SSM Health St. Mary's Hospital - Janesville
3400 East Racine Street, Janesville, WI · SSM Health · · NPI 1548654676
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 |
|---|---|---|---|---|
| X-ray knee ap standing bilateral CPT 73565 | $348.70 | $634.00 | $65.74 – $209.30 | 3 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $224.95 | $409.00 | $65.74 – $151.17 | 3 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $248.60 | $452.00 | $78.98 – $223.16 | 3 |
| X-ray lumbosacral spine >= 4 views CPT 72110 | $770.55 | $1,401.00 | $78.98 – $253.62 | 3 |
| X-ray lumbosacral spine complete including bending views >= 6 views CPT 72114 | $840.40 | $1,528.00 | $78.98 – $353.31 | 3 |
| X-ray male genital tract CPT 74440 | not published | not published | $180.25 – $486.21 | 3 |
| X-ray mandible complete > 4 views CPT 70110 | $462.00 | $840.00 | $78.98 – $192.70 | 3 |
| X-ray mandible ltd <4 views CPT 70100 | $389.40 | $708.00 | $65.74 – $181.64 | 3 |
| X-ray nasal bones complete > 3 views CPT 70160 | $370.15 | $673.00 | $65.74 – $181.64 | 3 |
| X-ray neck soft tissue CPT 70360 | $351.45 | $639.00 | $65.74 – $151.17 | 3 |
| X-ray nose to rectum for foreign body child CPT 76010 | $361.35 | $657.00 | $65.74 – $129.02 | 3 |
| X-ray of mammary ducts CPT 77054 | $697.95 | $1,269.00 | $180.25 – $416.99 | 3 |
| X-ray optic foramina CPT 70190 | not published | not published | $65.74 – $187.17 | 3 |
| X-ray pelvis 1-2 views CPT 72170 | $390.50 | $710.00 | $78.98 – $176.08 | 3 |
| X-ray pelvis complete > 3 views CPT 72190 | $416.35 | $757.00 | $78.98 – $209.30 | 3 |
| Xray place dist ext thor ao CPT 75959 | $1,203.95 | $2,189.00 | $1,272.51 – $1,272.51 | 1 |
| Xray place prox ext thor ao CPT 75958 | $1,375.00 | $2,500.00 | $1,451.41 – $1,451.41 | 1 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $765.60 | $1,392.00 | $263.55 – $2,709.74 | 3 |
| X-ray ribs 2 views left CPT 71100 | $449.35 | $817.00 | $65.74 – $165.02 | 3 |
| X-ray ribs 3 views bilateral CPT 71110 | $586.85 | $1,067.00 | $78.98 – $181.64 | 3 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $524.15 | $953.00 | $78.98 – $173.34 | 3 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $792.55 | $1,441.00 | $78.98 – $239.77 | 3 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $369.05 | $671.00 | $78.98 – $178.85 | 3 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $367.40 | $668.00 | $65.74 – $148.39 | 3 |
| X-ray scapula complete (both sides) CPT 73010 | $413.05 | $751.00 | $78.98 – $159.47 | 3 |
| X-ray sella turcica CPT 70240 | not published | not published | $65.74 – $153.94 | 3 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $186.45 | $339.00 | $65.74 – $115.17 | 3 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $547.25 | $995.00 | $65.74 – $189.94 | 3 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $429.00 | $780.00 | $220.39 – $550.38 | 3 |
| X-ray skull < 4 views CPT 70250 | $331.65 | $603.00 | $78.98 – $178.85 | 3 |
| X-ray skull > 4 views complete CPT 70260 | $630.30 | $1,146.00 | $78.98 – $214.87 | 3 |
| X-ray slg plne bdy sect without urogr CPT 76100 | not published | not published | $78.98 – $469.61 | 3 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | $833.25 | $1,515.00 | $132.50 – $619.13 | 3 |
| X-ray small intestine follow-through study CPT 74248 | $1,436.05 | $2,611.00 | $366.07 – $366.07 | 1 |
| X-ray spine single view CPT 72020 | $237.05 | $431.00 | $65.74 – $109.64 | 3 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $322.30 | $586.00 | $65.74 – $189.94 | 3 |
| X-ray sternum > 2 views CPT 71120 | $356.95 | $649.00 | $65.74 – $148.39 | 3 |
| X-ray surgical specimen CPT 76098 | $123.75 | $225.00 | $65.32 – $550.38 | 3 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | $633.05 | $1,151.00 | $132.50 – $779.74 | 3 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | $727.10 | $1,322.00 | $65.74 – $264.71 | 3 |
| X-ray thoracic spine 2 views CPT 72070 | $354.75 | $645.00 | $78.98 – $173.34 | 3 |
| X-ray thoracic spine 3 views CPT 72072 | $403.15 | $733.00 | $78.98 – $181.64 | 3 |
| X-ray thoracolumbar spine >=2 views CPT 72080 | $361.35 | $657.00 | $65.74 – $151.17 | 3 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $699.05 | $1,271.00 | $65.74 – $195.48 | 3 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views CPT 72082 | $986.15 | $1,793.00 | $78.98 – $356.06 | 3 |
| X-ray tibia/fibula 2 views (both sides) CPT 73590 | $370.70 | $674.00 | $65.74 – $153.94 | 3 |
| X-ray toe(s) > 2 views (both sides) CPT 73660 | $201.85 | $367.00 | $65.74 – $165.02 | 3 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 | $1,000.45 | $1,819.00 | $132.50 – $713.28 | 3 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 | $800.25 | $1,455.00 | $132.50 – $605.31 | 3 |
| X-ray wrist 2 views (both sides) CPT 73100 | $325.05 | $591.00 | $65.74 – $159.47 | 3 |
| X-ray xm phrnx&/crv esoph c+ CPT 74210 | not published | not published | $132.50 – $461.30 | 3 |
| Xwrap 1 sq cm HCPCS Q4204 | not published | not published | $94.01 – $7,172.07 | 4 |
| Xylose absorption test blood &/or urine CPT 84620 | not published | not published | $9.68 – $94.21 | 5 |
| Xyntha inj HCPCS J7185 | not published | not published | $1.03 – $2.93 | 5 |
| Yersinia antibody CPT 86793 | not published | not published | $9.89 – $46.24 | 5 |
| Zenith amniotic membrane psc HCPCS Q4253 | not published | not published | $94.01 – $220.95 | 5 |
| Ziconotide injection HCPCS J2278 | not published | not published | $8.09 – $19.25 | 5 |
| Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr HCPCS J3485 | not published | not published | $1.13 – $2.88 | 5 |
| Zika virus dna/rna amp probe CPT 87662 | not published | not published | $38.48 – $355.59 | 5 |
| Zika virus igm antibody CPT 86794 | not published | not published | $12.64 – $116.76 | 5 |
| Ziprasidone 20 mg/ml (final concentration) intramuscular solution HCPCS J3486 | not published | not published | $5.96 – $13.30 | 3 |
| Ziv-aflibercept 25 mg/ml intravenous solution (wrapper) HCPCS J9400 | not published | not published | $6.51 – $15.16 | 5 |
| Zolbetuximab-clzb 100 mg intravenous solution HCPCS J1326 | not published | not published | $25.44 – $63.76 | 3 |
| Zoledronic acid 4 mg/5 ml intravenous solution HCPCS J3489 | not published | not published | $9.89 – $13.80 | 3 |
| Zrsr2 gene common variants CPT 81360 | not published | not published | $144.94 – $1,128.09 | 5 |
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.