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 |
|---|---|---|---|---|
| Salivary glnd img serial img CPT 78231 | $1,023.66 | $1,551.00 | $342.56 – $1,311.10 | 11 |
| Salmonella antibody CPT 86768 | $66.00 | $100.00 | $11.50 – $17.15 | 11 |
| Sarscov coronavirus ag ia CPT 87426 | $73.92 | $112.00 | $35.33 – $45.93 | 11 |
| Scan duplex abd/pelvis/retroperitoneal complete CPT 93975 | $805.20 | $1,220.00 | $243.77 – $574.00 | 11 |
| Scan duplex abd/pelvis/retroperitoneal limited CPT 93976 | $699.60 | $1,060.00 | $106.81 – $574.00 | 11 |
| Scan duplex aorta/ivc/iliac or bypass grafts complete CPT 93978 | $601.26 | $911.00 | $243.77 – $510.50 | 11 |
| Scan duplex aorta/ivc/iliac unilateral/limited CPT 93979 | $461.34 | $699.00 | $106.81 – $574.00 | 11 |
| Scan duplex extracranial arteries unilateral/limited study CPT 93882 | $1,175.46 | $1,781.00 | $106.81 – $510.50 | 11 |
| Scan duplex extremity veins unilateral/limited study CPT 93971 | $881.10 | $1,335.00 | $106.81 – $510.50 | 11 |
| Scan duplex lower extremity arteries complete bilateral CPT 93925 | $1,951.62 | $2,957.00 | $243.77 – $510.50 | 11 |
| Scan duplex lower extremity arteries unilateral/limited study left CPT 93926 | $1,115.40 | $1,690.00 | $106.81 – $510.50 | 11 |
| Scan duplex upper extremity arteries unilateral/limited study left CPT 93931 | $531.30 | $805.00 | $106.81 – $510.50 | 11 |
| Screen cerv/vag thin layer HCPCS G0123 | $125.40 | $190.00 | $20.26 – $26.34 | 11 |
| Screening Colonoscopy (average risk) HCPCS G0121 | $1,052.70 | $1,595.00 | $176.42 – $1,595.00 | 13 |
| Screening Colonoscopy (high risk) HCPCS G0105 | $2,880.90 | $4,365.00 | $176.31 – $1,595.00 | 13 |
| Screening colorectal cancer fecal occult blood immunoassay 1-3 simultaneous determinations HCPCS G0328 | $110.22 | $167.00 | $15.21 – $23.47 | 11 |
| Screening hepatitis c antibody high risk HCPCS G0472 | $99.66 | $151.00 | $46.35 – $60.26 | 11 |
| Screening Mammogram CPT 77067 | $310.20 | $470.00 | $38.73 – $196.07 | 13 |
| Screening prostate cancer PSA HCPCS G0103 | $154.44 | $234.00 | $19.31 – $25.10 | 11 |
| Screen pap by tech w md supv HCPCS P3000 | $118.14 | $179.00 | $14.86 – $24.10 | 11 |
| Sedimentation rate erythrocyte automated CPT 85652 | $59.40 | $90.00 | $2.70 – $3.51 | 11 |
| Semen analysis presence/motility CPT 89321 | $207.90 | $315.00 | $12.05 – $15.67 | 11 |
| Serpina1 gene CPT 81332 | $663.30 | $1,005.00 | $43.65 – $65.03 | 11 |
| Sertraline (zoloft) - sendout CPT 80332 | $97.02 | $147.00 | $79.87 – $97.33 | 9 |
| Sho arthrs srg lmtd dbrdmt CPT 29822 | not published | not published | not published | 0 |
| Sho arthrs srg rpr slap les CPT 29807 | not published | not published | not published | 0 |
| Sho arthrs srg xtnsv dbrdmt CPT 29823 | not published | not published | not published | 0 |
| Shoulder Arthroscopy (Rotator Cuff Repair) CPT 29827 | not published | not published | not published | 0 |
| Shoulder MRI (with and without contrast) CPT 73223 | $2,669.70 | $4,045.00 | $356.43 – $1,513.40 | 11 |
| Shoulder MRI (with contrast) CPT 73222 | $2,542.32 | $3,852.00 | $660.90 – $1,513.40 | 11 |
