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 |
|---|---|---|---|---|
| Ghs removal pharyngeal foreign body CPT 42809 | not published | not published | $337.47 – $4,074.00 | 4 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | not published | not published | $1,214.74 – $4,321.00 | 4 |
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | $3,359.40 | $6,108.00 | $2,471.80 – $10,498.00 | 4 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | $31.90 | $58.00 | $11.92 – $46.24 | 5 |
| Ghs reticulocyte count CPT 85044 | not published | not published | $3.23 – $34.21 | 5 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | $125.95 | $229.00 | $10.43 – $95.32 | 5 |
| Ghs sedimentation rate CPT 85651 | not published | not published | $3.20 – $28.18 | 5 |
| Ghs semen analysis fert CPT 89320 | not published | not published | $9.23 – $95.79 | 5 |
| Ghs semen analysis, post-vas CPT 89300 | not published | not published | $7.38 – $70.98 | 5 |
| Ghs sensitivity (per antimicro) CPT 87184 | $72.60 | $132.00 | $5.61 – $54.81 | 5 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $1,099.45 | $1,999.00 | $307.10 – $4,074.00 | 4 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $811.25 | $1,475.00 | $307.10 – $4,074.00 | 4 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $1,533.95 | $2,789.00 | $307.10 – $4,074.00 | 4 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $926.20 | $1,684.00 | $307.10 – $4,074.00 | 4 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $627.00 | $1,140.00 | $151.57 – $4,074.00 | 4 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $804.10 | $1,462.00 | $151.57 – $4,074.00 | 4 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $718.85 | $1,307.00 | $151.57 – $4,074.00 | 4 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $2,085.05 | $3,791.00 | $151.57 – $4,074.00 | 4 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | $1,042.25 | $1,895.00 | $151.57 – $4,074.00 | 4 |
| Ghs sleep study unattended CPT 95800 | $778.80 | $1,416.00 | not published | 0 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | not published | not published | $648.73 – $864.97 | 2 |
| Ghs sphenopalatine ganglion block CPT 64505 | not published | not published | $231.88 – $4,074.00 | 4 |
| Ghs spont nystagmus CPT 92541 | not published | not published | $100.51 – $134.01 | 2 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $156.75 | $285.00 | not published | 0 |
| Ghs st - eval for alt comm CPT 92567 | not published | not published | $28.22 – $37.62 | 2 |
| Ghs strapping shoulder - 29240 CPT 29240 | $403.15 | $733.00 | $100.51 – $4,074.00 | 4 |
| Ghs st - re-eval for alt comm CPT 92597 | $276.10 | $502.00 | not published | 0 |
| Ghs subcutaneous infus, for therapy ea. add. hr CPT 96370 | not published | not published | $35.37 – $47.17 | 2 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | not published | not published | $160.68 – $214.25 | 2 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $610.50 | $1,110.00 | $558.33 – $4,074.00 | 4 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | not published | not published | $307.10 – $4,074.00 | 4 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | not published | not published | $1,172.13 – $4,321.00 | 4 |
| Ghs trypsin (fecal) CPT 84488 | not published | not published | $5.48 – $58.08 | 5 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $876.70 | $1,594.00 | $186.34 – $4,074.00 | 4 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | not published | not published | $186.34 – $4,074.00 | 4 |
| Ghs urine, hydroxproline total CPT 83505 | not published | not published | $18.22 – $193.34 | 5 |
| Ghs urine, porphyrins quant CPT 84120 | $55.00 | $100.00 | $11.03 – $116.99 | 5 |
| Ghs vaginal delivery only CPT 59409 | $2,632.85 | $4,787.00 | $2,445.46 – $6,798.00 | 4 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | not published | not published | $281.90 – $375.86 | 2 |
| Ghs windowing of cast CPT 29730 | not published | not published | $122.76 – $4,074.00 | 4 |
| Giardia ag if CPT 87269 | not published | not published | $10.21 – $95.32 | 5 |
| Giardia lamblia antibody CPT 86674 | $198.00 | $360.00 | $11.04 – $117.03 | 5 |
| Gi endoscopic ultrasound CPT 76975 | not published | not published | $180.25 – $450.18 | 3 |
| Gi inhouse confirmation CPT 87045 | $55.00 | $100.00 | $7.08 – $75.07 | 5 |
| Gingivoplasty each quadrant CPT 41872 | not published | not published | $2,504.63 – $14,543.00 | 4 |
| Gi protein loss CPT 78282 | not published | not published | $302.00 – $402.67 | 3 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | not published | not published | $685.17 – $3,232.00 | 3 |
| Gi trc img intral colon i&r CPT 91113 | not published | not published | $702.53 – $936.70 | 2 |
| Gi trc img intral esophagus CPT 91111 | not published | not published | $685.17 – $3,232.00 | 3 |
