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 |
|---|---|---|---|---|
| Adj gastric band via subq port CPT 43999 | not published | not published | $685.17 – $13,711.00 | 4 |
| Adjmt/revj ext fixj sys anes CPT 20693 | not published | not published | $5,481.64 – $18,190.00 | 4 |
| Adj tis trans/see area/10.1-30sqcm 14041 CPT 14041 | not published | not published | $1,558.69 – $4,321.00 | 4 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $79.20 | $144.00 | $54.39 – $72.52 | 2 |
| Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr CPT 96417 | $169.95 | $309.00 | $54.39 – $72.52 | 2 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $340.45 | $619.00 | $249.53 – $332.70 | 2 |
| Administration chemotherapy IV push single/initial substance/drug CPT 96409 | $172.70 | $314.00 | $249.53 – $332.70 | 2 |
| Administration chemotherapy subcutaneous/im anti neoplastic hormonal CPT 96402 | not published | not published | $54.39 – $72.52 | 2 |
| Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 | not published | not published | $54.39 – $72.52 | 2 |
| Administration immunization 1 vaccine CPT 90471 | $64.35 | $117.00 | $54.39 – $72.52 | 2 |
| Administration immunization each additional vaccine CPT 90472 | $129.25 | $235.00 | not published | 0 |
| Administration immunization intranasal/oral route 1 vaccine CPT 90473 | not published | not published | $54.39 – $72.52 | 2 |
| Administration vaccine hepatitis b HCPCS G0010 | $90.20 | $164.00 | $35.37 – $47.17 | 2 |
| Administration vaccine influenza virus HCPCS G0008 | $90.20 | $164.00 | $35.37 – $47.17 | 2 |
| Administration vaccine pneumococcal HCPCS G0009 | $90.20 | $164.00 | $35.37 – $47.17 | 2 |
| Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 | not published | not published | $32.72 – $79.52 | 5 |
| Adrenal cortex & medulla img CPT 78075 | not published | not published | $978.03 – $3,159.36 | 3 |
| Adrenalectomy expl w/exc retro tumor 60545 CPT 60545 | not published | not published | $9,811.00 – $9,811.00 | 1 |
| _afb id by dna probe rflx ast CPT 87149 | not published | not published | $15.04 – $159.48 | 5 |
| #afb mycobacteria suscep. #1 CPT 87190 | $316.80 | $576.00 | $5.48 – $22.89 | 5 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | $713.35 | $1,297.00 | $86.52 – $917.31 | 5 |
| Aflibercept injection HCPCS J0178 | not published | not published | $557.70 – $1,501.07 | 5 |
| After cataract laser surgery CPT 66821 | not published | not published | $415.49 – $4,074.00 | 4 |
| Agalsidase beta 35 mg intravenous solution HCPCS J0180 | not published | not published | $174.54 – $437.50 | 5 |
| Air conduction bilat CPT 92552 | not published | not published | $100.51 – $134.01 | 2 |
| Air injection into abdomen 49400 CPT 49400 | not published | not published | $1,704.00 – $1,704.00 | 1 |
| Airway resistance by impulse oscillometry 94728 CPT 94728 | not published | not published | $97.20 – $129.61 | 2 |
| Albumin body fluid quantitative each specimen CPT 82042 | $45.65 | $83.00 | $5.84 – $41.15 | 5 |
| Albumin (human), 25%, 50ml HCPCS P9047 | not published | not published | $39.99 – $100.85 | 5 |
| Albumin, human 25 % intravenous solution HCPCS P9046 | not published | not published | $16.00 – $40.34 | 5 |
| Albumin (human), 5%, 250 ml HCPCS P9045 | not published | not published | $39.81 – $100.85 | 5 |
| Albumin, human 5 % intravenous solution HCPCS P9041 | not published | not published | $7.96 – $20.17 | 5 |
| Albumin ischemia modified CPT 82045 | not published | not published | $25.46 – $269.93 | 5 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $83.05 | $151.00 | $4.34 – $45.94 | 5 |
| Albumin serum plasma or whole blood CPT 82040 | $43.45 | $79.00 | $3.71 – $39.35 | 5 |
| Albuterol ipratrop non-comp HCPCS J7620 | not published | not published | $0.28 – $0.38 | 3 |
| Albuterol non-comp con HCPCS J7611 | not published | not published | $0.26 – $0.31 | 3 |
| Albuterol non-comp unit HCPCS J7613 | not published | not published | $0.12 – $0.14 | 3 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | $227.70 | $414.00 | $12.95 – $100.82 | 5 |
| Alcohol/sub misuse assess HCPCS G2011 | not published | not published | $21.85 – $29.13 | 2 |
| Alemtuzumab 12 mg/1.2 ml intravenous solution HCPCS J0202 | not published | not published | $1,908.70 – $4,637.33 | 5 |
| Alkaline phosphatase CPT 84075 | $45.65 | $83.00 | $3.88 – $41.15 | 5 |
| Allergen alpha lactalbumin ige CPT 86008 | $353.10 | $642.00 | $13.45 – $124.28 | 5 |
| Allergen egg white ige CPT 86003 | $140.80 | $256.00 | $3.92 – $25.80 | 5 |
| Allergen specific ige qual multi scrn ea CPT 86005 | $13.75 | $25.00 | $5.98 – $63.38 | 5 |
| Allergy injections; 2 or more 95117 CPT 95117 | not published | not published | $35.37 – $47.17 | 2 |
| Allergy injection; single 95115 CPT 95115 | not published | not published | $35.37 – $47.17 | 2 |
| Allergy Skin Testing CPT 95004 | not published | not published | $648.73 – $864.97 | 2 |
| Allg patch or app # of tests 95044 CPT 95044 | not published | not published | $648.73 – $864.97 | 2 |
| Allgrft implnt knee w/scope CPT 29867 | not published | not published | $9,698.86 – $16,582.00 | 4 |
