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 |
|---|---|---|---|---|
| Nafcillin 2 gram solution for injection HCPCS J2290 | $0.61 | $0.92 | $0.10 – $0.11 | 4 |
| Naloxone 0.4 mg/ml injection (wrapper) HCPCS J2312 | $1.93 | $2.92 | $0.12 – $0.13 | 4 |
| Natriuretic peptide CPT 83880 | $207.24 | $314.00 | $39.26 – $51.04 | 11 |
| Natural killer cells total count CPT 86357 | $256.74 | $389.00 | $37.73 – $49.05 | 11 |
| Neck (Cervical Spine) CT scan (with and without contrast) CPT 72127 | $1,818.96 | $2,756.00 | $179.20 – $1,247.60 | 11 |
| Neck (Cervical Spine) CT scan (with contrast) CPT 72126 | $1,539.12 | $2,332.00 | $356.43 – $1,247.60 | 11 |
| Neck (Cervical Spine) CT scan (without contrast) CPT 72125 | $1,357.62 | $2,057.00 | $106.81 – $1,247.60 | 11 |
| Neck (Cervical Spine) MRI (with and without contrast) CPT 72156 | $2,001.12 | $3,032.00 | $356.43 – $1,513.40 | 11 |
| Neck (Cervical Spine) MRI (with contrast) CPT 72142 | $1,906.08 | $2,888.00 | $356.43 – $1,513.40 | 11 |
| Neck (Cervical Spine) MRI (without contrast) CPT 72141 | $1,815.00 | $2,750.00 | $121.89 – $1,513.40 | 11 |
| Neck MRA (blood vessel MRI, with and without contrast) CPT 70549 | $2,080.98 | $3,153.00 | $356.43 – $1,513.40 | 11 |
| Neck MRA (blood vessel MRI, with contrast) CPT 70548 | $1,801.80 | $2,730.00 | $356.43 – $1,513.40 | 11 |
| Neck MRA (blood vessel MRI, without contrast) CPT 70547 | $1,716.00 | $2,600.00 | $243.77 – $1,513.40 | 11 |
| Neostigmine methylsulfate 1 mg/ml injection (wrapper) HCPCS J2710 | $1.62 | $2.45 | $2.33 – $2.33 | 1 |
| Neuromuscular junction testing ea nerve any 1 method CPT 95937 | $458.70 | $695.00 | $131.46 – $496.70 | 11 |
| Neuroplasty nerve of hand or foot 64704 CPT 64704 | not published | not published | not published | 0 |
| New Patient Office Visit (level 2) CPT 99202 | $208.56 | $316.00 | $89.00 – $89.00 | 2 |
| New Patient Office Visit (level 3) CPT 99203 | $252.12 | $382.00 | $95.40 – $143.00 | 2 |
| New Patient Office Visit (level 4) CPT 99204 | $287.10 | $435.00 | $95.40 – $154.00 | 2 |
| New Patient Office Visit (level 5) CPT 99205 | $347.82 | $527.00 | $95.40 – $154.00 | 2 |
| Nicardipine 25 mg/10 ml intravenous solution HCPCS J2404 | $2.09 | $3.16 | $0.12 – $3.26 | 10 |
| Nitroglycerin 50 mg/250 ml (200 mcg/ml) in 5 % dextrose intravenous HCPCS J2305 | $13.00 | $19.70 | $2.51 – $2.72 | 4 |
| Njx aa&/strd lmbr plex nfs CPT 64449 | $1,028.28 | $1,558.00 | $903.63 – $1,651.48 | 8 |
| Njx aa&/strd sc nrv nfs img CPT 64446 | $2,263.80 | $3,430.00 | $903.63 – $2,202.19 | 8 |
| Njx interlaminar lmbr/sac CPT 62326 | $1,186.68 | $1,798.00 | $903.63 – $1,314.72 | 8 |
| Njx interlaminar lmbr/sac CPT 62327 | $1,482.36 | $2,246.00 | $903.63 – $1,314.72 | 8 |
| Nm imaging bone/joint 3 phase study CPT 78315 | $1,665.18 | $2,523.00 | $408.43 – $1,311.10 | 11 |
| Nm imaging bone/joint whole body CPT 78306 | $1,389.96 | $2,106.00 | $408.43 – $1,311.10 | 11 |
| Nm imaging cardiac blood pooling planar single study at rest or stress CPT 78472 | $1,620.96 | $2,456.00 | $408.43 – $1,311.10 | 11 |
| Nm imaging gastric emptying study CPT 78264 | $1,302.84 | $1,974.00 | $408.43 – $1,311.10 | 11 |
| Nm imaging gastrointestinal acute blood loss CPT 78278 | $1,316.70 | $1,995.00 | $408.43 – $1,514.75 | 11 |
| Nm imaging hepatobiliary system w/pharmacologic intervention CPT 78227 | $1,587.96 | $2,406.00 | $554.73 – $1,311.10 | 11 |
