Dbrdmt prmlg les w/pdt cost in Wisconsin

Dbrdmt prmlg les w/pdt · CPT 96574

Hospital	City	Cash price	Negotiated range	Payers
SSM Health St. Mary's Hospital - Janesville	Janesville	not published	$151.57 – $4,074.00	4
SSM Health St. Clare Hospital - Baraboo	Baraboo	not published	$146.16 – $4,401.00	4
UnityPoint Health - Meriter Hospital	Madison	not published	$191.93 – $1,076.92	10
Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Mequon	not published	$193.43 – $963.26	9
Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Milwaukee	not published	$193.43 – $963.26	9
Ascension Calumet Hospital, Inc.	Chilton	not published	$297.66 – $879.95	6
Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.)	Appleton	not published	$191.02 – $879.95	11
Ascension SE Wisconsin Hospital - St. Joseph Campus	Milwaukee	not published	$192.94 – $808.19	4
Ascension St. Francis Hospital, Inc.	Milwaukee	not published	$192.94 – $808.19	4
Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.)	Oshkosh	not published	$191.02 – $879.95	11
Midwest Orthopedic Specialty Hospital	Franklin	not published	$192.94 – $808.19	4
SSM Health Waupun Memorial Hospital	Waupun	not published	$1,887.00 – $2,334.00	2
SSM Health St. Agnes Hospital - Fond du Lac	Fond Du Lac	not published	$148.84 – $2,334.00	6
SSM Health Ripon Community Hospital	Ripon	not published	$1,887.00 – $2,334.00	2
SSM Health Monroe Hospital	Monroe	not published	$194.88 – $2,181.00	2
Orthopaedic Hospital of Wisconsin, LLC	Glendale	not published	$743.00 – $16,897.00	6
SSM Health St. Mary's Hospital - Madison	Madison	not published	$146.16 – $4,198.00	4