Tc-99m exame autol wbc diag per dose cost in Wisconsin
TC-99M EXAME AUTOL WBC DIAG PER DOSE · HCPCS A9569
$784.85
lowest in Wisconsin
$2,625.99
state median
$4,150.00
highest in Wisconsin
$2,435.36
national median
| Hospital | City | Cash price | Negotiated range | Payers |
|---|---|---|---|---|
| SSM Health St. Agnes Hospital - Fond du Lac | Fond Du Lac | $784.85 | $700.60 – $2,832.27 | 5 |
| SSM Health Waupun Memorial Hospital | Waupun | $784.85 | $2,832.27 – $2,832.27 | 1 |
| SSM Health Ripon Community Hospital | Ripon | $784.85 | $2,832.27 – $2,832.27 | 1 |
| SSM Health St. Mary's Hospital - Madison | Madison | $1,463.55 | not published | 0 |
| Ascension St. Francis Hospital, Inc. | Milwaukee | $2,608.66 | $2,550.81 – $2,550.81 | 1 |
| Ascension SE Wisconsin Hospital - St. Joseph Campus | Milwaukee | $2,608.66 | $2,550.81 – $2,550.81 | 1 |
| Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.) | Appleton | $2,625.99 | $2,851.61 – $2,851.61 | 2 |
| Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.) | Oshkosh | $2,625.99 | $2,851.61 – $2,851.61 | 2 |
| Aurora Medical Center Grafton | Grafton | $4,150.00 | $1,040.32 – $2,622.38 | 4 |
| Aurora Medical Center Manitowoc | Two Rivers | $4,150.00 | $1,040.32 – $2,622.38 | 4 |
| Aurora Medical Center Kenosha | Kenosha | $4,150.00 | $1,040.32 – $2,622.38 | 4 |
| Aurora Medical Center Fond du Lac | Fond Du Lac | $4,150.00 | $1,040.32 – $2,622.38 | 4 |
| Aurora Medical Center Summit | Summit | $4,150.00 | $1,040.32 – $2,622.38 | 4 |
| Aurora Medical Center Washington County | Hartford | $4,150.00 | $1,040.32 – $2,622.38 | 4 |
| Aurora West Allis Medical Center | West Allis | $4,150.00 | $1,040.32 – $2,622.38 | 4 |
| SSM Health Monroe Hospital | Monroe | not published | $934.13 – $2,832.27 | 2 |
| UnityPoint Health - Meriter Hospital | Madison | not published | $1,040.32 – $1,040.32 | 8 |
| Aurora Sinai Medical Center of Aurora Health Care Metro | Milwaukee | not published | $1,040.32 – $2,622.38 | 4 |
| Aurora Psychiatric Hospital | Wauwatosa | not published | $1,040.32 – $2,622.38 | 4 |
| Aurora Medical Center Sheboygan County | Sheboygan | not published | $1,040.32 – $2,622.38 | 4 |
| Aurora Medical Center Burlington | Burlington | not published | $1,040.32 – $2,622.38 | 4 |
| Aurora Medical Center Bay Area | Marinette | not published | $1,040.32 – $2,622.38 | 4 |
| Aurora Baycare Medical Center | Green Bay | not published | $1,040.32 – $2,622.38 | 4 |