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 |
|---|---|---|---|---|
| Drain thyroid/tongue cyst CPT 60000 | not published | not published | $1,172.13 – $4,321.00 | 4 |
| Drain to peritoneal cavity CPT 49062 | not published | not published | $10,498.00 – $10,498.00 | 1 |
| Dress/debride pt-tck burn/5-10% bs 16025 CPT 16025 | $586.30 | $1,066.00 | $151.57 – $4,074.00 | 4 |
| Dress/debride pt-thick burn/<5% bs 16020 CPT 16020 | $379.50 | $690.00 | $151.57 – $4,074.00 | 4 |
| Dress/debrid prtl-thick burn l 16030 CPT 16030 | $985.05 | $1,791.00 | $307.10 – $4,074.00 | 4 |
| Dressing change not for burn w/anes 15852 CPT 15852 | not published | not published | $558.33 – $4,074.00 | 4 |
| Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm HCPCS Q4108 | not published | not published | $73.20 – $125.35 | 5 |
| Drill hole evac+/drg subdural hematoma 61108 CPT 61108 | not published | not published | $10,498.00 – $10,498.00 | 1 |
| Drill hole implt ventricular cath/device 61107 CPT 61107 | not published | not published | $4,321.00 – $4,321.00 | 1 |
| Drng appendix abscess open 44900 CPT 44900 | not published | not published | $4,321.00 – $4,321.00 | 1 |
| Drng hand tendon sheath 26020 CPT 26020 | not published | not published | $2,471.80 – $10,498.00 | 4 |
| Drng of eyelid abscess 67700 CPT 67700 | not published | not published | $239.78 – $4,074.00 | 4 |
| Drng of finger abscess comp 26011 CPT 26011 | not published | not published | $1,247.68 – $4,321.00 | 4 |
| Drng of hydrocele 55000 CPT 55000 | not published | not published | $534.95 – $4,074.00 | 4 |
| Drng of mouth lesion 40801 CPT 40801 | not published | not published | $407.43 – $4,074.00 | 4 |
| Drng of ovarian cyst(s) 58800 CPT 58800 | $2,165.35 | $3,937.00 | $2,445.46 – $6,798.00 | 4 |
| Drng of palm multi bursas 26030 CPT 26030 | not published | not published | $2,471.80 – $10,498.00 | 4 |
| Drng of palm single bursa 26025 CPT 26025 | not published | not published | $2,471.80 – $10,498.00 | 4 |
| Drng of pelvic abscess transrectal 45000 CPT 45000 | not published | not published | $903.99 – $4,321.00 | 4 |
| Drng of salivary cyst 42409 CPT 42409 | not published | not published | $2,504.63 – $6,798.00 | 4 |
| Drng of scrotum abscess 55100 CPT 55100 | $523.60 | $952.00 | $1,247.68 – $4,321.00 | 4 |
| Drng open retroperitoneal abscess 49060 CPT 49060 | not published | not published | $10,498.00 – $10,498.00 | 1 |
| Drng open subdiaphragmatic/subphrenic absc 49040 CPT 49040 | not published | not published | $10,498.00 – $10,498.00 | 1 |
| Drng ovary abscess perqt 58822 CPT 58822 | not published | not published | $7,919.00 – $9,811.00 | 2 |
| Drng peritoneal abscess open 49020 CPT 49020 | not published | not published | $10,498.00 – $10,498.00 | 1 |
| Drng salivary gland simple 42300 CPT 42300 | not published | not published | $1,172.13 – $4,321.00 | 4 |
| Drng salivary gland submax/subling 42310 CPT 42310 | not published | not published | $407.43 – $4,074.00 | 4 |
| Dronabinol 2.5mg oral HCPCS Q0167 | not published | not published | $2.15 – $3.42 | 3 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | not published | not published | $10.19 – $12.43 | 2 |
| Drsg interceed 3x4in adh wnd barr absorb HCPCS C1765 | $370.42 | $673.49 | not published | 0 |
| Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm HCPCS Q4103 | not published | not published | $18.17 – $125.35 | 5 |
| Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 | not published | not published | $17.41 – $125.35 | 5 |
| Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm HCPCS Q4124 | not published | not published | $4.71 – $125.35 | 5 |
| Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm HCPCS Q4104 | not published | not published | $72.20 – $125.35 | 5 |
| Drug admin & hemodynmic meas CPT 93463 | not published | not published | $1,704.00 – $1,704.00 | 1 |
| Drug assay caffeine CPT 80155 | $62.15 | $113.00 | $28.93 – $112.50 | 5 |
| Drug assay posaconazole CPT 80187 | $118.80 | $216.00 | $20.33 – $158.27 | 5 |
| Drug assay rufinamide CPT 80210 | $301.95 | $549.00 | $20.33 – $158.27 | 5 |
| Drug assay vedolizumab CPT 80280 | $312.95 | $569.00 | $28.93 – $225.15 | 5 |
| Drug assay voriconazole CPT 80285 | $118.80 | $216.00 | $20.33 – $158.27 | 5 |
| Drug asy hydroxychloroquine CPT 80220 | not published | not published | $13.98 – $108.72 | 5 |
| Drug of abuse screen urine CPT 80305 | $25.30 | $46.00 | $9.45 – $87.32 | 5 |
| Drug screen quant tiagabine CPT 80199 | $95.70 | $174.00 | $20.33 – $143.58 | 5 |
| Drug test def 15-21 classes HCPCS G0482 | not published | not published | $149.06 – $969.19 | 5 |
| Drug test def 1-7 classes HCPCS G0480 | $227.70 | $414.00 | $85.82 – $466.65 | 5 |
| Drug test def 22+ classes HCPCS G0483 | not published | not published | $185.19 – $1,256.40 | 5 |
| Drug test def 8-14 classes HCPCS G0481 | not published | not published | $117.44 – $717.95 | 5 |
| Drug test prsmv instrmnt CPT 80306 | $105.05 | $191.00 | $12.86 – $116.46 | 5 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $342.10 | $622.00 | $46.60 – $465.90 | 5 |
| Drvvt confirm - quest CPT 85597 | $102.30 | $186.00 | $13.48 – $142.97 | 5 |
| Dstrj extensive retinopathy CPT 67227 | not published | not published | $2,969.94 – $10,498.00 | 4 |
| Dstrj nulyt agt gnclr nrv CPT 64624 | not published | not published | $1,475.17 – $6,798.00 | 4 |
| Dstr mal les s/n/h/f/g >4.0 CPT 17276 | not published | not published | $307.10 – $4,074.00 | 4 |
| Dstr mal ls f/e/e/n/l/m2.1-3 CPT 17283 | not published | not published | $307.10 – $4,074.00 | 4 |
| Dstr mal ls f/e/e/n/l/m3.1-4 CPT 17284 | not published | not published | $558.33 – $4,074.00 | 4 |
| Dstr mal ls f/e/e/n/l/m>4.0 CPT 17286 | not published | not published | $558.33 – $4,074.00 | 4 |
| Dstry eye lesn,fdr vssl tech HCPCS G0186 | not published | not published | $415.49 – $2,672.00 | 3 |
| Ductogram sgl duct CPT 77053 | $510.40 | $928.00 | $180.25 – $311.77 | 3 |
| Duodenal motility study CPT 91022 | not published | not published | $281.90 – $1,704.00 | 3 |
| Duplex scan bilateral study 93985 CPT 93985 | not published | not published | $180.25 – $240.33 | 2 |
| Duplex scan unilateral study 93986 CPT 93986 | not published | not published | $78.98 – $105.30 | 2 |
| Dup scan/hemodialysis access 93990 CPT 93990 | not published | not published | $78.98 – $105.30 | 2 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $1,705.00 | $3,100.00 | $180.25 – $240.33 | 2 |
| Durvalumab 50 mg/ml intravenous solution HCPCS J9173 | not published | not published | $65.96 – $161.98 | 5 |
| Dxa bone density axl vrt fx CPT 77085 | not published | not published | $78.98 – $314.54 | 3 |
| Dx aly aud oi snd prcsr 1st CPT 92622 | not published | not published | $97.20 – $129.61 | 2 |
