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 |
|---|---|---|---|---|
| Pt re-evaluation patient/family CPT 97164 | $89.10 | $135.00 | $65.77 – $117.00 | 5 |
| Pt repositioning canalith procedure(s) per day CPT 95992 | $130.02 | $197.00 | $39.63 – $197.00 | 5 |
| Pt therapeutic procedure >=1 area gait training each 15 minutes CPT 97116 | $80.52 | $122.00 | $28.25 – $122.00 | 11 |
| Pt therapeutic procedure >=1 area massage each 15 minutes CPT 97124 | $69.96 | $106.00 | $24.58 – $106.00 | 11 |
| Pt wheelchair management each 15 minutes CPT 97542 | $93.72 | $142.00 | $18.94 – $142.00 | 11 |
| Pulse ox continuous overnight monitoring CPT 94762 | $263.34 | $399.00 | $93.60 – $399.00 | 11 |
| Pulse ox single CPT 94760 | $147.84 | $224.00 | $224.00 – $224.00 | 3 |
| Pump on-q 100mlx2ml/hr 2 day delivery HCPCS C9804 | $623.70 | $945.00 | $144.79 – $241.31 | 2 |
| Puncture arterial withdrawal blood for diagnosis CPT 36600 | $129.36 | $196.00 | $117.60 – $135.93 | 10 |
| Puncture aspiration abscess/hematoma/bulla/cyst CPT 10160 | $487.74 | $739.00 | $268.03 – $415.32 | 9 |
| Puncture spinal lumbar diagnostic CPT 62270 | $1,019.04 | $1,544.00 | $721.17 – $1,314.72 | 8 |
| Pvb thoracic 2nd+ inj site CPT 64462 | $197.34 | $299.00 | $299.00 – $316.94 | 7 |
| Pvb thoracic cont infusion CPT 64463 | $1,430.22 | $2,167.00 | $721.17 – $1,314.72 | 8 |
| Pvb thoracic single inj site CPT 64461 | $1,321.98 | $2,003.00 | $721.17 – $1,314.72 | 8 |
| Pyruvate CPT 84210 | $89.76 | $136.00 | $14.48 – $18.82 | 11 |
| Pyruvate kinase CPT 84220 | $182.16 | $276.00 | $9.44 – $12.27 | 11 |
| Quest t3 uptake CPT 84479 | $54.12 | $82.00 | $6.47 – $8.41 | 11 |
| Rabies ig ht&sol human im/sc CPT 90377 | $1,003.91 | $1,521.08 | $240.13 – $1,612.34 | 11 |
| Rabies immune globulin (pf) 300 unit/ml intramuscular solution CPT 90375 | $660.22 | $1,000.33 | $279.95 – $1,060.35 | 11 |
| Radphm lcl tmr plnr bdy sgl day img CPT 78802 | $1,508.10 | $2,285.00 | $554.73 – $1,514.75 | 11 |
| Radphm lcl tomogr sgl area sgl day CPT 78803 | $1,682.34 | $2,549.00 | $554.73 – $1,514.75 | 11 |
| Radphm lcl tumor plr sgl day CPT 78800 | $877.80 | $1,330.00 | $408.43 – $1,409.80 | 11 |
| Rapid Strep Test CPT 87880 | $80.52 | $122.00 | $16.53 – $21.49 | 11 |
| Rbc count only automated CPT 85041 | $14.52 | $22.00 | $3.02 – $3.93 | 11 |
| Recon, cta for surg plan HCPCS G0288 | $153.78 | $233.00 | $233.00 – $233.00 | 4 |
| Reconstruction of nose CPT 30420 | $12,497.10 | $18,935.00 | $6,048.05 – $8,581.63 | 8 |
| Red blood cells leukocytes reduced cmv negative irradiated each unit HCPCS P9058 | $619.74 | $939.00 | $203.39 – $505.20 | 9 |
| Red blood cells leukocytes reduced each unit HCPCS P9016 | $345.84 | $524.00 | $184.91 – $505.20 | 9 |
| Red blood cells leukocytes reduced irradiated each unit HCPCS P9040 | $662.64 | $1,004.00 | $203.39 – $505.20 | 9 |
| Regadenoson 0.4 mg/5 ml intravenous syringe HCPCS J2785 | $304.73 | $461.71 | $4.42 – $4.80 | 4 |
| Release of lower leg tendon CPT 27680 | not published | not published | not published | 0 |
| Release palm contracture CPT 26123 | not published | not published | not published | 0 |
| Relieve bladder contracture CPT 52640 | not published | not published | not published | 0 |
