Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm cost in Wisconsin
KIT OMNIGRAFT 2.5X2.5CM DERMAL REGENERATION MATRIX - Q4105-COST PER SQ CM · HCPCS Q4105
| Hospital | City | Cash price | Negotiated range | Payers |
|---|---|---|---|---|
| SSM Health Ripon Community Hospital | Ripon | not published | $25.58 – $82.43 | 4 |
| SSM Health Monroe Hospital | Monroe | not published | $23.25 – $69.74 | 6 |
| UnityPoint Health - Meriter Hospital | Madison | not published | $25.17 – $35.34 | 4 |
| SSM Health St. Mary's Hospital - Madison | Madison | not published | $33.71 – $120.88 | 5 |
| SSM Health St. Mary's Hospital - Janesville | Janesville | not published | $33.71 – $125.35 | 5 |
| SSM Health St. Clare Hospital - Baraboo | Baraboo | not published | $33.71 – $120.88 | 5 |
| SSM Health Waupun Memorial Hospital | Waupun | not published | $25.58 – $82.43 | 4 |
| SSM Health St. Agnes Hospital - Fond du Lac | Fond Du Lac | not published | $25.58 – $237.56 | 7 |