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 |
|---|---|---|---|---|
| Unlisted px forearm/wrist CPT 25999 | not published | not published | $186.34 – $13,711.00 | 4 |
| Unlisted px hands/fingers CPT 26989 | not published | not published | $186.34 – $4,074.00 | 4 |
| Unlisted px inner ear CPT 69949 | not published | not published | $178.93 – $4,074.00 | 4 |
| Unlisted px lacrimal system CPT 68899 | not published | not published | $239.78 – $13,711.00 | 4 |
| Unlisted px leg/ankle CPT 27899 | not published | not published | $186.34 – $13,711.00 | 4 |
| Unlisted px male genital sys CPT 55899 | not published | not published | $188.75 – $13,711.00 | 4 |
| Unlisted px mediastinum CPT 39499 | not published | not published | $13,711.00 – $13,711.00 | 1 |
| Unlisted px med radj physics CPT 77399 | $512.05 | $931.00 | $101.54 – $135.38 | 2 |
| Unlisted px middle ear CPT 69799 | not published | not published | $178.93 – $13,711.00 | 4 |
| Unlisted px neck/thorax CPT 21899 | not published | not published | $178.93 – $13,711.00 | 4 |
| Unlisted px palate uvula CPT 42299 | not published | not published | $178.93 – $13,711.00 | 4 |
| Unlisted px pelvis/hip joint CPT 27299 | not published | not published | $186.34 – $13,711.00 | 4 |
| Unlisted px posterior segmnt CPT 67299 | not published | not published | $1,743.42 – $13,711.00 | 4 |
| Unlisted px salivry glnd/dux CPT 42699 | not published | not published | $178.93 – $13,711.00 | 4 |
| Unlisted px small intestine CPT 44799 | not published | not published | $685.17 – $13,711.00 | 4 |
| Unlisted px temporal bone CPT 69979 | not published | not published | $178.93 – $4,074.00 | 4 |
| Unlisted px ther rad tx plng CPT 77299 | not published | not published | $101.54 – $135.38 | 2 |
| Unlisted px tongue flr mouth CPT 41599 | not published | not published | $178.93 – $13,711.00 | 4 |
| Unlisted px vestibule mouth CPT 40899 | not published | not published | $178.93 – $13,711.00 | 4 |
| Unlisted reprod med lab proc CPT 89398 | not published | not published | $39.37 – $52.49 | 2 |
| Unlisted resp px dx nuc med CPT 78599 | not published | not published | $302.00 – $402.67 | 2 |
| Unlisted spec derm svc/px CPT 96999 | not published | not published | $151.57 – $202.09 | 2 |
| Unlisted surgical path px CPT 88399 | $200.75 | $365.00 | $39.37 – $52.49 | 2 |
| Unlisted transfusion med px CPT 86999 | $29.70 | $54.00 | $21.85 – $29.13 | 2 |
| Unlisted ultrasound procedure CPT 76999 | not published | not published | $65.74 – $87.66 | 2 |
| Unlisted vasc endoscopy px CPT 37501 | not published | not published | $473.89 – $4,074.00 | 4 |
| Unlstd hematop ret/endo lymp CPT 78199 | not published | not published | $302.00 – $402.67 | 2 |
| Unlstd laps px mat care&dlvr CPT 59898 | not published | not published | $4,567.04 – $14,906.00 | 4 |
| Unlstd laps px sprmatic cord CPT 55559 | not published | not published | $4,567.04 – $14,906.00 | 4 |
| Unsched dialysis esrd pt hos HCPCS G0257 | $1,371.15 | $2,493.00 | not published | 0 |
| Upgrade pm system CPT 33214 | not published | not published | $7,895.86 – $38,635.00 | 4 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $3,102.55 | $5,641.00 | $263.55 – $2,044.06 | 3 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $2,844.60 | $5,172.00 | $263.55 – $1,792.09 | 3 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $2,586.10 | $4,702.00 | $180.25 – $1,153.56 | 3 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | not published | not published | $685.17 – $4,074.00 | 4 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | not published | not published | $685.17 – $4,074.00 | 4 |
| Upper ext harvest for cabg1 seg 35600 CPT 35600 | not published | not published | $10,498.00 – $10,498.00 | 1 |
| Uppr gi scope w/submuc inj CPT 43236 | not published | not published | $685.17 – $4,074.00 | 4 |
| Urachal cyst/sinus excision 51500 CPT 51500 | not published | not published | $4,567.04 – $14,906.00 | 4 |
| Urea nitrogen CPT 84520 | $57.75 | $105.00 | $2.96 – $31.42 | 5 |
| Urea nitrogen 24 hour urine CPT 84540 | $84.70 | $154.00 | $4.17 – $37.77 | 5 |
| Urea nitrogen clearance CPT 84545 | not published | not published | $5.40 – $52.54 | 5 |
| Urea nitrogen semi-quant CPT 84525 | not published | not published | $3.85 – $29.94 | 5 |
| Ureteral embolization/occl CPT 50705 | not published | not published | $1,704.00 – $1,704.00 | 1 |
| Ureteral reflux study CPT 78740 | $851.40 | $1,548.00 | $302.00 – $1,533.43 | 3 |
| Ureter endoscopy CPT 50970 | not published | not published | $2,662.91 – $4,321.00 | 4 |
| Ureter endoscopy & biopsy CPT 50955 | not published | not published | $4,050.52 – $9,811.00 | 4 |
| Ureter endoscopy & biopsy CPT 50974 | not published | not published | $3,232.00 – $9,811.00 | 4 |
| Ureter endoscopy & catheter CPT 50972 | not published | not published | $2,662.91 – $10,498.00 | 4 |
| Ureter endoscopy & treatment CPT 50957 | not published | not published | $4,050.52 – $9,811.00 | 4 |
| Ureter endoscopy & treatment CPT 50961 | not published | not published | $4,050.52 – $9,811.00 | 4 |
