HSHS St. Clare Memorial Hospital
855 S MAIN STREET, OCONTO FALLS, WI · Hshs · · NPI 1851477913
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 |
|---|---|---|---|---|
| 11-desoxycortisol - sendout CPT 82634 | $40.92 | $62.00 | $29.28 – $38.06 | 11 |
| 17-hydroxypregnenolone CPT 84143 | $106.26 | $161.00 | $22.81 – $29.65 | 11 |
| 17-ketosteroids CPT 83586 | $73.92 | $112.00 | $12.80 – $16.64 | 11 |
| 2d tee w or without fol w/con,in HCPCS C8925 | $1,657.26 | $2,511.00 | $523.69 – $800.90 | 11 |
| 3d recon without postprocess indpndt CPT 76376 | $641.52 | $972.00 | $972.00 – $972.00 | 4 |
| 5' nucleotidase - sendout CPT 83915 | $117.48 | $178.00 | $11.15 – $14.50 | 11 |
| 88334 ap bill cytologic exam each additional site CPT 88334 | $154.44 | $234.00 | $23.58 – $143.78 | 10 |
| #a/b/c/c/h pnl-candida albicans ab CPT 86628 | $36.30 | $55.00 | $8.17 – $15.61 | 11 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $2,091.54 | $3,169.00 | $179.20 – $1,247.60 | 11 |
| Abdominal CT scan (with contrast) CPT 74160 | $1,750.32 | $2,652.00 | $179.20 – $1,247.60 | 11 |
| Abdominal CT scan (without contrast) CPT 74150 | $1,259.28 | $1,908.00 | $106.81 – $1,247.60 | 11 |
| Abdominal MRI (with and without contrast) CPT 74183 | $3,375.24 | $5,114.00 | $356.43 – $1,513.40 | 11 |
| Abdominal MRI (with contrast) CPT 74182 | $2,789.16 | $4,226.00 | $356.43 – $1,513.40 | 11 |
| Abdominal MRI (without contrast) CPT 74181 | $2,656.50 | $4,025.00 | $243.77 – $1,513.40 | 11 |
| Abdominal paracentesis w/image guidance CPT 49083 | $1,721.94 | $2,609.00 | $926.63 – $1,241.72 | 8 |
| Abdominal Ultrasound (complete) CPT 76700 | $769.56 | $1,166.00 | $106.81 – $574.00 | 11 |
| Abdominal Ultrasound (limited) CPT 76705 | $578.16 | $876.00 | $106.81 – $574.00 | 11 |
| Abd paracentesis/w/o image guide 49082 CPT 49082 | $1,083.06 | $1,641.00 | $926.63 – $1,241.72 | 8 |
| Abl1 gene CPT 81170 | $415.14 | $629.00 | $195.07 – $390.00 | 11 |
| Ablation of upper extremity nerves rf CPT 64999 | $351.12 | $532.00 | $313.60 – $563.92 | 8 |
| Abscess drain retroperitoneal surg code CPT 49406 | $1,627.56 | $2,466.00 | $456.60 – $1,687.37 | 11 |
| Acetaminophen 10 mg/ml soln 100 ml glass cont HCPCS J0131 | $1.80 | $2.73 | $0.10 – $0.11 | 4 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | $159.85 | $242.20 | $42.22 – $45.81 | 4 |
| Acetone qualitative CPT 82009 | $46.86 | $71.00 | $4.52 – $5.88 | 11 |
| Acetylcholine receptor modulating antibody CPT 86043 | $89.10 | $135.00 | $9.64 – $15.67 | 11 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | $8.93 | $13.53 | $0.61 – $0.66 | 4 |
| Aco annual medicare visit (awv), initial g0438aco HCPCS G0438 | $177.54 | $269.00 | $95.40 – $166.99 | 3 |
| Acute hepatitis panel CPT 80074 | $316.80 | $480.00 | $47.63 – $61.92 | 11 |
| #acylcarnitineprfl CPT 82017 | $387.42 | $587.00 | $16.87 – $21.93 | 11 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | $8.90 | $13.48 | $0.87 – $0.95 | 4 |
| Adh-sendout CPT 84588 | $207.24 | $314.00 | $33.94 – $44.12 | 11 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | $32.34 | $49.00 | $3.37 – $6.13 | 2 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $203.28 | $308.00 | $73.56 – $326.48 | 11 |
| Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr CPT 96417 | $279.18 | $423.00 | $73.56 – $448.38 | 11 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $772.20 | $1,170.00 | $337.46 – $1,170.00 | 11 |
| Administration chemotherapy IV push single/initial substance/drug CPT 96409 | $502.26 | $761.00 | $75.18 – $761.00 | 11 |
| Administration immunization 1 vaccine CPT 90471 | $120.12 | $182.00 | $63.08 – $73.56 | 8 |
| Administration immunization each additional vaccine CPT 90472 | $42.90 | $65.00 | $63.08 – $66.86 | 7 |
| Administration vaccine hepatitis b HCPCS G0010 | $62.70 | $95.00 | $47.84 – $66.86 | 8 |
| Administration vaccine influenza virus HCPCS G0008 | $53.46 | $81.00 | $47.84 – $66.86 | 10 |
| Administration vaccine pneumococcal HCPCS G0009 | $53.46 | $81.00 | $47.84 – $66.86 | 8 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | $594.66 | $901.00 | $115.36 – $149.97 | 11 |
| Airway resistance by impulse oscillometry 94728 CPT 94728 | $209.22 | $317.00 | $131.46 – $317.00 | 11 |
| Albumin body fluid quantitative each specimen CPT 82042 | $54.12 | $82.00 | $7.27 – $10.11 | 11 |
| Albumin (human), 25%, 50ml HCPCS P9047 | $279.68 | $423.75 | $53.08 – $215.59 | 11 |
| Albumin (human), 5%, 250 ml HCPCS P9045 | $337.92 | $512.00 | $53.08 – $363.47 | 11 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $144.54 | $219.00 | $5.78 – $7.51 | 11 |
| Albumin serum plasma or whole blood CPT 82040 | $31.02 | $47.00 | $4.95 – $6.44 | 11 |
| Alkaline phosphatase CPT 84075 | $25.74 | $39.00 | $5.18 – $6.73 | 11 |
| Allergen alpha lactalbumin ige CPT 86008 | $33.66 | $51.00 | $17.71 – $23.31 | 11 |
| Allergen egg white ige CPT 86003 | $9.24 | $14.00 | $4.57 – $6.79 | 11 |
| Allergy injections; 2 or more 95117 CPT 95117 | $52.80 | $80.00 | $40.71 – $80.00 | 9 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $629.64 | $954.00 | $127.14 – $270.59 | 5 |
| Alpha-fetoprotein tumor marker CPT 82105 | $99.00 | $150.00 | $16.77 – $21.80 | 11 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $304.31 | $461.08 | $93.83 – $167.96 | 11 |
| Alt/sgpt CPT 84460 | $60.06 | $91.00 | $5.30 – $6.89 | 11 |
| Aluminum - quest CPT 82108 | $126.06 | $191.00 | $25.48 – $33.12 | 11 |
| Aminolevulinic acid delta CPT 82135 | $137.28 | $208.00 | $16.45 – $21.39 | 11 |
| Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV HCPCS J0283 | $37.85 | $57.35 | $4.17 – $4.53 | 4 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | $3.23 | $4.90 | $0.68 – $0.73 | 4 |
| Amitriptyline (elavil) -sendout CPT 80335 | $62.70 | $95.00 | $18.33 – $27.00 | 9 |
| Ammonia CPT 82140 | $89.76 | $136.00 | $14.57 – $18.94 | 11 |
| Amphetamine confirm urine -sendout CPT 80324 | $62.70 | $95.00 | $18.33 – $29.40 | 9 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | $16.16 | $24.48 | $0.97 – $1.06 | 4 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | $38.86 | $58.88 | $2.19 – $2.38 | 4 |
| Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis CPT 81515 | $347.16 | $526.00 | $262.99 – $341.89 | 4 |
