Galactokinase - sendout cost in Wisconsin

Galactokinase - Sendout · CPT 82759

Hospital	City	Cash price	Negotiated range	Payers
Ascension SE Wisconsin Hospital - St. Joseph Campus	Milwaukee	not published	$21.48 – $96.81	17
SSM Health Ripon Community Hospital	Ripon	not published	$21.48 – $43.48	4
SSM Health Monroe Hospital	Monroe	not published	$21.48 – $37.59	4
Ascension St. Francis Hospital, Inc.	Milwaukee	not published	$21.48 – $96.81	17
Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.)	Oshkosh	not published	$21.48 – $82.91	16
UnityPoint Health - Meriter Hospital	Madison	not published	$12.89 – $33.43	9
Orthopaedic Hospital of Wisconsin, LLC	Glendale	not published	$20.84 – $38.49	5
Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Milwaukee	not published	$21.48 – $94.00	16
SSM Health St. Mary's Hospital - Madison	Madison	not published	$16.11 – $174.74	5
Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Mequon	not published	$21.48 – $94.00	16
Midwest Orthopedic Specialty Hospital	Franklin	not published	$21.48 – $96.81	17
SSM Health St. Mary's Hospital - Janesville	Janesville	not published	$16.11 – $170.86	5
SSM Health St. Clare Hospital - Baraboo	Baraboo	not published	$16.11 – $213.60	5
Ascension Calumet Hospital, Inc.	Chilton	not published	$22.55 – $82.91	11
SSM Health St. Agnes Hospital - Fond du Lac	Fond Du Lac	not published	$16.11 – $41.46	7
Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.)	Appleton	not published	$21.48 – $82.91	16
SSM Health Waupun Memorial Hospital	Waupun	not published	$21.48 – $43.48	4