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 |
|---|---|---|---|---|
| Apc gene dup/delet variants CPT 81203 | $905.52 | $1,372.00 | $200.00 – $260.00 | 11 |
| Apc gene full sequence CPT 81201 | $905.52 | $1,372.00 | $599.94 – $1,014.00 | 11 |
| Apl(pml-rara) quant - sendout CPT 81315 | $861.96 | $1,306.00 | $207.31 – $269.50 | 11 |
| App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm CPT 15277 | $2,112.66 | $3,201.00 | $1,760.55 – $3,341.59 | 9 |
| App high cost ss f/n/g/h/f >100sq cm addl 100sq cm CPT 15278 | $786.06 | $1,191.00 | $655.05 – $1,262.46 | 8 |
| App high cost ss f/n/g/h/f <100sq cm addl <25sq cm CPT 15276 | $323.40 | $490.00 | $269.50 – $519.40 | 8 |
| App high cost ss t/a/l >100sq cm 1st 100sq cm CPT 15273 | $4,228.62 | $6,407.00 | $2,107.97 – $3,523.85 | 9 |
| App high cost ss t/a/l >100sq cm addl 100sq cm CPT 15274 | $638.22 | $967.00 | $531.85 – $1,025.02 | 8 |
| App high cost ss t/a/l <100sq cm addl <25sq cm CPT 15272 | $342.54 | $519.00 | $285.45 – $550.14 | 8 |
| Application finger splntstatic 29130 CPT 29130 | $337.26 | $511.00 | $122.92 – $135.93 | 8 |
| Application long leg splint 29505 CPT 29505 | $384.78 | $583.00 | $122.92 – $166.02 | 8 |
| Application lower leg splint 29515 CPT 29515 | $384.78 | $583.00 | $122.92 – $166.02 | 8 |
| Application multi layer compression below knee (both sides) CPT 29581 | $474.54 | $719.00 | $95.40 – $309.44 | 9 |
| Application of forearm cast 29075 CPT 29075 | $277.20 | $420.00 | $285.75 – $309.44 | 8 |
| Application of long arm cast 29065 CPT 29065 | $306.90 | $465.00 | $285.75 – $309.44 | 8 |
| Application of long leg cast 29345 CPT 29345 | $758.34 | $1,149.00 | $285.75 – $309.44 | 8 |
| Application of paste boot 29580 CPT 29580 | $454.74 | $689.00 | $95.40 – $309.44 | 9 |
| Application short leg cast 29405 CPT 29405 | $384.78 | $583.00 | $285.75 – $309.44 | 8 |
| Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm CPT 15275 | $2,112.66 | $3,201.00 | $755.08 – $3,341.59 | 9 |
| Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm CPT 15271 | $1,837.44 | $2,784.00 | $755.08 – $2,951.04 | 9 |
| Appl modality 1/> areas vasopneumatic devices 97016 CPT 97016 | $62.70 | $95.00 | $11.55 – $95.00 | 11 |
| Apply forearm splintdynamic 29126 CPT 29126 | $246.18 | $373.00 | $122.92 – $135.93 | 8 |
| Apply of finger splint 29131 CPT 29131 | $246.18 | $373.00 | $60.27 – $130.30 | 8 |
| Apply rigid leg cast 29445 CPT 29445 | $919.38 | $1,393.00 | $95.40 – $309.44 | 9 |
| #aptt mix-1:1 incubated CPT 87532 | $139.92 | $212.00 | $35.09 – $45.62 | 11 |
| Aqaprn-4 antb flo cytmtry ea CPT 86053 | $320.10 | $485.00 | $12.05 – $49.05 | 11 |
| Aquaporin-4 antibody cba each CPT 86052 | $296.34 | $449.00 | $12.05 – $15.67 | 11 |
| Aquatic exercise - group charge CPT 97150 | $69.96 | $106.00 | $6.38 – $106.00 | 11 |
| Arterial blood draw/perc 36620 CPT 36620 | $486.42 | $737.00 | $737.00 – $781.22 | 7 |
| Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right CPT 20605 | $697.62 | $1,057.00 | $313.60 – $423.65 | 8 |
| Arthrocentesis/aspiration/injection intermediate joint/bursa w/ultrasound guidance (both sides) CPT 20606 | $880.44 | $1,334.00 | $721.17 – $789.68 | 8 |
