.15 | $31.97 – $71.92 | 16 |
| Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr HCPCS J2540 | $14.51 | $21.99 | $1.29 – $1.58 | 5 |
| Penile injection CPT 54235 | $711.48 | $1,078.00 | $38.07 – $549.77 | 14 |
| Perc d-e cor revasc chro add HCPCS C9608 | $8,915.28 | $13,508.00 | $3,625.53 – $3,843.06 | 7 |
| Perc d-e cor revasc chro sin HCPCS C9607 | $13,249.50 | $20,075.00 | $3,625.53 – $40,336.82 | 14 |
| Perc d-e cor revasc t cabg b HCPCS C9605 | $5,539.38 | $8,393.00 | $3,625.53 – $3,843.06 | 7 |
| Perc d-e cor revasc t cabg s HCPCS C9604 | $11,482.68 | $17,398.00 | $3,625.53 – $25,401.76 | 14 |
| Perc d-e cor stent ather br HCPCS C9603 | $10,730.28 | $16,258.00 | $3,625.53 – $3,843.06 | 7 |
| Perc d-e cor stent ather s HCPCS C9602 | $20,739.84 | $31,424.00 | $3,625.53 – $40,336.82 | 14 |
| Perc drug-el cor stent bran HCPCS C9601 | $8,234.16 | $12,476.00 | $3,625.53 – $3,843.06 | 7 |
| Perc drug-el cor stent sing HCPCS C9600 | $9,716.52 | $14,722.00 | $3,625.53 – $25,401.76 | 14 |
| Percut ablate liver rf CPT 47382 | $6,738.60 | $10,210.00 | $1,123.00 – $13,302.54 | 16 |
| Perflutren lipid microspheres 1.1 mg/ml intravenous suspension HCPCS Q9957 | $315.66 | $478.28 | $66.35 – $71.98 | 5 |
| Pericardiocentesis wwo imaging CPT 33016 | $1,794.54 | $2,719.00 | $440.45 – $3,463.76 | 14 |
| Perineoplasty rpr per nonob CPT 56810 | not published | not published | not published | 0 |
| Peripheral vascular rehab CPT 93668 | $92.40 | $140.00 | $13.81 – $140.00 | 16 |
| Peri-proc device eval pm CPT 93286 | $181.50 | $275.00 | $15.99 – $16.95 | 7 |
| Peritoneal cath sub q resv per CPT 49419 | $6,243.60 | $9,460.00 | $1,616.01 – $12,244.06 | 14 |
| Peritoneogram rs&i CPT 74190 | $551.76 | $836.00 | $52.32 – $1,202.33 | 16 |
| Perq dev breast 1st mr guide CPT 19287 | $2,034.78 | $3,083.00 | $476.00 – $1,558.17 | 16 |
| Perq dev breast 1st strtctc CPT 19283 | $1,202.52 | $1,822.00 | $187.60 – $1,558.17 | 16 |
| Perq nl/pl lithotrp cplx>2cm CPT 50081 | not published | not published | not published | 0 |
| Perq plmt bile duct stent CPT 47538 | $7,612.44 | $11,534.00 | $979.32 – $13,302.54 | 14 |
| Perq plmt bile duct stent CPT 47539 | $6,738.60 | $10,210.00 | $422.00 – $13,302.54 | 16 |
| Perq plmt bile duct stent CPT 47540 | $9,251.88 | $14,018.00 | $2,397.03 – $13,302.54 | 14 |
| Perq rplcmt g-tube req revsn gstrst trk CPT 43763 | $924.66 | $1,401.00 | $171.97 – $549.77 | 14 |
| Pet CT skull-mid thgh initial CPT 78815 | $5,121.60 | $7,760.00 | $589.87 – $3,928.74 | 16 |
| Pet CT whole body initial CPT 78816 | $5,121.60 | $7,760.00 | $589.87 – $3,928.74 | 16 |
| Pet fdg brain metoblic eval sb CPT 78608 | $4,901.82 | $7,427.00 | $589.87 – $3,928.74 | 16 |
| Pet image w/ct lmtd CPT 78814 | $4,901.82 | $7,427.00 | $589.87 – $3,928.74 | 16 |
