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 |
|---|---|---|---|---|
| Mayo receptor assay transferrin soluble CPT 84238 | $233.64 | $354.00 | $36.57 – $47.54 | 11 |
| Mayo renin CPT 84244 | $134.64 | $204.00 | $21.99 – $28.59 | 11 |
| Mayo repu protein electrophoresis urine CPT 84166 | $116.82 | $177.00 | $17.83 – $23.18 | 11 |
| Mayo selenium CPT 84255 | $152.46 | $231.00 | $25.53 – $33.19 | 11 |
| Mayo semb semen analysis volume/count/motility/differential strict morphologic criteria CPT 89322 | $310.86 | $471.00 | $15.50 – $20.15 | 11 |
| Mayo serotonin CPT 84260 | $152.46 | $231.00 | $30.98 – $40.27 | 11 |
| Mayo sfgp rickettsia rickettsii antibody igg CPT 86757 | $99.00 | $150.00 | $19.35 – $25.16 | 11 |
| Mayo sirolimus therapeutic drug level CPT 80195 | $71.28 | $108.00 | $13.73 – $17.85 | 11 |
| Mayo syphilis test non-treponemal antibody qualitative vdrl CPT 86592 | $32.34 | $49.00 | $4.27 – $5.55 | 11 |
| Mayo tcgr analysis gene rearrangement trb@ abnormal clonal population(s) amplification CPT 81340 | $455.40 | $690.00 | $208.92 – $271.60 | 11 |
| Mayo tgrp testosterone free CPT 84402 | $152.46 | $231.00 | $25.47 – $33.11 | 11 |
| Mayo tgrp testosterone total CPT 84403 | $170.94 | $259.00 | $25.81 – $33.55 | 11 |
| Mayo thiopurine s-methyltransferase CPT 84433 | $278.52 | $422.00 | $22.17 – $28.82 | 11 |
| Mayo thyroglobulin CPT 84432 | $287.76 | $436.00 | $16.06 – $20.88 | 11 |
| Mayo ticks anaplasma phagocytophilum antibody igg CPT 86666 | $36.30 | $55.00 | $8.17 – $13.23 | 11 |
| Mayo ticks babesia microti antibody igg CPT 86753 | $84.48 | $128.00 | $8.17 – $16.11 | 11 |
| Mayo tramadol definitive assay w metabolite quantitative urine CPT 80373 | $130.68 | $198.00 | $18.33 – $118.80 | 9 |
| Mayo valpg valproic acid free therapeutic drug level CPT 80165 | $58.08 | $88.00 | $13.54 – $17.60 | 11 |
| Mayo vasoactive intestinal peptide CPT 84586 | $152.46 | $231.00 | $17.93 – $45.93 | 11 |
| Mayo vitamin b-2 (riboflavin) CPT 84252 | $120.12 | $182.00 | $20.24 – $26.31 | 11 |
| Mayo vitamin k CPT 84597 | $314.82 | $477.00 | $13.72 – $17.84 | 11 |
| Mayo zonisamide therapeutic drug level CPT 80203 | $69.96 | $106.00 | $13.25 – $17.23 | 11 |
| Measurement post void urine by ultrasound CPT 51798 | $178.86 | $271.00 | $60.27 – $271.00 | 11 |
| #mec-opiates CPT 80356 | $69.30 | $105.00 | $18.33 – $63.00 | 9 |
| Mecp2 gene full seq CPT 81302 | $1,149.72 | $1,742.00 | $281.65 – $686.23 | 11 |
| Meperidine (pf) 25 mg/ml injection (wrapper) HCPCS J2175 | $23.10 | $35.00 | $13.45 – $14.59 | 4 |
| Meropenem 1 gram intravenous solution HCPCS J2185 | $14.61 | $22.14 | $0.63 – $0.68 | 4 |
| Metabolic Blood Panel (Basic) CPT 80048 | $125.40 | $190.00 | $8.46 – $11.00 | 11 |
| Metabolic Blood Panel (Comprehensive) CPT 80053 | $118.80 | $180.00 | $10.56 – $13.73 | 11 |
| Methotrexate sodium 2.5 mg tablet HCPCS J8610 | $8.01 | $12.13 | $0.25 – $0.27 | 4 |
| Methylphenidate CPT 80360 | $72.60 | $110.00 | $18.33 – $66.00 | 9 |
| Methylprednisolone 4 mg tablet HCPCS J7509 | $5.28 | $8.00 | $0.23 – $0.25 | 4 |
| Methylprednisolone acetate 40 mg/ml suspension for injection HCPCS J1010 | $1.20 | $1.82 | $0.20 – $0.21 | 4 |