| Arthrocentesis/aspiration/injection major joint/bursa w/ultrasound guidance (both sides) CPT 20611 | $1,087.02 | $1,647.00 | $313.60 – $789.68 | 8 |
| Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance CPT 20600 | $499.62 | $757.00 | $313.60 – $423.65 | 8 |
| Arthrocentesis/aspiration/inj major joint/bursa without Ultrasound guidance (both sides) CPT 20610 | $1,416.36 | $2,146.00 | $313.60 – $423.65 | 8 |
| Arthrocentesis aspir+/injection small jt/bursa with Ultrasound 20604 CPT 20604 | $850.74 | $1,289.00 | $313.60 – $789.68 | 8 |
| Arthrodesis subtalar CPT 28725 | not published | not published | not published | 0 |
| Arthro shoulder surgical distal claviculectomy incl/distal art surf left (rest method ii cah) CPT 29824 | not published | not published | not published | 0 |
| Arth shld srg decompr subacrml sp w/prt acrmplsty w/crccrml sep proc lt(rest method ii cah) CPT 29826 | not published | not published | not published | 0 |
| Asp core fat pad CPT 17999 | $199.32 | $302.00 | $95.40 – $284.11 | 9 |
| Aspirate pleura without imaging 32554 CPT 32554 | $1,087.02 | $1,647.00 | $456.60 – $1,714.55 | 11 |
| Aspiration fine needle (fna) biopsy w/ultrasound guidance 1st lesion CPT 10005 | $1,250.04 | $1,894.00 | $723.47 – $1,175.28 | 8 |
| Assay acid phosphatase CPT 84060 | $83.82 | $127.00 | $7.64 – $9.93 | 11 |
| Assay myeloperoxidase CPT 83876 | $100.98 | $153.00 | $19.54 – $66.12 | 11 |
| Assay of glutathione CPT 82978 | $208.56 | $316.00 | $15.45 – $20.09 | 11 |
| Assay of interleukin-6 (il-6) CPT 83529 | $87.12 | $132.00 | $17.27 – $22.45 | 11 |
| Assay of leflunomide CPT 80193 | $120.12 | $182.00 | $38.57 – $50.14 | 11 |
| Assay of osteocalcin CPT 83937 | $59.40 | $90.00 | $29.85 – $38.81 | 11 |
| Assay of procainamide w/metab CPT 80192 | $92.40 | $140.00 | $16.75 – $21.78 | 11 |
| Assay of prostaglandin CPT 84150 | $324.72 | $492.00 | $35.09 – $54.30 | 11 |
| Assay of tyrosine CPT 84510 | $114.18 | $173.00 | $10.63 – $13.82 | 11 |
| Assay phosphatidylglycerol CPT 84081 | $350.46 | $531.00 | $16.52 – $21.48 | 11 |
| Assay phosphohexose enzymes CPT 84087 | $346.50 | $525.00 | $10.73 – $13.95 | 11 |
| Assay toxin or antitoxin CPT 87230 | $115.50 | $175.00 | $19.74 – $25.66 | 11 |
| Assess cyst contrast inject CPT 49424 | $660.00 | $1,000.00 | $456.60 – $563.71 | 10 |
| Assessment leukocyte fecal qualitative/semiquantitative CPT 89055 | $60.06 | $91.00 | $4.27 – $5.55 | 11 |
| Ast/sgot CPT 84450 | $60.06 | $91.00 | $5.18 – $6.73 | 11 |
| Asxl1 full gene sequence CPT 81175 | $1,473.12 | $2,232.00 | $565.61 – $879.45 | 11 |
| Atropine 0.1 mg/ml injection syringe HCPCS J0461 | $0.83 | $1.25 | $0.17 – $0.18 | 4 |
| Autologous blood process CPT 86890 | $292.38 | $443.00 | $137.51 – $265.80 | 11 |
| Av fusion direct any site CPT 36821 | not published | not published | not published | 0 |
| Avul nail plate addl CPT 11732 | $212.52 | $322.00 | $107.97 – $114.45 | 7 |
| Avulsion nail plate partial/complete simple single nail plate CPT 11730 | $404.00 | $404.00 | $53.37 – $204.98 | 13 |
| Azithromycin 500 mg intravenous solution HCPCS J0456 | $70.22 | $106.40 | $3.37 – $3.65 | 4 |
| Aztreonam 1 gram solution for injection HCPCS J0457 | $16.31 | $24.71 | $3.68 – $3.99 | 4 |
| Baclofen eval charges CPT 97750 | $80.52 | $122.00 | $32.73 – $122.00 | 5 |