| Allograft allowrap 4x4cm dry 16sqcm HCPCS Q4150 | not published | not published | $94.01 – $161.23 | 5 |
| Allograft amnioexcel plus 17mm disk HCPCS Q4137 | not published | not published | $94.01 – $215.86 | 5 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | not published | not published | $35.48 – $125.35 | 5 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | not published | not published | $94.01 – $292.91 | 5 |
| Allograft umbil cord+amniotic membrane-q4148-cost per sq cm HCPCS Q4148 | not published | not published | $94.01 – $239.52 | 5 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | not published | not published | $94.01 – $459.55 | 5 |
| Alloskin HCPCS Q4115 | not published | not published | $17.95 – $125.35 | 5 |
| All tstg perq&iq drugs/biol CPT 95018 | not published | not published | $28.22 – $37.62 | 2 |
| All tstg perq&iq w/venoms CPT 95017 | not published | not published | $21.85 – $29.13 | 2 |
| Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution HCPCS J0256 | not published | not published | $3.85 – $9.85 | 5 |
| Alpha-fetoprotein afp-l3 frac & total CPT 82107 | not published | not published | $48.31 – $512.19 | 5 |
| Alpha-fetoprotein amniotic CPT 82106 | $63.80 | $116.00 | $12.75 – $133.39 | 5 |
| Alpha-fetoprotein tumor marker CPT 82105 | $42.90 | $78.00 | $12.58 – $133.39 | 5 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | not published | not published | $73.94 – $178.89 | 5 |
| Alt/sgpt CPT 84460 | $90.75 | $165.00 | $3.98 – $42.16 | 5 |
| Altuviiio per factor viii iu HCPCS J7214 | not published | not published | $3.47 – $8.88 | 5 |
| Aluminum - quest CPT 82108 | $19.25 | $35.00 | $19.11 – $202.62 | 5 |
| Alveoloplasty each quadrant CPT 41874 | not published | not published | $2,504.63 – $4,321.00 | 4 |
| Amantadine (symmetrel)-sendout CPT 80375 | $295.35 | $537.00 | $137.83 – $137.83 | 1 |
| Ambl bp mntr w/sw a/r CPT 93788 | not published | not published | $100.51 – $134.01 | 2 |
| Amikacin 4 mg/ml intravitreal injection - cnr HCPCS J0278 | not published | not published | $0.87 – $1.17 | 3 |
| Amino acid screen, urine CPT 82128 | $401.50 | $730.00 | $10.40 – $110.28 | 5 |
| Amino acid single qual CPT 82127 | not published | not published | $10.64 – $110.28 | 5 |
| Amino acids quant 2-5 CPT 82136 | not published | not published | $14.71 – $114.58 | 5 |
| Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr HCPCS J0281 | not published | not published | $1.89 – $2.84 | 2 |
| Aminolevulinic acid, 10% gel HCPCS J7345 | not published | not published | $1.39 – $3.44 | 5 |
| Aminolevulinic acid delta CPT 82135 | $118.25 | $215.00 | $12.34 – $130.81 | 5 |
| Aminolevulinic acid hcl top HCPCS J7308 | not published | not published | $291.96 – $748.36 | 5 |
| Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 | not published | not published | $9.56 – $16.02 | 3 |
| Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV HCPCS J0283 | not published | not published | $3.76 – $4.96 | 3 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | not published | not published | $0.48 – $0.96 | 3 |
| Amitriptyline (elavil) -sendout CPT 80335 | $63.80 | $116.00 | $137.83 – $137.83 | 1 |
| Amivantamab-vmjw 50 mg/ml intravenous solution HCPCS J9061 | not published | not published | $17.41 – $42.19 | 5 |
| Ammonia CPT 82140 | $186.45 | $339.00 | $10.93 – $115.87 | 5 |
| Amniocentesisdiagnostic 59000 CPT 59000 | $668.25 | $1,215.00 | $695.80 – $4,074.00 | 4 |
| Amniocentesis therapeutic CPT 59001 | not published | not published | $230.21 – $4,074.00 | 4 |
| Amniotic fluid scan CPT 82143 | not published | not published | $7.01 – $54.59 | 5 |
| Amp f/th 1/2 jt/phalanx w/neurect local flap CPT 26952 | not published | not published | $2,471.80 – $10,498.00 | 4 |
| Amphetamine confirm urine -sendout CPT 80324 | $166.10 | $302.00 | $137.83 – $137.83 | 1 |
| Amphetamines 5 or more CPT 80326 | $69.30 | $126.00 | not published | 0 |
| Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr HCPCS J0285 | not published | not published | $64.84 – $92.63 | 3 |
| Amphotericin b lipid complex HCPCS J0287 | not published | not published | $14.94 – $19.57 | 2 |
| Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J0289 | not published | not published | $14.88 – $44.36 | 5 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | not published | not published | $0.87 – $1.31 | 3 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | not published | not published | $2.28 – $3.03 | 3 |
| Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis CPT 81515 | $165.00 | $300.00 | $197.24 – $1,157.16 | 5 |
| Amp metatarsal w/toe single 28810 CPT 28810 | not published | not published | $2,471.80 – $10,498.00 | 4 |
| Amp thigh through femur re-amp 27596 CPT 27596 | not published | not published | $2,471.80 – $16,582.00 | 4 |
| Amputate hand at wrist CPT 25922 | not published | not published | $1,214.74 – $6,798.00 | 4 |
| Amputate metacarpal bone 26910 CPT 26910 | not published | not published | $2,471.80 – $10,498.00 | 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.