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 |
|---|---|---|---|---|
| Liver imaging CPT 78201 | not published | not published | $395.55 – $1,866.65 | 3 |
| Liver imag w/vasclr flow CPT 78202 | not published | not published | $395.55 – $1,993.98 | 3 |
| Liver/spleen imag static only CPT 78215 | $1,026.30 | $1,866.00 | $291.23 – $1,912.96 | 3 |
| Liver/spleen imag w/vasclr flow CPT 78216 | not published | not published | $291.23 – $1,098.80 | 3 |
| Lmtd oph exam general anes CPT 92019 | not published | not published | $1,732.00 – $6,687.00 | 3 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | $2,383.65 – $11,257.00 | 4 |
| Lockingelbow forearm cntrbal HCPCS L6693 | not published | not published | $2,621.89 – $3,495.85 | 2 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | not published | not published | $1.35 – $3.42 | 3 |
| Loncastuximab tesirine-lpyl 10 mg intravenous solution HCPCS J9359 | not published | not published | $169.96 – $411.81 | 5 |
| Long tongue stirrup HCPCS L2265 | not published | not published | $123.91 – $165.21 | 2 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | not published | not published | $2.28 – $2.50 | 3 |
| Lo rig pos pnl l1-l5 pre ots HCPCS L0641 | not published | not published | $38.55 – $51.40 | 2 |
| Lo sag rig pnl stays pre cst HCPCS L0626 | not published | not published | $71.84 – $95.79 | 2 |
| Loudness balance test CPT 92562 | not published | not published | $157.30 – $209.73 | 2 |
| Low back disk surgery CPT 63030 | not published | not published | $5,286.15 – $20,477.00 | 4 |
| Low cost skin substitute app HCPCS C5271 | not published | not published | $1,676.00 – $4,401.00 | 2 |
| Low cost skin substitute app HCPCS C5273 | not published | not published | $3,179.00 – $4,867.00 | 2 |
| Low cost skin substitute app HCPCS C5275 | not published | not published | $1,676.00 – $4,401.00 | 2 |
| Low cost skin substitute app HCPCS C5277 | not published | not published | $1,676.00 – $4,401.00 | 2 |
| Low cost skin substitute app HCPCS C5272 | not published | not published | $1,676.00 – $1,676.00 | 1 |
| Low cost skin substitute app HCPCS C5274 | not published | not published | $1,676.00 – $1,676.00 | 1 |
| Low cost skin substitute app HCPCS C5276 | not published | not published | $1,676.00 – $1,676.00 | 1 |
| Low cost skin substitute app HCPCS C5278 | not published | not published | $1,676.00 – $1,676.00 | 1 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $2,394.70 | $4,354.00 | $127.78 – $2,228.63 | 3 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $1,778.70 | $3,234.00 | $254.15 – $1,800.34 | 3 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $1,497.10 | $2,722.00 | $76.16 – $1,391.34 | 3 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $2,448.60 | $4,452.00 | $254.15 – $2,832.84 | 3 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $2,384.25 | $4,335.00 | $254.15 – $2,485.58 | 3 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $2,318.25 | $4,215.00 | $173.82 – $1,591.98 | 3 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $344.85 | $627.00 | $76.16 – $253.09 | 3 |
| Lower jaw bone graft CPT 21215 | not published | not published | $4,312.59 – $14,304.00 | 4 |
| Low frequency non-thermal Ultrasound CPT 97610 | not published | not published | $146.16 – $194.88 | 2 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | $7,743.83 – $16,781.00 | 4 |
| Lsh uterus above 250 g CPT 58543 | not published | not published | $7,743.83 – $18,408.00 | 4 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $7,743.83 – $18,408.00 | 4 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | $7,743.83 – $18,408.00 | 4 |
| Lso corset front HCPCS L0972 | not published | not published | $89.66 – $119.54 | 2 |
| Lso flex no ri stays pre ots HCPCS L0628 | not published | not published | $41.49 – $55.32 | 2 |
| Lso full corset HCPCS L0976 | not published | not published | $137.81 – $183.75 | 2 |
| Lso r post pnl sj-t9 pre cst HCPCS L0630 | not published | not published | $149.29 – $199.05 | 2 |
| Lso sag-coronal panel custom HCPCS L0638 | not published | not published | $1,215.68 – $1,620.91 | 2 |
| Lso sag-co shell pnl pre ots HCPCS L0651 | not published | not published | $587.48 – $783.31 | 2 |
| Lso sag ctr rigi pos pre ots HCPCS L0643 | not published | not published | $80.10 – $106.80 | 2 |
| Lso sagit rigid panel prefab HCPCS L0635 | not published | not published | $921.02 – $1,228.02 | 2 |
| Lso sagittal rigid panel cus HCPCS L0636 | not published | not published | $1,249.66 – $1,666.22 | 2 |
| Lso sc r pos/lat pnl pre cst HCPCS L0633 | not published | not published | $264.31 – $352.41 | 2 |
| Lso sc r pos/lat pnl pre ots HCPCS L0649 | not published | not published | $141.83 – $189.11 | 2 |
| Lso s/c shell/panel custom HCPCS L0640 | not published | not published | $964.48 – $1,285.97 | 2 |
| Lso s/c shell/panel prefab HCPCS L0639 | not published | not published | $1,194.10 – $1,592.13 | 2 |