| Bacterial meningitis antigen CPT 86403 | $82.50 | $125.00 | $11.54 – $15.00 | 11 |
| Bacterial vaginosis pcr CPT 87801 | $475.86 | $721.00 | $50.62 – $91.26 | 11 |
| Bartonella dna pcr-sendout CPT 87471 | $351.12 | $532.00 | $35.09 – $45.62 | 11 |
| B cells total count CPT 86355 | $256.74 | $389.00 | $37.73 – $49.05 | 11 |
| Bebtelovimab injection HCPCS M0222 | $404.58 | $613.00 | $75.18 – $79.69 | 7 |
| Benign lesion paring 2-4 CPT 11056 | $227.04 | $344.00 | $95.40 – $284.11 | 9 |
| #_benzodiazconfur CPT 80346 | $131.34 | $199.00 | $18.33 – $24.60 | 9 |
| Benztropine 1 mg/ml injection solution HCPCS J0515 | $152.22 | $230.63 | $22.80 – $24.74 | 4 |
| Beta 2 glycoprotein 1 antibody iga CPT 86146 | $74.58 | $113.00 | $8.17 – $33.09 | 11 |
| Beta-2 microglobulin CPT 82232 | $99.00 | $150.00 | $16.18 – $21.03 | 11 |
| Betamethasone acetate and sodium phos 6 mg/ml suspension for injection HCPCS J0702 | $42.54 | $64.45 | $11.40 – $12.37 | 4 |
| Bilateral n blobk inj pudendal 64430 CPT 64430 | $1,235.52 | $1,872.00 | $903.63 – $1,984.32 | 11 |
| Bilateral n block inj occipital 64405 CPT 64405 | $919.38 | $1,393.00 | $313.60 – $686.55 | 8 |
| Bilateral n block inj trigeminal 64400 CPT 64400 | $742.50 | $1,125.00 | $313.60 – $686.55 | 8 |
| Bilirubin direct CPT 82248 | $54.12 | $82.00 | $4.70 – $6.53 | 11 |
| Bilirubin total CPT 82247 | $35.64 | $54.00 | $4.24 – $6.53 | 11 |
| Biopsy abdominal mass CPT 49180 | $1,627.56 | $2,466.00 | $1,171.43 – $1,687.37 | 8 |
| Biopsy bone trocar/needle superficial CPT 20220 | $1,871.10 | $2,835.00 | $1,108.75 – $1,687.37 | 8 |
| Biopsy(ies) & aspiration(s) bone marrow diagnostic (both sides) CPT 38222 | $2,874.30 | $4,355.00 | $2,689.73 – $2,967.63 | 8 |
| Biopsy muscle percutaneous needle CPT 20206 | $1,871.10 | $2,835.00 | $55.12 – $1,687.37 | 13 |
| Biopsy needle liver percutaneous CPT 47000 | $1,627.56 | $2,466.00 | $1,171.43 – $1,687.37 | 11 |
| Biopsy needle lymph node superficial CPT 38505 | $2,046.00 | $3,100.00 | $1,687.37 – $2,081.33 | 8 |
| Biopsy of prostate CPT 55700 | $2,366.10 | $3,585.00 | $2,764.02 – $2,929.86 | 7 |
| Biopsy skin incisional single lesion CPT 11106 | $706.86 | $1,071.00 | $682.65 – $755.08 | 8 |
| Biotinidase - quest CPT 82261 | $102.30 | $155.00 | $16.87 – $21.93 | 11 |
| Bladder irrigate/lavage/instill 51700 CPT 51700 | $474.54 | $719.00 | $139.82 – $255.26 | 8 |
| Bld prd mix CPT 86965 | $198.00 | $300.00 | $108.39 – $188.70 | 11 |
| Bln 1.2 mono emrg 15x1.2 HCPCS C1725 | $104.28 | $158.00 | $86.90 – $86.90 | 1 |
| Bln 30frx10mmx12cm renal nephromax HCPCS C1726 | $2,655.18 | $4,023.00 | $235.79 – $235.79 | 1 |
| Block brachial plexus w/cath plmt w/img CPT 64416 | $2,269.08 | $3,438.00 | $903.63 – $2,202.19 | 9 |
| Block femoral nerve cont infusion cath w/img CPT 64448 | $1,028.28 | $1,558.00 | $856.90 – $1,651.48 | 9 |
| Block plantar digital nerve CPT 64455 | $524.04 | $794.00 | $313.60 – $686.55 | 8 |
| Block tap inj(s) w/wo img bi CPT 64488 | $962.94 | $1,459.00 | $1,459.00 – $1,546.54 | 7 |
| Block tap inj(s) w/wo img uni CPT 64486 | $869.88 | $1,318.00 | $647.69 – $686.55 | 7 |
| Blood clot lysis time CPT 85175 | $68.64 | $104.00 | $6.40 – $26.48 | 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.