SSM Health St. Clare Hospital - Baraboo
707 14Th St, Baraboo, WI · SSM Health · · NPI 1720472848
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 |
|---|---|---|---|---|
| Destruction anal lesion(s) CPT 46924 | not published | not published | $2,022.07 – $6,687.00 | 4 |
| Destruction anal lesion(s) smpl chem 46900 CPT 46900 | not published | not published | $296.15 – $4,401.00 | 4 |
| Destruction benign lesions < 14 lesions CPT 17110 | not published | not published | $146.16 – $4,401.00 | 4 |
| Destruction by injection tx of nerve 64630 CPT 64630 | not published | not published | $644.34 – $4,401.00 | 4 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) CPT 64636 | not published | not published | $1,676.00 – $1,676.00 | 1 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | not published | not published | $1,422.56 – $6,687.00 | 4 |
| Destruction ciliary body CPT 66700 | not published | not published | $1,681.25 – $4,867.00 | 4 |
| Destruction ciliary body CPT 66720 | not published | not published | $1,732.00 – $6,687.00 | 4 |
| Destruction ciliary body CPT 66740 | not published | not published | $1,732.00 – $6,687.00 | 4 |
| Destruction cryosurgery anal lesion(s) simpl 46916 CPT 46916 | not published | not published | $146.16 – $4,401.00 | 4 |
| Destruction laser surgery anal lesions 46917 CPT 46917 | not published | not published | $2,022.07 – $6,687.00 | 4 |
| Destruction les conjunctiva CPT 68135 | not published | not published | $1,732.00 – $6,687.00 | 4 |
| Destruction mal lsn s/n/h/f/g 2.1-3cm CPT 17273 | not published | not published | $296.15 – $4,401.00 | 4 |
| Destruction mal lsn s/n/h/f/g 3.1-4cm CPT 17274 | not published | not published | $296.15 – $4,401.00 | 4 |
| Destruction mal lsn t/a/l 3.1-4cm CPT 17264 | not published | not published | $296.15 – $4,401.00 | 4 |
| Destruction mal lsn t/a/l >4cm CPT 17266 | not published | not published | $296.15 – $4,401.00 | 4 |
| Destruction penis lesion(s) chem 54050 CPT 54050 | not published | not published | $296.15 – $4,401.00 | 4 |
| Destruction penis lesion(s) exten 54065 CPT 54065 | not published | not published | $1,503.10 – $4,867.00 | 4 |
| Destruction premal lesions 15/> 17004 CPT 17004 | not published | not published | $296.15 – $4,401.00 | 4 |
| Destruction rectal tumor 45190 CPT 45190 | not published | not published | $2,022.07 – $6,687.00 | 4 |
| Destruction vag lesions complex 57065 CPT 57065 | not published | not published | $2,358.24 – $6,687.00 | 4 |
| Destruction vag lesions simple 57061 CPT 57061 | not published | not published | $2,358.24 – $6,687.00 | 4 |
| Destruct penis les/smp/electrodesi 54055 CPT 54055 | not published | not published | $1,503.10 – $4,867.00 | 4 |
| Detect agent nos dna dir CPT 87797 | not published | not published | $22.52 – $199.35 | 5 |
| Detect agnt mult dna direc CPT 87800 | not published | not published | $32.75 – $398.70 | 5 |
| Developmental screen/score/document 96110 CPT 96110 | $244.75 | $445.00 | not published | 0 |
| Devel tst phys/qhp 1st hr CPT 96112 | not published | not published | $93.74 – $124.98 | 2 |
| Devise bowel pouch CPT 44316 | not published | not published | $11,257.00 – $11,257.00 | 1 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $102.30 | $186.00 | $63.40 – $183.65 | 3 |
| Dexametha opth insert 0.1 mg HCPCS J1096 | not published | not published | $67.51 – $208.96 | 5 |
| Dexamethasone 4 mg tablet HCPCS J8540 | not published | not published | $0.03 – $0.11 | 3 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | not published | not published | $0.13 – $0.23 | 3 |
| Dexamethasone intra implant HCPCS J7312 | not published | not published | $152.74 – $390.02 | 5 |
| Dexamethasone panel CPT 80420 | not published | not published | $121.41 – $716.11 | 5 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | not published | not published | $31.08 – $149.63 | 5 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | not published | not published | $1.81 – $2.57 | 3 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | not published | not published | $2.64 – $3.85 | 3 |
| Dextrose 5 % IV bolus HCPCS J7070 | not published | not published | $5.28 – $6.66 | 3 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $11.00 | $20.00 | $16.67 – $221.02 | 5 |
| Diabetes (HbA1c) Test CPT 83036 | $149.60 | $272.00 | $7.28 – $96.46 | 5 |
| Diab manage trn ind/group HCPCS G0109 | not published | not published | $11.62 – $15.49 | 2 |
| Diag bronchoscope/catheter CPT 31643 | not published | not published | $1,296.65 – $4,867.00 | 4 |
| Diag laparo separate proc 49320 CPT 49320 | not published | not published | $4,404.16 – $16,781.00 | 4 |
| Diagnostic anoscopy CPT 46601 | not published | not published | $325.44 – $4,401.00 | 4 |
| Diagnostic anoscopy & biopsy CPT 46607 | not published | not published | $871.75 – $4,867.00 | 4 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $162.80 | $296.00 | $96.93 – $4,401.00 | 4 |
| Diagnostic digital breast tomosynthesis bil CPT 77062 | $26.40 | $48.00 | $1,268.61 – $1,268.61 | 1 |
| Diagnostic digital breast tomosynthesis unil CPT 77061 | $26.40 | $48.00 | $994.57 – $994.57 | 1 |
