Lso sag-co shell pnl pre ots cost in Wisconsin

LSO sag-co shell pnl pre ots ยท HCPCS L0651

Hospital City Cash price Negotiated range Payers
UnityPoint Health - Meriter Hospital Madison not published $762.72 โ€“ $1,475.06 8
SSM Health St. Clare Hospital - Baraboo Baraboo not published $587.48 โ€“ $783.31 2
SSM Health St. Agnes Hospital - Fond du Lac Fond Du Lac not published $587.48 โ€“ $1,511.79 4