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 |
|---|---|---|---|---|
| Collection of venous blood by venipuncture CPT 36415 | $33.00 | $50.00 | $4.36 – $12.14 | 11 |
| Colonoscopy (diagnostic) CPT 45378 | $1,338.48 | $2,028.00 | $176.31 – $1,696.06 | 13 |
| Colonoscopy flex w/rem of tumor(s)/polyp(s)/lesion(s) by hot biopsy(s) forceps (rest meth ii cah) CPT 45384 | $1,896.18 | $2,873.00 | $215.27 – $1,696.06 | 13 |
| Colonoscopy submucous njx CPT 45381 | not published | not published | not published | 0 |
| Colonoscopy thru stoma spx CPT 44388 | not published | not published | not published | 0 |
| Colonoscopy w/control bleed CPT 45382 | not published | not published | not published | 0 |
| Colonoscopy (with biopsy) CPT 45380 | $1,472.46 | $2,231.00 | $190.88 – $1,696.06 | 13 |
| Colonoscopy (with polyp removal) CPT 45385 | $1,896.18 | $2,873.00 | $240.64 – $1,696.06 | 13 |
| Colonoscopy w/resection CPT 45390 | not published | not published | not published | 0 |
| Colporrhapy/vag injury sut/non ob 57200 CPT 57200 | $7,072.56 | $10,716.00 | $3,307.24 – $4,192.47 | 8 |
| Compatibility test each unit antiglobulin technique CPT 86922 | $172.26 | $261.00 | $124.37 – $226.20 | 11 |
| Compatibility test each unit electronic CPT 86923 | $172.26 | $261.00 | $93.56 – $226.20 | 11 |
| Compatibility test each unit immediate spin technique CPT 86920 | $172.26 | $261.00 | $116.38 – $226.20 | 11 |
| Complement antigen each component c3 CPT 86160 | $79.86 | $121.00 | $12.00 – $15.60 | 11 |
| Complement fixation each CPT 86171 | $281.16 | $426.00 | $10.01 – $13.01 | 11 |
| Complex repair trunk 1.1-2.5cm 13120 CPT 13120 | $898.92 | $1,362.00 | $415.32 – $723.61 | 8 |
| Complex repair trunk 2.6-7.5cm 13101 CPT 13101 | $898.92 | $1,362.00 | $682.65 – $755.08 | 8 |
| Complx repair enel 1.1-2.5 cm 13151 CPT 13151 | $1,186.68 | $1,798.00 | $682.65 – $755.08 | 8 |
| Complx repair enel 2.6-7.5 cm 13152 CPT 13152 | $1,285.02 | $1,947.00 | $682.65 – $755.08 | 8 |
| Complx repair enel addl 5cm/< 13153 CPT 13153 | $744.48 | $1,128.00 | $1,128.00 – $1,195.68 | 7 |
| Complx repair fccmnaxghf 13131 CPT 13131 | $1,186.68 | $1,798.00 | $415.32 – $723.61 | 8 |
| Complx repair fccmnaxghf 13132 CPT 13132 | $1,285.02 | $1,947.00 | $415.32 – $723.61 | 8 |
| Complx repair fccmnaxghf 13133 CPT 13133 | $494.34 | $749.00 | $682.65 – $723.61 | 7 |
| Complx repair sal addl 5 cm/> 13122 CPT 13122 | $494.34 | $749.00 | $682.65 – $723.61 | 7 |
| Complx repair trunk 1.1-2.5 cm 13100 CPT 13100 | $898.92 | $1,362.00 | $682.65 – $755.08 | 8 |
| Concentration infection agents any type CPT 87015 | $40.92 | $62.00 | $5.25 – $8.68 | 11 |
| Condylomata destruction 56420 CPT 56420 | $463.98 | $703.00 | $206.55 – $363.57 | 8 |
| Consultation pathology during surgery CPT 88329 | $353.10 | $535.00 | $40.75 – $321.00 | 11 |
| Consultation pathology during surgery cytological exam initial site CPT 88333 | $820.38 | $1,243.00 | $107.61 – $931.81 | 11 |
| Consultation pathology during surgery frozen section each additional block CPT 88332 | $168.30 | $255.00 | $30.10 – $153.00 | 10 |
| Consultation pathology during surgery frozen section first tissue block CPT 88331 | $262.68 | $398.00 | $135.64 – $238.80 | 11 |
| Consultation/report referred material w/preparation of slides CPT 88323 | $366.96 | $556.00 | $53.24 – $333.60 | 11 |
