Acid perfusion of esophagus cost in Wisconsin

Acid perfusion of esophagus · CPT 91030

Hospital	City	Cash price	Negotiated range	Payers
SSM Health Waupun Memorial Hospital	Waupun	not published	$1,887.00 – $2,334.00	2
SSM Health St. Mary's Hospital - Madison	Madison	not published	$271.85 – $2,036.00	3
SSM Health St. Mary's Hospital - Janesville	Janesville	not published	$281.90 – $1,704.00	3
SSM Health St. Clare Hospital - Baraboo	Baraboo	not published	$271.85 – $1,676.00	3
SSM Health St. Agnes Hospital - Fond du Lac	Fond Du Lac	not published	$276.82 – $2,334.00	6
SSM Health Ripon Community Hospital	Ripon	not published	$1,887.00 – $2,334.00	2
SSM Health Monroe Hospital	Monroe	not published	$362.46 – $2,181.00	2
Ascension St. Francis Hospital, Inc.	Milwaukee	not published	$158.98 – $721.31	4
Ascension SE Wisconsin Hospital - St. Joseph Campus	Milwaukee	not published	$158.98 – $721.31	4
Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.)	Oshkosh	not published	$48.93 – $1,071.21	12
Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Mequon	not published	$75.04 – $1,136.37	9
Orthopaedic Hospital of Wisconsin, LLC	Glendale	not published	$949.00 – $16,897.00	6
Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.)	Appleton	not published	$48.93 – $1,071.21	12
Ascension Calumet Hospital, Inc.	Chilton	not published	$48.93 – $158.49	7
Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Milwaukee	not published	$75.04 – $1,136.37	9
Midwest Orthopedic Specialty Hospital	Franklin	not published	$158.98 – $721.31	4
UnityPoint Health - Meriter Hospital	Madison	not published	$42.45 – $182.11	10