Assay of feces/urobilinogen cost in Wisconsin

Assay of feces/urobilinogen · CPT 84577

Hospital	City	Cash price	Negotiated range	Payers
SSM Health Waupun Memorial Hospital	Waupun	not published	$16.80 – $29.40	4
SSM Health St. Mary's Hospital - Madison	Madison	not published	$12.60 – $101.49	5
SSM Health St. Mary's Hospital - Janesville	Janesville	not published	$12.60 – $99.23	5
SSM Health St. Clare Hospital - Baraboo	Baraboo	not published	$12.60 – $124.04	5
SSM Health St. Agnes Hospital - Fond du Lac	Fond Du Lac	not published	$12.60 – $32.42	7
SSM Health Ripon Community Hospital	Ripon	not published	$16.80 – $29.40	4
SSM Health Monroe Hospital	Monroe	not published	$16.80 – $29.40	4
Ascension St. Francis Hospital, Inc.	Milwaukee	not published	$16.80 – $55.48	17
Ascension SE Wisconsin Hospital - St. Joseph Campus	Milwaukee	not published	$16.80 – $55.48	17
Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.)	Oshkosh	not published	$16.80 – $64.85	16
Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Mequon	not published	$16.80 – $64.94	16
Orthopaedic Hospital of Wisconsin, LLC	Glendale	not published	$16.30 – $22.35	5
Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.)	Appleton	not published	$16.80 – $64.85	16
Ascension Calumet Hospital, Inc.	Chilton	not published	$17.64 – $64.85	11
Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Milwaukee	not published	$16.80 – $64.94	16
Midwest Orthopedic Specialty Hospital	Franklin	not published	$16.80 – $55.48	17
UnityPoint Health - Meriter Hospital	Madison	not published	$10.08 – $26.14	9