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 |
|---|---|---|---|---|
| Drainage of arm bursa 23931 CPT 23931 | $1,871.10 | $2,835.00 | $1,687.37 – $3,005.10 | 8 |
| Drainage of urethra abscess 53060 CPT 53060 | $2,366.10 | $3,585.00 | $2,135.66 – $3,800.10 | 8 |
| Drain blood from under nail 11740 CPT 11740 | $149.16 | $226.00 | $107.97 – $135.93 | 8 |
| Drain finger abscess;simple 26010 CPT 26010 | $395.34 | $599.00 | $204.98 – $284.11 | 8 |
| Drain neck/chest lesion 21501 CPT 21501 | $8,646.66 | $13,101.00 | $2,967.63 – $3,984.85 | 8 |
| Drain thigh/knee lesion 27301 CPT 27301 | $5,360.52 | $8,122.00 | $2,905.45 – $3,079.78 | 8 |
| Dress/debride pt-tck burn/5-10% bs 16025 CPT 16025 | $434.28 | $658.00 | $204.98 – $361.90 | 9 |
| Dress/debride pt-thick burn/<5% bs 16020 CPT 16020 | $374.88 | $568.00 | $95.40 – $313.69 | 9 |
| Dress/debrid prtl-thick burn l 16030 CPT 16030 | $524.04 | $794.00 | $415.32 – $656.98 | 9 |
| Drng of finger abscess comp 26011 CPT 26011 | $3,873.54 | $5,869.00 | $1,687.37 – $1,846.17 | 8 |
| Drng of scrotum abscess 55100 CPT 55100 | $1,871.10 | $2,835.00 | $1,687.37 – $3,005.10 | 8 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | $51.81 | $78.50 | $11.85 – $12.85 | 4 |
| Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 | $23.10 | $35.00 | $20.20 – $127.14 | 5 |
| Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm HCPCS Q4104 | $8,543.70 | $12,945.00 | $127.14 – $127.14 | 1 |
| Drug assay caffeine CPT 80155 | $125.40 | $190.00 | $15.44 – $50.14 | 11 |
| Drug assay posaconazole CPT 80187 | $130.02 | $197.00 | $21.69 – $35.24 | 11 |
| Drug assay vedolizumab CPT 80280 | $308.88 | $468.00 | $30.85 – $50.14 | 11 |
| Drug assay voriconazole CPT 80285 | $100.98 | $153.00 | $21.69 – $35.24 | 11 |
| Drug screening tapentadol CPT 80372 | $36.30 | $55.00 | $18.33 – $33.00 | 9 |
| Drug screen quant tiagabine CPT 80199 | $83.82 | $127.00 | $19.70 – $35.24 | 11 |
| Drug test def 15-21 classes HCPCS G0482 | $244.86 | $371.00 | $132.80 – $258.36 | 11 |
| Drug test def 1-7 classes HCPCS G0480 | $230.34 | $349.00 | $63.95 – $148.76 | 11 |
| Drug test def 22+ classes HCPCS G0483 | $699.60 | $1,060.00 | $172.18 – $321.00 | 11 |
| Drug test def 8-14 classes HCPCS G0481 | $188.76 | $286.00 | $98.39 – $203.57 | 11 |
| Drug test prsmv instrmnt CPT 80306 | $209.88 | $318.00 | $17.14 – $22.28 | 11 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $258.72 | $392.00 | $62.14 – $80.78 | 11 |
| Ductogram sgl duct CPT 77053 | $691.68 | $1,048.00 | $148.68 – $495.60 | 11 |
| Duplex scan bilateral study 93985 CPT 93985 | $552.42 | $837.00 | $177.46 – $510.50 | 11 |
| Duplex scan unilateral study 93986 CPT 93986 | $149.82 | $227.00 | $106.81 – $227.00 | 11 |
| Dup scan/hemodialysis access 93990 CPT 93990 | $489.72 | $742.00 | $106.81 – $510.50 | 11 |
| Dup scan/lwr xtr vasc stdy bilat 93924 CPT 93924 | $1,885.62 | $2,857.00 | $177.46 – $510.50 | 11 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $769.56 | $1,166.00 | $177.46 – $510.50 | 11 |
| Dx gastr intub w/asp spec CPT 43754 | $642.18 | $973.00 | $220.60 – $220.60 | 1 |
| Ear irrigation 69209 CPT 69209 | $122.10 | $185.00 | $60.27 – $60.27 | 1 |
