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 |
|---|---|---|---|---|
| Pt evaluation high complexity patient/family CPT 97163 | $155.10 | $235.00 | $88.79 – $215.33 | 12 |
| Pt evaluation low complexity patient/family CPT 97161 | $155.10 | $235.00 | $88.79 – $215.33 | 12 |
| Pt evaluation moderate complexity patient/family CPT 97162 | $155.10 | $235.00 | $62.66 – $215.33 | 16 |
| Pt re-evaluation patient/family CPT 97164 | $89.10 | $135.00 | $65.77 – $147.98 | 12 |
| Pt repositioning canalith procedure(s) per day CPT 95992 | $130.02 | $197.00 | $16.89 – $197.00 | 12 |
| Pt stimulation electrial unattended >= 1 area other than wound care part of therapy plan HCPCS G0283 | $108.90 | $165.00 | $12.19 – $165.00 | 16 |
| Pt therapeutic procedure >=1 area gait training each 15 minutes CPT 97116 | $80.52 | $122.00 | $14.19 – $122.00 | 16 |
| Pt therapeutic procedure >=1 area massage each 15 minutes CPT 97124 | $69.96 | $106.00 | $14.19 – $106.00 | 16 |
| Pt wheelchair management each 15 minutes CPT 97542 | $56.10 | $85.00 | $16.89 – $85.00 | 16 |
| Pulse ox continuous overnight monitoring CPT 94762 | $263.34 | $399.00 | $25.49 – $399.00 | 16 |
| Pump on-q 100mlx2ml/hr 2 day delivery HCPCS C9804 | $623.70 | $945.00 | $258.93 – $582.59 | 9 |
| Punc of shunt for asp or inj CPT 61070 | $801.24 | $1,214.00 | $105.49 – $1,553.22 | 16 |
| Puncture arterial withdrawal blood for diagnosis CPT 36600 | $129.36 | $196.00 | $23.90 – $292.76 | 16 |
| Puncture aspiration abscess/hematoma/bulla/cyst CPT 10160 | $487.74 | $739.00 | $72.99 – $894.49 | 14 |
| Puncture spinal lumbar diagnostic CPT 62270 | $1,019.04 | $1,544.00 | $337.74 – $1,553.22 | 14 |
| Pvb thoracic 2nd+ inj site CPT 64462 | $197.34 | $299.00 | $299.00 – $316.94 | 7 |
| Pvb thoracic cont infusion CPT 64463 | $1,430.22 | $2,167.00 | $337.74 – $1,553.22 | 14 |
| Pvb thoracic single inj site CPT 64461 | $1,321.98 | $2,003.00 | $337.74 – $1,553.22 | 14 |
| Pyridoxine hcl 100 mg HCPCS J3415 | $105.86 | $160.40 | $17.15 – $27.85 | 5 |
| Pyruvate CPT 84210 | $89.76 | $136.00 | $14.48 – $32.58 | 16 |
| Pyruvate kinase CPT 84220 | $182.16 | $276.00 | $9.44 – $21.24 | 16 |
| Quest t3 uptake CPT 84479 | $54.12 | $82.00 | $6.47 – $14.56 | 16 |
| Rabies immune globulin (pf) 300 unit/ml intramuscular solution CPT 90375 | $660.23 | $1,000.35 | $279.95 – $629.89 | 16 |
| Radiation physics consult CPT 77336 | $646.80 | $980.00 | $52.58 – $980.00 | 16 |
| Radiation therapy dose plan CPT 77300 | $599.94 | $909.00 | $52.58 – $909.00 | 16 |
| Radiation treatment aid(s) CPT 77332 | $581.46 | $881.00 | $52.58 – $881.00 | 16 |
| Radiation treatment aid(s) CPT 77333 | $754.38 | $1,143.00 | $52.58 – $1,143.00 | 16 |
| Radiation treatment aid(s) CPT 77334 | $1,512.72 | $2,292.00 | $82.46 – $2,025.50 | 16 |
| Radiation treatment delivery CPT 77402 | $693.66 | $1,051.00 | $79.49 – $1,051.00 | 16 |
| Radiation treatment delivery CPT 77412 | $1,097.58 | $1,663.00 | $79.49 – $1,663.00 | 16 |
| Radiology port images(s) CPT 77417 | $399.96 | $606.00 | $24.82 – $606.00 | 10 |
| Radiotherapy dose plan imrt CPT 77301 | $4,513.08 | $6,838.00 | $470.57 – $3,045.63 | 16 |
| Radphm lcl tmr plnr bdy sgl day img CPT 78802 | $1,508.10 | $2,285.00 | $389.13 – $1,246.46 | 16 |
