Mastectomy form cost in Wisconsin

Mastectomy form ยท HCPCS L8020

Hospital City Cash price Negotiated range Payers
UnityPoint Health - Meriter Hospital Madison not published $136.17 โ€“ $295.35 8
SSM Health St. Clare Hospital - Baraboo Baraboo not published $208.80 โ€“ $278.40 2
SSM Health St. Agnes Hospital - Fond du Lac Fond Du Lac not published $208.80 โ€“ $537.31 4