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 |
|---|---|---|---|---|
| Esoph egd dilation <30 mm CPT 43249 | not published | not published | not published | 0 |
| Established Patient Office Visit (level 1) CPT 99211 | $199.32 | $302.00 | $95.40 – $154.00 | 2 |
| Established Patient Office Visit (level 2) CPT 99212 | $268.62 | $407.00 | $95.40 – $154.00 | 2 |
| Established Patient Office Visit (level 3) CPT 99213 | $243.54 | $369.00 | $95.40 – $106.00 | 2 |
| Established Patient Office Visit (level 4) CPT 99214 | $268.62 | $407.00 | $95.40 – $154.00 | 2 |
| Established Patient Office Visit (level 5) CPT 99215 | $339.24 | $514.00 | $95.40 – $154.00 | 2 |
| Estradiol total CPT 82670 | $170.94 | $259.00 | $27.94 – $36.32 | 11 |
| Estrogens total-sendout CPT 82672 | $134.64 | $204.00 | $21.70 – $28.21 | 11 |
| Ethylene glycol -sendout CPT 82693 | $321.42 | $487.00 | $7.95 – $19.37 | 11 |
| Etonogestrel implant system HCPCS J7307 | $856.68 | $1,298.00 | $737.59 – $1,298.00 | 8 |
| Evaluation of speech fluency 92521 CPT 92521 | $181.50 | $275.00 | $103.44 – $275.00 | 11 |
| Event monitor CPT 93270 | $231.00 | $350.00 | $38.13 – $350.00 | 11 |
| Exc back tum deep 5 cm/> CPT 21933 | not published | not published | not published | 0 |
| Exc benign tal 0.5 < cm 11400 CPT 11400 | $1,475.76 | $2,236.00 | $682.65 – $723.61 | 8 |
| Exc ben+marg excep skin tag snhfg >4cm 11426 CPT 11426 | $3,305.94 | $5,009.00 | $260.19 – $3,076.62 | 13 |
| Exc face tum deep 2cm/> 21014 CPT 21014 | not published | not published | not published | 0 |
| Excision benign lesion face/ears/eyelids/nose/lips/muc memb 0.6 - 1.0 cm CPT 11441 | $812.46 | $1,231.00 | $95.40 – $723.61 | 9 |
| Excision benign lesion scalp/neck/hands/feet/genitalia 1.1 - 2.0 cm CPT 11422 | $1,871.10 | $2,835.00 | $134.29 – $2,081.33 | 13 |
| Excision benign lesion trunk/arms/legs 1.1 - 2.0 cm CPT 11402 | not published | not published | not published | 0 |
| Excision benign lesion trunk/arms/legs > 4.0 cm CPT 11406 | $3,509.22 | $5,317.00 | $240.51 – $3,076.62 | 13 |
| Excision breast lesion CPT 19125 | $4,422.66 | $6,701.00 | $467.19 – $4,000.24 | 13 |
| Excision tumor soft tissue back/flank subcutaneous >= 3 cm CPT 21931 | not published | not published | not published | 0 |
| Exc malig feenl 3.1-4.0 11644 CPT 11644 | $1,871.10 | $2,835.00 | $95.40 – $2,081.33 | 9 |
| Exc malig snhfg 2.1-3 cm 11623 CPT 11623 | $1,871.10 | $2,835.00 | $191.16 – $2,081.33 | 13 |
| Exc mal+marg tal 1.1-2 cm 11602 CPT 11602 | $1,432.86 | $2,171.00 | $95.40 – $723.61 | 9 |
| Exc mal+marg tal 2.1-3 cm 11603 CPT 11603 | $1,871.10 | $2,835.00 | $95.40 – $723.61 | 9 |
| Exc skn hdrdnt ax smpl/ntrm CPT 11450 | $3,305.94 | $5,009.00 | $267.86 – $3,076.62 | 13 |
| Exc snhfg mal+mrg 1.1-2 11622 CPT 11622 | $812.46 | $1,231.00 | $95.40 – $723.61 | 9 |
| Exc sq tumor/foot or toe < 1.5 cm 28039 CPT 28039 | $3,305.94 | $5,009.00 | $95.40 – $3,678.14 | 9 |
| Exc sq tumor/thigh/knee area 3cm/> 27337 CPT 27337 | not published | not published | not published | 0 |
| Exc tr-ext mal+marg tal >4 cm 11606 CPT 11606 | $1,871.10 | $2,835.00 | $290.13 – $2,835.00 | 13 |
