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 |
|---|---|---|---|---|
| Sodium chloride 0.9 % IV bolus HCPCS J7050 | $25.38 | $38.45 | $1.09 – $1.18 | 5 |
| Sodium chloride 3 % ivpb HCPCS J7131 | $0.45 | $0.68 | $0.15 – $0.17 | 2 |
| Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous HCPCS J2916 | $30.98 | $46.94 | $3.64 – $3.96 | 5 |
| Sodium serum/plasma/whole blood CPT 84295 | $20.46 | $31.00 | $4.81 – $10.82 | 16 |
| So neo gsap dna mcrstl ins CPT 81457 | $2,972.64 | $4,504.00 | $128.83 – $2,017.96 | 16 |
| Sp bone algrft morsel add-on CPT 20930 | not published | not published | not published | 0 |
| Special physics consult CPT 77370 | $1,056.00 | $1,600.00 | $52.58 – $1,600.00 | 16 |
| Special radiation dosimetry CPT 77331 | $422.40 | $640.00 | $53.11 – $640.00 | 16 |
| Special radiation treatment CPT 77470 | $1,909.38 | $2,893.00 | $116.81 – $2,025.50 | 16 |
| Special teletx port plan CPT 77321 | $1,358.28 | $2,058.00 | $82.46 – $2,025.50 | 16 |
| Specific gravity body fluid CPT 84315 | $13.20 | $20.00 | $3.28 – $7.38 | 16 |
| Specimen fat stain CPT 89125 | $31.68 | $48.00 | $5.88 – $13.23 | 16 |
| Speech evaluation complex CPT 70371 | $551.76 | $836.00 | $52.32 – $525.02 | 16 |
| Sperm antibody test CPT 89325 | $55.44 | $84.00 | $1.78 – $24.01 | 16 |
| Spinal bone allograftstructural 20931 CPT 20931 | not published | not published | not published | 0 |
| Spinal bone autograftlocal 20936 CPT 20936 | not published | not published | not published | 0 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $1,364.88 | $2,068.00 | $337.74 – $1,553.22 | 14 |
| Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 | $654.72 | $992.00 | $45.62 – $821.09 | 16 |
| Splint dorsal bloc wh med perf 3.2mm lf polyflex ii HCPCS L3906 | $684.42 | $1,037.00 | $660.83 – $1,486.87 | 9 |
| Splint finger frog med HCPCS L3927 | $48.84 | $74.00 | $46.12 – $103.77 | 9 |
| Split blood or products CPT 86985 | $198.00 | $300.00 | $37.44 – $374.88 | 16 |
| Sputum specimen collection CPT 89220 | $198.00 | $300.00 | $31.06 – $374.88 | 16 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $184.14 | $279.00 | $84.55 – $259.68 | 16 |
| Staph a dna amp probe CPT 87640 | $237.60 | $360.00 | $35.09 – $78.95 | 16 |
| Static or dynami afo pre ots HCPCS L4397 | $85.80 | $130.00 | $130.00 – $429.71 | 9 |
| Stent/athrectomy/fem/pop/unilat 37227 CPT 37227 | $15,719.88 | $23,818.00 | $4,729.17 – $5,012.92 | 7 |
| Stent iliac/open or perc/uni/init 37221 CPT 37221 | $13,098.36 | $19,846.00 | $4,729.17 – $5,012.92 | 7 |
| Stent iliac/open/perc/ea ad/ipsila 37223 CPT 37223 | $5,539.38 | $8,393.00 | $4,729.17 – $5,012.92 | 7 |
| Stent placemt retro carotid CPT 37217 | $4,540.14 | $6,879.00 | $6,215.80 – $6,588.75 | 7 |
| Stent/tib/peroneal/unilat/initial 37230 CPT 37230 | $20,739.84 | $31,424.00 | $4,729.17 – $5,012.92 | 7 |
| St evaluate speech sound production CPT 92522 | $181.50 | $275.00 | $86.18 – $259.68 | 16 |
| St evaluate speech sound production comprehensive/expressive CPT 92523 | $345.18 | $523.00 | $106.76 – $499.77 | 16 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $282.48 | $428.00 | $55.46 – $259.68 | 16 |
| St evaluation swallow function CPT 92610 | $273.24 | $414.00 | $75.84 – $259.68 | 16 |
| Strep a ag ia CPT 87430 | $79.86 | $121.00 | $16.81 – $37.82 | 16 |
| Strep b assay w/optic CPT 87802 | $116.82 | $177.00 | $12.73 – $28.64 | 16 |
| Strep b dna amp probe CPT 87653 | $237.60 | $360.00 | $35.09 – $78.95 | 16 |
| Stress test pulmonary CPT 94618 | $447.48 | $678.00 | $25.49 – $632.97 | 16 |
| Stress tte complete CPT 93351 | $2,050.62 | $3,107.00 | $191.46 – $1,202.33 | 16 |