| Diagnostic laryngoscopy 31505 CPT 31505 | $105.05 | $191.00 | $145.41 – $4,401.00 | 4 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $277.20 | $504.00 | $145.41 – $4,401.00 | 4 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $254.10 | $462.00 | $79.11 – $1,307.40 | 3 |
| Diagnostic Mammogram (one breast) CPT 77065 | $127.05 | $231.00 | $61.76 – $1,021.55 | 3 |
| Diagnostic radio unlisted proc CPT 76499 | not published | not published | $63.40 – $84.53 | 2 |
| Dialysis circuit perm vascular embolization 36909 CPT 36909 | not published | not published | $1,676.00 – $1,676.00 | 1 |
| Dialysis one evaluation CPT 90945 | not published | not published | $303.98 – $405.30 | 2 |
| Diathermy eg microwave CPT 97024 | not published | not published | $5.18 – $6.91 | 2 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | not published | not published | $0.12 – $0.14 | 3 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | not published | not published | $8.40 – $15.82 | 3 |
| Dicyclomine injection HCPCS J0500 | not published | not published | $18.65 – $27.57 | 3 |
| Diffusing capacity CPT 94729 | $157.30 | $286.00 | not published | 0 |
| Digit nerve surgery add-on CPT 64778 | not published | not published | $1,676.00 – $1,676.00 | 1 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | not published | not published | $7.08 – $16.32 | 3 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | not published | not published | $4,037.49 – $9,440.30 | 5 |
| Digoxin total therapeutic drug level CPT 80162 | $156.20 | $284.00 | $9.96 – $132.01 | 5 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | not published | not published | $75.92 – $184.44 | 3 |
| Dilate biliary duct/ampulla CPT 47542 | not published | not published | $1,676.00 – $1,676.00 | 1 |
| Dilate esophagus CPT 43453 | not published | not published | $1,397.92 – $4,867.00 | 4 |
| Dilate esophagus 1/mult pass CPT 43450 | not published | not published | $660.74 – $4,401.00 | 4 |
| Dilate ic vasospasm ea add vsl diff territory CPT 61642 | not published | not published | $20,477.00 – $20,477.00 | 1 |
| Dilate ic vasospasm ea add vsl same territory CPT 61641 | not published | not published | $20,477.00 – $20,477.00 | 1 |
| Dilate ic vasospasm init CPT 61640 | not published | not published | $20,477.00 – $20,477.00 | 1 |
| Dilate tear duct opening CPT 68801 | not published | not published | $325.44 – $4,401.00 | 4 |
| Dilate urethra stricture CPT 53600 | not published | not published | $182.01 – $4,401.00 | 4 |
| Dilate urethra stricture CPT 53601 | not published | not published | $96.93 – $4,401.00 | 4 |
| Dilate urethra stricture CPT 53605 | not published | not published | $2,567.95 – $4,867.00 | 4 |
| Dilate urethra stricture CPT 53621 | not published | not published | $182.01 – $4,401.00 | 4 |
| Dilation/female urethra/initial 53660 CPT 53660 | not published | not published | $93.74 – $4,401.00 | 4 |
| Dilation of anal sphincter CPT 45905 | not published | not published | $871.75 – $4,867.00 | 4 |
| Dilation of cervical canal 57800 CPT 57800 | not published | not published | $2,358.24 – $6,687.00 | 4 |
| Dilation of rectal stricture 45910 CPT 45910 | not published | not published | $871.75 – $4,867.00 | 4 |
| Dilation of salivary duct CPT 42660 | not published | not published | $392.90 – $4,401.00 | 4 |
| Dilation of urethra CPT 53661 | not published | not published | $96.93 – $4,401.00 | 4 |
| Dilation of urethra CPT 53665 | not published | not published | $1,522.84 – $6,687.00 | 4 |
| Dilation of vagina CPT 57400 | not published | not published | $2,358.24 – $6,687.00 | 4 |
| Dilation salivary duct 42650 CPT 42650 | not published | not published | $1,130.33 – $4,867.00 | 4 |
| Dilation/urethral strict/male/ini 53620 CPT 53620 | not published | not published | $507.98 – $4,401.00 | 4 |
| Dilat xst trc ndurlgc px CPT 50436 | not published | not published | $2,567.95 – $6,687.00 | 4 |
| Dilat xst trc new access rcs CPT 50437 | not published | not published | $2,567.95 – $11,257.00 | 4 |
| Diltiazem 5 mg/ml intravenous solution HCPCS J1163 | not published | not published | $0.07 – $0.07 | 1 |
| Dimenhydrinate injection HCPCS J1240 | not published | not published | $12.11 – $16.04 | 3 |
| Dimethyl sulfoxide 50% 50 ml HCPCS J1212 | not published | not published | $561.66 – $1,411.50 | 5 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | not published | not published | $0.96 – $1.72 | 3 |
| Dipyridamole injection HCPCS J1245 | not published | not published | $5.57 – $7.34 | 3 |
| Dir nsl mucous membrane test CPT 95065 | not published | not published | $27.21 – $36.28 | 2 |
| Disability dlco CPT 94727 | not published | not published | $157.30 – $209.73 | 2 |
| Disaccharidases CPT 82657 | $365.75 | $665.00 | $16.63 – $179.50 | 5 |
| Disarticulation sho sec clsr CPT 23921 | not published | not published | $1,503.10 – $4,867.00 | 4 |
| Disarticulation shoulder CPT 23920 | not published | not published | $9,352.97 – $16,310.00 | 4 |
| Discectomy ant dcmprn cord thoracic 1 ntrspc 63077 CPT 63077 | not published | not published | $20,477.00 – $20,477.00 | 1 |
| Discectomy ant dcmprn cord thoracic ea ntrsp 63078 CPT 63078 | not published | not published | $4,867.00 – $4,867.00 | 1 |
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.