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 |
|---|---|---|---|---|
| Warde immunofixation electrophoresis urine CPT 86335 | $198.00 | $300.00 | $29.35 – $38.16 | 11 |
| Warde infectious agent antigen immunoassay ql/sq multi step hepatitis be agn CPT 87350 | $59.40 | $90.00 | $11.53 – $14.99 | 11 |
| Warde infectious agent nucleic acid genotype hepatitis c CPT 87902 | $1,387.32 | $2,102.00 | $257.45 – $334.69 | 11 |
| Warde lipoprotein (a) CPT 83695 | $64.68 | $98.00 | $14.32 – $18.62 | 11 |
| Warde lipoprotein-associated phospholipase a2 CPT 83698 | $107.58 | $163.00 | $46.31 – $60.20 | 11 |
| Warde neutralization rabies CPT 86382 | $138.60 | $210.00 | $16.91 – $21.98 | 11 |
| Warde oxcarbazepine therapeutic drug level CPT 80183 | $69.96 | $106.00 | $13.25 – $17.23 | 11 |
| Warde protein c antigen CPT 85302 | $129.36 | $196.00 | $12.01 – $15.61 | 11 |
| Warde sex hormone binding globulin CPT 84270 | $134.64 | $204.00 | $21.73 – $28.25 | 11 |
| Warde somatomedin CPT 84305 | $134.64 | $204.00 | $21.26 – $27.64 | 11 |
| Warde sugars single qualitative each specimen stool CPT 84376 | $54.12 | $82.00 | $5.50 – $7.15 | 11 |
| Warde t3 (triiodothyronine) reverse CPT 84482 | $54.12 | $82.00 | $10.82 – $20.49 | 11 |
| Warde thyroid stimulating immunoglobulins CPT 84445 | $233.64 | $354.00 | $32.70 – $66.12 | 11 |
| Warde topiramate therapeutic drug level CPT 80201 | $77.88 | $118.00 | $11.92 – $15.50 | 11 |
| Warde virus isolation tissue culture innoculation presumptive id herpes simplex CPT 87252 | $178.86 | $271.00 | $26.07 – $33.89 | 11 |
| Warde viscosity CPT 85810 | $89.10 | $135.00 | $11.67 – $15.17 | 11 |
| Warde vitamin a CPT 84590 | $72.60 | $110.00 | $11.61 – $15.09 | 11 |
| Warde vitamin b-1 (thiamine) CPT 84425 | $107.58 | $163.00 | $21.23 – $27.60 | 11 |
| Warde vitamin b6 (pyridoxine) CPT 84207 | $170.94 | $259.00 | $28.10 – $36.53 | 11 |
| Warde vitamin c (ascorbic acid) CPT 82180 | $62.70 | $95.00 | $9.89 – $12.86 | 11 |
| Warde vitamin d (1 25 dihydroxy) CPT 82652 | $233.64 | $354.00 | $38.50 – $50.05 | 11 |
| Warde vitamin e (alpha-tocopherol) CPT 84446 | $89.76 | $136.00 | $14.18 – $18.43 | 11 |
| Warde zinc CPT 84630 | $62.70 | $95.00 | $11.39 – $14.81 | 11 |
| Wbc automated CPT 85048 | $17.16 | $26.00 | $2.54 – $3.30 | 11 |
| Western blot test CPT 84181 | $127.38 | $193.00 | $17.03 – $22.14 | 11 |
| Whfo nontorsion joint prefab HCPCS L3931 | $152.46 | $231.00 | $232.76 – $232.76 | 1 |
| Whfo w/joint(s) custom fab HCPCS L3806 | $615.12 | $932.00 | $592.82 – $592.82 | 1 |
| Whole blood for transfusion HCPCS P9010 | $980.10 | $1,485.00 | $189.84 – $505.20 | 9 |
| Whole blood/red blood cells leukocytes reduced cmv negative each unit HCPCS P9051 | $491.04 | $744.00 | $151.58 – $505.20 | 9 |
| Whole mitochondrial genome CPT 81460 | $2,272.38 | $3,443.00 | $1,029.60 – $1,673.10 | 11 |
| Wnd prep f/n/hf/g addl cm CPT 15005 | not published | not published | not published | 0 |
| Wound therapy negative pressure per session <= 50 sq cm dme CPT 97605 | $199.32 | $302.00 | $40.86 – $302.00 | 5 |
| Wound therapy negative pressure per session > 50 sq cm dme CPT 97606 | $401.28 | $608.00 | $48.93 – $331.00 | 5 |
