Cine/video x-rays add-on cost in Wisconsin

Cine/video x-rays add-on · CPT 76125

Hospital	City	Cash price	Negotiated range	Payers
UnityPoint Health - Meriter Hospital	Madison	not published	$12.35 – $40.88	10
Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Mequon	not published	$21.22 – $47.07	6
Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Milwaukee	not published	$21.22 – $47.07	6
SSM Health Waupun Memorial Hospital	Waupun	not published	$105.72 – $105.72	1
SSM Health St. Mary's Hospital - Madison	Madison	not published	$258.45 – $258.45	1
SSM Health St. Mary's Hospital - Janesville	Janesville	not published	$246.36 – $246.36	1
SSM Health St. Clare Hospital - Baraboo	Baraboo	not published	$343.28 – $343.28	1
SSM Health St. Agnes Hospital - Fond du Lac	Fond Du Lac	not published	$105.72 – $105.72	1
SSM Health Ripon Community Hospital	Ripon	not published	$105.72 – $105.72	1
SSM Health Monroe Hospital	Monroe	not published	$86.57 – $86.57	1
Ascension St. Francis Hospital, Inc.	Milwaukee	not published	$48.47 – $204.00	2
Ascension SE Wisconsin Hospital - St. Joseph Campus	Milwaukee	not published	$48.47 – $204.00	2
Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.)	Oshkosh	not published	$13.88 – $32.96	7
Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.)	Appleton	not published	$13.88 – $32.96	7
Ascension Calumet Hospital, Inc.	Chilton	not published	$13.88 – $32.96	7
Midwest Orthopedic Specialty Hospital	Franklin	not published	$48.47 – $204.00	2