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 |
|---|---|---|---|---|
| T cells total count CPT 86359 | $268.62 | $407.00 | $37.73 – $49.05 | 11 |
| Team conf without pat by hc pro CPT 99368 | $112.86 | $171.00 | $171.00 – $171.00 | 4 |
| Team conf w/pat by hc prof CPT 99366 | $112.86 | $171.00 | $171.00 – $171.00 | 4 |
| Telehealth original site facility fee HCPCS Q3014 | $197.34 | $299.00 | $22.87 – $31.85 | 9 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $322.00 | $487.88 | $186.97 – $517.15 | 11 |
| Tenotomy open tndn flxr toe sgl tndn spx CPT 28232 | not published | not published | not published | 0 |
| Testicular imaging w/vasc flow CPT 78761 | $1,023.66 | $1,551.00 | $408.43 – $1,311.10 | 11 |
| Test stress cardiovascular tracing only CPT 93017 | $990.66 | $1,501.00 | $110.30 – $862.10 | 11 |
| Tgsap so neo 5-50 rna alys CPT 81449 | $2,178.00 | $3,300.00 | $597.91 – $3,251.61 | 11 |
| Theophylline therapeutic drug level CPT 80198 | $96.36 | $146.00 | $14.14 – $18.38 | 11 |
| Therapeutic procd strg endur HCPCS G0237 | $79.20 | $120.00 | $29.55 – $99.60 | 11 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | $24.24 | $36.73 | $2.99 – $3.24 | 4 |
| Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides) CPT 32555 | $1,364.88 | $2,068.00 | $456.60 – $1,714.55 | 11 |
| Thor rib belt custom fabrica HCPCS L0220 | $128.04 | $194.00 | $165.81 – $165.81 | 1 |
| Thrombin time CPT 85670 | $89.10 | $135.00 | $5.77 – $7.50 | 11 |
| Thromboplastin inhibition CPT 85705 | $49.50 | $75.00 | $8.17 – $12.52 | 11 |
| Thromboplastin time partial (ptt) substitution fractions each CPT 85732 | $68.64 | $104.00 | $6.47 – $8.41 | 11 |
| Thyroglobulin antibody CPT 86800 | $108.90 | $165.00 | $15.91 – $20.68 | 11 |
| Thyroid imaging CPT 78013 | $694.98 | $1,053.00 | $408.43 – $1,053.00 | 11 |
| Thyroid mets imag whole body CPT 78018 | $1,493.58 | $2,263.00 | $554.73 – $1,311.10 | 11 |
| Thyroid (TSH) Test CPT 84443 | $114.84 | $174.00 | $16.80 – $21.84 | 11 |
| Thyroid Ultrasound CPT 76536 | $552.42 | $837.00 | $53.41 – $574.00 | 11 |
| Thyroid uptake measurement CPT 78012 | $463.98 | $703.00 | $291.30 – $703.00 | 11 |
| Thyroxine binding globulin (tbg) CPT 84442 | $65.34 | $99.00 | $14.78 – $19.21 | 11 |
| Tigecycline injection HCPCS J3243 | $8.04 | $12.18 | $0.92 – $1.00 | 4 |
| Tissue culture placenta CPT 88235 | $483.78 | $733.00 | $70.04 – $195.39 | 11 |
| Tissue culture skin/biopsy CPT 88233 | $320.76 | $486.00 | $70.04 – $182.95 | 11 |
| Tissue culture tumor CPT 88239 | $520.74 | $789.00 | $70.04 – $191.78 | 11 |
| Tissue exam koh skin/hair/nails CPT 87220 | $60.72 | $92.00 | $4.27 – $5.55 | 11 |
| Tissue transglutaminase iga CPT 86364 | $32.34 | $49.00 | $11.53 – $14.99 | 11 |
| Tixagev and cilgav inj HCPCS M0220 | $80.52 | $122.00 | $122.00 – $129.32 | 7 |
| Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr HCPCS J3260 | $32.34 | $49.00 | $3.42 – $3.71 | 4 |
| Tobramycin peak therapeutic drug level CPT 80200 | $77.88 | $118.00 | $16.13 – $20.97 | 11 |
| Total Hip Replacement CPT 27130 | not published | not published | not published | 0 |
| Total Knee Replacement CPT 27447 | not published | not published | not published | 0 |