| Radphm lcl tmr plnr bdy two day img CPT 78804 | $1,584.00 | $2,400.00 | $389.13 – $1,246.46 | 16 |
| Radphm lcl tmr spect/ct 2+ areas/2+ days CPT 78831 | $1,791.90 | $2,715.00 | $389.13 – $2,848.74 | 16 |
| Radphm lcl tomogr sgl area sgl day CPT 78803 | $1,682.34 | $2,549.00 | $389.13 – $1,246.46 | 16 |
| Radphm lcl tumor plr sgl day CPT 78800 | $877.80 | $1,330.00 | $389.13 – $1,246.46 | 16 |
| Rapid Strep Test CPT 87880 | $79.86 | $121.00 | $16.53 – $37.19 | 16 |
| Rbc count only automated CPT 85041 | $14.52 | $22.00 | $3.02 – $6.80 | 16 |
| Recon, cta for surg plan HCPCS G0288 | $153.78 | $233.00 | $233.00 – $233.00 | 5 |
| Reconstruction knee CPT 27427 | not published | not published | not published | 0 |
| Reconstruct shoulder joint CPT 23470 | not published | not published | not published | 0 |
| Reconstruct shoulder joint CPT 23472 | not published | not published | not published | 0 |
| Red blood cells each unit HCPCS P9021 | $343.86 | $521.00 | $55.39 – $338.78 | 14 |
| Red blood cells leukocytes reduced cmv negative irradiated each unit HCPCS P9058 | $619.74 | $939.00 | $55.39 – $561.15 | 14 |
| Red blood cells leukocytes reduced each unit HCPCS P9016 | $345.84 | $524.00 | $184.91 – $476.46 | 14 |
| Red blood cells leukocytes reduced irradiated each unit HCPCS P9040 | $727.32 | $1,102.00 | $55.39 – $597.17 | 14 |
| Regadenoson 0.4 mg/5 ml intravenous syringe HCPCS J2785 | $36.53 | $55.35 | $4.42 – $5.76 | 5 |
| Release palm contracture CPT 26123 | not published | not published | not published | 0 |
| Release palm contracture CPT 26125 | not published | not published | not published | 0 |
| Release wrist/forearm tendon CPT 25295 | not published | not published | not published | 0 |
| Relocation skin pocket aicd CPT 33223 | $2,112.66 | $3,201.00 | $693.47 – $4,540.03 | 14 |
| Relocation skin pocket pm CPT 33222 | $2,395.14 | $3,629.00 | $693.47 – $4,540.03 | 14 |
| Rem/biv cast full arm/leg CPT 29705 | $434.28 | $658.00 | $79.49 – $615.43 | 14 |
| Remdesivir 100 mg intravenous powder for solution HCPCS J0248 | $12.63 | $19.13 | $6.35 – $15.52 | 16 |
| Rem endovas vena cava filter CPT 37193 | $4,117.08 | $6,238.00 | $1,628.87 – $6,947.70 | 14 |
| Removal biliary drg cath CPT 47537 | $1,387.32 | $2,102.00 | $171.97 – $1,995.72 | 14 |
| Removal central venous catheter tunneled without port/pump CPT 36589 | $1,052.04 | $1,594.00 | $325.87 – $1,380.31 | 14 |
| Removal central venous device tunneled w/port/pump central/peripheral insertion CPT 36590 | $2,198.46 | $3,331.00 | $325.87 – $3,463.76 | 14 |
| Removal cerumen impacted (both sides) CPT 69210 | $99.66 | $151.00 | $57.69 – $129.81 | 9 |
| Removal devitalized tissue non-selective debridement without anesthesia per session CPT 97602 | $229.68 | $348.00 | $178.90 – $331.00 | 6 |
| Removal duct glbldr calculi CPT 47544 | $3,295.38 | $4,993.00 | $290.51 – $2,540.86 | 11 |
| Removal embedded foreign body vestibule mouth smpl CPT 40804 | $1,440.78 | $2,183.00 | $528.96 – $1,995.72 | 14 |
| Removal foreign body foot subcutaneous right CPT 28190 | $830.28 | $1,258.00 | $185.89 – $1,558.17 | 14 |
| Removal implant superficial separate procedure CPT 20670 | $3,065.04 | $4,644.00 | $279.76 – $3,634.16 | 16 |
