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 |
|---|---|---|---|---|
| Ghs ot group caregiver training CPT 97552 | $43.56 | $66.00 | $21.22 – $36.30 | 9 |
| Ghs ot prosthetic training/15 min CPT 97761 | $69.96 | $106.00 | $22.47 – $106.00 | 11 |
| Ghs ot sensory integrative tech/15min CPT 97533 | $67.32 | $102.00 | $18.87 – $102.00 | 11 |
| Ghs paravert facet/nerve cerv ea add bil CPT 64492 | $369.60 | $560.00 | $560.00 – $593.60 | 7 |
| Ghs paravert facet/nerve lumb ea add bil CPT 64495 | $395.34 | $599.00 | $599.00 – $634.94 | 7 |
| Ghs peritonsillar abscess i andd CPT 42700 | $583.44 | $884.00 | $241.98 – $291.52 | 8 |
| Ghs picc line insert < 5 CPT 36568 | $1,794.54 | $2,719.00 | $1,608.25 – $1,888.33 | 8 |
| Ghs plngl fx pm cl CPT 26725 | $701.58 | $1,063.00 | $252.01 – $791.66 | 8 |
| Ghs ppd (tb intradermal) CPT 86580 | $92.40 | $140.00 | $15.21 – $54.00 | 11 |
| Ghs protoporphyrins fract CPT 84202 | $72.60 | $110.00 | $14.35 – $18.66 | 11 |
| Ghs pr without cont pulse ox CPT 94625 | $137.94 | $209.00 | $55.43 – $60.27 | 8 |
| Ghs quinidine CPT 80194 | $88.44 | $134.00 | $14.60 – $18.98 | 11 |
| Ghs removal intranasal foreign body CPT 30300 | $345.84 | $524.00 | $135.93 – $291.52 | 8 |
| Ghs removal pharyngeal foreign body CPT 42809 | $460.68 | $698.00 | $275.02 – $456.40 | 8 |
| Ghs reticulocyte count CPT 85044 | $129.36 | $196.00 | $4.31 – $5.60 | 11 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | $99.00 | $150.00 | $13.91 – $18.08 | 11 |
| Ghs semen analysis, post-vas CPT 89300 | $66.66 | $101.00 | $9.84 – $12.79 | 11 |
| Ghs sensitivity (per antimicro) CPT 87184 | $67.32 | $102.00 | $7.48 – $9.72 | 11 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $658.68 | $998.00 | $295.93 – $415.32 | 8 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $731.28 | $1,108.00 | $295.93 – $415.32 | 8 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $701.58 | $1,063.00 | $111.35 – $415.32 | 13 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $751.08 | $1,138.00 | $295.93 – $415.32 | 8 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $701.58 | $1,063.00 | $204.98 – $313.69 | 8 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $602.58 | $913.00 | $204.98 – $313.69 | 8 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $721.38 | $1,093.00 | $204.98 – $313.69 | 8 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $721.38 | $1,093.00 | $204.98 – $313.69 | 8 |
| Ghs strapping shoulder - 29240 CPT 29240 | $246.18 | $373.00 | $122.92 – $135.93 | 8 |
| Ghs st - re-eval for alt comm CPT 92597 | $251.46 | $381.00 | $69.45 – $283.80 | 11 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $1,186.68 | $1,798.00 | $619.79 – $755.08 | 8 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $701.58 | $1,063.00 | $252.01 – $791.66 | 8 |
| Ghs urine, hydroxproline total CPT 83505 | $144.54 | $219.00 | $24.30 – $31.59 | 11 |
| Ghs urine, porphyrins quant CPT 84120 | $134.64 | $204.00 | $14.71 – $19.12 | 11 |