| Shoulder MRI (without contrast) CPT 73221 | $2,420.88 | $3,668.00 | $243.77 – $1,513.40 | 11 |
| Shoulder X-ray CPT 73030 | $315.48 | $478.00 | $88.91 – $478.00 | 11 |
| Sickling rbc CPT 85660 | $59.40 | $90.00 | $5.51 – $7.16 | 11 |
| Sigmoidoscopy and biopsy CPT 45331 | not published | not published | not published | 0 |
| Sigmoidoscopy for bleeding CPT 45334 | not published | not published | not published | 0 |
| Sincalide 5 mcg solution for injection HCPCS J2805 | $449.10 | $680.45 | $157.44 – $197.13 | 10 |
| Sinus CT scan (with and without contrast) CPT 70488 | $1,679.04 | $2,544.00 | $179.20 – $1,247.60 | 11 |
| Sinus CT scan (with contrast) CPT 70487 | $1,624.92 | $2,462.00 | $179.20 – $1,247.60 | 11 |
| Sinus CT scan (without contrast) CPT 70486 | $1,271.16 | $1,926.00 | $106.81 – $1,247.60 | 11 |
| Skin Biopsy CPT 11102 | $306.24 | $464.00 | $415.32 – $491.84 | 8 |
| Sleep Study (Polysomnography) CPT 95810 | $3,812.16 | $5,776.00 | $455.52 – $3,939.70 | 11 |
| Sleeve fing rolyan med HCPCS L3933 | $296.34 | $449.00 | $280.71 – $280.71 | 1 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $118.14 | $179.00 | $5.39 – $7.01 | 11 |
| Smear gram stain CPT 87205 | $39.60 | $60.00 | $4.27 – $5.55 | 11 |
| Smear nasal eosinophil CPT 89190 | $33.00 | $50.00 | $5.79 – $7.53 | 11 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $129.36 | $196.00 | $5.99 – $7.79 | 11 |
| Smear wet mount CPT 87210 | $39.60 | $60.00 | $5.82 – $7.57 | 11 |
| Snrpn/ube3a gene CPT 81331 | $327.36 | $496.00 | $51.07 – $66.39 | 11 |
| Sodium 24 hour urine CPT 84300 | $29.70 | $45.00 | $5.06 – $6.58 | 11 |
| Sodium chloride 0.9 % intravenous solution HCPCS J7030 | $69.96 | $106.00 | $3.28 – $3.56 | 4 |
| Sodium chloride 0.9 % IV bolus HCPCS J7040 | $69.96 | $106.00 | $2.13 – $2.31 | 4 |
| Sodium chloride 0.9 % IV bolus HCPCS J7050 | $21.32 | $32.30 | $1.09 – $1.18 | 4 |
| Sodium serum/plasma/whole blood CPT 84295 | $20.46 | $31.00 | $4.81 – $6.25 | 11 |
| So neo gsap dna mcrstl ins CPT 81457 | $2,972.64 | $4,504.00 | $473.12 – $1,165.93 | 11 |
| Specific gravity body fluid CPT 84315 | $13.20 | $20.00 | $3.28 – $4.26 | 11 |
| Specimen fat stain CPT 89125 | $31.68 | $48.00 | $5.88 – $7.64 | 11 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $1,364.88 | $2,068.00 | $721.17 – $1,314.72 | 8 |
| Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 | $654.72 | $992.00 | $90.89 – $381.24 | 11 |
| Splint dorsal bloc wh med perf 3.2mm lf polyflex ii HCPCS L3906 | $684.42 | $1,037.00 | $660.83 – $660.83 | 1 |
| Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 % CPT 15120 | $4,228.62 | $6,407.00 | $95.40 – $3,620.48 | 13 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $184.14 | $279.00 | $84.55 – $279.00 | 11 |
| Staph a dna amp probe CPT 87640 | $237.60 | $360.00 | $35.09 – $45.62 | 11 |
| Static or dynami afo pre ots HCPCS L4397 | $85.80 | $130.00 | $190.98 – $190.98 | 1 |
| St evaluate speech sound production CPT 92522 | $181.50 | $275.00 | $86.18 – $275.00 | 11 |
| St evaluate speech sound production comprehensive/expressive CPT 92523 | $345.18 | $523.00 | $177.92 – $283.80 | 11 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $282.48 | $428.00 | $88.43 – $283.80 | 11 |
