Tlh w/t/o 250 g or less cost in Wisconsin
Tlh w/t/o 250 g or less · CPT 58571
| Hospital | City | Cash price | Negotiated range | Payers |
|---|---|---|---|---|
| HSHS St. Vincent Hospital | Green Bay | not published | not published | 0 |
| HSHS St. Nicholas Hospital | SHEBOYGAN | not published | not published | 0 |
| HSHS St. Mary's Hospital Medical Center | GREEN BAY | not published | not published | 0 |
| Ascension SE Wisconsin Hospital - St. Joseph Campus | Milwaukee | not published | $3,221.75 – $3,221.75 | 1 |
| SSM Health Ripon Community Hospital | Ripon | not published | $7,609.00 – $18,364.00 | 3 |
| SSM Health Monroe Hospital | Monroe | not published | $10,325.10 – $17,116.00 | 3 |
| Ascension St. Francis Hospital, Inc. | Milwaukee | not published | $3,221.75 – $3,221.75 | 1 |
| Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.) | Oshkosh | not published | $943.44 – $3,234.41 | 7 |
| Orthopaedic Hospital of Wisconsin, LLC | Glendale | not published | $4,812.00 – $16,897.00 | 6 |
| UnityPoint Health - Meriter Hospital | Madison | not published | $818.01 – $2,732.15 | 10 |
| Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Milwaukee | not published | $1,441.31 – $3,536.29 | 6 |
| SSM Health St. Mary's Hospital - Madison | Madison | not published | $7,743.83 – $20,778.00 | 4 |
| Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Mequon | not published | $1,441.31 – $3,536.29 | 6 |
| Midwest Orthopedic Specialty Hospital | Franklin | not published | $3,221.75 – $3,221.75 | 1 |
| SSM Health St. Mary's Hospital - Janesville | Janesville | not published | $8,030.21 – $16,582.00 | 4 |
| SSM Health St. Clare Hospital - Baraboo | Baraboo | not published | $7,743.83 – $18,408.00 | 4 |
| Ascension Calumet Hospital, Inc. | Chilton | not published | $943.44 – $3,234.41 | 7 |
| Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.) | Appleton | not published | $943.44 – $3,234.41 | 7 |
| SSM Health Waupun Memorial Hospital | Waupun | not published | $7,609.00 – $18,364.00 | 3 |
| SSM Health St. Agnes Hospital - Fond du Lac | Fond Du Lac | not published | $7,609.00 – $20,292.15 | 6 |