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 |
|---|---|---|---|---|
| Kidney img w/bldflw sgl without rx CPT 78707 | $1,682.34 | $2,549.00 | $554.73 – $1,311.10 | 11 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $566.28 | $858.00 | $106.81 – $574.00 | 11 |
| Kit gene analys d816 variant CPT 81273 | $683.10 | $1,035.00 | $73.92 – $162.33 | 11 |
| Knee Arthroscopy (Meniscus Repair) CPT 29881 | not published | not published | not published | 0 |
| Knee arthroscopy/surgery CPT 29875 | not published | not published | not published | 0 |
| Knee arthroscopy/surgery CPT 29880 | not published | not published | not published | 0 |
| Knee MRI (with and without contrast) CPT 73723 | $2,669.70 | $4,045.00 | $356.43 – $1,513.40 | 11 |
| Knee MRI (with contrast) CPT 73722 | $2,542.32 | $3,852.00 | $660.90 – $1,513.40 | 11 |
| Knee MRI (without contrast) CPT 73721 | $2,420.88 | $3,668.00 | $243.77 – $1,513.40 | 11 |
| Knee X-ray CPT 73564 | $363.00 | $550.00 | $91.15 – $495.60 | 11 |
| Kras gene variants exon 2 CPT 81275 | $931.26 | $1,411.00 | $157.98 – $251.23 | 11 |
| Lab draw < 3 yrs fem/jugular 36400 CPT 36400 | $157.08 | $238.00 | $4.36 – $4.62 | 7 |
| Labetalol 5 mg/ml IV (wrapper) HCPCS J1920 | $1.95 | $2.95 | $0.58 – $0.63 | 4 |
| Lactate dehydrogenase (ldh) CPT 83615 | $67.32 | $102.00 | $6.04 – $7.85 | 11 |
| Lactated ringers intravenous solution HCPCS J7120 | $69.96 | $106.00 | $3.93 – $4.26 | 4 |
| Lactic acid CPT 83605 | $72.60 | $110.00 | $11.57 – $15.04 | 11 |
| Lactoferrin fecal quant CPT 83631 | $114.18 | $173.00 | $19.63 – $25.52 | 11 |
| Laparoscopy biopsy CPT 49321 | $6,738.60 | $10,210.00 | $339.92 – $6,290.64 | 13 |
| Largsc w/rmvl foreign bdy(s) CPT 31577 | $766.92 | $1,162.00 | $399.59 – $1,039.09 | 8 |
| Laryngeal function studies CPT 92520 | $267.30 | $405.00 | $61.57 – $283.80 | 11 |
| Lead capillary CPT 83655 | $72.60 | $110.00 | $12.11 – $15.74 | 11 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $1,283.70 | $1,945.00 | $243.77 – $510.50 | 11 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $2.40 | $3.63 | $0.07 – $0.07 | 4 |
| Levetiracetam therapeutic drug level CPT 80177 | $77.22 | $117.00 | $13.25 – $17.23 | 11 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $49.63 | $75.20 | $3.56 – $3.87 | 4 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | $34.71 | $52.59 | $9.87 – $10.70 | 4 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $1.62 | $2.45 | $0.08 – $0.08 | 1 |
| Lidocaine therapeutic drug level CPT 80176 | $155.76 | $236.00 | $14.69 – $19.10 | 11 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | $1,871.10 | $2,835.00 | $195.73 – $2,835.00 | 13 |
| Ligation major artery chest CPT 37616 | $3,503.94 | $5,309.00 | $1,095.73 – $5,309.00 | 12 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $71.74 | $108.70 | $4.52 – $4.90 | 4 |
| Lipase CPT 83690 | $143.88 | $218.00 | $6.89 – $8.96 | 11 |
| Lipoprotein blood quant CPT 83704 | $217.80 | $330.00 | $34.19 – $44.45 | 11 |
| Lipoprotein direct measurement hdl CPT 83718 | $54.12 | $82.00 | $8.19 – $10.65 | 11 |
| Lipoprotein direct measurement ldl CPT 83721 | $62.70 | $95.00 | $10.50 – $13.65 | 11 |
| Lithium therapeutic drug level CPT 80178 | $39.60 | $60.00 | $6.61 – $8.59 | 11 |
| Liver Function Test CPT 80076 | $131.34 | $199.00 | $8.17 – $10.62 | 11 |
| Liver imaging CPT 78201 | $1,961.52 | $2,972.00 | $554.73 – $1,514.75 | 11 |
| Liver imag w/vasclr flow CPT 78202 | $2,070.42 | $3,137.00 | $554.73 – $1,514.75 | 11 |
| Liver/spleen imag static only CPT 78215 | $951.06 | $1,441.00 | $408.43 – $1,514.75 | 11 |
| Liver/spleen imag w/vasclr flow CPT 78216 | $1,243.44 | $1,884.00 | $408.43 – $1,514.75 | 11 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | not published | 0 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $188.76 | $286.00 | $2.33 – $2.52 | 4 |
| Low cost skin substitute app HCPCS C5271 | $776.16 | $1,176.00 | $95.40 – $1,246.56 | 8 |
| Low cost skin substitute app HCPCS C5273 | $1,032.90 | $1,565.00 | $95.40 – $1,658.90 | 8 |
| Low cost skin substitute app HCPCS C5275 | $780.78 | $1,183.00 | $95.40 – $1,253.98 | 8 |
| Low cost skin substitute app HCPCS C5277 | $865.26 | $1,311.00 | $95.40 – $1,389.66 | 8 |
| Low cost skin substitute app HCPCS C5272 | $341.22 | $517.00 | $95.40 – $548.02 | 8 |
| Low cost skin substitute app HCPCS C5274 | $616.44 | $934.00 | $95.40 – $990.04 | 8 |
| Low cost skin substitute app HCPCS C5276 | $306.24 | $464.00 | $95.40 – $491.84 | 8 |
