Myocrd img pet mlt rst&strs cost in Wisconsin

MYOCRD IMG PET MLT RST&STRS · CPT 78492

Hospital	City	Cash price	Negotiated range	Payers
Ascension SE Wisconsin Hospital - St. Joseph Campus	Milwaukee	not published	$306.88 – $3,756.00	3
SSM Health Ripon Community Hospital	Ripon	not published	$1,533.24 – $1,533.24	1
SSM Health Monroe Hospital	Monroe	not published	$1,180.21 – $1,388.96	2
Ascension St. Francis Hospital, Inc.	Milwaukee	not published	$306.88 – $3,756.00	3
Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.)	Oshkosh	not published	$89.97 – $213.80	7
UnityPoint Health - Meriter Hospital	Madison	not published	$77.95 – $258.01	9
Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Milwaukee	not published	$138.70 – $3,330.77	7
SSM Health St. Mary's Hospital - Madison	Madison	not published	$1,041.72 – $3,603.37	3
Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.)	Mequon	not published	$138.70 – $3,330.77	7
Midwest Orthopedic Specialty Hospital	Franklin	not published	$306.88 – $3,756.00	3
SSM Health St. Mary's Hospital - Janesville	Janesville	not published	$1,080.24 – $3,434.33	3
SSM Health St. Clare Hospital - Baraboo	Baraboo	not published	$1,041.72 – $4,785.83	3
Ascension Calumet Hospital, Inc.	Chilton	not published	$89.97 – $213.80	7
Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.)	Appleton	not published	$89.97 – $213.80	7
SSM Health Waupun Memorial Hospital	Waupun	not published	$1,533.24 – $1,533.24	1
SSM Health St. Agnes Hospital - Fond du Lac	Fond Du Lac	not published	$1,060.78 – $2,729.74	4