Assay of pregnanetriol cost in Wisconsin

Assay of pregnanetriol · CPT 84138

Hospital	City	Cash price	Negotiated range	Payers
SSM Health Waupun Memorial Hospital	Waupun	not published	$21.05 – $38.30	4
SSM Health St. Mary's Hospital - Madison	Madison	not published	$15.79 – $153.97	5
SSM Health St. Mary's Hospital - Janesville	Janesville	not published	$15.79 – $150.54	5
SSM Health St. Clare Hospital - Baraboo	Baraboo	not published	$15.79 – $188.20	5
SSM Health St. Agnes Hospital - Fond du Lac	Fond Du Lac	not published	$15.79 – $40.63	7
SSM Health Ripon Community Hospital	Ripon	not published	$21.05 – $38.30	4
SSM Health Monroe Hospital	Monroe	not published	$21.05 – $36.84	4
Ascension St. Francis Hospital, Inc.	Milwaukee	not published	$21.05 – $85.01	17
Ascension SE Wisconsin Hospital - St. Joseph Campus	Milwaukee	not published	$21.05 – $85.01	17
Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.)	Oshkosh	not published	$21.05 – $81.25	16
Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Mequon	not published	$21.05 – $82.54	16
Orthopaedic Hospital of Wisconsin, LLC	Glendale	not published	$20.42 – $33.93	5
Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.)	Appleton	not published	$21.05 – $81.25	16
Ascension Calumet Hospital, Inc.	Chilton	not published	$22.10 – $81.25	11
Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Milwaukee	not published	$21.05 – $82.54	16
Midwest Orthopedic Specialty Hospital	Franklin	not published	$21.05 – $85.01	17
UnityPoint Health - Meriter Hospital	Madison	not published	$12.63 – $29.47	9