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 |
|---|---|---|---|---|
| CT t-spine w /wo contrast CPT 72130 | $1,818.96 | $2,756.00 | $179.20 – $1,247.60 | 11 |
| CT upper extremity w/contrast (both sides) CPT 73201 | $1,770.12 | $2,682.00 | $356.43 – $1,247.60 | 11 |
| CT upper extremity without contrast (both sides) CPT 73200 | $1,335.18 | $2,023.00 | $106.81 – $1,247.60 | 11 |
| CT uppr extremity w/o&w/dye CPT 73202 | $1,846.68 | $2,798.00 | $179.20 – $1,247.60 | 11 |
| Culture aerobic additional method definitive id each CPT 87077 | $108.90 | $165.00 | $8.08 – $10.50 | 11 |
| Culture afb any source CPT 87116 | $143.22 | $217.00 | $10.80 – $14.04 | 11 |
| Culture anaerobic additional method definitive id each CPT 87076 | $59.40 | $90.00 | $8.08 – $10.50 | 11 |
| Culture anaerobic except blood CPT 87075 | $89.10 | $135.00 | $9.47 – $12.31 | 11 |
| Culture bact stool aero addl path ea CPT 87046 | $203.94 | $309.00 | $3.40 – $12.27 | 11 |
| Culture body fluid CPT 87070 | $237.60 | $360.00 | $8.62 – $11.21 | 11 |
| Culture fungi definitive id mold CPT 87107 | $68.64 | $104.00 | $10.32 – $13.42 | 11 |
| Culture fungi definitive id yeast CPT 87106 | $85.14 | $129.00 | $10.32 – $13.42 | 11 |
| Culture fungi other (except blood) CPT 87102 | $68.64 | $104.00 | $8.41 – $10.93 | 11 |
| Culture fungi skin/hair/nail CPT 87101 | $118.14 | $179.00 | $7.71 – $10.02 | 11 |
| Culture mycobacteria definitive id each isolate CPT 87118 | $138.60 | $210.00 | $14.61 – $18.99 | 11 |
| Culture mycoplasma any source CPT 87109 | $79.86 | $121.00 | $14.01 – $20.01 | 11 |
| Culture screening strep group a CPT 87081 | $55.44 | $84.00 | $6.63 – $8.62 | 11 |
| Culture typing immunologic CPT 87147 | $117.48 | $178.00 | $5.18 – $6.73 | 11 |
| Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets CPT 87154 | $483.78 | $733.00 | $12.05 – $283.48 | 11 |
| Culture typing nucleic acid probe amplified per culture/isolate each organism CPT 87150 | $173.58 | $263.00 | $35.09 – $45.62 | 11 |
| Culture urine each isolate CPT 87088 | $85.80 | $130.00 | $8.09 – $10.52 | 11 |
| Cv line/pic reposition CPT 36597 | $1,878.36 | $2,846.00 | $1,196.70 – $1,608.25 | 8 |
| Cv stress test i&r only 93018 CPT 93018 | $157.08 | $238.00 | $15.31 – $238.00 | 12 |
| Cv stress test/supervision only 93016 CPT 93016 | $149.16 | $226.00 | $23.28 – $226.00 | 12 |
| Cyanocobalamin unsat binding capacity CPT 82608 | $13.20 | $20.00 | $14.32 – $18.62 | 11 |
| Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution HCPCS J3420 | $32.34 | $49.00 | $1.06 – $1.15 | 4 |
| Cyclic citrullinated peptide antibody CPT 86200 | $89.10 | $135.00 | $12.95 – $16.84 | 11 |
| Cyclosporine 2 hour CPT 80158 | $69.96 | $106.00 | $18.05 – $23.47 | 11 |
| Cyp2d6 gene com variants CPT 81226 | $1,585.32 | $2,402.00 | $450.91 – $586.18 | 11 |
| Cystatin c CPT 82610 | $99.00 | $150.00 | $18.52 – $24.08 | 11 |
| Cystine urine quantitative CPT 82131 | $136.62 | $207.00 | $21.01 – $29.87 | 11 |
| Cystogram >= 3 views supervision & interpretation CPT 74430 | $785.40 | $1,190.00 | $105.73 – $495.60 | 11 |
| Cystoscopy (Bladder Scope) CPT 52000 | $1,171.50 | $1,775.00 | $95.40 – $1,881.50 | 9 |
