Polyvalent mult org ea ag ia cost in Wisconsin

POLYVALENT MULT ORG EA AG IA · CPT 87451

Hospital	City	Cash price	Negotiated range	Payers
Ascension SE Wisconsin Hospital - St. Joseph Campus	Milwaukee	not published	$10.51 – $42.50	17
SSM Health Ripon Community Hospital	Ripon	not published	$10.51 – $19.40	4
SSM Health Monroe Hospital	Monroe	not published	$10.51 – $18.39	4
Ascension St. Francis Hospital, Inc.	Milwaukee	not published	$10.51 – $42.50	17
Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.)	Oshkosh	not published	$10.51 – $40.57	16
Orthopaedic Hospital of Wisconsin, LLC	Glendale	not published	$10.19 – $17.18	5
UnityPoint Health - Meriter Hospital	Madison	not published	$6.31 – $14.92	9
SSM Health St. Mary's Hospital - Madison	Madison	not published	$7.88 – $78.03	5
Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Milwaukee	not published	$10.51 – $41.27	16
Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Mequon	not published	$10.51 – $41.27	16
Midwest Orthopedic Specialty Hospital	Franklin	not published	$10.51 – $42.50	17
SSM Health St. Mary's Hospital - Janesville	Janesville	not published	$7.88 – $76.29	5
SSM Health St. Clare Hospital - Baraboo	Baraboo	not published	$7.88 – $95.39	5
Ascension Calumet Hospital, Inc.	Chilton	not published	$11.04 – $40.57	11
Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.)	Appleton	not published	$10.51 – $40.57	16
SSM Health Waupun Memorial Hospital	Waupun	not published	$10.51 – $19.40	4
SSM Health St. Agnes Hospital - Fond du Lac	Fond Du Lac	not published	$7.88 – $20.28	7