Derma-gide, 1 sq cm cost in Wisconsin

Derma-gide, 1 sq cm · HCPCS Q4203

Hospital City Cash price Negotiated range Payers
SSM Health Ripon Community Hospital Ripon not published $330.20 – $1,655.60 4
SSM Health Monroe Hospital Monroe not published $120.88 – $817.25 6
UnityPoint Health - Meriter Hospital Madison not published $231.29 – $871.37 4
SSM Health St. Mary's Hospital - Madison Madison not published $90.66 – $1,655.60 5
SSM Health St. Mary's Hospital - Janesville Janesville not published $94.01 – $1,655.60 5
SSM Health St. Clare Hospital - Baraboo Baraboo not published $90.66 – $1,655.60 5
SSM Health Waupun Memorial Hospital Waupun not published $330.20 – $1,655.60 4
SSM Health St. Agnes Hospital - Fond du Lac Fond Du Lac not published $92.32 – $1,655.60 7