| Ph body fluid CPT 83986 | $25.08 | $38.00 | $3.58 – $8.06 | 16 |
| Phencyclidine (pcp) CPT 83992 | $89.76 | $136.00 | $20.67 – $59.57 | 11 |
| Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr HCPCS J2560 | $128.37 | $194.50 | $47.98 – $55.71 | 5 |
| Phenobarbital therapeutic drug level CPT 80184 | $77.88 | $118.00 | $15.30 – $34.43 | 16 |
| Phentolaine mesylate inj HCPCS J2760 | $1,047.32 | $1,586.85 | $51.22 – $946.26 | 16 |
| Phenylephrine 10 mg/ml injection solution HCPCS J2371 | $0.65 | $0.98 | $0.02 – $0.02 | 2 |
| Phenytoin total therapeutic drug level CPT 80185 | $77.88 | $118.00 | $13.25 – $29.81 | 16 |
| Phlebotomy therapeutic CPT 99195 | $227.70 | $345.00 | $33.22 – $292.76 | 16 |
| Phleb veins 1 extrm 10-20 stab CPT 37765 | not published | not published | not published | 0 |
| Phleb veins 1 extrm >20 stab CPT 37766 | not published | not published | not published | 0 |
| Phosphorus CPT 84100 | $29.04 | $44.00 | $4.74 – $10.67 | 16 |
| Phosphorus 24 hour urine CPT 84105 | $31.68 | $48.00 | $5.78 – $13.01 | 16 |
| Phytonadione (vitamin k1) 10 mg/ml injection solution HCPCS J3430 | $120.48 | $182.55 | $4.64 – $5.03 | 5 |
| Pinworm exam CPT 87172 | $23.76 | $36.00 | $4.27 – $9.61 | 16 |
| Piperacillin-tazobactam 3.375 gram intravenous solution HCPCS J2543 | $23.25 | $35.23 | $1.80 – $2.01 | 5 |
| Place cath intracranial art CPT 36228 | $2,486.22 | $3,767.00 | $1,954.15 – $2,071.40 | 7 |
| Place cath xtrnl carotid CPT 36227 | $2,445.30 | $3,705.00 | $1,954.15 – $2,071.40 | 7 |
| Place cecostomy tube perc CPT 49442 | $2,768.04 | $4,194.00 | $392.66 – $2,633.08 | 16 |
| Place duod/jej tube perc CPT 49441 | $2,926.44 | $4,434.00 | $171.97 – $4,222.35 | 16 |
| Place gastrostomy tube perc CPT 49440 | $2,191.20 | $3,320.00 | $171.97 – $4,222.35 | 16 |
| Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides) CPT 19281 | $1,871.10 | $2,835.00 | $186.92 – $3,634.16 | 16 |
| Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left CPT 19282 | $137.94 | $209.00 | $209.00 – $221.54 | 7 |
| Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides) CPT 19285 | $1,595.22 | $2,417.00 | $588.15 – $1,558.17 | 14 |
| Placement nephrostomy catheter (both sides) CPT 50432 | $4,361.94 | $6,609.00 | $383.86 – $4,599.67 | 16 |
| Placement occlusive device venous/arterial access site post procedure HCPCS G0269 | $434.28 | $658.00 | $658.00 – $658.00 | 3 |
| Placement of seton CPT 46020 | not published | not published | not published | 0 |
| Placement stent(s) intravascular transcatheter artery initial CPT 37236 | $13,098.36 | $19,846.00 | $4,729.17 – $25,401.76 | 14 |
| Place non-slctv cath thoracic arta CPT 36221 | $4,559.28 | $6,908.00 | $1,954.15 – $6,947.70 | 14 |
| Place slctv cath carotd art uni CPT 36224 | $5,318.94 | $8,059.00 | $1,954.15 – $12,244.06 | 14 |