| Ghs vaginal delivery only CPT 59409 | $7,298.28 | $11,058.00 | $3,307.24 – $3,706.58 | 8 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | $4,775.10 | $7,235.00 | $381.24 – $771.23 | 11 |
| Ghs windowing of cast CPT 29730 | $655.38 | $993.00 | $166.02 – $309.44 | 8 |
| Giardia lamblia antibody CPT 86674 | $89.10 | $135.00 | $14.72 – $19.14 | 11 |
| Gi inhouse confirmation CPT 87045 | $106.26 | $161.00 | $9.44 – $12.27 | 11 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $875.95 | $1,327.20 | $164.86 – $295.10 | 11 |
| Glucagon plasma - sendout CPT 82943 | $50.16 | $76.00 | $13.88 – $18.58 | 11 |
| Glucose 1 hr post dose CPT 82950 | $72.60 | $110.00 | $4.75 – $6.18 | 11 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $15.84 | $24.00 | $3.28 – $4.26 | 11 |
| Glucose blood quantitative CPT 82947 | $24.42 | $37.00 | $3.93 – $5.11 | 11 |
| Glucose body fluid CPT 82945 | $43.56 | $66.00 | $3.93 – $5.11 | 11 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $89.76 | $136.00 | $12.87 – $16.73 | 11 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $25.08 | $38.00 | $3.92 – $5.10 | 11 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $32.99 | $49.98 | $0.63 – $0.68 | 4 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $117.48 | $178.00 | $18.58 – $24.15 | 11 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $117.48 | $178.00 | $18.52 – $24.08 | 11 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $60.72 | $92.00 | $51.39 – $127.14 | 5 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | $64.02 | $97.00 | $127.14 – $127.14 | 1 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $193.38 | $293.00 | $103.75 – $209.78 | 11 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $1,007.99 | $1,527.25 | $127.14 – $248.34 | 11 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $58.08 | $88.00 | $127.14 – $127.14 | 1 |
| Great toe with reduction 28495 CPT 28495 | $568.26 | $861.00 | $95.40 – $791.66 | 9 |
| G-tube reposition CPT 43761 | $830.28 | $1,258.00 | $255.26 – $669.43 | 11 |
| Guided cath fluid drainage 10030 CPT 10030 | $1,186.68 | $1,798.00 | $723.47 – $1,846.17 | 8 |
| Guide wire threaded 1.4x150mm HCPCS C1769 | $197.34 | $299.00 | $20.90 – $20.90 | 1 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $32.34 | $49.00 | $1.20 – $1.31 | 4 |
| Hand X-ray CPT 73130 | $388.74 | $589.00 | $88.91 – $448.00 | 11 |
| Haptoglobin quantitative CPT 83010 | $81.18 | $123.00 | $12.58 – $16.35 | 11 |
| Hba1/hba2 full gene sequence CPT 81259 | $698.94 | $1,059.00 | $480.00 – $780.00 | 11 |
| Hba1/hba2 gene dup/del vrnts CPT 81269 | $684.42 | $1,037.00 | $161.92 – $263.12 | 11 |
| Hbb full gene sequence CPT 81364 | $374.88 | $568.00 | $259.66 – $421.95 | 11 |
| Hbb gene dup/del variants CPT 81363 | $641.52 | $972.00 | $161.92 – $263.12 | 11 |
| Hbot, full body chamber, 30m HCPCS G0277 | $543.84 | $824.00 | $140.59 – $824.00 | 9 |
| Hcg qualitative CPT 84703 | $62.04 | $94.00 | $7.52 – $9.78 | 11 |