| Ecg 12 lead tracing only CPT 93005 | $186.78 | $283.00 | $41.73 – $155.60 | 11 |
| Ecg/1-3 leads/tracing only 93041 CPT 93041 | $134.64 | $204.00 | $41.73 – $155.60 | 11 |
| Ecg < 30 days transmission & analysis CPT 93271 | $675.18 | $1,023.00 | $67.71 – $592.00 | 11 |
| Ecg external < 48 hours recording CPT 93225 | $396.00 | $600.00 | $100.27 – $592.00 | 11 |
| Ecg external < 48 hours scanning analysis w/report CPT 93226 | $582.12 | $882.00 | $60.27 – $592.00 | 11 |
| Ecg external > 48 hours up to 7 days recording CPT 93242 | $105.60 | $160.00 | $38.16 – $160.00 | 11 |
| Ecg external >7 days up to 15 days recording CPT 93246 | $149.82 | $227.00 | $38.16 – $155.60 | 11 |
| Echocardiogram (Heart Ultrasound) CPT 93306 | $1,709.40 | $2,590.00 | $523.69 – $745.31 | 11 |
| Echocardiography doppler color flow mapping CPT 93325 | $666.60 | $1,010.00 | $88.73 – $567.70 | 10 |
| Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler HCPCS C8929 | $1,906.74 | $2,889.00 | $523.69 – $800.90 | 11 |
| Echocardiography transthoracic 2d followup/limited CPT 93308 | $766.92 | $1,162.00 | $243.77 – $745.31 | 11 |
| Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast HCPCS C8924 | $1,004.52 | $1,522.00 | $356.43 – $745.31 | 11 |
| Echocardiograpy doppler follow up/limited study CPT 93321 | $418.44 | $634.00 | $351.56 – $567.70 | 10 |
| Echo exam uterus 76831- CPT 76831 | $489.72 | $742.00 | $129.04 – $521.52 | 15 |
| Echo guidance radiotherapy CPT 76965 | $83.82 | $127.00 | $127.00 – $134.62 | 10 |
| Echo stress CPT 93350 | $1,606.44 | $2,434.00 | $523.69 – $745.31 | 11 |
| Echo tee probe placement image acquisition interpretation & report CPT 93312 | $2,113.98 | $3,203.00 | $523.69 – $745.31 | 11 |
| Eeg/cerebral death evaluation only 95824 -26 CPT 95824 | $864.60 | $1,310.00 | $381.24 – $570.31 | 11 |
| Eeg monitor/record/awake/drowsy 95816 CPT 95816 | $787.38 | $1,193.00 | $220.60 – $570.31 | 11 |
| Eeg recording awake and asleep CPT 95819 | $1,351.02 | $2,047.00 | $220.60 – $570.31 | 11 |
| Eeg without vid 2-12hr cont mntr CPT 95707 | $3,153.48 | $4,778.00 | $220.60 – $570.31 | 11 |
| Eeg without vid 2-12 hr unmntr CPT 95705 | $2,432.76 | $3,686.00 | $220.60 – $570.31 | 11 |
| Eeg without vid ea 12-26hr intmt CPT 95709 | $4,775.10 | $7,235.00 | $381.24 – $771.23 | 11 |
| Eeg wo vid 2-12hr intmt mntr CPT 95706 | $2,702.70 | $4,095.00 | $220.60 – $570.31 | 11 |
| Eeg wo vid ea 12-26hr unmntr CPT 95708 | $4,505.16 | $6,826.00 | $381.24 – $771.23 | 11 |
| E equine encephalitis igg CPT 86652 | $60.06 | $91.00 | $8.17 – $17.15 | 11 |
| Egd endo mucosal resection CPT 43254 | not published | not published | not published | 0 |
| Egd guide wire insertion CPT 43248 | not published | not published | not published | 0 |
| Egd varices ligation CPT 43244 | not published | not published | not published | 0 |
| Egfr gene com variants CPT 81235 | $1,189.32 | $1,802.00 | $264.01 – $421.95 | 11 |
| Ehrlicha chaffeensis amp prb CPT 87484 | $237.60 | $360.00 | $35.09 – $45.62 | 11 |
| Eia hiv-1/hiv-2 screen HCPCS G0432 | $79.86 | $121.00 | $13.92 – $25.44 | 11 |
| EKG (Electrocardiogram) CPT 93000 | $193.38 | $293.00 | $41.73 – $155.60 | 10 |