| St treatment speech individual CPT 92507 | $224.40 | $340.00 | $59.16 – $259.68 | 16 |
| St treatment swallow dysfunction/oral CPT 92526 | $224.40 | $340.00 | $16.89 – $259.68 | 16 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $14.72 | $22.30 | $1.21 – $2.56 | 2 |
| Sulfonylurea screen qn-sendout CPT 80377 | $157.74 | $239.00 | $4.99 – $143.40 | 10 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $167.77 | $254.20 | $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 |
| Surgical pathology level 1 gross examination only CPT 88300 | $97.02 | $147.00 | $14.25 – $88.20 | 16 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $198.66 | $301.00 | $14.25 – $180.60 | 16 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $248.16 | $376.00 | $14.25 – $225.60 | 16 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $297.66 | $451.00 | $14.25 – $270.60 | 16 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $974.16 | $1,476.00 | $58.17 – $885.60 | 16 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $1,391.94 | $2,109.00 | $58.17 – $1,772.81 | 16 |
| 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 – $3,463.76 | 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 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | $997.66 | $1,511.60 | $0.25 – $88.22 | 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 w/pat by hc prof CPT 99366 | $112.86 | $171.00 | $50.97 – $171.00 | 5 |
| Telehealth original site facility fee HCPCS Q3014 | $197.34 | $299.00 | $6.23 – $71.66 | 14 |
| Telethx isodose plan cplx CPT 77307 | $2,457.84 | $3,724.00 | $82.46 – $2,025.50 | 16 |
| Telethx isodose plan simple CPT 77306 | $580.80 | $880.00 | $53.11 – $880.00 | 16 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $322.00 | $487.88 | $186.97 – $487.88 | 16 |
| Tenolysis extensor tendon hand/finger each CPT 26445 | not published | not published | not published | 0 |
| Tenotomy length/rls abductor hallucis musc 28240 CPT 28240 | not published | not published | not published | 0 |
| Tenotomy open tndn flxr toe sgl tndn spx CPT 28232 | not published | not published | not published | 0 |
| Terbutaline 1 mg/ml subcutaneous solution HCPCS J3105 | $32.34 | $49.00 | $4.08 – $6.22 | 5 |
| Test stress cardiovascular tracing only CPT 93017 | $990.66 | $1,501.00 | $36.63 – $237.56 | 16 |
| Test urine urobilinogen CPT 84578 | $20.46 | $31.00 | $4.47 – $10.06 | 16 |
| Tgsap so/hl 51/< rna alys CPT 81456 | $4,899.18 | $7,423.00 | $835.31 – $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 | $15.09 – $90.89 | 16 |
| Therapy nutrition individual initial f2f w/patient each 15 minutes CPT 97802 | $94.38 | $143.00 | $30.36 – $143.00 | 16 |
| Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes CPT 97803 | $79.86 | $121.00 | $26.19 – $121.00 | 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 | $52.32 – $456.60 | 16 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | $24.24 | $36.72 | $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 – $1,380.31 | 16 |
| Thor rib belt custom fabrica HCPCS L0220 | $128.04 | $194.00 | $165.81 – $373.07 | 9 |
| Thrombectmy crnry perq mechanical CPT 92973 | $3,218.82 | $4,877.00 | $3,625.53 – $3,843.06 | 7 |
| Thrombectomy/inf pq dialysis circuit CPT 36904 | $10,075.56 | $15,266.00 | $1,628.87 – $12,523.68 | 14 |
| Thrombectomy/inf pq dialysis circuit w/pta CPT 36905 | $20,413.80 | $30,930.00 | $2,731.45 – $25,401.76 | 14 |
| Thrombectomy/inf pq dialysis circuit w/stent plcmnt CPT 36906 | $32,652.84 | $49,474.00 | $4,729.17 – $40,336.82 | 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.