Carbohydrate urine - sendout cost in Wisconsin

Carbohydrate Urine - Sendout · CPT 84377

Hospital	City	Cash price	Negotiated range	Payers
UnityPoint Health - Meriter Hospital	Madison	not published	$3.30 – $8.56	9
Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Mequon	not published	$5.50 – $24.09	16
Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Milwaukee	not published	$5.50 – $24.09	16
SSM Health Waupun Memorial Hospital	Waupun	not published	$5.50 – $11.12	4
SSM Health St. Mary's Hospital - Madison	Madison	not published	$4.12 – $44.73	5
SSM Health St. Mary's Hospital - Janesville	Janesville	not published	$4.12 – $43.73	5
SSM Health St. Clare Hospital - Baraboo	Baraboo	not published	$4.12 – $54.65	5
SSM Health St. Agnes Hospital - Fond du Lac	Fond Du Lac	not published	$4.12 – $10.62	7
SSM Health Ripon Community Hospital	Ripon	not published	$5.50 – $11.12	4
SSM Health Monroe Hospital	Monroe	not published	$5.50 – $9.63	4
Ascension St. Francis Hospital, Inc.	Milwaukee	not published	$5.50 – $24.81	17
Ascension SE Wisconsin Hospital - St. Joseph Campus	Milwaukee	not published	$5.50 – $24.81	17
Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.)	Oshkosh	not published	$5.50 – $21.23	16
Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.)	Appleton	not published	$5.50 – $21.23	16
Ascension Calumet Hospital, Inc.	Chilton	not published	$5.78 – $21.23	11
Midwest Orthopedic Specialty Hospital	Franklin	not published	$5.50 – $24.81	17
Orthopaedic Hospital of Wisconsin, LLC	Glendale	not published	$5.33 – $9.86	5