| Methylprednisolone sodium succinate 1,000 mg intravenous solution HCPCS J2919 | $23.10 | $35.00 | $0.43 – $0.47 | 4 |
| Metoclopramide in d5w IV syringe 0.2 mg/ml (neo/ped) - cnr HCPCS J2765 | $32.34 | $49.00 | $1.78 – $1.93 | 4 |
| Metoprolol tartrate 5 mg/5 ml intravenous (wrapper) HCPCS J0616 | $6.47 | $9.80 | $0.20 – $0.21 | 4 |
| Metronidazole 500 mg/100 ml in sodium chlor(iso) intravenous piggyback HCPCS J1836 | $0.67 | $1.01 | $0.05 – $0.05 | 4 |
| Mgmt promoter methylation analysis CPT 81287 | $521.40 | $790.00 | $83.09 – $162.03 | 11 |
| Micafungin 100 mg intravenous solution HCPCS J2248 | $6.14 | $9.31 | $0.41 – $0.45 | 4 |
| Microbe susceptible mlc CPT 87187 | $138.60 | $210.00 | $14.57 – $52.22 | 11 |
| Microdissection laser CPT 88380 | $1,026.30 | $1,555.00 | $86.21 – $933.00 | 10 |
| Microdissection manual CPT 88381 | $248.16 | $376.00 | $52.32 – $191.00 | 10 |
| Microsatellite instability CPT 81301 | $1,080.42 | $1,637.00 | $316.03 – $453.13 | 11 |
| Midazolam 1 mg/ml injection solution HCPCS J2250 | $16.17 | $24.50 | $0.23 – $0.25 | 4 |
| Midazolam 1 mg/ml in sodium chloride IV infusion (wrapper) HCPCS J2251 | $1.66 | $2.52 | $0.30 – $0.32 | 4 |
| Mlh1 gene CPT 81288 | $458.04 | $694.00 | $164.96 – $250.02 | 11 |
| Mnpj anes sho jt fixj aprats CPT 23700 | $2,259.18 | $3,423.00 | $1,567.01 – $1,661.03 | 8 |
| Mog-igg1 antb flo cytmtry ea CPT 86363 | $488.40 | $740.00 | $12.05 – $49.05 | 11 |
| Mopath procedure level 1 CPT 81400 | $370.92 | $562.00 | $51.17 – $83.15 | 11 |
| Mopath procedure level 3 CPT 81402 | $495.00 | $750.00 | $120.26 – $195.43 | 11 |
| Mopath procedure level 6 CPT 81405 | $686.40 | $1,040.00 | $241.08 – $391.76 | 11 |
| Mopath procedure level 7 CPT 81406 | $1,016.40 | $1,540.00 | $226.30 – $367.74 | 11 |
| Mopath procedure level 8 CPT 81407 | $977.46 | $1,481.00 | $677.02 – $1,100.15 | 11 |
| Mopath procedure level 9 CPT 81408 | $2,310.00 | $3,500.00 | $1,600.00 – $2,600.00 | 11 |
| Morphine 4 mg/ml injection (wrapper) HCPCS J2270 | $32.34 | $49.00 | $5.02 – $5.44 | 4 |
| Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain computer-assisted CPT 88361 | $424.38 | $643.00 | $213.63 – $388.93 | 11 |
| Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain manual CPT 88360 | $411.18 | $623.00 | $174.06 – $373.80 | 11 |
| M/phmtrc alys ishquant/semiq CPT 88377 | $551.76 | $836.00 | $174.06 – $501.60 | 11 |
| M/phmtrc alysishquant/semiq CPT 88369 | $362.34 | $549.00 | $52.32 – $329.40 | 10 |
| MRA abdomen post contrast CPT 74185 | $2,913.90 | $4,415.00 | $798.32 – $1,513.40 | 10 |
| MRA chest w IV cont HCPCS C8909 | $2,913.90 | $4,415.00 | $356.43 – $1,513.40 | 11 |
| MRA pelvis w IV cont HCPCS C8918 | $2,913.90 | $4,415.00 | $356.43 – $1,513.40 | 11 |
| MRA w/cont, abd HCPCS C8900 | $2,789.16 | $4,226.00 | $356.43 – $1,513.40 | 11 |
| MRA without fol w/cont, lwr ext HCPCS C8914 | $2,913.90 | $4,415.00 | $356.43 – $1,513.40 | 11 |
| Mr elastography CPT 76391 | $1,535.16 | $2,326.00 | $243.77 – $1,513.40 | 11 |
| MRI breast without cont bi CPT 77047 | $2,656.50 | $4,025.00 | $243.77 – $1,513.40 | 11 |
| MRI cardiac morph & func wo IV cont CPT 75557 | $2,913.90 | $4,415.00 | $243.77 – $1,513.40 | 11 |