| Ureter endoscopy & treatment CPT 50976 | not published | not published | $3,232.00 – $9,811.00 | 4 |
| Ureter endoscopy & treatment CPT 50980 | not published | not published | $4,050.52 – $9,811.00 | 4 |
| Ureteroneocystostomy 50780 CPT 50780 | not published | not published | $6,798.00 – $10,498.00 | 2 |
| Ureteroureterostomy 50760 CPT 50760 | not published | not published | $10,498.00 – $10,498.00 | 1 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | not published | not published | $180.25 – $405.62 | 3 |
| Urethrlys transvag with scope CPT 53500 | not published | not published | $2,662.91 – $10,498.00 | 4 |
| Urethrocystography void s&i CPT 74455 | $1,331.00 | $2,420.00 | $180.25 – $502.82 | 3 |
| Uric acid blood CPT 84550 | $45.65 | $83.00 | $3.39 – $35.95 | 5 |
| Uric acid urine CPT 84560 | $45.65 | $83.00 | $3.81 – $37.77 | 5 |
| Urinalysis glass test CPT 81020 | not published | not published | $3.52 – $29.29 | 5 |
| Urinalysis microscopic only CPT 81015 | $57.20 | $104.00 | $2.29 – $24.22 | 5 |
| Urinalysis qual/semiquant excpt ia CPT 81005 | not published | not published | $1.63 – $17.22 | 5 |
| Urinalysis (with microscopy) CPT 81001 | $67.10 | $122.00 | $2.38 – $25.23 | 5 |
| Urinalysis (without microscopy) CPT 81003 | $39.05 | $71.00 | $1.69 – $17.87 | 5 |
| Urinary bldr retent nuc study CPT 78730 | not published | not published | $552.68 – $552.68 | 1 |
| Urinary reflex study CPT 51792 | not published | not published | $44.57 – $1,704.00 | 3 |
| Urine Culture Test CPT 87086 | $197.45 | $359.00 | $6.05 – $64.22 | 5 |
| Urine flow measurement 51736 CPT 51736 | not published | not published | $100.51 – $1,704.00 | 3 |
| Urine pregnancy test CPT 81025 | $95.15 | $173.00 | $6.46 – $50.26 | 5 |
| Urine screen for bacteria CPT 81007 | not published | not published | $20.37 – $52.47 | 5 |
| Urine shunt to intestine CPT 50815 | not published | not published | $10,498.00 – $10,498.00 | 1 |
| Urine specimen collect mult HCPCS P9615 | not published | not published | $11.36 – $17.50 | 3 |
| Urography, antegrade CPT 74425 | $517.00 | $940.00 | $263.55 – $2,709.74 | 3 |
| Urography inf drip &/or bolus CPT 74410 | not published | not published | $132.50 – $646.83 | 3 |
| Use 1st target lesion CPT 76982 | not published | not published | $78.98 – $517.12 | 3 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | not published | not published | $8.52 – $25.25 | 5 |
| Ustekinumab 45 mg/0.5 ml subcutaneous solution HCPCS J3357 | not published | not published | $288.38 – $288.38 | 1 |
| U/s trtmt, not leiomyomata HCPCS C9734 | not published | not published | $6,798.00 – $16,352.00 | 4 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | not published | not published | $234.39 – $307.14 | 3 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | not published | not published | $213.24 – $279.41 | 3 |
| Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im CPT 91320 | not published | not published | $226.06 – $296.20 | 3 |
| Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im CPT 91319 | not published | not published | $127.28 – $166.78 | 3 |
| Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im CPT 91318 | not published | not published | $95.05 – $124.55 | 3 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | not published | not published | $104.63 – $138.10 | 3 |
| Vaccine hepatitis b (hepb) adolescent 2 dose im CPT 90743 | not published | not published | $108.97 – $142.78 | 3 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | not published | not published | $102.05 – $133.71 | 3 |
| Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im CPT 90739 | not published | not published | $257.46 – $337.35 | 3 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | not published | not published | $45.92 – $60.17 | 3 |
| Vaccine influenza (iiv) preservative free antigen content im CPT 90662 | not published | not published | $121.06 – $158.63 | 3 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | not published | not published | $121.06 – $158.63 | 3 |
| Vaccine influenza nos 0.5ml dose im CPT 90658 | not published | not published | $31.70 – $41.53 | 3 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | not published | not published | $32.41 – $42.47 | 3 |
| Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im CPT 90661 | not published | not published | $53.43 – $70.01 | 3 |
| Vaccine influenza trivalent (iiv3) 0.25ml dose im CPT 90657 | not published | not published | $15.85 – $20.77 | 3 |
| Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im CPT 90732 | not published | not published | $193.53 – $253.60 | 3 |
| Vaccine pneumococcal conjugate 13 valent (pcv13) im CPT 90670 | not published | not published | $374.09 – $490.18 | 3 |
| Vaccine pneumonococcal conjugate 15 valent (pcv15) im CPT 90671 | not published | not published | $378.67 – $496.18 | 3 |
| Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 | not published | not published | $453.71 – $594.51 | 3 |
| Vaccine rabies im CPT 90675 | not published | not published | $248.98 – $606.39 | 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.