| Gi wireless capsule measure CPT 91112 | not published | not published | $685.17 – $3,232.00 | 3 |
| Gjb2 gene full sequence CPT 81252 | not published | not published | $75.84 – $567.58 | 5 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $46.14 – $345.31 | 5 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $26.25 – $196.46 | 5 |
| Glassia injection HCPCS J0257 | not published | not published | $4.19 – $10.85 | 5 |
| Glaucoma scrn hgh risk direc HCPCS G0117 | not published | not published | $21.85 – $29.13 | 2 |
| Glaucoma scrn hgh risk direc HCPCS G0118 | not published | not published | $28.22 – $37.62 | 2 |
| Glaucoma surgery CPT 66150 | not published | not published | $3,122.55 – $9,811.00 | 4 |
| Glaucoma surgery CPT 66155 | not published | not published | $3,122.55 – $9,811.00 | 4 |
| Glaucoma surgery CPT 66160 | not published | not published | $1,743.42 – $6,798.00 | 4 |
| Glaucoma surgery CPT 66170 | not published | not published | $1,743.42 – $6,798.00 | 4 |
| Glucagon 1 mg solution for injection HCPCS J1610 | not published | not published | $88.00 – $372.00 | 5 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | not published | not published | $96.96 – $275.28 | 5 |
| Glucagon plasma - sendout CPT 82943 | $31.90 | $58.00 | $10.72 – $78.47 | 5 |
| Glucagon tolerance panel CPT 80422 | not published | not published | $34.55 – $366.37 | 5 |
| Glucagon tolerance panel CPT 80424 | not published | not published | $37.88 – $401.58 | 5 |
| Glucagon tolerance test CPT 82946 | not published | not published | $13.33 – $59.09 | 5 |
| Glucose 1 hr post dose CPT 82950 | $74.80 | $136.00 | $3.56 – $37.77 | 5 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | not published | not published | $4.54 – $48.11 | 5 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $7.15 | $13.00 | $2.46 – $18.62 | 5 |
| Glucose blood quantitative CPT 82947 | $50.05 | $91.00 | $2.95 – $31.23 | 5 |
| Glucose body fluid CPT 82945 | $95.70 | $174.00 | $2.95 – $31.23 | 5 |
| Glucose monitoring continual min 72hr pt CPT 95249 | not published | not published | $44.57 – $59.42 | 2 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $152.90 | $278.00 | $9.65 – $102.35 | 5 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $83.60 | $152.00 | $2.94 – $31.19 | 5 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | not published | not published | $0.74 – $1.07 | 3 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | not published | not published | $8.28 – $20.96 | 5 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $128.15 | $233.00 | $13.94 – $147.75 | 5 |
| Gonadotropin hormone panel CPT 80426 | not published | not published | $111.31 – $1,180.11 | 5 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $127.05 | $231.00 | $13.89 – $147.22 | 5 |
| Gonioscopy CPT 92020 | not published | not published | $100.51 – $134.01 | 2 |
| Goniotomy CPT 65820 | not published | not published | $3,122.55 – $9,811.00 | 4 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | not published | not published | $1,022.45 – $1,394.89 | 3 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | not published | not published | $44.02 – $125.35 | 5 |
| Graft bone flex 2.5cm x 5cm grafton-cost per sq cm HCPCS Q4205 | not published | not published | $94.01 – $2,261.83 | 5 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | not published | not published | $92.25 – $139.60 | 5 |
| Graft hand or finger tendon CPT 26416 | not published | not published | $2,471.80 – $10,498.00 | 4 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | not published | not published | $94.01 – $125.35 | 5 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | not published | not published | $94.01 – $195.53 | 5 |
| Graft repair of spine defect 63710 CPT 63710 | not published | not published | $10,498.00 – $10,498.00 | 1 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | not published | not published | $94.01 – $258.74 | 5 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | not published | not published | $75.10 – $125.35 | 5 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | not published | not published | $54.38 – $253.17 | 5 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $500.73 | $910.41 | not published | 0 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $352.38 | $640.70 | not published | 0 |
| Granisetron hcl injection HCPCS J1626 | not published | not published | $0.38 – $0.43 | 3 |
| Granulocyte pheresis ea unit HCPCS P9050 | $3,481.50 | $6,330.00 | not published | 0 |
| Great toe-hand transfer CPT 26551 | not published | not published | $5,481.64 – $14,543.00 | 4 |
| Great toe with reduction 28495 CPT 28495 | $534.05 | $971.00 | $186.34 – $4,074.00 | 4 |
| Grfg autol fat lipo 25 cc/< CPT 15773 | not published | not published | $1,558.69 – $4,321.00 | 4 |
| Grfg autol fat lipo 50 cc/< CPT 15771 | not published | not published | $2,677.07 – $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.