Ascension NE Wisconsin - St. Elizabeth Campus (Ascension NE Wisconsin, Inc.)
1506 S. Oneida St, Appleton, WI · Ascension · · NPI 1407803638
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| X-ray pelvis complete > 3 views CPT 72190 | $119.70 | $210.00 | $13.01 – $214.68 | 12 |
| Xray place dist ext thor ao CPT 75959 | not published | not published | $0.02 – $394.36 | 7 |
| Xray place prox ext thor ao CPT 75958 | not published | not published | $0.02 – $458.27 | 7 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $243.96 | $428.00 | $26.06 – $720.99 | 12 |
| X-ray ribs 2 views left CPT 71100 | $98.04 | $172.00 | $11.18 – $177.77 | 12 |
| X-ray ribs 3 views bilateral CPT 71110 | $196.08 | $344.00 | $14.86 – $214.68 | 12 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $98.04 | $172.00 | $13.76 – $214.68 | 12 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $196.08 | $344.00 | $16.46 – $214.68 | 12 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $60.99 | $107.00 | $11.55 – $214.68 | 12 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $76.95 | $135.00 | $8.96 – $177.77 | 12 |
| X-ray scapula complete (both sides) CPT 73010 | $60.99 | $107.00 | $9.32 – $214.68 | 12 |
| X-ray sella turcica CPT 70240 | not published | not published | $9.70 – $177.77 | 12 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $50.73 | $89.00 | $7.86 – $177.77 | 12 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $57.00 | $100.00 | $11.18 – $177.77 | 12 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $314.64 | $552.00 | $25.98 – $1,106.93 | 12 |
| X-ray skull < 4 views CPT 70250 | $60.99 | $107.00 | $9.33 – $214.68 | 12 |
| X-ray skull > 4 views complete CPT 70260 | $65.55 | $115.00 | $14.49 – $214.68 | 12 |
| X-ray slg plne bdy sect without urogr CPT 76100 | not published | not published | $29.49 – $214.68 | 12 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | $116.85 | $205.00 | $40.68 – $359.39 | 12 |
| X-ray small intestine follow-through study CPT 74248 | $74.67 | $131.00 | $35.15 – $85.61 | 6 |
| X-ray spine single view CPT 72020 | $63.84 | $112.00 | $8.23 – $177.77 | 12 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $50.73 | $89.00 | $11.18 – $177.77 | 12 |
| X-ray sternum > 2 views CPT 71120 | $50.73 | $89.00 | $10.08 – $177.77 | 12 |
| X-ray surgical specimen CPT 76098 | $443.46 | $778.00 | $16.09 – $1,106.93 | 12 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | $201.21 | $353.00 | $26.91 – $359.39 | 12 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | $51.30 | $90.00 | $12.28 – $177.77 | 12 |
| X-ray thoracic spine 2 views CPT 72070 | $94.62 | $166.00 | $10.43 – $214.68 | 12 |
| X-ray thoracic spine 3 views CPT 72072 | $111.15 | $195.00 | $11.55 – $214.68 | 12 |
| X-ray thoracolumbar spine >=2 views CPT 72080 | $99.18 | $174.00 | $10.81 – $177.77 | 12 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $50.73 | $89.00 | $13.38 – $177.77 | 11 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views CPT 72082 | $83.79 | $147.00 | $16.09 – $214.68 | 11 |
| X-ray tibia/fibula 2 views (both sides) CPT 73590 | $78.09 | $137.00 | $8.23 – $177.77 | 12 |
| X-ray toe(s) > 2 views (both sides) CPT 73660 | $50.73 | $89.00 | $6.75 – $177.77 | 12 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 | $200.07 | $351.00 | $45.23 – $359.39 | 12 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 | $191.52 | $336.00 | $40.67 – $359.39 | 12 |
| X-ray upper gi delay w/kub CPT 74241 | not published | not published | $78.25 – $151.12 | 3 |
| X-ray upper gi&small intest CPT 74245 | not published | not published | $103.69 – $199.19 | 3 |
| X-ray wrist 2 views (both sides) CPT 73100 | $54.72 | $96.00 | $8.59 – $177.77 | 12 |
| X-ray xm phrnx&/crv esoph c+ CPT 74210 | not published | not published | $29.50 – $359.39 | 12 |
| Xtrnl ecg rec>48hr<7d CPT 93241 | not published | not published | $254.01 – $276.38 | 6 |
| Xtrnl ecg rec up to 48 hrs CPT 93224 | not published | not published | $76.99 – $288.42 | 7 |
| Xylose absorption test blood &/or urine CPT 84620 | not published | not published | $12.91 – $49.83 | 16 |
| Yersinia antibody CPT 86793 | not published | not published | $8.32 – $50.91 | 16 |
| Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr HCPCS J3485 | $3.08 | $5.40 | $2.11 – $5.40 | 6 |
| Zika virus dna/rna amp probe CPT 87662 | not published | not published | $51.31 – $198.06 | 12 |
| Zika virus igm antibody CPT 86794 | not published | not published | $16.85 – $65.04 | 12 |
| Ziprasidone 20 mg/ml (final concentration) intramuscular solution HCPCS J3486 | $67.52 | $118.46 | $12.52 – $118.46 | 6 |
| Zoledronic acid 4 mg/5 ml intravenous solution HCPCS J3489 | $95.14 | $166.91 | $8.88 – $43.35 | 7 |
| Zoster vaccine-live inj CPT 90736 | not published | not published | $227.57 – $227.57 | 2 |
| Zrsr2 gene common variants CPT 81360 | not published | not published | $193.25 – $745.95 | 12 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.