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 |
|---|---|---|---|---|
| Fusion of foot bones CPT 28735 | not published | not published | not published | 0 |
| Fusion of foot bones CPT 28740 | not published | not published | not published | 0 |
| Gabapentin non-blood CPT 80355 | $36.30 | $55.00 | $18.33 – $33.00 | 9 |
| Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution HCPCS A9581 | $24.18 | $36.63 | $24.34 – $26.40 | 4 |
| Galac-1-phosphate uridyltran - sendout CPT 82775 | $224.40 | $340.00 | $21.07 – $27.39 | 11 |
| Galectin-3 CPT 82777 | $147.84 | $224.00 | $24.14 – $57.53 | 11 |
| Gallbladder Removal (Laparoscopic) CPT 47562 | $6,738.60 | $10,210.00 | $646.02 – $6,176.47 | 13 |
| Gammaglobulin iga CPT 82784 | $80.52 | $122.00 | $9.30 – $12.09 | 11 |
| Gammaglobulin ige CPT 82785 | $99.00 | $150.00 | $16.46 – $21.40 | 11 |
| Gamma glutamyltransferase CPT 82977 | $44.22 | $67.00 | $7.20 – $9.36 | 11 |
| Gastro/jejuno tube, std HCPCS B4087 | $40.92 | $62.00 | $32.74 – $34.10 | 2 |
| Gated heart multiple CPT 78473 | $1,609.74 | $2,439.00 | $408.43 – $1,311.10 | 11 |
| General health panel CPT 80050 | $300.30 | $455.00 | $11.92 – $268.80 | 10 |
| Genetic tstg severe inh cond CPT 81443 | $3,915.78 | $5,933.00 | $2,448.56 – $3,183.13 | 11 |
| Genome sequence analysis CPT 81425 | $5,811.30 | $8,805.00 | $3,067.56 – $6,540.56 | 11 |
| Genome sequence analysis CPT 81426 | $3,129.72 | $4,742.00 | $2,709.95 – $3,522.94 | 11 |
| Gentamicin peak therapeutic drug level CPT 80170 | $138.60 | $210.00 | $16.38 – $21.29 | 11 |
| Ghs abscess perianal iandd CPT 46050 | $1,087.02 | $1,647.00 | $950.10 – $1,745.82 | 8 |
| Ghs alpha thalasemia, 7 deletions CPT 81257 | $554.40 | $840.00 | $102.26 – $132.94 | 11 |
| Ghs antibodies (torch) igm CPT 86694 | $97.68 | $148.00 | $14.39 – $18.71 | 11 |
| Ghs block ilioinguinal/gentitofemoral CPT 64425 | $799.92 | $1,212.00 | $647.69 – $1,212.00 | 11 |
| Ghs central line insert < age 5, failed CPT 36555 | $3,635.28 | $5,508.00 | $1,781.44 – $3,225.87 | 8 |
| Ghs change cysto/gastrost CPT 43762 | $701.58 | $1,063.00 | $255.26 – $669.43 | 8 |
| Ghs chemo IV push, ea addtl CPT 96411 | $287.76 | $436.00 | $73.56 – $436.00 | 11 |
| Ghs chlamydia pneumoniae by pcr (arup) (306630) CPT 87486 | $198.66 | $301.00 | $35.09 – $45.62 | 11 |
| Ghs closd tx interphalang jt disloc w/ma CPT 26770 | $780.78 | $1,183.00 | $252.01 – $791.66 | 8 |
| Ghs closed reduction ankle dislocation CPT 27840 | $543.84 | $824.00 | $252.01 – $791.66 | 8 |
| Ghs closed tx bimalleolar fracture w/manip CPT 27810 | $1,607.10 | $2,435.00 | $746.85 – $1,642.82 | 8 |
| Ghs closed tx radiocarpal disloc w manip CPT 25660 | $593.34 | $899.00 | $252.01 – $791.66 | 8 |
| Ghs clsd red med malleolus fx w manip CPT 27762 | $4,391.64 | $6,654.00 | $746.85 – $1,642.82 | 8 |
| Ghs cl tx knee disl; wo anesth CPT 27550 | $549.78 | $833.00 | $252.01 – $791.66 | 8 |
| Ghs conjunctiva foreign body-superf bil CPT 65205 | $352.44 | $534.00 | $61.15 – $67.97 | 8 |
| Ghs corneal fb without slit lamp bilat CPT 65220 | $460.68 | $698.00 | $122.29 – $456.40 | 8 |
| Ghs corneal fb with slit lamp bilat CPT 65222 | $372.90 | $565.00 | $122.29 – $135.93 | 8 |
