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 |
|---|---|---|---|---|
| Blood Clotting (PT/INR) Test CPT 85610 | $65.34 | $99.00 | $4.29 – $5.58 | 11 |
| Blood Clotting (PTT) Test CPT 85730 | $91.08 | $138.00 | $6.01 – $7.81 | 11 |
| Blood Count (CBC) Test CPT 85025 | $64.02 | $97.00 | $7.77 – $10.10 | 11 |
| Blood Count (CBC) Test (without differential) CPT 85027 | $108.24 | $164.00 | $6.47 – $8.41 | 11 |
| Blood Culture Test CPT 87040 | $124.74 | $189.00 | $10.32 – $13.42 | 11 |
| Blood draw capillary 36416 CPT 36416 | $27.06 | $41.00 | $4.36 – $19.20 | 10 |
| Blood gases o2 saturation direct measurement CPT 82805 | $174.90 | $265.00 | $39.91 – $102.40 | 11 |
| Blood occult fecal hemoglobin immunoassay qualitative 1-3 simultaneous determinations diagnostic CPT 82274 | $99.00 | $150.00 | $15.92 – $20.70 | 11 |
| Blood occult feces 1-3 determinations other than neoplasm screening qualitative CPT 82272 | $31.02 | $47.00 | $4.23 – $5.50 | 11 |
| Blood occult feces colorectal neoplasm screening qualitative CPT 82270 | $52.14 | $79.00 | $3.66 – $5.69 | 11 |
| Blood occult peroxidase activity qualitative gastric CPT 82271 | $24.42 | $37.00 | $4.26 – $6.92 | 11 |
| Blood smear microscopic w manual differential wbc count CPT 85007 | $31.02 | $47.00 | $3.80 – $4.94 | 11 |
| Blood typing abo CPT 86900 | $129.36 | $196.00 | $3.09 – $135.93 | 11 |
| Blood typing ag donor ea ag CPT 86902 | $361.02 | $547.00 | $5.37 – $366.21 | 11 |
| Blood typing patient serum CPT 86904 | $68.64 | $104.00 | $13.37 – $60.27 | 11 |
| Blood typing rbc ag non abo/rh ea CPT 86905 | $361.02 | $547.00 | $3.96 – $366.21 | 11 |
| Blood typing rh (d) CPT 86901 | $39.60 | $60.00 | $3.09 – $38.16 | 11 |
| Blood typing rh phenotype complete reference CPT 86906 | $66.00 | $100.00 | $8.01 – $38.16 | 11 |
| Bone Density Scan (DEXA) CPT 77080 | $592.02 | $897.00 | $106.81 – $495.60 | 11 |
| Bone marrow;aspiration only 38220 CPT 38220 | $1,871.10 | $2,835.00 | $1,687.37 – $2,851.11 | 8 |
| Bone marrow biopsyneedle/trocar 38221 CPT 38221 | $1,871.10 | $2,835.00 | $1,687.37 – $2,851.11 | 8 |
| Bone marrow imaging body CPT 78104 | $951.06 | $1,441.00 | $408.43 – $1,311.10 | 11 |
| Bone marrow imaging ltd CPT 78102 | $731.28 | $1,108.00 | $408.43 – $1,108.00 | 11 |
| Bone marrow interpretation CPT 85097 | $943.80 | $1,430.00 | $162.43 – $931.81 | 11 |
| Bone survey-lead poisoning CPT 77074 | $391.38 | $593.00 | $91.15 – $495.60 | 11 |
| Boot j walker l HCPCS L4386 | $237.60 | $360.00 | $227.89 – $227.89 | 1 |
| Boot walker genesis full shell 3-strap s HCPCS L4360 | $382.80 | $580.00 | $370.54 – $370.54 | 1 |
| Borrelia burgdorferi (lyme disease) antibody nonspecific CPT 86618 | $138.60 | $210.00 | $17.03 – $22.14 | 11 |
| Borrelia miyamotoi amp prb CPT 87478 | $99.66 | $151.00 | $35.09 – $45.62 | 11 |
| Bowel imaging CPT 78290 | $1,243.44 | $1,884.00 | $408.43 – $1,311.10 | 11 |
| Brace ank air stirrup univ HCPCS L4350 | $145.20 | $220.00 | $139.12 – $139.12 | 1 |
| Brace knee extender plus 22-30in HCPCS L1832 | $130.02 | $197.00 | $716.61 – $716.61 | 1 |
| Brace m arm board HCPCS L3809 | $349.80 | $530.00 | $329.74 – $329.74 | 1 |