| Low cost skin substitute app HCPCS C5278 | $801.24 | $1,214.00 | $95.40 – $1,286.84 | 8 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $1,818.96 | $2,756.00 | $179.20 – $1,247.60 | 11 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $1,562.88 | $2,368.00 | $356.43 – $1,247.60 | 11 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $1,359.60 | $2,060.00 | $106.81 – $1,247.60 | 11 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $2,700.06 | $4,091.00 | $356.43 – $1,513.40 | 11 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $2,571.36 | $3,896.00 | $356.43 – $1,513.40 | 11 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $2,337.72 | $3,542.00 | $121.89 – $1,513.40 | 11 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $363.66 | $551.00 | $91.15 – $495.60 | 11 |
| Lumbar diskogram s&i CPT 72295 | $2,484.90 | $3,765.00 | $299.69 – $1,995.02 | 11 |
| Lung function test (mbc/mvv) CPT 94200 | $190.74 | $289.00 | $60.27 – $146.20 | 11 |
| Lung Function Test (Spirometry) CPT 94010 | $363.00 | $550.00 | $32.52 – $550.00 | 15 |
| Lung perfusion imaging CPT 78580 | $1,226.28 | $1,858.00 | $408.43 – $1,514.75 | 11 |
| Lymphatics/lymph node imaging CPT 78195 | $1,463.22 | $2,217.00 | $554.73 – $1,514.75 | 11 |
| Lymphocyte transformation mitogen CPT 86353 | $267.30 | $405.00 | $49.03 – $63.74 | 11 |
| Macroscopic exam arthropod CPT 87168 | $68.64 | $104.00 | $4.27 – $5.55 | 11 |
| Macroscopic exam parasite CPT 87169 | $68.64 | $104.00 | $4.31 – $5.60 | 11 |
| Magnesium CPT 83735 | $62.04 | $94.00 | $6.70 – $8.71 | 11 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $25.84 | $39.15 | $0.68 – $0.73 | 4 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $129.36 | $196.00 | $90.89 – $135.93 | 11 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $319.44 | $484.00 | $90.89 – $135.93 | 11 |
| Mastectomy partial CPT 19301 | $4,422.66 | $6,701.00 | $649.47 – $5,598.49 | 13 |
| Mastoids complete CPT 70130 | $315.48 | $478.00 | $91.15 – $478.00 | 11 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $118.80 | $180.00 | $14.46 – $18.80 | 11 |
| Mayo aathr protein s free CPT 85306 | $118.14 | $179.00 | $15.32 – $19.92 | 11 |
| Mayo activated protein c resistance assay CPT 85307 | $118.14 | $179.00 | $15.32 – $19.92 | 11 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | $260.04 | $394.00 | $30.85 – $50.14 | 11 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $174.90 | $265.00 | $18.33 – $159.00 | 9 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $89.76 | $136.00 | $14.78 – $19.21 | 11 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $142.56 | $216.00 | $18.33 – $129.60 | 9 |
| Mayo alpha 1 antitrypsin CPT 82103 | $81.18 | $123.00 | $13.44 – $17.47 | 11 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $95.70 | $145.00 | $15.08 – $19.60 | 11 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | $75.90 | $115.00 | $18.33 – $69.00 | 9 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $520.08 | $788.00 | $98.08 – $158.12 | 11 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $495.00 | $750.00 | $91.66 – $119.16 | 11 |
| Mayo analysis microarray cytogenomic copy number/snp variants CPT 81229 | $2,378.64 | $3,604.00 | $608.00 – $1,508.00 | 11 |
| Mayo androstenedione CPT 82157 | $180.18 | $273.00 | $29.28 – $38.06 | 11 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $157.08 | $238.00 | $14.60 – $18.98 | 11 |
| Mayo antithrombin iii antigen CPT 85301 | $89.10 | $135.00 | $10.81 – $14.05 | 11 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $51.48 | $78.00 | $8.17 – $19.57 | 11 |
| Mayo avwpr vw factor activity CPT 85397 | $254.76 | $386.00 | $30.86 – $40.12 | 11 |
| Mayo babpb infectious agent nucleic acid amplified probe babesia microti CPT 87469 | $99.66 | $151.00 | $35.09 – $45.62 | 11 |
| Mayo barbiturates definitive assay confirmation urine CPT 80345 | $71.28 | $108.00 | $18.33 – $24.60 | 9 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $50.82 | $77.00 | $8.17 – $13.23 | 11 |
| Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 | $910.80 | $1,380.00 | $144.84 – $188.29 | 11 |
| Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative CPT 81208 | $273.90 | $415.00 | $175.54 – $279.01 | 11 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $68.64 | $104.00 | $8.17 – $16.77 | 11 |
| Mayo bnzu sedative hypnotics definitive urine CPT 80368 | $39.60 | $60.00 | $18.33 – $36.00 | 9 |
| Mayo brcmg brucella antibody igm CPT 86622 | $59.40 | $90.00 | $8.17 – $11.61 | 11 |
| Mayo c1 esterase inhibitor CPT 83883 | $112.20 | $170.00 | $13.60 – $17.68 | 11 |
| Mayo cannabinoids natural definitive assay thc confirmation urine CPT 80349 | $102.30 | $155.00 | $18.33 – $93.00 | 9 |
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.