| Removal of adenoids CPT 42830 | not published | not published | not published | 0 |
| Removal of anal tags CPT 46230 | not published | not published | not published | 0 |
| Removal of breast lesion CPT 19120 | not published | not published | not published | 0 |
| Removal of calcium deposits CPT 23000 | not published | not published | not published | 0 |
| Removal of eye lesion CPT 65400 | not published | not published | not published | 0 |
| Removal of eye lesion CPT 65426 | $5,776.98 | $8,753.00 | $1,404.12 – $5,231.40 | 14 |
| Removal of foot lesion CPT 28090 | not published | not published | not published | 0 |
| Removal of foot lesion CPT 28104 | not published | not published | not published | 0 |
| Removal of heel bone CPT 28118 | not published | not published | not published | 0 |
| Removal of heel spur CPT 28119 | not published | not published | not published | 0 |
| Removal of hydrocele CPT 55040 | not published | not published | not published | 0 |
| Removal of hydrocele CPT 55500 | not published | not published | not published | 0 |
| Removal of implant deep CPT 20680 | not published | not published | not published | 0 |
| Removal of kneecap bursa CPT 27340 | not published | not published | not published | 0 |
| Removal of sesamoid bone CPT 28315 | not published | not published | not published | 0 |
| Removal of sperm cord lesion CPT 55520 | not published | not published | not published | 0 |
| Removal of testis CPT 54530 | not published | not published | not published | 0 |
| Removal of toe lesions CPT 28092 | not published | not published | not published | 0 |
| Removal of toe lesions CPT 28108 | not published | not published | not published | 0 |
| Removal of wrist bone CPT 25210 | not published | not published | not published | 0 |
| Removal/replacement ppm generator dual lead system CPT 33228 | $5,210.70 | $7,895.00 | $3,478.75 – $22,998.51 | 14 |
| Removal skin tags fibrocutaneous any area <= 15 lesions CPT 11200 | $246.18 | $373.00 | $72.99 – $441.47 | 14 |
| Removal sutr/staple req anes CPT 15851 | not published | not published | not published | 0 |
| Removal tunnled intprtnl cath CPT 49422 | $4,350.06 | $6,591.00 | $318.99 – $6,947.70 | 14 |
| Remove anal fist complex CPT 46280 | not published | not published | not published | 0 |
| Remove anal fist inter CPT 46275 | not published | not published | not published | 0 |
| Remove anal fist subq CPT 46270 | $6,120.18 | $9,273.00 | $994.56 – $6,107.55 | 14 |
| Remove bladder stone CPT 52317 | not published | not published | not published | 0 |
| Remove bladder stone CPT 52318 | not published | not published | not published | 0 |
| Remove cva lumen obstruct CPT 75902 | $621.72 | $942.00 | $89.39 – $495.60 | 11 |
| Remove ear canal lesion(s) CPT 69145 | not published | not published | not published | 0 |
| Remove epididymis lesion CPT 54840 | not published | not published | not published | 0 |
| Remove ext hem groups 2+ CPT 46250 | not published | not published | not published | 0 |
| Remove eyelid lesion(s) CPT 67808 | not published | not published | not published | 0 |
| Remove foreign body from eye CPT 65235 | $2,634.06 | $3,991.00 | $445.53 – $5,078.12 | 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.