| Ghs diphtheria toxoid ab igg CPT 86648 | $79.86 | $121.00 | $8.17 – $19.77 | 11 |
| Ghs dislocation elbow closed treatment CPT 24600 | $529.32 | $802.00 | $126.01 – $395.83 | 8 |
| Ghs ed therapeutic lp, drain csf w fluoro CPT 62329 | $1,186.68 | $1,798.00 | $721.17 – $1,314.72 | 8 |
| Ghs eeg cont rec w/video by tec min 8 chnls CPT 95700 | $2,522.52 | $3,822.00 | $220.60 – $570.31 | 11 |
| Ghs excision ingrown nail CPT 11765 | $461.34 | $699.00 | $107.97 – $415.32 | 8 |
| Ghs eyelid foreign body-embedded - bil CPT 67938 | $486.42 | $737.00 | $324.28 – $497.27 | 8 |
| Ghs fb removal - incisional CPT 10121 | $3,562.68 | $5,398.00 | $1,687.37 – $2,081.33 | 8 |
| Ghs fb removal - non-incisional CPT 20520 | $3,762.00 | $5,700.00 | $1,687.37 – $3,079.78 | 8 |
| Ghs febrile agglutinns(mayo) CPT 86000 | $38.28 | $58.00 | $6.98 – $9.07 | 11 |
| Ghs fish cytogen CPT 88271 | $357.06 | $541.00 | $20.36 – $27.85 | 11 |
| Ghs fish hybrid in situ 100-300 CPT 88275 | $260.04 | $394.00 | $51.19 – $66.55 | 11 |
| Ghs gastric intub aspiration lavage CPT 43753 | $583.44 | $884.00 | $220.60 – $220.60 | 1 |
| Ghs hepatitis c virus (hcv riba) CPT 86804 | $144.54 | $219.00 | $15.49 – $20.14 | 11 |
| Ghs hgb stability-thal CPT 83068 | $97.02 | $147.00 | $9.47 – $12.31 | 11 |
| Ghs histoplasma antigen CPT 87385 | $129.36 | $196.00 | $13.25 – $17.23 | 11 |
| Ghs HIV antibody CPT 86703 | $89.10 | $135.00 | $13.71 – $17.82 | 11 |
| Ghs i and d perirectal abscess 46040 CPT 46040 | $2,471.04 | $3,744.00 | $1,222.56 – $2,475.04 | 8 |
| Ghs i and d pilonidal cyst simple CPT 10080 | $706.86 | $1,071.00 | $95.40 – $723.47 | 9 |
| Ghs incision thrombosed ext hemorrhoid CPT 46083 | $434.28 | $658.00 | $255.26 – $697.48 | 8 |
| Ghs inhibitor screen CPT 85335 | $441.54 | $669.00 | $12.87 – $16.73 | 11 |
| Ghs init tx 1st degree burn CPT 16000 | $229.68 | $348.00 | $204.98 – $313.69 | 8 |
| Ghs inj neurolytic other perph nerve CPT 64640 | $2,125.20 | $3,220.00 | $903.63 – $2,202.19 | 8 |
| Ghs inj transforaminal cerv ea add bil CPT 64480 | $721.38 | $1,093.00 | $1,093.00 – $1,158.58 | 7 |
| Ghs inj transforaminal cerv single bil CPT 64479 | $1,413.72 | $2,142.00 | $903.63 – $1,314.72 | 8 |
| Ghs insertion of needle - bone CPT 36680 | $533.94 | $809.00 | $399.67 – $456.40 | 8 |
| Ghs intermed repair 12.6 - 20.0 cm-12035 CPT 12035 | $840.18 | $1,273.00 | $237.30 – $656.98 | 13 |
| Ghs intermed repair 20.1 - 30.0 cm-12036 CPT 12036 | $898.92 | $1,362.00 | $619.79 – $755.08 | 8 |
| Ghs intro needle/intracath vein - 36000 CPT 36000 | $97.02 | $147.00 | $121.98 – $147.00 | 10 |
| Ghs IV infusion bamlanivimab/etesevimab HCPCS M0245 | $606.54 | $919.00 | $450.00 – $477.00 | 7 |
| Ghs IV infusion casirivimab/imdevimab HCPCS M0243 | $651.42 | $987.00 | $450.00 – $477.00 | 7 |
| Ghs IV infusion sotrovimab HCPCS M0247 | $904.86 | $1,371.00 | $478.28 – $506.98 | 7 |
| Ghs IV thrombolytics - cerebral CPT 37195 | $528.00 | $800.00 | $337.46 – $506.98 | 8 |
| Ghs lac repair mouth.ant tong 2.5cm/less CPT 41250 | $513.48 | $778.00 | $275.02 – $456.40 | 8 |
| Ghs layer closure 2.5 cm or less - 12031 CPT 12031 | $642.18 | $973.00 | $415.32 – $656.98 | 9 |