| Consultation/report referred slides prepared elsewhere CPT 88321 | $456.72 | $692.00 | $38.16 – $415.20 | 11 |
| Consult comp w/report rfrd material CPT 88325 | $993.96 | $1,506.00 | $135.64 – $903.60 | 11 |
| Contrast x-ray of ankle CPT 73615 | $1,242.78 | $1,883.00 | $192.14 – $495.60 | 11 |
| Contrast x-ray of elbow CPT 73085 | $900.90 | $1,365.00 | $192.14 – $495.60 | 11 |
| Contrast x-ray of hip CPT 73525 | $1,657.92 | $2,512.00 | $192.14 – $495.60 | 11 |
| Contrast x-ray of knee joint CPT 73580 | $955.68 | $1,448.00 | $192.14 – $495.60 | 11 |
| Contrast x-ray of wrist CPT 73115 | $830.94 | $1,259.00 | $192.14 – $495.60 | 11 |
| Control nosebleed pack+caut 30905 CPT 30905 | $411.84 | $624.00 | $135.93 – $291.52 | 8 |
| Control of nosebleed ant comp 30903 CPT 30903 | $434.28 | $658.00 | $135.93 – $291.52 | 8 |
| Control of nosebleedantersmpl 30901 CPT 30901 | $357.72 | $542.00 | $135.93 – $291.52 | 8 |
| Coombs direct CPT 86880 | $59.40 | $90.00 | $5.57 – $60.27 | 11 |
| Coombs indirect qualitative each reagent red cell reference CPT 86885 | $172.26 | $261.00 | $5.91 – $174.06 | 11 |
| Coombs indirect titer reference CPT 86886 | $172.26 | $261.00 | $5.35 – $174.06 | 11 |
| Core ndl bx lng/med perq CPT 32408 | $4,041.18 | $6,123.00 | $1,617.50 – $1,714.55 | 8 |
| Cor hlx vlgs dstl mtar osteo CPT 28296 | not published | not published | not published | 0 |
| Coronary thrombolysis/iv infusion 92977 CPT 92977 | $603.24 | $914.00 | $749.21 – $794.16 | 7 |
| Corrj halux rigdus without implt CPT 28289 | not published | not published | not published | 0 |
| Cortisol total am CPT 82533 | $99.00 | $150.00 | $16.30 – $21.19 | 11 |
| Cosyntropin 0.25 mg solution for injection HCPCS J0834 | $350.33 | $530.80 | $34.07 – $36.96 | 4 |
| Counseling smoke cess interm >10mins CPT 99407 | $52.80 | $80.00 | $37.46 – $80.00 | 11 |
| #coxa-coxsackie a serotype a16 CPT 86658 | $129.36 | $196.00 | $8.17 – $16.94 | 11 |
| C-peptide CPT 84681 | $81.18 | $123.00 | $7.34 – $27.05 | 11 |
| C-reactive protein CPT 86140 | $125.40 | $190.00 | $5.18 – $6.73 | 11 |
| C-reactive protein high sensitivity CPT 86141 | $147.84 | $224.00 | $12.95 – $16.84 | 11 |
| C-reactive protein, quantitative CPT 86406 | $71.28 | $108.00 | $9.85 – $13.83 | 11 |
| Creatine kinase CPT 82550 | $42.24 | $64.00 | $6.51 – $8.46 | 11 |
| Creatine kinase isoenzymes CPT 82552 | $73.92 | $112.00 | $13.39 – $17.41 | 11 |
| Creatine kinase mb CPT 82553 | $54.12 | $82.00 | $8.66 – $15.02 | 11 |
| Creatine - sendout CPT 82540 | $33.66 | $51.00 | $4.64 – $6.03 | 11 |
| Creatinine CPT 82565 | $62.04 | $94.00 | $5.12 – $6.66 | 11 |
| Creatinine 24 hour urine CPT 82570 | $62.70 | $95.00 | $5.18 – $6.73 | 11 |
| Creatinine clearance urine CPT 82575 | $72.60 | $110.00 | $9.46 – $12.30 | 11 |
| Critical care 30-74 minutes CPT 99291 | $1,448.04 | $2,194.00 | $843.92 – $843.92 | 1 |
| Cryofibrinogen qualitative - sendout CPT 82585 | $42.24 | $64.00 | $9.02 – $18.38 | 11 |
| Cryoprecipitate each unit HCPCS P9012 | $155.10 | $235.00 | $71.95 – $249.10 | 9 |
| Cryptosporidium antigen CPT 87272 | $89.10 | $135.00 | $11.98 – $15.57 | 11 |
| Crystal identification light microscopy CPT 89060 | $49.50 | $75.00 | $7.33 – $9.53 | 11 |
| Csf leakage imaging CPT 78650 | $1,828.86 | $2,771.00 | $983.08 – $1,514.75 | 11 |
