SSM Health Monroe Hospital
515 22Nd Ave, Monroe, WI · SSM Health · · NPI 1073653523
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 pelvis 1-2 views CPT 72170 | $177.65 | $323.00 | $48.14 – $101.55 | 2 |
| X-ray pelvis complete > 3 views CPT 72190 | $253.55 | $461.00 | $70.98 – $101.55 | 2 |
| Xray place dist ext thor ao CPT 75959 | not published | not published | $461.61 – $461.61 | 1 |
| Xray place prox ext thor ao CPT 75958 | not published | not published | $539.78 – $539.78 | 1 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $595.10 | $1,082.00 | $338.87 – $705.69 | 2 |
| X-ray ribs 2 views left CPT 71100 | $135.85 | $247.00 | $50.04 – $84.53 | 2 |
| X-ray ribs 3 views bilateral CPT 71110 | $331.65 | $603.00 | $61.48 – $101.55 | 2 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $152.35 | $277.00 | $59.57 – $101.55 | 2 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $486.75 | $885.00 | $81.45 – $101.55 | 2 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $239.25 | $435.00 | $61.48 – $101.55 | 2 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $211.20 | $384.00 | $50.04 – $84.53 | 2 |
| X-ray scapula complete (both sides) CPT 73010 | $179.85 | $327.00 | $53.85 – $101.55 | 2 |
| X-ray sella turcica CPT 70240 | $160.05 | $291.00 | $51.95 – $84.53 | 2 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $199.10 | $362.00 | $39.57 – $84.53 | 2 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $293.70 | $534.00 | $64.32 – $84.53 | 2 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $299.20 | $544.00 | $75.74 – $530.75 | 2 |
| X-ray skull < 4 views CPT 70250 | $199.10 | $362.00 | $60.52 – $101.55 | 2 |
| X-ray skull > 4 views complete CPT 70260 | $301.95 | $549.00 | $72.88 – $101.55 | 2 |
| X-ray slg plne bdy sect without urogr CPT 76100 | $299.20 | $544.00 | $101.55 – $160.44 | 2 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | $265.65 | $483.00 | $170.37 – $212.77 | 2 |
| X-ray small intestine follow-through study CPT 74248 | $196.35 | $357.00 | $125.81 – $125.81 | 1 |
| X-ray spine single view CPT 72020 | $199.65 | $363.00 | $36.73 – $84.53 | 2 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $253.55 | $461.00 | $64.32 – $84.53 | 2 |
| X-ray sternum > 2 views CPT 71120 | $250.25 | $455.00 | $50.04 – $84.53 | 2 |
| X-ray surgical specimen CPT 76098 | $138.60 | $252.00 | $21.52 – $530.75 | 2 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | $279.95 | $509.00 | $170.37 – $269.86 | 2 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | $294.80 | $536.00 | $84.53 – $90.01 | 2 |
| X-ray thoracic spine 2 views CPT 72070 | $244.75 | $445.00 | $51.95 – $101.55 | 2 |
| X-ray thoracic spine 3 views CPT 72072 | $264.00 | $480.00 | $61.48 – $101.55 | 2 |
| X-ray thoracolumbar spine >=2 views CPT 72080 | $251.35 | $457.00 | $54.95 – $84.53 | 2 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $360.80 | $656.00 | $67.18 – $84.53 | 2 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views CPT 72082 | $450.45 | $819.00 | $101.55 – $122.38 | 2 |
| X-ray tibia/fibula 2 views (both sides) CPT 73590 | $318.45 | $579.00 | $46.24 – $84.53 | 2 |
| X-ray toe(s) > 2 views (both sides) CPT 73660 | $221.65 | $403.00 | $55.75 – $84.53 | 2 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 | $330.55 | $601.00 | $170.37 – $245.12 | 2 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 | $279.95 | $509.00 | $170.37 – $208.01 | 2 |
| X-ray wrist 2 views (both sides) CPT 73100 | $216.15 | $393.00 | $53.85 – $84.53 | 2 |
| X-ray xm phrnx&/crv esoph c+ CPT 74210 | not published | not published | $157.56 – $170.37 | 2 |
| Xwrap 1 sq cm HCPCS Q4204 | not published | not published | $120.88 – $7,974.25 | 5 |
| Xylose absorption test blood &/or urine CPT 84620 | $108.90 | $198.00 | $12.91 – $22.59 | 4 |
| Xyntha inj HCPCS J7185 | not published | not published | $1.37 – $4.06 | 6 |
| Yersinia antibody CPT 86793 | $95.15 | $173.00 | $13.19 – $23.08 | 4 |
| Yttrium y-90 ibritumomab ther HCPCS A9543 | not published | not published | $56,824.55 – $154,704.84 | 2 |
| Zenith amniotic membrane psc HCPCS Q4253 | not published | not published | $71.50 – $194.67 | 6 |
| Ziconotide injection HCPCS J2278 | not published | not published | $9.70 – $26.42 | 6 |
| Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr HCPCS J3485 | not published | not published | $1.51 – $4.11 | 6 |
| Zidovudine, oral, 100 mg HCPCS S0104 | not published | not published | $5.79 – $5.79 | 1 |
| Zika virus dna/rna amp probe CPT 87662 | not published | not published | $51.31 – $89.79 | 4 |
| Zika virus igm antibody CPT 86794 | not published | not published | $16.85 – $29.49 | 4 |
| Ziprasidone 20 mg/ml (final concentration) intramuscular solution HCPCS J3486 | not published | not published | $5.18 – $15.55 | 6 |
| Ziv-aflibercept 25 mg/ml intravenous solution (wrapper) HCPCS J9400 | not published | not published | $8.30 – $22.61 | 6 |
| Zoledronic acid 4 mg/5 ml intravenous solution HCPCS J3489 | not published | not published | $7.29 – $28.57 | 6 |
| Zoster vaccine-live inj CPT 90736 | not published | not published | $361.93 – $361.93 | 1 |
| Zrsr2 gene common variants CPT 81360 | not published | not published | $193.25 – $338.19 | 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.