| Total tau CPT 84394 | $468.60 | $710.00 | $128.92 – $167.60 | 4 |
| Toxoplasma antibody igg CPT 86777 | $99.00 | $150.00 | $14.39 – $18.71 | 11 |
| Toxoplasma antibody igm CPT 86778 | $89.10 | $135.00 | $14.41 – $18.73 | 11 |
| Tp53 gene full gene sequence CPT 81351 | $1,083.72 | $1,642.00 | $513.48 – $834.41 | 11 |
| Tp53 gene trgt sequence alys CPT 81352 | $790.68 | $1,198.00 | $329.51 – $428.36 | 11 |
| Training self management diabetes individual outpatient department per 30 minutes HCPCS G0108 | $90.42 | $137.00 | $53.83 – $137.00 | 11 |
| Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution HCPCS J3290 | $0.17 | $0.25 | $0.21 – $0.21 | 1 |
| Transferrin CPT 84466 | $43.56 | $66.00 | $12.76 – $16.59 | 11 |
| Transfusion blood/blood component(s) CPT 36430 | $883.74 | $1,339.00 | $450.73 – $694.99 | 9 |
| Trauma partial team response w/critical care services level 4 HCPCS G0390 | $2,693.46 | $4,081.00 | $2,244.55 – $2,244.55 | 1 |
| Treat elbow dislocation CPT 24605 | $1,848.66 | $2,801.00 | $1,567.01 – $1,661.03 | 8 |
| Treat finger fracture each CPT 26742 | $1,848.66 | $2,801.00 | $746.85 – $1,642.82 | 8 |
| Treat foot bone lesion CPT 28005 | $3,747.48 | $5,678.00 | $580.00 – $5,678.00 | 13 |
| Treat fracture of radius CPT 25505 | $3,712.50 | $5,625.00 | $746.85 – $1,642.82 | 8 |
| Treat fracture of radius CPT 25520 | $3,754.08 | $5,688.00 | $746.85 – $1,642.82 | 8 |
| Treat hip dislocation CPT 27252 | $1,848.66 | $2,801.00 | $1,567.01 – $1,661.03 | 8 |
| Treat kneecap dislocation CPT 27562 | not published | not published | not published | 0 |
| Treat lower leg joint CPT 27829 | not published | not published | not published | 0 |
| Treatment fx radial distal open w/internal fixation 3+ frag left (restricted method ii cah) CPT 25609 | not published | not published | not published | 0 |
| Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour CPT 94644 | $240.90 | $365.00 | $90.89 – $135.93 | 11 |
| Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour CPT 94645 | $39.60 | $60.00 | $60.00 – $63.60 | 10 |
| Treatment inhalation pressurized/nonpressurized acute airway obstruction CPT 94640 | $244.20 | $370.00 | $90.89 – $223.72 | 11 |
| Treatment of ankle fracture 27786 CPT 27786 | $487.74 | $739.00 | $252.01 – $783.34 | 8 |
| Treatment of penis lesion CPT 54115 | $6,753.12 | $10,232.00 | $2,967.63 – $3,391.85 | 8 |
| Treatment of toe fracture 28510 CPT 28510 | $629.64 | $954.00 | $252.01 – $791.66 | 8 |
| Treat midfoot fracture each CPT 28465 | not published | not published | not published | 0 |
| Treat vaginal bleeding CPT 57180 | $1,052.04 | $1,594.00 | $206.55 – $915.11 | 8 |
| Treat wrist dislocation CPT 25675 | $1,022.34 | $1,549.00 | $252.01 – $791.66 | 8 |
| Treponema pallidum antibody CPT 86780 | $38.28 | $58.00 | $11.13 – $17.21 | 11 |
| Triamcinolone acetonide 40 mg/ml suspension for injection HCPCS J3301 | $11.40 | $17.28 | $1.22 – $1.32 | 4 |
| Trichinella antibody CPT 86784 | $96.36 | $146.00 | $8.17 – $16.33 | 11 |
| #tricyclicantidprssnt CPT 80337 | $91.08 | $138.00 | $18.33 – $82.80 | 9 |
| Triglycerides CPT 84478 | $35.64 | $54.00 | $5.74 – $7.46 | 11 |
