Intraoral periapical first cost in Wisconsin

Intraoral periapical first · HCPCS D0220

Hospital City Cash price Negotiated range Payers
SSM Health Monroe Hospital Monroe not published $84.53 – $84.53 1
SSM Health St. Mary's Hospital - Madison Madison not published $63.40 – $84.53 2
SSM Health St. Mary's Hospital - Janesville Janesville not published $65.74 – $87.66 2
SSM Health St. Clare Hospital - Baraboo Baraboo not published $63.40 – $84.53 2
SSM Health St. Agnes Hospital - Fond du Lac Fond Du Lac not published $64.56 – $166.13 4