| MRI cardiac morph & func wwo IV cont CPT 75561 | $2,913.90 | $4,415.00 | $356.43 – $1,513.40 | 11 |
| MRI chest without contrast CPT 71550 | $2,656.50 | $4,025.00 | $243.77 – $1,513.40 | 11 |
| MRI chest without & w/contrast CPT 71552 | $3,036.00 | $4,600.00 | $356.43 – $1,513.40 | 11 |
| MRI chest w IV cont CPT 71551 | $2,845.92 | $4,312.00 | $660.90 – $1,513.40 | 11 |
| MRI fetal sngl/1st gestation CPT 74712 | $2,233.44 | $3,384.00 | $243.77 – $1,513.40 | 11 |
| MRI loex nonjt w IV cont CPT 73719 | $2,311.32 | $3,502.00 | $356.43 – $1,513.40 | 11 |
| MRI lower extremity other than joint without contrast (both sides) CPT 73718 | $2,420.88 | $3,668.00 | $243.77 – $1,513.40 | 11 |
| MRI lower extremity other than joint without & w/contrast (both sides) CPT 73720 | $2,669.70 | $4,045.00 | $356.43 – $1,513.40 | 11 |
| MRI orbit/face/neck without contrast CPT 70540 | $2,310.00 | $3,500.00 | $243.77 – $1,513.40 | 11 |
| MRI orbit/face/neck without & w/contrast CPT 70543 | $2,934.36 | $4,446.00 | $356.43 – $1,513.40 | 11 |
| MRI tmj CPT 70336 | $3,107.94 | $4,709.00 | $243.77 – $495.60 | 11 |
| MRI upper extremity other than joint without contrast (both sides) CPT 73218 | $2,410.98 | $3,653.00 | $243.77 – $1,513.40 | 11 |
| MRI upper extremity other than joint without & w/contrast (both sides) CPT 73220 | $2,669.70 | $4,045.00 | $356.43 – $1,513.40 | 11 |
| MRI upper extremity w/dye CPT 73219 | $2,542.32 | $3,852.00 | $356.43 – $1,513.40 | 11 |
| MRI without fol w/cont, breast HCPCS C8908 | $3,204.96 | $4,856.00 | $356.43 – $1,513.40 | 11 |
| Mr safety determination physician/other qhp CPT 76016 | $203.94 | $309.00 | $88.91 – $309.00 | 5 |
| Mr safety implant elec prepj CPT 76018 | $239.58 | $363.00 | $97.13 – $363.00 | 5 |
| Mr safety implant&/fb assmt clin staff ea add 30 CPT 76015 | $80.52 | $122.00 | $122.00 – $122.00 | 4 |
| Mr safety implt pos&/immoblj CPT 76019 | $143.22 | $217.00 | $60.27 – $217.00 | 5 |
| Mr sfty implt&/fb asmt stf 1 CPT 76014 | $65.34 | $99.00 | $29.55 – $99.00 | 5 |
| Mr sfty med physics xm cstmz CPT 76017 | $718.08 | $1,088.00 | $243.77 – $1,088.00 | 5 |
| Mthfr gene analy common variants CPT 81291 | $277.20 | $420.00 | $61.35 – $84.94 | 11 |
| Mumps antibody igg CPT 86735 | $108.90 | $165.00 | $13.05 – $16.97 | 11 |
| Mycobacteria dna amp probe CPT 87551 | $482.46 | $731.00 | $48.24 – $62.71 | 11 |
| Mycophenolate mofetil 250 mg capsule HCPCS J7517 | $2.64 | $4.00 | $0.25 – $0.27 | 4 |
| Mycophenolic acid HCPCS J7518 | $10.26 | $15.54 | $0.53 – $0.57 | 4 |
| Mycoplasma antibody igm CPT 86738 | $68.64 | $104.00 | $13.24 – $17.21 | 11 |
| Myelography l-s spine CPT 72265 | $1,922.58 | $2,913.00 | $291.38 – $962.32 | 11 |
| Myelography via inj w/s&i 2+ regions CPT 62305 | $3,280.20 | $4,970.00 | $456.60 – $962.32 | 11 |
| Myelography via inj w/s&i cervical CPT 62302 | $2,624.82 | $3,977.00 | $456.60 – $962.32 | 11 |
| Myelography via inj w/s&i lumbosacral CPT 62304 | $2,100.12 | $3,182.00 | $456.60 – $962.32 | 11 |
| Myelography via inj w/s&i thoracic CPT 62303 | $1,679.70 | $2,545.00 | $456.60 – $962.32 | 11 |
| Myeloperoxidase ab multi step qualitative/semiquantitative CPT 83516 | $81.18 | $123.00 | $11.53 – $14.99 | 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.