Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm cost in Wisconsin
GRAFT SFT TISS THERASKIN LG 5.1X7.6CM MESHED 39 SQ CM-Q4121-COST PER SQ CM · HCPCS Q4121
$56.00
lowest in Wisconsin
$68.90
state median
$68.90
highest in Wisconsin
$208.78
national median
| Hospital | City | Cash price | Negotiated range | Payers |
|---|---|---|---|---|
| UnityPoint Health - Meriter Hospital | Madison | $56.00 | $16.10 – $59.50 | 10 |
| Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Milwaukee | $68.90 | $50.95 – $103.57 | 8 |
| Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Mequon | $68.90 | $50.95 – $103.57 | 8 |
| SSM Health Ripon Community Hospital | Ripon | not published | $56.97 – $131.90 | 4 |
| SSM Health Monroe Hospital | Monroe | not published | $51.79 – $140.99 | 6 |
| SSM Health St. Mary's Hospital - Madison | Madison | not published | $67.12 – $120.88 | 5 |
| SSM Health St. Mary's Hospital - Janesville | Janesville | not published | $75.10 – $125.35 | 5 |
| SSM Health St. Clare Hospital - Baraboo | Baraboo | not published | $75.10 – $120.88 | 5 |
| SSM Health Waupun Memorial Hospital | Waupun | not published | $56.97 – $131.90 | 4 |
| SSM Health St. Agnes Hospital - Fond du Lac | Fond Du Lac | not published | $56.97 – $237.56 | 7 |