| Wrist endoscopy/surgery CPT 29848 | not published | not published | not published | 0 |
| Wrist X-ray CPT 73110 | $318.78 | $483.00 | $88.91 – $483.00 | 11 |
| Xm archive tissue molec anal CPT 88363 | $110.88 | $168.00 | $25.80 – $45.58 | 11 |
| X-ray abdomen 1 view CPT 74018 | $310.86 | $471.00 | $87.72 – $471.00 | 11 |
| X-ray abdomen 2 views CPT 74019 | $332.64 | $504.00 | $91.15 – $495.60 | 11 |
| X-ray abdomen complete acute series including spine erect and/or decubitus single view chest CPT 74022 | $504.90 | $765.00 | $91.15 – $495.60 | 11 |
| X-ray acromioclavicular joints without or w/weighted distraction bilateral CPT 73050 | $315.48 | $478.00 | $79.41 – $478.00 | 11 |
| X-ray ankle 2 views (both sides) CPT 73600 | $315.48 | $478.00 | $44.46 – $478.00 | 11 |
| X-ray arthrogram shoulder supervision & interpretation (both sides) CPT 73040 | $1,657.92 | $2,512.00 | $192.14 – $495.60 | 11 |
| X-ray bone age studies CPT 77072 | $506.22 | $767.00 | $69.71 – $495.60 | 11 |
| X-ray bone length studies CPT 77073 | $450.12 | $682.00 | $91.15 – $495.60 | 11 |
| X-ray bone survey complete CPT 77075 | $516.12 | $782.00 | $106.81 – $495.60 | 11 |
| X-ray bone survey infant CPT 77076 | $391.38 | $593.00 | $91.15 – $495.60 | 11 |
| X-ray cervical spine 2-3 views CPT 72040 | $420.42 | $637.00 | $88.91 – $495.60 | 11 |
| X-ray cervical spine 4-5 views CPT 72050 | $467.28 | $708.00 | $91.15 – $495.60 | 11 |
| X-ray cervical spine >= 6 views CPT 72052 | $582.78 | $883.00 | $91.15 – $495.60 | 11 |
| X-ray clavicle complete (both sides) CPT 73000 | $333.96 | $506.00 | $88.91 – $495.60 | 11 |
| X-ray colon abdominal radiograph(s) & delayed images single contrast study CPT 74270 | $636.24 | $964.00 | $179.20 – $495.60 | 11 |
| X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study CPT 74280 | $916.08 | $1,388.00 | $179.20 – $495.60 | 11 |
| X-ray elbow 2 views (both sides) CPT 73070 | $315.48 | $478.00 | $44.46 – $478.00 | 11 |
| X-ray elbow >= 3 views (both sides) CPT 73080 | $337.92 | $512.00 | $88.91 – $495.60 | 11 |
| X-ray esophogram chest radiograph(s) & delayed images single contrast study CPT 74220 | $516.12 | $782.00 | $45.58 – $495.60 | 11 |
| X-ray exam entire spi 4/5 vw CPT 72083 | $347.82 | $527.00 | $91.15 – $495.60 | 11 |
| X-ray exam entire spi 6/> vw CPT 72084 | $365.64 | $554.00 | $91.15 – $495.60 | 11 |
| X-ray exam of arm infant CPT 73092 | $315.48 | $478.00 | $91.15 – $478.00 | 11 |
| X-ray exam of eye sockets CPT 70200 | $391.38 | $593.00 | $91.15 – $495.60 | 11 |
| X-ray exam of femur 1 CPT 73551 | $315.48 | $478.00 | $88.91 – $478.00 | 11 |
| X-ray exam of middle ear CPT 70134 | $391.38 | $593.00 | $91.15 – $558.25 | 11 |
| X-ray exam of sinuses CPT 70210 | $315.48 | $478.00 | $88.91 – $478.00 | 11 |
| X-ray exam thorac spine4/>vw CPT 72074 | $347.82 | $527.00 | $91.15 – $495.60 | 11 |
| X-ray eye detection foreign body (both sides) CPT 70030 | $268.62 | $407.00 | $88.91 – $407.00 | 11 |
| X-ray facial bones complete > 3 views CPT 70150 | $391.38 | $593.00 | $91.15 – $495.60 | 11 |
| X-ray femur >=2 views (both sides) CPT 73552 | $322.74 | $489.00 | $88.91 – $489.00 | 11 |
| X-ray finger(s) >= 2 views (both sides) CPT 73140 | $315.48 | $478.00 | $44.46 – $478.00 | 11 |