| Cystoscopy chemodenervation CPT 52287 | not published | not published | not published | 0 |
| Cystourethroscop/calib/dilat stric 52281 CPT 52281 | $3,641.22 | $5,517.00 | $2,135.66 – $2,679.70 | 8 |
| Cytogenetics 25-99 CPT 88274 | $173.58 | $263.00 | $42.38 – $55.09 | 11 |
| Cytogenetics 3-5 CPT 88272 | $262.68 | $398.00 | $35.62 – $52.91 | 11 |
| Cytomegalovirus (cmv) antibody igg CPT 86644 | $99.00 | $150.00 | $14.39 – $18.71 | 11 |
| Cytomegalovirus (cmv) antibody igm CPT 86645 | $89.10 | $135.00 | $8.17 – $21.91 | 11 |
| Cytopathology cellular enhancement technique non-gyn CPT 88112 | $168.30 | $255.00 | $43.20 – $153.00 | 11 |
| Cytopathology cervical/vaginal thin layer manual screening CPT 88142 | $139.26 | $211.00 | $20.26 – $26.34 | 11 |
| Cytopathology concentration technique smears & interpretation CPT 88108 | $217.80 | $330.00 | $38.16 – $198.00 | 11 |
| Cytopathology fluids/washings/brushings smears with interpretation CPT 88104 | $148.50 | $225.00 | $38.16 – $135.00 | 11 |
| Cytopathology fna adequacy evaluation first episode each site CPT 88172 | $198.00 | $300.00 | $64.25 – $254.36 | 11 |
| Cytopathology fna adequacy evaluation first episode each site interp/rpt CPT 88173 | $357.72 | $542.00 | $53.24 – $325.20 | 11 |
| Cytopath smear other source CPT 88160 | $168.30 | $255.00 | $29.55 – $153.00 | 11 |
| Cytotoxic antibody screening CPT 86808 | $76.56 | $116.00 | $29.68 – $38.58 | 11 |
| Daptomycin 500 mg/10 ml intravenous solution HCPCS J0878 | $0.29 | $0.44 | $0.05 – $0.05 | 4 |
| Dch glucoscan CPT 82948 | $27.72 | $42.00 | $4.45 – $6.55 | 11 |
| Debridement (>20 cm) charge pt CPT 97598 | $180.84 | $274.00 | $35.14 – $274.00 | 11 |
| Debridement bone <= 20 sq cm CPT 11044 | $2,175.36 | $3,296.00 | $95.40 – $1,747.80 | 9 |
| Debridement/bone/20 sq cm or less 11046 CPT 11046 | $721.38 | $1,093.00 | $95.40 – $1,158.58 | 8 |
| Debridement/bone/ea add 20 sq cm 11047 CPT 11047 | $1,373.46 | $2,081.00 | $95.40 – $1,747.80 | 8 |
| Debridement subcutaneous tissue <= 20 sq cm CPT 11042 | $533.28 | $808.00 | $95.40 – $656.98 | 9 |
| Debride nail1-5 11720 CPT 11720 | $89.10 | $135.00 | $60.27 – $114.45 | 9 |
| Debride/subq tissue/ea add 20sq cm 11045 CPT 11045 | $114.84 | $174.00 | $95.40 – $184.44 | 8 |
| Debr musc/fascia 20sq cm/< 11043 CPT 11043 | $988.02 | $1,497.00 | $95.40 – $755.08 | 9 |
| Decalcification CPT 88311 | $79.86 | $121.00 | $10.16 – $72.60 | 10 |
| Declotting thrombolytic agent implanted vas access device 36 CPT 36593 | $583.44 | $884.00 | $95.40 – $506.98 | 9 |
| Decompression of tibia nerve CPT 28035 | not published | not published | not published | 0 |
| Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution HCPCS J0897 | $60.65 | $91.90 | $29.46 – $97.41 | 11 |
| Dentoalveolar/drain abs/cyst/hema 41800 CPT 41800 | $384.78 | $583.00 | $135.93 – $291.52 | 8 |
| Dermagraft HCPCS Q4106 | $64.68 | $98.00 | $76.40 – $84.05 | 4 |
| Desoxycorticosterone CPT 82633 | $184.14 | $279.00 | $30.98 – $40.27 | 11 |
| Destroy cervthor facet jnt 64633 CPT 64633 | $2,960.10 | $4,485.00 | $1,995.02 – $2,202.19 | 8 |
| Destroy cth facet jnt addl 64634 CPT 64634 | $647.46 | $981.00 | $647.69 – $686.55 | 7 |