| EKG interpret & report preve g0405 HCPCS G0405 | $62.70 | $95.00 | $9.22 – $44.23 | 12 |
| EKG tracing for initial prev HCPCS G0404 | $112.20 | $170.00 | $29.55 – $155.60 | 11 |
| Electrolyte panel CPT 80051 | $48.84 | $74.00 | $7.01 – $9.11 | 11 |
| Electron microscopy diagnostic CPT 88348 | $2,982.54 | $4,519.00 | $213.63 – $1,319.40 | 11 |
| Encephalitis, california igg/igm CPT 86651 | $49.50 | $75.00 | $8.17 – $17.15 | 11 |
| Encephalitis, st louis igg/igm CPT 86653 | $60.72 | $92.00 | $8.17 – $17.15 | 11 |
| Encephalitis, western equine igg/igm CPT 86654 | $60.06 | $91.00 | $8.17 – $17.15 | 11 |
| Endo abl/incom vein/ext/laser/#1 36478 CPT 36478 | not published | not published | not published | 0 |
| Endo abl/incom vein/ext/rad fre/#1 36475 CPT 36475 | not published | not published | not published | 0 |
| Endoscopic injection/implant CPT 51715 | not published | not published | not published | 0 |
| Endoscpy nsl/sns w/cntrl nsl hmrrgh CPT 31238 | $2,168.76 | $3,286.00 | $1,818.45 – $3,239.21 | 8 |
| Enoxaparin 30 mg/0.3 ml subcutaneous syringe HCPCS J1650 | $15.84 | $24.00 | $0.87 – $0.95 | 4 |
| Enzyme histochemistry CPT 88319 | $943.80 | $1,430.00 | $213.63 – $931.81 | 11 |
| Epidrm a-grft face/nck/hf/g 15115 CPT 15115 | $1,665.18 | $2,523.00 | $95.40 – $2,674.38 | 9 |
| Epidrm a-grft f/n/hf/g addl CPT 15116 | $180.18 | $273.00 | $95.40 – $289.38 | 8 |
| Epidrm agrft t/a/l 1st 100 CPT 15110 | $2,220.24 | $3,364.00 | $95.40 – $3,341.59 | 9 |
| Epidrm autogrft t/a/l add-on CPT 15111 | $180.18 | $273.00 | $95.40 – $289.38 | 8 |
| Epidural/lumbar/sacral/ea add level64484 CPT 64484 | $829.62 | $1,257.00 | $1,240.30 – $1,314.72 | 7 |
| Epinephrine 0.1 mg/ml injection syringe HCPCS J0168 | $6.69 | $10.14 | $4.95 – $5.37 | 4 |
| Epinephrine 1 mg/ml im kit - adult HCPCS J0169 | $7.29 | $11.05 | $2.28 – $2.47 | 4 |
| Epinephrine hcl (pf) 1 mg/ml (1 ml) injection solution HCPCS J0166 | $4.38 | $6.64 | $1.83 – $1.99 | 4 |
| Epoetin alfa-epbx 40,000 unit/ml injection solution HCPCS Q5106 | $36.25 | $54.93 | $7.57 – $55.42 | 11 |
| Epstein barr early antigen antibody CPT 86663 | $89.10 | $135.00 | $13.12 – $17.06 | 11 |
| Epstein barr nuclear antigen antibody CPT 86664 | $99.00 | $150.00 | $15.29 – $19.88 | 11 |
| Epstein barr viral capsid antigen antibody igm CPT 86665 | $118.14 | $179.00 | $18.14 – $23.58 | 11 |
| Eptinezumab-jjmr 100 mg/ml intravenous solution HCPCS J3032 | $35.47 | $53.74 | $20.50 – $56.96 | 11 |
| Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr HCPCS J1335 | $228.12 | $345.63 | $15.11 – $16.40 | 4 |
| ER Visit (level 1, minor) CPT 99281 | $140.58 | $213.00 | $86.15 – $86.15 | 1 |
| ER Visit (level 2) CPT 99282 | $208.56 | $316.00 | $156.87 – $156.87 | 1 |
| ER Visit (level 3) CPT 99283 | $329.34 | $499.00 | $278.89 – $278.89 | 1 |
| ER Visit (level 4) CPT 99284 | $538.56 | $816.00 | $426.30 – $426.30 | 1 |
| ER Visit (level 5, high severity) CPT 99285 | $1,723.92 | $2,612.00 | $608.43 – $608.43 | 1 |
| Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only HCPCS J1805 | $3.58 | $5.42 | $0.35 – $0.38 | 4 |
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.