| Place slctv cath carotid/inom art excrn uni CPT 36222 | $5,076.72 | $7,692.00 | $1,954.15 – $6,947.70 | 14 |
| Place slctv cath carotid/inom art intcrn uni CPT 36223 | $9,492.12 | $14,382.00 | $1,954.15 – $12,244.06 | 14 |
| Place slctv cath subclavian art CPT 36225 | $5,652.24 | $8,564.00 | $1,954.15 – $6,947.70 | 14 |
| Place slctv cath vertebral art uni CPT 36226 | $7,252.74 | $10,989.00 | $1,954.15 – $12,244.06 | 14 |
| Platelet aggregation each agent teg CPT 85576 | $196.68 | $298.00 | $24.91 – $56.05 | 16 |
| Platelet automated CPT 85049 | $34.32 | $52.00 | $4.48 – $10.08 | 16 |
| Platelets hla matched leukocytes reduced apheresis/pheresis each unit HCPCS P9052 | $1,809.72 | $2,742.00 | $122.12 – $1,593.14 | 14 |
| Platelets leukocytes reduced each unit HCPCS P9031 | $271.26 | $411.00 | $122.12 – $324.59 | 14 |
| Platelets leukocytes reduced irradiated each unit HCPCS P9033 | $396.00 | $600.00 | $122.12 – $426.58 | 14 |
| Platelets pheresis leukocytes reduced each unit HCPCS P9035 | $1,206.48 | $1,828.00 | $122.12 – $1,151.08 | 14 |
| Platelets pheresis leukocytes reduced irradiated each unit HCPCS P9037 | $1,259.94 | $1,909.00 | $122.12 – $1,531.37 | 14 |
| Platelets pheresis pathogen-reduced each unit HCPCS P9073 | $1,007.82 | $1,527.00 | $122.12 – $1,366.72 | 14 |
| Plcmnt biliary drainage cath w/img ext CPT 47533 | $6,031.08 | $9,138.00 | $422.00 – $7,878.29 | 16 |
| Plcmnt stent transcath ctrl dialysis seg add-on CPT 36908 | $7,735.86 | $11,721.00 | $2,731.45 – $2,895.34 | 7 |
| Plcmnt ureteral stent pq w/img exstng trct CPT 50693 | $3,940.20 | $5,970.00 | $381.79 – $7,756.35 | 16 |
| Plcmnt ureteral stent pq w/img new w/cath CPT 50695 | $17,796.90 | $26,965.00 | $1,279.94 – $7,756.35 | 14 |
| Plcmt dlyd xtn pros 1st vsl CPT 34710 | $17,216.76 | $26,086.00 | $7,257.52 – $7,692.97 | 7 |
| Plcmt xtn pros evasc rpr per vsl CPT 34709 | $2,469.72 | $3,742.00 | $3,742.00 – $3,966.52 | 7 |
| Plc pq device breast ea addl lesion MRI guide CPT 19288 | $97.02 | $147.00 | $147.00 – $155.82 | 7 |
| Plc pq device breast ea addl lesion stereo guide CPT 19284 | $137.94 | $209.00 | $209.00 – $221.54 | 7 |
| Plc pq device breast ea addl lesion Ultrasound guide CPT 19286 | $120.12 | $182.00 | $182.00 – $192.92 | 7 |
| Plethysmography lung volumes/airway resistance CPT 94726 | $476.52 | $722.00 | $45.62 – $821.09 | 16 |
| Plmt access bil tree sm bwl CPT 47541 | $7,207.20 | $10,920.00 | $2,397.03 – $14,244.96 | 14 |
| Plmt biliary drainage cath CPT 47534 | $6,328.08 | $9,588.00 | $422.00 – $7,878.29 | 16 |
| Plmt nephroureteral catheter CPT 50433 | $5,920.86 | $8,971.00 | $1,279.94 – $7,756.35 | 14 |
| Plmt ureteral stent prq CPT 50694 | $5,536.74 | $8,389.00 | $1,279.94 – $7,756.35 | 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.