| Brace oths wrist hnd fngr without HCPCS L3807 | $168.96 | $256.00 | $274.94 – $274.94 | 1 |
| Brace wrist classic lft sm HCPCS L3908 | $113.52 | $172.00 | $87.80 – $87.80 | 1 |
| Braf gene CPT 81210 | $475.20 | $720.00 | $143.40 – $228.02 | 11 |
| Brain image w/flow < 4 views CPT 78601 | $1,535.82 | $2,327.00 | $408.43 – $1,311.10 | 11 |
| Brain image w/flow 4 + views CPT 78606 | $1,828.86 | $2,771.00 | $554.73 – $1,311.10 | 11 |
| Brain MRA (blood vessel MRI, with and without contrast) CPT 70546 | $2,667.72 | $4,042.00 | $356.43 – $1,513.40 | 11 |
| Brain MRA (blood vessel MRI, without contrast) CPT 70544 | $2,310.00 | $3,500.00 | $243.77 – $1,513.40 | 11 |
| Brain MRI (with and without contrast) CPT 70553 | $2,721.18 | $4,123.00 | $356.43 – $1,513.40 | 11 |
| Brain MRI (with contrast) CPT 70552 | $2,591.82 | $3,927.00 | $356.43 – $1,513.40 | 11 |
| Brain MRI (without contrast) CPT 70551 | $2,360.16 | $3,576.00 | $243.77 – $1,513.40 | 11 |
| Brcassure comprehensive panel-sendout CPT 81162 | $2,108.04 | $3,194.00 | $1,471.63 – $2,372.34 | 11 |
| Breast Biopsy (ultrasound-guided, percutaneous) CPT 19083 | $3,779.16 | $5,726.00 | $500.00 – $2,289.48 | 11 |
| Breast punct aspir cyst, bil CPT 19000 | $812.46 | $1,231.00 | $723.47 – $1,175.28 | 8 |
| Bronchial allergy tests CPT 95070 | $613.14 | $929.00 | $75.41 – $381.24 | 11 |
| Bronchial challenge CPT 94070 | $925.32 | $1,402.00 | $167.54 – $687.30 | 11 |
| Br punct aspir ea add, l CPT 19001 | $374.88 | $568.00 | $568.00 – $602.08 | 7 |
| Bumetanide in d5w IV syringe 0.04 mg/ml (neo/ped) - cnr HCPCS J1939 | $16.17 | $24.50 | $0.59 – $0.64 | 4 |
| Bundled special stain group 1 microorganisms CPT 88312 | $317.46 | $481.00 | $52.32 – $288.60 | 11 |
| Bundled special stain group 2 CPT 88313 | $258.06 | $391.00 | $40.75 – $234.60 | 11 |
| Bupivacaine 0.1 % epidural pca - 1 hour dose limit HCPCS J0665 | $3.23 | $4.90 | $0.02 – $0.02 | 4 |
| Buprenorphine and metabolite - sendout CPT 80348 | $116.82 | $177.00 | $18.33 – $106.20 | 9 |
| Bx breast 1st lesion mr imag CPT 19085 | $1,871.10 | $2,835.00 | $1,687.37 – $2,289.48 | 8 |
| Bx breast add lesion mr imag CPT 19086 | $258.72 | $392.00 | $392.00 – $415.52 | 7 |
| Bx breast add lesion strtctc CPT 19082 | $231.00 | $350.00 | $350.00 – $371.00 | 7 |
| Bx breast add lesion Ultrasound imag CPT 19084 | $212.52 | $322.00 | $322.00 – $341.32 | 7 |
| Bx skin incisnl ea sep/add l les CPT 11107 | $148.50 | $225.00 | $225.00 – $238.50 | 7 |
| Bx skin punch ea sep/ addl les CPT 11105 | $148.50 | $225.00 | $225.00 – $238.50 | 7 |
| Bx skin tangential ea sep/ addl les CPT 11103 | $148.50 | $225.00 | $225.00 – $238.50 | 7 |
| Bx thyroid/percutan core needle 60100 CPT 60100 | $869.88 | $1,318.00 | $723.47 – $1,247.60 | 11 |
| Bypass temp external fem-fem CPT 37799 | $1,138.50 | $1,725.00 | $640.89 – $1,828.50 | 8 |
| C1 esterase inhibitor func - sendout CPT 86161 | $76.56 | $116.00 | $12.00 – $15.60 | 11 |
| Cacna1a gene full gene seq CPT 81185 | $977.46 | $1,481.00 | $677.01 – $1,100.15 | 11 |
| Calcium 24 hour urine CPT 82340 | $36.96 | $56.00 | $6.03 – $7.84 | 11 |
| Calcium chloride 100 mg/ml (10 %) intravenous syringe HCPCS J0618 | $0.13 | $0.19 | $0.05 – $0.05 | 1 |