| Exercise tst brncspsm w/ecg CPT 94617 | $247.50 | $375.00 | $93.60 – $375.00 | 11 |
| Exome re-evaluation CPT 81417 | $1,395.90 | $2,115.00 | $216.83 – $416.00 | 11 |
| Exome sequence analysis CPT 81415 | $5,520.90 | $8,365.00 | $3,067.56 – $6,214.00 | 11 |
| Exome sequence analysis CPT 81416 | $13,860.00 | $21,000.00 | $3,067.56 – $15,600.00 | 11 |
| Explore penetrating wnd/extremity 20103 CPT 20103 | $1,871.10 | $2,835.00 | $619.79 – $1,687.37 | 8 |
| Ext ecg>48hr<7d scan a/r CPT 93243 | $157.08 | $238.00 | $100.27 – $238.00 | 11 |
| Ext ecg>7d<15d scan a/r CPT 93247 | $316.80 | $480.00 | $100.27 – $480.00 | 11 |
| External chromosome analysis 20-25 cells CPT 88264 | $737.22 | $1,117.00 | $144.61 – $187.99 | 11 |
| External tissue culture neoplastic disorders bone marrow/blood cells CPT 88237 | $339.24 | $514.00 | $70.04 – $186.88 | 11 |
| Extractable nuclear antigen/antibody any method each antibody centromere CPT 86235 | $118.14 | $179.00 | $17.93 – $23.31 | 11 |
| Facial bones <3 CPT 70140 | $315.48 | $478.00 | $88.91 – $478.00 | 11 |
| Facility svs dental rehab HCPCS G0330 | not published | not published | not published | 0 |
| Factor ix CPT 85250 | $198.00 | $300.00 | $19.04 – $24.75 | 11 |
| Factor viii CPT 85240 | $102.30 | $155.00 | $9.84 – $23.27 | 11 |
| Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr HCPCS J1308 | $0.40 | $0.61 | $0.02 – $0.02 | 4 |
| Fat/lipids feces qualitative CPT 82705 | $28.38 | $43.00 | $5.10 – $6.63 | 11 |
| Fatty acids nonesterified CPT 82725 | $126.06 | $191.00 | $18.72 – $24.40 | 11 |
| #fecal-sodium CPT 84302 | $29.70 | $45.00 | $4.86 – $6.32 | 11 |
| Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper) HCPCS J3010 | $32.34 | $49.00 | $1.96 – $2.13 | 4 |
| Ferric carboxymaltose 50 mg iron/ml intravenous solution HCPCS J1439 | $6.53 | $9.89 | $1.12 – $10.48 | 11 |
| Ferritin CPT 82728 | $114.18 | $173.00 | $13.63 – $17.72 | 11 |
| Fetal biophys profile w/nst 76818 CPT 76818 | $489.72 | $742.00 | $106.81 – $574.00 | 11 |
| Fetal fibronectin CPT 82731 | $396.00 | $600.00 | $64.41 – $83.73 | 11 |
| Fetal hemoglobin (kleihauer betke) CPT 85460 | $147.84 | $224.00 | $7.73 – $10.05 | 11 |
| Fetal hemoglobin rosette CPT 85461 | $59.40 | $90.00 | $9.33 – $12.17 | 11 |
| Fetal lung maturity assess lam body dnst CPT 83664 | $131.34 | $199.00 | $6.82 – $25.12 | 11 |
| #_fet/norfentcnfrmur CPT 80354 | $126.06 | $191.00 | $18.33 – $114.60 | 9 |
| Fibrin degradation d dimer quantitative CPT 85379 | $130.68 | $198.00 | $10.18 – $13.23 | 11 |
| Fibrin degradation products CPT 85362 | $47.52 | $72.00 | $6.89 – $8.96 | 11 |
| Fibrinogen activity CPT 85384 | $68.64 | $104.00 | $9.72 – $12.64 | 11 |
| Fibrinolysins/coagulopathy screen interpretation/report CPT 85390 | $294.36 | $446.00 | $7.27 – $20.12 | 11 |
| Fibrinolytic antiplasmin CPT 85410 | $178.86 | $271.00 | $7.71 – $10.02 | 11 |
| Fibrinolytic plasminogen CPT 85421 | $126.06 | $191.00 | $10.18 – $13.23 | 11 |
| Fine needle aspiration biopsy w/fluor gdn;1st lesion 10007 CPT 10007 | $1,087.02 | $1,647.00 | $723.47 – $1,175.28 | 8 |
