Unlisted all/immlg svc/px cost in Wisconsin

UNLISTED ALL/IMMLG SVC/PX · CPT 95199

Hospital	City	Cash price	Negotiated range	Payers
Ascension SE Wisconsin Hospital - St. Joseph Campus	Milwaukee	not published	$23.78 – $33.29	3
Ascension St. Francis Hospital, Inc.	Milwaukee	not published	$23.78 – $33.29	3
Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.)	Oshkosh	not published	$23.54 – $49.43	5
UnityPoint Health - Meriter Hospital	Madison	not published	$23.66 – $23.66	7
SSM Health St. Mary's Hospital - Madison	Madison	not published	$21.07 – $28.09	2
Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Milwaukee	not published	$23.84 – $52.45	3
Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Mequon	not published	$23.84 – $52.45	3
Midwest Orthopedic Specialty Hospital	Franklin	not published	$23.78 – $33.29	3
SSM Health St. Mary's Hospital - Janesville	Janesville	not published	$21.85 – $29.13	2
Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.)	Appleton	not published	$23.54 – $49.43	5
SSM Health St. Agnes Hospital - Fond du Lac	Fond Du Lac	not published	$21.46 – $55.21	4