| Calcium gluconate 100 mg/ml (10 %) intravenous solution HCPCS J0612 | $1.06 | $1.61 | $0.05 – $0.05 | 4 |
| Calcium gluconate 2 gram/100 ml in sodium chloride,iso-osm IV solution HCPCS J0613 | $1.06 | $1.61 | $0.15 – $0.16 | 4 |
| Calcium ionized CPT 82330 | $81.18 | $123.00 | $13.68 – $17.78 | 11 |
| Calcium total CPT 82310 | $31.02 | $47.00 | $5.16 – $6.71 | 11 |
| Calculi urinary-sendout CPT 82360 | $85.14 | $129.00 | $12.87 – $16.73 | 11 |
| Calprotectin fecal CPT 83993 | $126.06 | $191.00 | $19.63 – $25.52 | 11 |
| Candida dna CPT 87480 | $138.60 | $210.00 | $20.05 – $26.07 | 11 |
| Cap trach decann 15mm HCPCS C1750 | $550.44 | $834.00 | $458.70 – $458.70 | 1 |
| Carbamazepine free CPT 80157 | $99.66 | $151.00 | $13.25 – $17.23 | 11 |
| Carbamazepine total therapeutic drug level CPT 80156 | $152.46 | $231.00 | $14.57 – $18.94 | 11 |
| Carbohydrate deficient transf - sendout CPT 82373 | $415.80 | $630.00 | $10.38 – $23.48 | 11 |
| Carbon dioxide CPT 82374 | $81.18 | $123.00 | $4.88 – $6.34 | 11 |
| Carboxyhemoglobin quantitative CPT 82375 | $134.64 | $204.00 | $12.32 – $16.02 | 11 |
| Carcinoembryonic ag (cea) CPT 82378 | $135.30 | $205.00 | $18.96 – $24.65 | 11 |
| Cardiac perf spect sgl/ef/wm rst/strs CPT 78451 | $3,072.96 | $4,656.00 | $1,066.21 – $1,514.75 | 11 |
| Cardiac rehabilitation op phase 2 w/continous ecg monitoring CPT 93798 | $407.88 | $618.00 | $131.70 – $487.00 | 11 |
| Cardiac rehabilitation op phase 2 without continous ecg monitoring CPT 93797 | $145.20 | $220.00 | $131.70 – $233.20 | 11 |
| Cardiolipin antibody iga CPT 86147 | $68.64 | $104.00 | $8.17 – $33.09 | 11 |
| Cardioversion elective electrical conversion arrhythmia external CPT 92960 | $1,704.78 | $2,583.00 | $675.26 – $1,420.20 | 11 |
| Caregiver training strategies&tq 1st 30 minutes CPT 97550 | $102.96 | $156.00 | $51.46 – $85.80 | 9 |
| Caregiver training strategies&tq ea addl 15 min CPT 97551 | $51.48 | $78.00 | $25.72 – $42.90 | 9 |
| Car ion chnnlpath inc 10 gns CPT 81413 | $772.20 | $1,170.00 | $467.92 – $760.37 | 11 |
| Car ion chnnlpath inc 2 gns CPT 81414 | $772.20 | $1,170.00 | $467.92 – $760.37 | 11 |
| Carotene CPT 82380 | $46.20 | $70.00 | $9.22 – $11.99 | 11 |
| Carotid Artery Ultrasound (Duplex) CPT 93880 | $1,877.04 | $2,844.00 | $243.77 – $510.50 | 11 |
| Carpal Tunnel Release Surgery CPT 64721 | not published | not published | not published | 0 |
| Ca screen;flexi sigmoidscope HCPCS G0104 | $1,479.06 | $2,241.00 | $950.10 – $1,696.06 | 8 |
| Cath acuity innr ic130 6f 63cm HCPCS C1887 | $807.18 | $1,223.00 | $34.10 – $34.10 | 1 |
| Cath adherent clot 10mm 6f 10 HCPCS C1757 | $1,030.26 | $1,561.00 | $204.05 – $204.05 | 1 |
| Cath cv dl inj 7fx16cm HCPCS C1751 | $270.60 | $410.00 | $225.50 – $225.50 | 1 |
| Catheterization collection of specimen single patient all places of service HCPCS P9612 | $107.58 | $163.00 | $4.36 – $12.14 | 11 |
| Cath malecot 28fr 4-wing ltx HCPCS C1729 | $763.62 | $1,157.00 | $30.80 – $30.80 | 1 |
| Cath/saline/contrast/sis/hysteosal 58340 CPT 58340 | $528.00 | $800.00 | $456.60 – $563.71 | 10 |
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.