Membrane affinity fresh amniotic 2.5x2.5cm -cost per sq cm cost in Wisconsin
MEMBRANE AFFINITY FRESH AMNIOTIC 2.5X2.5CM -COST PER SQ CM · HCPCS Q4159
$1,410.75
lowest in Wisconsin
$1,410.75
state median
$1,410.75
highest in Wisconsin
$1,154.53
national median
| Hospital | City | Cash price | Negotiated range | Payers |
|---|---|---|---|---|
| Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.) | Appleton | $1,410.75 | $473.65 – $2,228.00 | 7 |
| SSM Health Ripon Community Hospital | Ripon | not published | $289.22 – $716.97 | 4 |
| SSM Health Monroe Hospital | Monroe | not published | $120.88 – $715.82 | 6 |
| UnityPoint Health - Meriter Hospital | Madison | not published | $220.70 – $305.58 | 4 |
| SSM Health St. Mary's Hospital - Madison | Madison | not published | $90.66 – $487.20 | 5 |
| SSM Health St. Mary's Hospital - Janesville | Janesville | not published | $94.01 – $487.20 | 5 |
| SSM Health St. Clare Hospital - Baraboo | Baraboo | not published | $90.66 – $487.20 | 5 |
| SSM Health Waupun Memorial Hospital | Waupun | not published | $289.22 – $716.97 | 4 |
| SSM Health St. Agnes Hospital - Fond du Lac | Fond Du Lac | not published | $92.32 – $716.97 | 7 |