| Rem/biv cast full arm/leg CPT 29705 | $434.28 | $658.00 | $285.75 – $309.44 | 8 |
| Remdesivir 100 mg intravenous powder for solution HCPCS J0248 | $12.32 | $18.67 | $6.35 – $12.35 | 11 |
| Removal central venous catheter tunneled without port/pump CPT 36589 | $1,052.04 | $1,594.00 | $640.89 – $1,268.50 | 8 |
| Removal central venous device tunneled w/port/pump central/peripheral insertion CPT 36590 | $2,198.46 | $3,331.00 | $1,196.70 – $1,608.25 | 8 |
| Removal cerumen impacted (both sides) CPT 69210 | $99.66 | $151.00 | $60.27 – $60.27 | 1 |
| Removal embedded foreign body vestibule mouth smpl CPT 40804 | $1,440.78 | $2,183.00 | $926.63 – $2,059.07 | 8 |
| Removal foreign body foot subcutaneous right CPT 28190 | $830.28 | $1,258.00 | $682.65 – $723.61 | 8 |
| Removal implant superficial separate procedure CPT 20670 | $3,065.04 | $4,644.00 | $500.00 – $3,984.18 | 11 |
| Removal of bone for graft CPT 20900 | not published | not published | not published | 0 |
| Removal of breast lesion CPT 19120 | $4,422.66 | $6,701.00 | $422.41 – $4,000.24 | 13 |
| Removal of foot lesion CPT 28080 | not published | not published | not published | 0 |
| Removal of foot lesion CPT 28090 | not published | not published | not published | 0 |
| Removal of hydrocele CPT 55040 | not published | not published | not published | 0 |
| Removal of implant deep CPT 20680 | not published | not published | not published | 0 |
| Removal skin tags fibrocutaneous any area <= 15 lesions CPT 11200 | $246.18 | $373.00 | $75.46 – $284.11 | 13 |
| Remove bladder stone CPT 52317 | not published | not published | not published | 0 |
| Remove foreign body from eye CPT 65265 | $5,758.50 | $8,725.00 | $1,665.42 – $2,357.81 | 8 |
| Remove skin nerve lesion 64788 CPT 64788 | not published | not published | not published | 0 |
| Remove spine eltrd perq aray CPT 63661 | $4,715.70 | $7,145.00 | $1,995.02 – $5,743.11 | 8 |
| Remove ureter stent percut CPT 50384 | not published | not published | not published | 0 |
| Renal function panel CPT 80069 | $113.52 | $172.00 | $8.68 – $11.28 | 11 |
| Repair complex wound scalp/arms/legs 2.6 - 7.5 cm CPT 13121 | $1,186.68 | $1,798.00 | $415.32 – $723.61 | 8 |
| Repair dental ellis ii fx CPT 41899 | $542.52 | $822.00 | $241.98 – $871.32 | 8 |
| Repair extns tendon finger without grft ea CPT 26418 | $1,878.36 | $2,846.00 | $1,642.82 – $2,245.21 | 8 |
| Repair foot dislocation CPT 28615 | not published | not published | not published | 0 |
| Repair lip full thkns =<one-half vert height CPT 40652 | $988.02 | $1,497.00 | $275.02 – $551.01 | 8 |
| Repair lower leg tendons CPT 27675 | not published | not published | not published | 0 |
| Repair of ankle ligament CPT 27695 | not published | not published | not published | 0 |
| Repair of ankle ligament CPT 27698 | not published | not published | not published | 0 |
| Repair of foot tendon CPT 28200 | not published | not published | not published | 0 |
| Repair of kneecap tendon CPT 27380 | $11,784.30 | $17,855.00 | $5,078.99 – $7,413.38 | 8 |
| Repair of leg tendon each CPT 27658 | not published | not published | not published | 0 |
| Repair of leg tendon each CPT 27659 | not published | not published | not published | 0 |
