Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm cost in Wisconsin

INTEGRA MATRIX WND INJ FLOWABLE 3CC-Q4114-COST PER SQ CM · HCPCS Q4114

Hospital City Cash price Negotiated range Payers
SSM Health Ripon Community Hospital Ripon not published $1,643.79 – $4,357.67 4
SSM Health Monroe Hospital Monroe not published $1,494.35 – $4,483.04 6
SSM Health St. Mary's Hospital - Madison Madison not published $2,166.81 – $2,961.13 3
SSM Health St. Mary's Hospital - Janesville Janesville not published $2,166.81 – $2,961.13 3
SSM Health St. Clare Hospital - Baraboo Baraboo not published $2,166.81 – $2,961.13 3
SSM Health Waupun Memorial Hospital Waupun not published $1,643.79 – $4,357.67 4
SSM Health St. Agnes Hospital - Fond du Lac Fond Du Lac not published $1,643.79 – $4,357.67 4