Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm cost in Wisconsin
DRSG WND MESH BOVINE BILAYER 4X10IN MATRIX-Q4104-COST PER SQ CM · HCPCS Q4104
| Hospital | City | Cash price | Negotiated range | Payers |
|---|---|---|---|---|
| SSM Health St. Mary's Hospital - Janesville | Janesville | not published | $72.20 – $125.35 | 5 |
| SSM Health St. Clare Hospital - Baraboo | Baraboo | not published | $72.20 – $120.88 | 5 |
| SSM Health Waupun Memorial Hospital | Waupun | not published | $54.77 – $142.66 | 4 |
| SSM Health St. Agnes Hospital - Fond du Lac | Fond Du Lac | not published | $54.77 – $237.56 | 7 |
| SSM Health Ripon Community Hospital | Ripon | not published | $54.77 – $142.66 | 4 |
| SSM Health Monroe Hospital | Monroe | not published | $49.79 – $135.55 | 6 |
| SSM Health St. Mary's Hospital - Madison | Madison | not published | $71.81 – $120.88 | 5 |