| Destruction benign lesions < 14 lesions CPT 17110 | $229.68 | $348.00 | $68.16 – $284.11 | 13 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) CPT 64636 | $744.48 | $1,128.00 | $1,128.00 – $1,195.68 | 7 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | $3,202.98 | $4,853.00 | $1,995.02 – $2,202.19 | 8 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $544.50 | $825.00 | $86.33 – $495.60 | 11 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $0.24 | $0.37 | $0.02 – $0.02 | 4 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $8.09 | $12.25 | $0.18 – $0.20 | 4 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | $69.96 | $106.00 | $9.98 – $9.98 | 1 |
| Dextrose 5 % IV bolus HCPCS J7070 | $69.96 | $106.00 | $4.85 – $5.26 | 4 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $134.64 | $204.00 | $22.23 – $28.90 | 11 |
| Diabetes (HbA1c) Test CPT 83036 | $103.62 | $157.00 | $9.71 – $12.62 | 11 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $160.38 | $243.00 | $135.93 – $257.58 | 8 |
| Diagnostic laryngoscopy 31505 CPT 31505 | $344.52 | $522.00 | $203.93 – $291.52 | 8 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $224.40 | $340.00 | $203.93 – $291.52 | 8 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $369.60 | $560.00 | $77.45 – $180.10 | 9 |
| Diagnostic Mammogram (one breast) CPT 77065 | $310.20 | $470.00 | $77.45 – $180.10 | 9 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $81.97 | $124.20 | $11.04 – $11.98 | 4 |
| Diffusing capacity CPT 94729 | $286.44 | $434.00 | $93.60 – $434.00 | 10 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $32.34 | $49.00 | $15.79 – $17.13 | 4 |
| Digoxin total therapeutic drug level CPT 80162 | $140.58 | $213.00 | $13.28 – $17.26 | 11 |
| Diltiazem 5 mg/ml intravenous solution HCPCS J1163 | $0.32 | $0.49 | $0.05 – $0.05 | 4 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $32.34 | $49.00 | $1.17 – $1.27 | 4 |
| Disability dlco CPT 94727 | $276.54 | $419.00 | $93.60 – $419.00 | 11 |
| Dmpk gene detc abnor allele CPT 81234 | $368.94 | $559.00 | $109.60 – $178.10 | 11 |
| Dna antibody native/double stranded CPT 86225 | $89.10 | $135.00 | $13.74 – $17.86 | 11 |
| Dna gardnerella CPT 87510 | $138.60 | $210.00 | $20.05 – $26.07 | 11 |
| Dna trichomonas CPT 87660 | $138.60 | $210.00 | $20.05 – $26.07 | 11 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | $8.94 | $13.55 | $1.32 – $1.43 | 4 |
| Doppler echo complete CPT 93320 | $456.06 | $691.00 | $523.69 – $732.46 | 10 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $1,603.80 | $2,430.00 | $220.60 – $510.50 | 11 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $1,116.72 | $1,692.00 | $135.93 – $510.50 | 11 |
| Doxycycline hyclate 100 mg intravenous powder for solution HCPCS J1271 | $1.23 | $1.86 | $0.17 – $0.18 | 4 |
| Dpyd gene common variants CPT 81232 | $822.36 | $1,246.00 | $174.81 – $229.84 | 11 |
| Drainage ext aud canal abscess 69020 CPT 69020 | $1,325.28 | $2,008.00 | $275.02 – $723.47 | 8 |
| Drainage mouth roof lesion CPT 42000 | $460.68 | $698.00 | $241.98 – $291.52 | 8 |
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.