Lefort i-3/> piece without graft cost in Wisconsin
Lefort i-3/> piece w/o graft · CPT 21143
| Hospital | City | Cash price | Negotiated range | Payers |
|---|---|---|---|---|
| Ascension SE Wisconsin Hospital - St. Joseph Campus | Milwaukee | not published | $5,217.90 – $5,217.90 | 1 |
| SSM Health Ripon Community Hospital | Ripon | not published | $4,428.00 – $16,106.00 | 3 |
| SSM Health Monroe Hospital | Monroe | not published | $5,750.12 – $15,012.00 | 3 |
| Ascension St. Francis Hospital, Inc. | Milwaukee | not published | $5,217.90 – $5,217.90 | 1 |
| Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.) | Oshkosh | not published | $1,483.04 – $5,253.30 | 7 |
| Orthopaedic Hospital of Wisconsin, LLC | Glendale | not published | $4,935.00 – $20,066.00 | 6 |
| UnityPoint Health - Meriter Hospital | Madison | not published | $1,297.53 – $4,333.75 | 10 |
| Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Milwaukee | not published | $2,285.00 – $5,743.61 | 6 |
| SSM Health St. Mary's Hospital - Madison | Madison | not published | $4,312.59 – $16,624.00 | 4 |
| Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Mequon | not published | $2,285.00 – $5,743.61 | 6 |
| Midwest Orthopedic Specialty Hospital | Franklin | not published | $5,217.90 – $5,217.90 | 1 |
| SSM Health St. Mary's Hospital - Janesville | Janesville | not published | $4,472.08 – $14,543.00 | 4 |
| SSM Health St. Clare Hospital - Baraboo | Baraboo | not published | $4,312.59 – $14,304.00 | 4 |
| Ascension Calumet Hospital, Inc. | Chilton | not published | $1,483.04 – $5,253.30 | 7 |
| Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.) | Appleton | not published | $1,483.04 – $5,253.30 | 7 |
| SSM Health Waupun Memorial Hospital | Waupun | not published | $4,428.00 – $16,106.00 | 3 |
| SSM Health St. Agnes Hospital - Fond du Lac | Fond Du Lac | not published | $4,391.52 – $16,106.00 | 6 |