| Hcg quantitative CPT 84702 | $91.08 | $138.00 | $15.05 – $19.57 | 11 |
| Hc metata joint dislocation anes CPT 28635 | $2,799.06 | $4,241.00 | $1,567.01 – $1,661.03 | 8 |
| Hc nm kidney imaging with flow CPT 78701 | $1,170.18 | $1,773.00 | $408.43 – $1,311.10 | 11 |
| Head CT scan (with and without contrast) CPT 70470 | $1,818.96 | $2,756.00 | $179.20 – $1,247.60 | 11 |
| Head CT scan (with contrast) CPT 70460 | $1,770.12 | $2,682.00 | $179.20 – $1,247.60 | 11 |
| Head CT scan (without contrast) CPT 70450 | $1,259.28 | $1,908.00 | $106.81 – $1,247.60 | 11 |
| Helicobacter pylori antibody igm CPT 86677 | $79.86 | $121.00 | $8.17 – $21.91 | 11 |
| Hematocrit CPT 85014 | $55.44 | $84.00 | $2.37 – $3.08 | 11 |
| Hemin 350 mg intravenous powder for solution HCPCS J1640 | $62.05 | $94.01 | $35.31 – $99.65 | 11 |
| Hemoglobin CPT 85018 | $55.44 | $84.00 | $2.37 – $3.08 | 11 |
| Hemoglobin fetal qualitative CPT 83033 | $44.22 | $67.00 | $8.00 – $10.40 | 11 |
| Hemoglobin methemoglobin quantitative CPT 83050 | $54.12 | $82.00 | $4.12 – $10.66 | 11 |
| Hemoglobin plasma CPT 83051 | $20.46 | $31.00 | $4.90 – $9.50 | 11 |
| Hemolysins/agglutinins auto CPT 86940 | $73.92 | $112.00 | $8.77 – $11.40 | 11 |
| Hemophilus influenza antibdy CPT 86684 | $138.60 | $210.00 | $15.84 – $20.59 | 11 |
| Heparin assay CPT 85520 | $167.64 | $254.00 | $13.09 – $17.02 | 11 |
| Heparin bolus from bag HCPCS J1644 | $18.85 | $28.56 | $0.30 – $0.32 | 4 |
| Heparin, porcine (pf) 10 unit/ml flush (wrapper) HCPCS J1642 | $0.53 | $0.80 | $0.03 – $0.04 | 4 |
| Hepatitis a antibody igm CPT 86709 | $138.60 | $210.00 | $11.26 – $14.64 | 11 |
| Hepatitis b core antibody igm CPT 86705 | $147.84 | $224.00 | $11.77 – $15.30 | 11 |
| Hepatitis b core antibody total CPT 86704 | $87.12 | $132.00 | $12.05 – $15.67 | 11 |
| Hepatitis b surface antibody CPT 86706 | $68.64 | $104.00 | $10.74 – $13.96 | 11 |
| Hepatitis c antibody CPT 86803 | $99.00 | $150.00 | $14.27 – $18.55 | 11 |
| Hepatobiliary system imaging CPT 78226 | $1,663.20 | $2,520.00 | $408.43 – $1,311.10 | 11 |
| Hernia Repair (Inguinal) CPT 49505 | not published | not published | not published | 0 |
| Herpes simplex 1 ag if CPT 87274 | $75.24 | $114.00 | $11.98 – $15.57 | 11 |
| Herpes simplex 2 ag if CPT 87273 | $75.24 | $114.00 | $11.98 – $15.57 | 11 |
| Herpes simplex type 1 antibody igg CPT 86695 | $122.76 | $186.00 | $13.19 – $17.15 | 11 |
| Herpes simplex type 2 antibody igg CPT 86696 | $129.36 | $196.00 | $19.35 – $25.16 | 11 |
| Heterophile antibodies screening CPT 86308 | $80.52 | $122.00 | $5.18 – $6.73 | 11 |
| Hhv-6 dna quant CPT 87533 | $436.92 | $662.00 | $41.76 – $54.29 | 11 |
| Hip X-ray CPT 73502 | $363.66 | $551.00 | $88.91 – $495.60 | 11 |
| Histamine CPT 83088 | $170.94 | $259.00 | $29.53 – $38.39 | 11 |
| Histochemical stains add-on CPT 88314 | $168.96 | $256.00 | $52.32 – $153.60 | 10 |
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.