Chimerism anal no cell selec cost in Wisconsin

Chimerism anal no cell selec · CPT 81267

Hospital	City	Cash price	Negotiated range	Payers
UnityPoint Health - Meriter Hospital	Madison	not published	$124.48 – $322.73	9
Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Mequon	not published	$207.46 – $904.37	16
Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Milwaukee	not published	$207.46 – $904.37	16
SSM Health Waupun Memorial Hospital	Waupun	not published	$207.46 – $419.78	4
SSM Health St. Mary's Hospital - Madison	Madison	not published	$155.60 – $1,687.16	5
SSM Health St. Mary's Hospital - Janesville	Janesville	not published	$155.60 – $1,649.69	5
SSM Health St. Clare Hospital - Baraboo	Baraboo	not published	$155.60 – $2,062.08	5
SSM Health St. Agnes Hospital - Fond du Lac	Fond Du Lac	not published	$155.60 – $400.40	7
SSM Health Ripon Community Hospital	Ripon	not published	$207.46 – $419.78	4
SSM Health Monroe Hospital	Monroe	not published	$207.46 – $363.06	4
Ascension St. Francis Hospital, Inc.	Milwaukee	not published	$207.46 – $931.36	17
Ascension SE Wisconsin Hospital - St. Joseph Campus	Milwaukee	not published	$207.46 – $931.36	17
Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.)	Oshkosh	not published	$207.46 – $800.80	15
Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.)	Appleton	not published	$207.46 – $800.80	15
Ascension Calumet Hospital, Inc.	Chilton	not published	$217.83 – $800.80	10
Midwest Orthopedic Specialty Hospital	Franklin	not published	$207.46 – $931.36	17
Orthopaedic Hospital of Wisconsin, LLC	Glendale	not published	$201.24 – $360.32	5