| Nm imaging kidney morphology vascular flow/function single study w/pharmacological intervention CPT 78708 | $1,722.60 | $2,610.00 | $482.93 – $1,311.10 | 11 |
| Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s) CPT 78014 | $1,097.58 | $1,663.00 | $408.43 – $1,311.10 | 11 |
| Npm1 gene CPT 81310 | $507.54 | $769.00 | $197.71 – $320.48 | 11 |
| Nuclear Stress Test (Heart) CPT 78452 | $3,365.34 | $5,099.00 | $1,246.46 – $1,514.75 | 11 |
| Nushield 1 square cm HCPCS Q4160 | $508.86 | $771.00 | $127.14 – $734.00 | 5 |
| Observation direct referral from physician office for admission HCPCS G0379 | $643.50 | $975.00 | not published | 0 |
| Observation/inpatient hospital care mod severity 99235 CPT 99235 | $421.74 | $639.00 | $156.48 – $352.08 | 7 |
| Observation per hour HCPCS G0378 | $182.82 | $277.00 | not published | 0 |
| Obstetric panel inc HIV tstg CPT 80081 | $356.40 | $540.00 | $74.86 – $97.32 | 11 |
| Obstetrics panel CPT 80055 | $256.74 | $389.00 | $18.84 – $62.15 | 11 |
| Obtaining screen pap smear HCPCS Q0091 | $51.48 | $78.00 | $17.12 – $38.52 | 13 |
| Octreotide acetate 100 mcg/ml injection (wrapper) HCPCS J2354 | $32.34 | $49.00 | $1.09 – $1.18 | 4 |
| Ondansetron hcl (pf) 2 mg/ml injection (wrapper) HCPCS J2405 | $19.14 | $29.00 | $0.15 – $0.16 | 4 |
| Opioids & opiate analogs 3/4 CPT 80363 | $23.10 | $35.00 | $18.33 – $21.00 | 9 |
| Opps service,sched team conf HCPCS G0175 | $491.70 | $745.00 | $259.68 – $426.30 | 5 |
| Optx clavicular fx w/int fix CPT 23515 | not published | not published | not published | 0 |
| Organic acids total quant ea spec CPT 83918 | $531.30 | $805.00 | $23.14 – $30.68 | 11 |
| Oritavancin 400 mg intravenous solution HCPCS J2407 | $56.31 | $85.32 | $28.47 – $90.44 | 11 |
| Orphenadrine citrate 30 mg/ml injection solution HCPCS J2360 | $76.00 | $115.15 | $10.54 – $11.44 | 4 |
| Ortho elbow without jnt cstm w/fit&adj HCPCS L3702 | $349.80 | $530.00 | $364.38 – $364.38 | 1 |
| Ortho ewh rgd without jnt cstm w/fit&adj HCPCS L3763 | $552.42 | $837.00 | $836.99 – $836.99 | 1 |
| Ortho hnd/fngr without jnt cstm w/fit&adj HCPCS L3913 | $371.58 | $563.00 | $354.92 – $354.92 | 1 |
| Ortho hnd/fngr w/jnt cstm w/fit&adj HCPCS L3921 | $283.80 | $430.00 | $232.21 – $373.42 | 8 |
| Ortho hnd without jnt w/fit&adj HCPCS L3919 | $208.56 | $316.00 | $305.52 – $305.52 | 1 |
| Orthopantogram CPT 70355 | $315.48 | $478.00 | $32.30 – $478.00 | 11 |
| Ortho whf rigd without jnt cstm w/fit&adj HCPCS L3808 | $485.76 | $736.00 | $354.14 – $354.14 | 1 |
| Oscillation chest wall mechanical per session CPT 94669 | $526.02 | $797.00 | $90.89 – $223.72 | 11 |
| Osmolality blood CPT 83930 | $40.26 | $61.00 | $6.61 – $8.59 | 11 |
| Osmolality urine CPT 83935 | $42.90 | $65.00 | $6.82 – $8.87 | 11 |
| Ot evaluation high complexity patient/family CPT 97167 | $155.76 | $236.00 | $62.66 – $149.00 | 11 |
| Ot evaluation low complexity patient/family CPT 97165 | $155.76 | $236.00 | $62.66 – $149.00 | 11 |
| Ot evaluation moderate complexity patient/family CPT 97166 | $155.76 | $236.00 | $62.66 – $149.00 | 11 |
| Oth resp proc, group HCPCS G0239 | $167.64 | $254.00 | $38.16 – $99.60 | 11 |
| Oth resp proc, indiv HCPCS G0238 | $84.48 | $128.00 | $29.55 – $99.60 | 11 |
| Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes CPT 97763 | $80.52 | $122.00 | $28.15 – $122.00 | 11 |
| Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes CPT 97760 | $85.14 | $129.00 | $27.40 – $129.00 | 11 |