| Trim nail(s) HCPCS G0127 | $108.90 | $165.00 | $60.27 – $114.45 | 9 |
| Trim nondyst nails CPT 11719 | $118.14 | $179.00 | $60.27 – $114.45 | 9 |
| Troponin quantitative CPT 84484 | $84.48 | $128.00 | $12.47 – $16.21 | 11 |
| Tte w or without fol w/con,stres HCPCS C8928 | $1,657.92 | $2,512.00 | $351.56 – $567.70 | 11 |
| Tx closed hip disl traumatic without anes CPT 27250 | $662.64 | $1,004.00 | $252.01 – $791.66 | 8 |
| Tx closed tib fx proximal w/w/o manip w/skel trac CPT 27532 | $6,407.94 | $9,709.00 | $746.85 – $3,342.87 | 8 |
| Tx closed tib shaft fx without manip CPT 27750 | $2,983.20 | $4,520.00 | $252.01 – $791.66 | 8 |
| Ugt1a1 gene analy common variants CPT 81350 | $619.08 | $938.00 | $234.00 – $304.20 | 11 |
| Ultrasound abdomen aorta screening study aaa CPT 76706 | $386.76 | $586.00 | $106.81 – $574.00 | 11 |
| Ultrasound breast complete CPT 76641 | $546.48 | $828.00 | $106.81 – $574.00 | 11 |
| Ultrasound breast unilateral limited (both sides) CPT 76642 | $392.70 | $595.00 | $88.91 – $574.00 | 11 |
| Ultrasound chest CPT 76604 | $405.24 | $614.00 | $106.81 – $574.00 | 11 |
| Ultrasound doppler velocimetry fetal umbilical artery CPT 76820 | $292.38 | $443.00 | $106.81 – $443.00 | 11 |
| Ultrasound exam k transpl w/doppler CPT 76776 | $573.54 | $869.00 | $106.81 – $574.00 | 11 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | $398.64 | $604.00 | $106.81 – $574.00 | 11 |
| Ultrasound guidance for vascular access CPT 76937 | $370.26 | $561.00 | $182.53 – $561.00 | 10 |
| Ultrasound guided needle placement supervision & interpretation CPT 76942 | $699.60 | $1,060.00 | $182.53 – $574.00 | 10 |
| Ultrasound guide intraoperative CPT 76998 | $839.52 | $1,272.00 | $182.53 – $574.00 | 10 |
| Ultrasound joint complete left CPT 76881 | $566.28 | $858.00 | $106.81 – $574.00 | 11 |
| Ultrasound joint/nonvascular extremity limited left CPT 76882 | $384.78 | $583.00 | $106.81 – $574.00 | 11 |
| Ultrasound ob >=14wks ea addl gest CPT 76810 | $307.56 | $466.00 | $163.49 – $466.00 | 10 |
| Ultrasound pregnant uterus < 14 weeks each additional gestation CPT 76802 | $251.46 | $381.00 | $163.49 – $381.00 | 10 |
| Ultrasound pregnant uterus detailed fetal exam single/1st gestation CPT 76811 | $650.10 | $985.00 | $163.49 – $574.00 | 11 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | $321.42 | $487.00 | $106.81 – $487.00 | 11 |
| Ultrasound pregnant uterus limited >= 1 fetuses CPT 76815 | $335.28 | $508.00 | $106.81 – $508.00 | 11 |
| Ultrasound pregnant uterus transvaginal CPT 76817 | $440.22 | $667.00 | $106.81 – $574.00 | 11 |
| Ultrasound prostate/transrectal CPT 76872 | $228.36 | $346.00 | $106.81 – $346.00 | 11 |
| Ultrasound retroperitoneal limited CPT 76775 | $517.44 | $784.00 | $106.81 – $574.00 | 11 |
| Ultrasound scrotum and contents CPT 76870 | $578.16 | $876.00 | $106.81 – $574.00 | 11 |
| Ultrasound spinal canal and contents CPT 76800 | $349.80 | $530.00 | $106.81 – $530.00 | 11 |
| Ultrasound transabd ea addl gest CPT 76812 | $297.00 | $450.00 | $163.49 – $450.00 | 10 |
| Ultrasound transvaginal non obstetric CPT 76830 | $531.30 | $805.00 | $53.41 – $574.00 | 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.