| St evaluation swallow function CPT 92610 | $273.24 | $414.00 | $75.84 – $283.80 | 11 |
| Strep a ag ia CPT 87430 | $79.86 | $121.00 | $16.81 – $21.85 | 11 |
| Strep b dna amp probe CPT 87653 | $237.60 | $360.00 | $35.09 – $45.62 | 11 |
| Stress test pulmonary CPT 94618 | $447.48 | $678.00 | $93.60 – $678.00 | 11 |
| St treatment speech individual CPT 92507 | $224.40 | $340.00 | $59.16 – $283.80 | 11 |
| St treatment swallow dysfunction/oral CPT 92526 | $224.40 | $340.00 | $65.44 – $283.80 | 11 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $6.47 | $9.80 | $2.56 – $2.56 | 1 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $89.76 | $136.00 | $136.00 – $136.00 | 1 |
| Support clav 29.6-40.5in med HCPCS L3650 | $115.50 | $175.00 | $99.48 – $99.48 | 1 |
| Surgical pathology level 1 gross examination only CPT 88300 | $97.02 | $147.00 | $29.55 – $88.20 | 11 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $198.66 | $301.00 | $29.95 – $180.60 | 11 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $248.16 | $376.00 | $52.32 – $225.60 | 11 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $297.66 | $451.00 | $52.32 – $270.60 | 11 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $974.16 | $1,476.00 | $213.63 – $885.60 | 11 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $1,391.94 | $2,109.00 | $213.63 – $1,265.40 | 11 |
| Susceptibility agar dilution per agent CPT 87181 | $68.64 | $104.00 | $4.75 – $6.18 | 11 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $49.50 | $75.00 | $4.75 – $6.18 | 11 |
| Susceptibility mic per plate CPT 87186 | $356.40 | $540.00 | $8.65 – $11.25 | 11 |
| Suscept studies macrobroth dilution ea CPT 87188 | $143.88 | $218.00 | $6.64 – $8.63 | 11 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $42.24 | $64.00 | $4.40 – $5.72 | 11 |
| T3 (triiodothyronine) free CPT 84481 | $72.60 | $110.00 | $16.62 – $22.02 | 11 |
| T3 (triiodothyronine) total CPT 84480 | $89.76 | $136.00 | $14.18 – $18.43 | 11 |
| T4 (thyroxine) free CPT 84439 | $130.02 | $197.00 | $9.02 – $11.73 | 11 |
| T4 (thyroxine) total CPT 84436 | $31.68 | $48.00 | $6.87 – $8.93 | 11 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $7.51 | $11.38 | $0.33 – $0.36 | 4 |
| Tacrolimus therapeutic drug level CPT 80197 | $77.88 | $118.00 | $13.73 – $17.85 | 11 |
| Tap block bilat cont infusion 64489 CPT 64489 | $4,907.10 | $7,435.00 | $2,077.54 – $2,202.19 | 7 |
| Target gsa panel hmtlmph neop CPT 81450 | $1,954.92 | $2,962.00 | $607.62 – $987.39 | 11 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | $4,368.54 | $6,619.00 | $2,335.68 – $3,795.48 | 11 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $295.02 | $447.00 | $90.12 – $130.00 | 11 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $415.14 | $629.00 | $61.98 – $80.57 | 11 |
| Tc-99m non-heu per study dose HCPCS Q9969 | $11.88 | $18.00 | $16.50 – $16.50 | 1 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $316.80 | $480.00 | $46.98 – $61.07 | 11 |
| T cells absolute cd 4 count CPT 86361 | $172.92 | $262.00 | $26.78 – $34.81 | 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.