| Ghs layer closure 2.5 cm or less - 12041 CPT 12041 | $583.44 | $884.00 | $415.32 – $656.98 | 8 |
| Ghs layer closure 2.5cm or less - 12051 CPT 12051 | $715.44 | $1,084.00 | $415.32 – $656.98 | 8 |
| Ghs layer closure 2.6 - 5.0 cm - 12052 CPT 12052 | $783.42 | $1,187.00 | $186.28 – $656.98 | 13 |
| Ghs layer closure 2.6 - 7.5 cm - 12042 CPT 12042 | $642.18 | $973.00 | $415.32 – $656.98 | 8 |
| Ghs layer closure 5.1 - 7.5 cm - 12053 CPT 12053 | $792.66 | $1,201.00 | $415.32 – $656.98 | 8 |
| Ghs layer closure 7.6 - 12.5 cm - 12034 CPT 12034 | $770.22 | $1,167.00 | $415.32 – $656.98 | 8 |
| Ghs layer closure 7.6 - 12.5 cm - 12044 CPT 12044 | $711.48 | $1,078.00 | $204.15 – $755.08 | 13 |
| Ghs layer closure 7.6 - 12.5 cm - 12054 CPT 12054 | $809.82 | $1,227.00 | $415.32 – $656.98 | 8 |
| Ghs layered repair 12.6 - 20.0 cm -12045 CPT 12045 | $840.18 | $1,273.00 | $619.79 – $755.08 | 8 |
| Ghs layered repair 12.6 - 20.0 cm -12055 CPT 12055 | $865.26 | $1,311.00 | $415.32 – $656.98 | 8 |
| Ghs layered repair 20.1 - 30.0 cm -12046 CPT 12046 | $898.92 | $1,362.00 | $619.79 – $755.08 | 8 |
| Ghs layered repair 20.1 - 30.0 cm -12056 CPT 12056 | $898.92 | $1,362.00 | $415.32 – $656.98 | 8 |
| Ghs leukocyte alkaline phos (mayo) CPT 85540 | $123.42 | $187.00 | $8.60 – $11.18 | 11 |
| Ghs mbp CPT 83873 | $89.76 | $136.00 | $17.20 – $22.36 | 11 |
| Ghs moderate sedation < 5 yr, 30 min CPT 99151 | $351.12 | $532.00 | $36.92 – $292.60 | 8 |
| Ghs moderate sedation < 5 yr, 30 min, other CPT 99155 | $351.12 | $532.00 | $36.92 – $292.60 | 8 |
| Ghs moderate sedation, > 5 yr, 30 min, other CPT 99156 | $351.12 | $532.00 | $36.92 – $292.60 | 8 |
| Ghs moderate sedation ea addtl 15 min CPT 99153 | $74.58 | $113.00 | $36.92 – $62.15 | 8 |
| Ghs moderate sedation ea addtl 15 min, other CPT 99157 | $74.58 | $113.00 | $36.92 – $62.15 | 8 |
| Ghs nailbed repair/nail removal CPT 11760 | $657.36 | $996.00 | $107.97 – $755.08 | 8 |
| Ghs nerve blk intercostal, ea addtl level CPT 64421 | $1,028.28 | $1,558.00 | $903.63 – $1,651.48 | 8 |
| Ghs nerve blk intercostal, single level CPT 64420 | $799.92 | $1,212.00 | $647.69 – $721.17 | 8 |
| Ghs nerve block axillary nerve CPT 64417 | $1,028.28 | $1,558.00 | $647.69 – $903.63 | 8 |
| Ghs nerve block brachial plexus CPT 64415 | $949.74 | $1,439.00 | $791.45 – $1,525.34 | 9 |
| Ghs nerve block interscaline CPT 64510 | $1,314.72 | $1,992.00 | $903.63 – $2,111.52 | 11 |
| Ghs nerve block lumbar or thoracic symp CPT 64520 | $1,196.58 | $1,813.00 | $903.63 – $1,314.72 | 8 |
| Ghs nerve block sciatic nerve CPT 64445 | $1,482.36 | $2,246.00 | $647.69 – $721.17 | 8 |
| Ghs nerve block suprascapular CPT 64418 | $1,696.20 | $2,570.00 | $647.69 – $721.17 | 8 |
| Ghs ng placement w fluoro guidance CPT 43752 | $460.68 | $698.00 | $456.40 – $669.43 | 11 |
| Ghs o2 saturation CPT 82810 | $121.44 | $184.00 | $9.77 – $12.70 | 11 |
| Ghs opcc repair cvp without subq port CPT 36575 | $1,656.60 | $2,510.00 | $640.89 – $1,268.50 | 8 |
| Ghs osteopathic manipulative tx, 1-2 regions CPT 98925 | $66.00 | $100.00 | $22.06 – $55.00 | 9 |
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.