Cptrz oph img pst sg rta oct cost in Wisconsin

CPTRZ OPH IMG PST SG RTA OCT · CPT 92137

Hospital	City	Cash price	Negotiated range	Payers
SSM Health St. Clare Hospital - Baraboo	Baraboo	not published	$157.30 – $209.73	2
UnityPoint Health - Meriter Hospital	Madison	not published	$22.09 – $94.77	9
Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Mequon	not published	$90.39 – $700.65	7
Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Milwaukee	not published	$90.39 – $700.65	7
Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.)	Appleton	not published	$299.37 – $628.68	5
Ascension SE Wisconsin Hospital - St. Joseph Campus	Milwaukee	not published	$75.11 – $700.65	5
Ascension St. Francis Hospital, Inc.	Milwaukee	not published	$75.11 – $700.65	5
Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.)	Oshkosh	not published	$299.37 – $628.68	5
Midwest Orthopedic Specialty Hospital	Franklin	not published	$75.11 – $700.65	5
SSM Health St. Agnes Hospital - Fond du Lac	Fond Du Lac	not published	$160.18 – $412.19	4
SSM Health Monroe Hospital	Monroe	not published	$209.73 – $209.73	1
SSM Health St. Mary's Hospital - Madison	Madison	not published	$157.30 – $209.73	2