| Repair of metatarsals CPT 28322 | not published | not published | not published | 0 |
| Repair rotator cuff acute CPT 23410 | not published | not published | not published | 0 |
| Repair rpr lip full thickness vermilion only CPT 40650 | $988.02 | $1,497.00 | $275.02 – $551.01 | 8 |
| Repair tendon extensor foot 1/2 each tendon CPT 28208 | not published | not published | not published | 0 |
| Replace duod/jej tube perc CPT 49451 | $1,364.88 | $2,068.00 | $456.60 – $926.63 | 11 |
| Replace g/c tube perc CPT 49450 | $2,228.82 | $3,377.00 | $456.60 – $926.63 | 11 |
| Reptilase test CPT 85635 | $108.90 | $165.00 | $9.85 – $12.81 | 11 |
| #resp virpnl dfa-adenovirus CPT 87260 | $75.24 | $114.00 | $14.43 – $18.76 | 11 |
| #resp virpnl dfa-parainfluenza CPT 87279 | $75.24 | $114.00 | $16.43 – $21.36 | 11 |
| Resuscitation cardiopulmonary CPT 92950 | $601.92 | $912.00 | $220.60 – $966.72 | 11 |
| Reticulocyte automated CPT 85045 | $30.36 | $46.00 | $3.99 – $5.19 | 11 |
| Revise lower leg tendon CPT 27691 | not published | not published | not published | 0 |
| Revision of calf tendon CPT 27687 | not published | not published | not published | 0 |
| Revision of foot bones CPT 28737 | not published | not published | not published | 0 |
| Revision of knee joint CPT 27446 | not published | not published | not published | 0 |
| Rev/rmv perph nstim eltrd ra CPT 64585 | not published | not published | not published | 0 |
| Rev/rmv prph sac/gstr npg/r CPT 64595 | not published | not published | not published | 0 |
| Rf abltj nrv nrvtg si jt CPT 64625 | $3,262.38 | $4,943.00 | $1,995.02 – $2,317.26 | 8 |
| Rheumatoid factor qualitative CPT 86430 | $63.36 | $96.00 | $6.14 – $7.98 | 11 |
| Rheumatoid factor quantitative CPT 86431 | $38.94 | $59.00 | $5.67 – $7.37 | 11 |
| Rho(d) immune globulin 1,500 unit (300 mcg)/2 ml injection syringe HCPCS J2791 | $37.28 | $56.49 | $7.97 – $59.88 | 10 |
| Rho d immune globulin inj HCPCS J2790 | $94.94 | $143.85 | $86.31 – $152.48 | 9 |
| Rituximab-abbs 10 mg/ml intravenous solution HCPCS Q5115 | $258.64 | $391.88 | $30.15 – $415.39 | 11 |
| Rituximab-pvvr 10 mg/ml intravenous solution HCPCS Q5119 | $233.16 | $353.28 | $13.27 – $374.48 | 11 |
| Rmv implant contraceptive capsule 11976 CPT 11976 | $1,223.64 | $1,854.00 | $95.40 – $723.61 | 9 |
| Rmvl ndwellg tun pleural cath CPT 32552 | $1,285.02 | $1,947.00 | $640.89 – $1,714.55 | 8 |
| Romosozumab-aqqg 105 mg/1.17 ml subcutaneous syringe (wrapper) HCPCS J3111 | $24.29 | $36.81 | $12.11 – $39.02 | 11 |
| Ropivacaine 0.2 % epidural pca - 1 hour dose limit HCPCS J2795 | $1.02 | $1.55 | $0.08 – $0.09 | 4 |
| Rp loclzj tum 2+area 1+d img CPT 78801 | $1,535.82 | $2,327.00 | $408.43 – $1,514.75 | 11 |
| Rpl picc wo subq port/pump incl image guidnc w/s&i CPT 36584 | $2,174.04 | $3,294.00 | $1,608.25 – $1,888.33 | 8 |
| Rpl tun-cvad w subq port CPT 36582 | $5,536.74 | $8,389.00 | $3,225.87 – $3,646.82 | 8 |
| Rubella antibody igg CPT 86762 | $99.00 | $150.00 | $14.39 – $18.71 | 11 |
| Rubeola antibody igg CPT 86765 | $89.10 | $135.00 | $12.88 – $16.74 | 11 |
| Russell viper venom diluted CPT 85613 | $68.64 | $104.00 | $9.58 – $12.45 | 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.