| L/s ratio fetal lung CPT 83661 | not published | not published | $16.49 – $218.55 | 5 |
| Lumbar bolster pad HCPCS L1030 | not published | not published | $72.17 – $96.23 | 2 |
| Lumbar derotation pad HCPCS L1240 | not published | not published | $83.83 – $111.77 | 2 |
| Lumbar diskogram s&i CPT 72295 | $1,877.70 | $3,414.00 | $596.48 – $1,896.75 | 3 |
| Lumbar or lumbar rib pad HCPCS L1040 | not published | not published | $81.72 – $108.96 | 2 |
| Lumbar sling HCPCS L1090 | not published | not published | $92.74 – $123.66 | 2 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | $12,773.37 – $18,408.00 | 4 |
| Lumizyme injection HCPCS J0221 | not published | not published | $158.35 – $392.57 | 5 |
| Lung function test (mbc/mvv) CPT 94200 | not published | not published | $42.98 – $57.30 | 2 |
| Lung Function Test (Spirometry) CPT 94010 | $81.95 | $149.00 | $157.30 – $209.73 | 2 |
| Lung perfusion imaging CPT 78580 | $1,251.80 | $2,276.00 | $291.23 – $2,279.50 | 3 |
| Lung transplant double CPT 32853 | not published | not published | $14,312.00 – $14,312.00 | 1 |
| Lung transplant single CPT 32851 | not published | not published | $14,312.00 – $14,312.00 | 1 |
| Lung transplant with bypass CPT 32852 | not published | not published | $14,312.00 – $14,312.00 | 1 |
| Lung transplant with bypass CPT 32854 | not published | not published | $14,312.00 – $14,312.00 | 1 |
| Lung volume reduction 32491 CPT 32491 | not published | not published | $18,408.00 – $18,408.00 | 1 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | not published | not published | $161.96 – $391.64 | 5 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | not published | not published | $32.64 – $79.73 | 5 |
| Lvad shower bag heartmate HCPCS Q0501 | not published | not published | $471.63 – $628.84 | 2 |
| Lw ntsty Ultrasound stimj bone healg CPT 20979 | not published | not published | $21.07 – $4,401.00 | 4 |
| Lwr ext dynamic prosth pylon HCPCS L5985 | not published | not published | $260.80 – $347.73 | 2 |
| Lyme dis dna dir probe CPT 87475 | not published | not published | $15.04 – $199.35 | 5 |
| Lymphadenect/stage/pelv/paraaortic 38562 CPT 38562 | not published | not published | $5,954.31 – $16,781.00 | 4 |
| Lymphatics/lymph node imaging CPT 78195 | $594.55 | $1,081.00 | $395.55 – $3,339.01 | 3 |
| Lymphocyte culture mixed CPT 86821 | not published | not published | $27.42 – $561.20 | 5 |
| Lymphocyte transformation mitogen CPT 86353 | not published | not published | $36.77 – $487.34 | 5 |
| Lymphocytotoxicity assay CPT 86805 | not published | not published | $142.13 – $519.76 | 5 |
| Lymphocytotoxicity assay CPT 86806 | not published | not published | $35.69 – $473.06 | 5 |
| Lymph vessel x-ray arm/leg CPT 75801 | not published | not published | $456.99 – $2,224.36 | 3 |
| Lymph vessel x-ray arms/legs CPT 75803 | not published | not published | $1,146.77 – $2,135.63 | 3 |
| Lymph vessel x-ray trunk CPT 75805 | not published | not published | $2,300.22 – $3,066.96 | 3 |
| Lymph vessel x-ray trunk CPT 75807 | not published | not published | $2,294.07 – $3,066.96 | 3 |
| Lysis intranasal synechia 30560 CPT 30560 | not published | not published | $392.90 – $4,401.00 | 4 |
| Lysis of labial adhesions CPT 56441 | not published | not published | $2,358.24 – $6,687.00 | 4 |
| Lysis penil circumic lesion CPT 54162 | not published | not published | $1,522.84 – $6,687.00 | 4 |
| Lyumjev for insulin pump use HCPCS J1813 | not published | not published | $22.23 – $29.02 | 3 |
| Macro exam dissect molec study ea CPT 88387 | not published | not published | $63.90 – $63.90 | 1 |
| Macroscopic exam arthropod CPT 87168 | $91.30 | $166.00 | $3.20 – $42.45 | 5 |
| Macroscopic exam parasite CPT 87169 | $125.95 | $229.00 | $3.23 – $42.45 | 5 |
| Magnesium CPT 83735 | $85.80 | $156.00 | $5.02 – $66.55 | 5 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | not published | not published | $0.71 – $0.95 | 3 |
| Magnetic image bone marrow CPT 77084 | not published | not published | $173.82 – $3,342.18 | 3 |
| Malaria antibody CPT 86750 | not published | not published | $9.89 – $131.11 | 5 |
| Male sling procedure CPT 53440 | not published | not published | $9,611.43 – $23,826.00 | 4 |
| Management of liver hemorrhage 47361 CPT 47361 | not published | not published | $11,257.00 – $11,257.00 | 1 |
| Manipulate finger w/anesth CPT 26340 | not published | not published | $1,171.42 – $4,867.00 | 4 |
| Manipulate wrist w/anesthes CPT 25259 | not published | not published | $1,171.42 – $4,867.00 | 4 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $162.25 | $295.00 | $96.93 – $129.23 | 2 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $218.90 | $398.00 | $96.93 – $129.23 | 2 |
| Manipulation of hip joint CPT 27275 | not published | not published | $1,171.42 – $4,867.00 | 4 |
| Manipulation of spine CPT 22505 | not published | not published | $1,171.42 – $4,867.00 | 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.