| Amp metatarsal w/toe single 28810 CPT 28810 | $3,747.48 | $5,678.00 | $423.63 – $5,678.00 | 13 |
| Amputation thru metatarsal CPT 28805 | not published | not published | not published | 0 |
| Amputation toe interphalangeal joint CPT 28825 | not published | not published | not published | 0 |
| Amputation toe metatarsophalangeal joint CPT 28820 | not published | not published | not published | 0 |
| Amylase CPT 82150 | $70.62 | $107.00 | $6.48 – $8.42 | 11 |
| Ana ds-dna CPT 86226 | $101.64 | $154.00 | $12.11 – $15.74 | 11 |
| Analysis gene f2 20210g>a variant CPT 81240 | $237.60 | $360.00 | $53.70 – $85.40 | 11 |
| Analysis gene f5 leiden variant CPT 81241 | $237.60 | $360.00 | $66.70 – $95.38 | 11 |
| Anaplsma phgcytophlm amp prb CPT 87468 | $237.60 | $360.00 | $35.09 – $45.62 | 11 |
| Anca screen with reflex to titer -quest CPT 86021 | $108.90 | $165.00 | $15.05 – $19.57 | 11 |
| An cholangiogram percutaneous compl CPT 47531 | $3,544.20 | $5,370.00 | $456.60 – $3,657.95 | 11 |
| An fluoro guide for cvp CPT 77001 | $465.96 | $706.00 | $328.27 – $495.60 | 10 |
| Ankle arthroscopy/surgery CPT 29891 | not published | not published | not published | 0 |
| Ankle arthroscopy/surgery CPT 29895 | not published | not published | not published | 0 |
| Ankle arthroscopy/surgery CPT 29897 | not published | not published | not published | 0 |
| Ankle arthroscopy/surgery CPT 29898 | not published | not published | not published | 0 |
| Ankle X-ray CPT 73610 | $315.48 | $478.00 | $88.91 – $478.00 | 11 |
| Antibody CPT 86744 | $36.30 | $55.00 | $8.17 – $20.79 | 11 |
| Antibody bacterium, not elsewhere specified CPT 86609 | $31.02 | $47.00 | $8.17 – $16.74 | 11 |
| Antibody elution rbc reference CPT 86860 | $198.00 | $300.00 | $104.97 – $226.20 | 11 |
| Antibody htlv/hiv confirm test CPT 86689 | $312.18 | $473.00 | $19.35 – $25.16 | 11 |
| Antibody identification platelet antibodies heparin-pf4 igg CPT 86022 | $178.86 | $271.00 | $18.37 – $23.88 | 11 |
| Antibody id rbc panel CPT 86870 | $415.80 | $630.00 | $143.76 – $388.93 | 11 |
| Antibody screen rbc CPT 86850 | $75.24 | $114.00 | $5.38 – $53.24 | 11 |
| Antibody tetanus CPT 86774 | $99.00 | $150.00 | $14.80 – $19.24 | 11 |
| Antidepressant not specified CPT 80338 | $42.24 | $64.00 | $18.33 – $38.40 | 9 |
| Antihemophilic factor-vwf 250 unit-600 unit intravenous solution HCPCS J7187 | $2.92 | $4.42 | $1.49 – $4.69 | 11 |
| Antinuclear antibodies CPT 86038 | $116.82 | $177.00 | $12.09 – $15.72 | 11 |
| Antinuclear antibodies titer CPT 86039 | $79.86 | $121.00 | $11.16 – $14.51 | 11 |
| Antipsychotics nos 7/more CPT 80344 | $95.04 | $144.00 | $18.33 – $86.40 | 9 |
| Antistreptolysin o screen CPT 86063 | $93.06 | $141.00 | $5.77 – $7.50 | 11 |
| Antistreptolysin o titer CPT 86060 | $108.90 | $165.00 | $7.30 – $9.49 | 11 |
| Antithrombin iii activity CPT 85300 | $129.36 | $196.00 | $11.85 – $15.41 | 11 |
| Aortic dysfunction/dilation CPT 81410 | $2,284.26 | $3,461.00 | $403.20 – $655.20 | 11 |
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.