| Ot manual therpy techniques >=1 region each 15 minutes CPT 97140 | $80.52 | $122.00 | $25.53 – $122.00 | 11 |
| Ot re-evaluation patient/family CPT 97168 | $104.94 | $159.00 | $62.66 – $138.00 | 11 |
| Ot therapeutic activities direct patient contact each 15 minutes CPT 97530 | $95.70 | $145.00 | $32.94 – $145.00 | 11 |
| Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes CPT 97130 | $71.94 | $109.00 | $18.01 – $109.00 | 11 |
| Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes CPT 97129 | $71.94 | $109.00 | $18.86 – $109.00 | 11 |
| Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes CPT 97110 | $80.52 | $122.00 | $28.25 – $122.00 | 11 |
| Ot therapeutic procedure neuromuscular reeducate each 15 minutes CPT 97112 | $93.72 | $142.00 | $19.32 – $142.00 | 11 |
| Ot training self care/home management direct contact each 15 minutes CPT 97535 | $89.10 | $135.00 | $20.93 – $135.00 | 11 |
| Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr HCPCS J2470 | $34.52 | $52.30 | $14.34 – $14.34 | 1 |
| Parathormone (pth) intact CPT 83970 | $252.12 | $382.00 | $41.28 – $53.66 | 11 |
| Parathyroid planar imaging CPT 78070 | $1,170.18 | $1,773.00 | $408.43 – $1,514.75 | 11 |
| Parathyroid planar img w/tomo spect CPT 78071 | $1,609.74 | $2,439.00 | $408.43 – $1,311.10 | 11 |
| Paring/cutting benign hyperkeratotic lesion single CPT 11055 | $199.98 | $303.00 | $95.40 – $284.11 | 9 |
| Partial excision bone tars/metatars exc talus/calcaneus (both sides) (rest meth ii cah) CPT 28122 | not published | not published | not published | 0 |
| Partial removal finger bone CPT 26236 | $3,032.04 | $4,594.00 | $1,642.82 – $2,245.21 | 8 |
| Partial removal foot fascia CPT 28060 | not published | not published | not published | 0 |
| Part removal of metatarsal 28112 CPT 28112 | not published | not published | not published | 0 |
| Passy muir valve metal trach HCPCS L8501 | $203.94 | $309.00 | $180.10 – $180.10 | 1 |
| Path clin consltj sf 5-20 CPT 80503 | $107.58 | $163.00 | $17.07 – $97.80 | 11 |
| Pelvic CT scan (with and without contrast) CPT 72194 | $1,818.96 | $2,756.00 | $179.20 – $1,247.60 | 11 |
| Pelvic CT scan (with contrast) CPT 72193 | $1,539.12 | $2,332.00 | $179.20 – $1,247.60 | 11 |
| Pelvic CT scan (without contrast) CPT 72192 | $1,259.28 | $1,908.00 | $106.81 – $1,247.60 | 11 |
| Pelvic MRI (with and without contrast) CPT 72197 | $2,893.44 | $4,384.00 | $356.43 – $1,513.40 | 11 |
| Pelvic MRI (with contrast) CPT 72196 | $2,504.70 | $3,795.00 | $356.43 – $1,513.40 | 11 |
| Pelvic MRI (without contrast) CPT 72195 | $2,277.00 | $3,450.00 | $243.77 – $1,513.40 | 11 |
| Pelvic Ultrasound (complete) CPT 76856 | $615.12 | $932.00 | $106.81 – $574.00 | 11 |
| Pelvic Ultrasound (limited) CPT 76857 | $482.46 | $731.00 | $106.81 – $574.00 | 11 |
| Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe HCPCS J0561 | $101.09 | $153.16 | $31.97 – $162.35 | 11 |
| Perflutren lipid microspheres 1.1 mg/ml intravenous suspension HCPCS Q9957 | $304.08 | $460.73 | $66.35 – $71.98 | 4 |
| Peripheral vascular rehab CPT 93668 | $92.40 | $140.00 | $13.81 – $140.00 | 11 |
| Perq dev breast 1st mr guide CPT 19287 | $314.16 | $476.00 | $476.00 – $723.47 | 8 |
| Perq rplcmt g-tube req revsn gstrst trk CPT 43763 | $924.66 | $1,401.00 | $255.26 – $669.43 | 8 |
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.