| X-ray foot 2 views (both sides) CPT 73620 | $319.44 | $484.00 | $44.46 – $484.00 | 11 |
| X-ray forearm 2 views (both sides) CPT 73090 | $315.48 | $478.00 | $87.72 – $478.00 | 11 |
| X-ray hand 2 views (both sides) CPT 73120 | $310.20 | $470.00 | $45.58 – $470.00 | 11 |
| X-ray heel/calcaneus > 2 views (both sides) CPT 73650 | $316.80 | $480.00 | $44.46 – $480.00 | 11 |
| X-ray hip uni w/wo pelvis min 4 views CPT 73503 | $391.38 | $593.00 | $91.15 – $495.60 | 11 |
| X-ray hip with pelvis when performed bilateral 2 views CPT 73521 | $391.38 | $593.00 | $91.15 – $495.60 | 11 |
| X-ray hip with pelvis when performed bilateral 3-4 views CPT 73522 | $494.34 | $749.00 | $91.15 – $495.60 | 11 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | $515.46 | $781.00 | $91.15 – $495.60 | 11 |
| X-ray hip with pelvis when performed unilateral 1 view left CPT 73501 | $363.00 | $550.00 | $88.91 – $495.60 | 11 |
| X-ray humerus >= 2 views left CPT 73060 | $315.48 | $478.00 | $44.46 – $478.00 | 11 |
| X-ray joint survey 1 view CPT 77077 | $151.14 | $229.00 | $91.15 – $229.00 | 11 |
| X-ray knee 1-2 views (both sides) CPT 73560 | $315.48 | $478.00 | $88.91 – $478.00 | 11 |
| X-ray knee 3 views (both sides) CPT 73562 | $327.36 | $496.00 | $88.91 – $495.60 | 11 |
| X-ray knee ap standing bilateral CPT 73565 | $315.48 | $478.00 | $88.91 – $478.00 | 11 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $315.48 | $478.00 | $88.91 – $478.00 | 11 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $582.78 | $883.00 | $91.15 – $495.60 | 11 |
| X-ray lumbosacral spine >= 4 views CPT 72110 | $582.78 | $883.00 | $91.15 – $495.60 | 11 |
| X-ray lumbosacral spine complete including bending views >= 6 views CPT 72114 | $582.78 | $883.00 | $91.15 – $495.60 | 11 |
| X-ray mandible complete > 4 views CPT 70110 | $391.38 | $593.00 | $91.15 – $495.60 | 11 |
| X-ray mandible ltd <4 views CPT 70100 | $315.48 | $478.00 | $88.91 – $478.00 | 11 |
| X-ray nasal bones complete > 3 views CPT 70160 | $315.48 | $478.00 | $44.46 – $478.00 | 11 |
| X-ray neck soft tissue CPT 70360 | $316.80 | $480.00 | $88.91 – $480.00 | 11 |
| X-ray nose to rectum for foreign body child CPT 76010 | $279.84 | $424.00 | $86.33 – $424.00 | 11 |
| X-ray of mammary ducts CPT 77054 | $691.68 | $1,048.00 | $192.14 – $495.60 | 11 |
| X-ray pelvis 1-2 views CPT 72170 | $326.04 | $494.00 | $79.41 – $494.00 | 11 |
| X-ray pelvis complete > 3 views CPT 72190 | $394.68 | $598.00 | $91.15 – $495.60 | 11 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $708.84 | $1,074.00 | $192.14 – $495.60 | 11 |
| X-ray ribs 2 views left CPT 71100 | $322.74 | $489.00 | $88.91 – $489.00 | 11 |
| X-ray ribs 3 views bilateral CPT 71110 | $391.38 | $593.00 | $91.15 – $495.60 | 11 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $477.18 | $723.00 | $91.15 – $495.60 | 11 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $498.30 | $755.00 | $91.15 – $495.60 | 11 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $363.00 | $550.00 | $91.15 – $495.60 | 11 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $330.00 | $500.00 | $88.91 – $495.60 | 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.