Assay of urine urobilinogen cost in Wisconsin

Assay of urine urobilinogen · CPT 84583

Hospital	City	Cash price	Negotiated range	Payers
SSM Health Waupun Memorial Hospital	Waupun	not published	$6.05 – $10.59	4
SSM Health St. Mary's Hospital - Madison	Madison	not published	$4.54 – $40.89	5
SSM Health St. Mary's Hospital - Janesville	Janesville	not published	$4.54 – $39.98	5
SSM Health St. Clare Hospital - Baraboo	Baraboo	not published	$4.54 – $49.99	5
SSM Health St. Agnes Hospital - Fond du Lac	Fond Du Lac	not published	$4.54 – $11.68	7
SSM Health Ripon Community Hospital	Ripon	not published	$6.05 – $10.59	4
SSM Health Monroe Hospital	Monroe	not published	$6.05 – $10.59	4
Ascension St. Francis Hospital, Inc.	Milwaukee	not published	$6.05 – $22.43	17
Ascension SE Wisconsin Hospital - St. Joseph Campus	Milwaukee	not published	$6.05 – $22.43	17
Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.)	Oshkosh	not published	$6.05 – $23.35	16
Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Mequon	not published	$6.05 – $21.78	16
Orthopaedic Hospital of Wisconsin, LLC	Glendale	not published	$5.87 – $9.00	5
Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.)	Appleton	not published	$6.05 – $23.35	16
Ascension Calumet Hospital, Inc.	Chilton	not published	$6.35 – $23.35	11
Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Milwaukee	not published	$6.05 – $21.78	16
Midwest Orthopedic Specialty Hospital	Franklin	not published	$6.05 – $22.43	17
UnityPoint Health - Meriter Hospital	Madison	not published	$3.63 – $8.48	9