| Dx bronchoscope/brush 31623 CPT 31623 | not published | not published | $1,344.61 – $4,321.00 | 4 |
| Dx bronchoscope/lavage 31624 CPT 31624 | not published | not published | $1,344.61 – $4,321.00 | 4 |
| Dx bronchoscope/wash 31622 CPT 31622 | not published | not published | $1,344.61 – $4,321.00 | 4 |
| Dx duod intub w/asp spec 43756 CPT 43756 | not published | not published | $685.17 – $4,074.00 | 4 |
| Dx duod intub w/asp specs CPT 43757 | not published | not published | $685.17 – $4,074.00 | 4 |
| Dx gastr intub w/asp spec CPT 43754 | not published | not published | $163.12 – $4,074.00 | 4 |
| Dx gastr intub w/asp specs CPT 43755 | not published | not published | $97.20 – $4,074.00 | 4 |
| Dx laryngoscopy newborn CPT 31520 | not published | not published | $295.47 – $4,074.00 | 4 |
| Dx laryngoscopy w/oper scope CPT 31526 | not published | not published | $1,344.61 – $4,321.00 | 4 |
| Dynamic cavernosometry CPT 54231 | not published | not published | $188.75 – $4,074.00 | 4 |
| Ear and throat examination CPT 92502 | not published | not published | $407.43 – $1,704.00 | 3 |
| Ear canal biopsy 69105 CPT 69105 | not published | not published | $1,172.13 – $4,321.00 | 4 |
| Ear cartilage graft CPT 21235 | not published | not published | $3,232.00 – $9,811.00 | 4 |
| Ear irrigation 69209 CPT 69209 | $171.05 | $311.00 | $44.57 – $4,074.00 | 4 |
| Ear protector evaluation CPT 92596 | not published | not published | $28.22 – $37.62 | 2 |
| Ecallantide injection HCPCS J1290 | not published | not published | $446.96 – $1,101.98 | 5 |
| Ecg 12 lead tracing only CPT 93005 | $221.65 | $403.00 | $44.57 – $59.42 | 2 |
| Ecg/1-3 leads/tracing only 93041 CPT 93041 | not published | not published | $44.57 – $59.42 | 2 |
| Ecg < 30 days transmission & analysis CPT 93271 | $700.70 | $1,274.00 | not published | 0 |
| Ecg external < 48 hours recording CPT 93225 | $476.85 | $867.00 | $100.51 – $134.01 | 2 |
| Ecg external < 48 hours scanning analysis w/report CPT 93226 | $649.55 | $1,181.00 | $44.57 – $59.42 | 2 |
| Ecg external > 48 hours up to 7 days recording CPT 93242 | not published | not published | $28.22 – $37.62 | 2 |
| Ecg external >7 days up to 15 days recording CPT 93246 | not published | not published | $28.22 – $37.62 | 2 |
| Echocardiogram (Heart Ultrasound) CPT 93306 | $1,850.20 | $3,364.00 | $412.78 – $550.38 | 2 |
| Echocardiography doppler color flow mapping CPT 93325 | $561.00 | $1,020.00 | not published | 0 |
| Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler HCPCS C8929 | $2,006.40 | $3,648.00 | $592.21 – $789.61 | 2 |
| Echocardiography transthoracic 2d followup/limited CPT 93308 | $349.80 | $636.00 | $180.25 – $240.33 | 2 |
| Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast HCPCS C8924 | $485.65 | $883.00 | $263.55 – $351.40 | 2 |
| Echocardiograpy doppler follow up/limited study CPT 93321 | $234.85 | $427.00 | not published | 0 |
| Echo exam of eye CPT 76516 | not published | not published | $78.98 – $372.70 | 3 |
| Echo exam of eye CPT 76519 | not published | not published | $78.98 – $414.23 | 3 |
| Echo exam of eye CPT 76529 | not published | not published | $65.74 – $364.37 | 3 |
| Echo exam of eye thickness CPT 76514 | not published | not published | $21.85 – $40.41 | 3 |
| Echo exam of fetal heart CPT 76825 | $1,470.70 | $2,674.00 | $412.78 – $1,506.87 | 3 |
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.