| Fine needle aspiration biopsy w/fluor gdn; ea addtl 10008 CPT 10008 | $543.84 | $824.00 | $824.00 – $873.44 | 7 |
| Fine needle aspiration biopsy w/us gdn; ea addtl 10006 CPT 10006 | $543.84 | $824.00 | $824.00 – $873.44 | 7 |
| Fine needle asp without image guide 10021 CPT 10021 | $461.34 | $699.00 | $95.40 – $740.94 | 9 |
| Fix g/colon tube w/device CPT 49460 | $1,083.06 | $1,641.00 | $456.60 – $926.63 | 11 |
| Flecainide (tambocor)-sendout CPT 80181 | $21.78 | $33.00 | $14.91 – $24.23 | 11 |
| Fl exam g/colon tube w contrast CPT 49465 | $499.62 | $757.00 | $192.14 – $495.60 | 11 |
| Flow cytometry marker each additional CPT 88185 | $258.06 | $391.00 | $28.87 – $234.60 | 10 |
| Flow cytometry one marker technical component CPT 88184 | $416.46 | $631.00 | $226.63 – $388.93 | 11 |
| #flow interp 9 - 15 markers CPT 88188 | $263.34 | $399.00 | $43.20 – $239.40 | 10 |
| Flt3 gene CPT 81245 | $247.50 | $375.00 | $132.74 – $215.16 | 11 |
| Flt3 gene analysis CPT 81246 | $207.90 | $315.00 | $83.00 – $107.90 | 11 |
| Fluidotherapy charges pt CPT 97022 | $77.22 | $117.00 | $15.06 – $117.00 | 11 |
| Fluorescent antibody titer dna CPT 86256 | $79.86 | $121.00 | $12.05 – $15.67 | 11 |
| Fluoroguide for spine inject 77003-26 CPT 77003 | $568.92 | $862.00 | $319.09 – $495.60 | 10 |
| Fluoroguide needle placement CPT 77002 | $517.44 | $784.00 | $328.27 – $495.60 | 10 |
| Fluoro polarize fetal lung CPT 83663 | $434.94 | $659.00 | $13.65 – $24.58 | 11 |
| Fluoroscopy up to 1 hour CPT 76000 | $517.44 | $784.00 | $114.04 – $495.60 | 11 |
| Fluzone vacc, 3 yrs & >, im HCPCS Q2038 | $23.10 | $35.00 | $8.40 – $36.64 | 9 |
| Fna bx w/ct gdn 1st les CPT 10009 | $1,087.02 | $1,647.00 | $723.47 – $1,175.28 | 8 |
| Fna bx w/ct gdn ea addl CPT 10010 | $543.84 | $824.00 | $824.00 – $873.44 | 7 |
| Folic acid CPT 82746 | $89.76 | $136.00 | $14.70 – $19.11 | 11 |
| Folic acid 5 mg/ml injection solution HCPCS J1808 | $3.23 | $4.90 | $0.08 – $0.09 | 4 |
| Fondaparinux sodium HCPCS J1652 | $29.94 | $45.37 | $1.45 – $1.58 | 4 |
| Fo nontorsion joint cf HCPCS L3935 | $170.28 | $258.00 | $249.26 – $249.26 | 1 |
| Foot arch support remov prem HCPCS L3030 | $33.00 | $50.00 | $85.02 – $85.02 | 1 |
| Foot drp splt w/exp heel lg HCPCS L4398 | $118.80 | $180.00 | $111.94 – $111.94 | 1 |
| Foot X-ray CPT 73630 | $335.94 | $509.00 | $88.91 – $495.60 | 11 |
| Fresh frozen plasma 8-24 hours collection each unit HCPCS P9059 | $1,226.28 | $1,858.00 | $73.77 – $505.20 | 9 |
| Fresh frozen plasma frozen within 8 hours of collection each unit HCPCS P9017 | $188.76 | $286.00 | $38.65 – $286.00 | 9 |
| Fresh frozen plasma thawing ea un CPT 86927 | $198.00 | $300.00 | $66.18 – $188.70 | 11 |
| Fructosamine glycated protein CPT 82985 | $72.60 | $110.00 | $16.62 – $21.79 | 11 |
| Furosemide 10 mg/ml injection solution HCPCS J1938 | $1.62 | $2.45 | $0.03 – $0.04 | 4 |
| Fusion of big toe joint CPT 28750 | not published | not published | not published | 0 |
| Fusion of big toe joint CPT 28755 | not published | not published | not published | 0 |
| Fusion of foot bones CPT 28730 | not published | not published | not published | 0 |
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.