| Cstb gene full gene sequence CPT 81189 | $317.46 | $481.00 | $219.86 – $357.28 | 11 |
| Cta abdomen without & /or w/contrast CPT 74175 | $1,994.52 | $3,022.00 | $179.20 – $1,247.60 | 11 |
| Cta abdominal aorta & (both sides) ileofemoral lower extremity w runoff without & w/contrast CPT 75635 | $1,907.40 | $2,890.00 | $179.20 – $1,247.60 | 11 |
| Cta lower extremity without & w/contrast (both sides) CPT 73706 | $2,002.44 | $3,034.00 | $179.20 – $1,247.60 | 11 |
| Cta neck without &/or w/contrast CPT 70498 | $1,818.96 | $2,756.00 | $179.20 – $1,247.60 | 11 |
| CT Angiogram of Abdomen and Pelvis CPT 74174 | $3,358.08 | $5,088.00 | $356.43 – $1,247.60 | 11 |
| CT Angiogram of the Chest (for blood clot) CPT 71275 | $1,859.88 | $2,818.00 | $179.20 – $1,247.60 | 11 |
| CT Angiogram of the Head CPT 70496 | $2,091.54 | $3,169.00 | $179.20 – $1,247.60 | 11 |
| CT angio pelvis CPT 72191 | $1,818.96 | $2,756.00 | $179.20 – $1,247.60 | 11 |
| Cta upper extremity w &/or without contrast left CPT 73206 | $1,818.96 | $2,756.00 | $179.20 – $1,247.60 | 11 |
| CT guidance for needle placement CPT 77012 | $1,263.24 | $1,914.00 | $133.68 – $1,247.60 | 10 |
| CT guidance for percutaneous drain w/catheter placement supervision & interpretation CPT 75989 | $1,215.06 | $1,841.00 | $245.66 – $495.60 | 10 |
| CT guid cryo ablat intramuscular CPT 20999 | not published | not published | not published | 0 |
| CT limited or localized follow-up study CPT 76380 | $769.56 | $1,166.00 | $88.91 – $1,166.00 | 11 |
| CT lower extremity w/contrast (both sides) CPT 73701 | $1,574.76 | $2,386.00 | $179.20 – $1,247.60 | 11 |
| CT lower extremity without contrast (both sides) CPT 73700 | $1,430.88 | $2,168.00 | $106.81 – $1,247.60 | 11 |
| CT lwr extremity w/o&w/dye CPT 73702 | $1,818.96 | $2,756.00 | $179.20 – $1,247.60 | 11 |
| CT neck soft tissue w/contrast CPT 70491 | $1,595.22 | $2,417.00 | $179.20 – $1,247.60 | 11 |
| CT neck soft tissue without contrast CPT 70490 | $1,259.28 | $1,908.00 | $106.81 – $1,247.60 | 11 |
| CT neck soft tissue without & w/contrast CPT 70492 | $2,091.54 | $3,169.00 | $179.20 – $1,247.60 | 11 |
| CT orbit/sella/fossa w/wo contrast CPT 70482 | $1,818.96 | $2,756.00 | $179.20 – $1,247.60 | 11 |
| CT orbit/sella/ or posterior outer inner or middle ear w/contrast CPT 70481 | $1,770.12 | $2,682.00 | $179.20 – $1,247.60 | 11 |
| CT orbit/sella/ or posterior outer inner or middle ear without contrast CPT 70480 | $1,351.02 | $2,047.00 | $106.81 – $1,247.60 | 11 |
| CT scan for localization CPT 77011 | $2,583.90 | $3,915.00 | $133.68 – $1,247.60 | 10 |
| CT Scan of Abdomen and Pelvis (with and without contrast) CPT 74178 | $3,550.14 | $5,379.00 | $356.43 – $1,247.60 | 11 |
| CT Scan of Abdomen and Pelvis (with contrast) CPT 74177 | $3,016.86 | $4,571.00 | $178.22 – $1,247.60 | 11 |
| CT Scan of Abdomen and Pelvis (without contrast) CPT 74176 | $2,544.96 | $3,856.00 | $243.77 – $1,247.60 | 11 |
| CT thoracic spine w/contrast CPT 72129 | $1,539.12 | $2,332.00 | $179.20 – $1,247.60 | 11 |
| CT thoracic spine without contrast CPT 72128 | $1,448.04 | $2,194.00 | $106.81 – $1,247.60 | 11 |
| CT thorax low dose for lung screening without contrast CPT 71271 | $769.56 | $1,166.00 | $106.81 – $1,166.00 | 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.