Midwest Orthopedic Specialty Hospital
10101 S. 27th St, Franklin, WI · Ascension · · NPI 1861635971
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 |
|---|---|---|---|---|
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) CPT 64636 | $920.61 | $1,737.00 | $635.33 – $635.33 | 1 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | $1,841.22 | $3,474.00 | $1,538.63 – $1,538.63 | 1 |
| Destruction ciliary body CPT 66700 | not published | not published | $1,638.89 – $1,638.89 | 1 |
| Destruction ciliary body CPT 66720 | not published | not published | $1,724.30 – $1,724.30 | 1 |
| Destruction ciliary body CPT 66740 | not published | not published | $1,594.20 – $1,594.20 | 1 |
| Destruction cryosurgery anal lesion(s) simpl 46916 CPT 46916 | not published | not published | $192.94 – $835.18 | 4 |
| Destruction laser surgery anal lesions 46917 CPT 46917 | not published | not published | $1,637.95 – $1,637.95 | 1 |
| Destruction les conjunctiva CPT 68135 | not published | not published | $569.46 – $569.46 | 1 |
| Destruction mal lsn s/n/h/f/g 2.1-3cm CPT 17273 | not published | not published | $387.95 – $748.72 | 4 |
| Destruction mal lsn s/n/h/f/g 3.1-4cm CPT 17274 | not published | not published | $387.95 – $884.38 | 4 |
| Destruction mal lsn t/a/l 3.1-4cm CPT 17264 | not published | not published | $387.95 – $739.66 | 4 |
| Destruction mal lsn t/a/l >4cm CPT 17266 | not published | not published | $387.95 – $837.76 | 4 |
| Destruction penis lesion(s) chem 54050 CPT 54050 | not published | not published | $387.95 – $543.13 | 4 |
| Destruction penis lesion(s) exten 54065 CPT 54065 | not published | not published | $794.08 – $794.08 | 1 |
| Destruction premal lesions 15/> 17004 CPT 17004 | not published | not published | $387.95 – $543.13 | 4 |
| Destruction rectal tumor 45190 CPT 45190 | not published | not published | $2,526.89 – $2,526.89 | 1 |
| Destruction vag lesions complex 57065 CPT 57065 | not published | not published | $701.72 – $701.72 | 1 |
| Destruction vag lesions simple 57061 CPT 57061 | not published | not published | $409.93 – $409.93 | 1 |
| Destruct penis les/smp/electrodesi 54055 CPT 54055 | not published | not published | $430.55 – $430.55 | 1 |
| Detect agent nos dna dir CPT 87797 | not published | not published | $30.03 – $89.70 | 17 |
| Detect agnt mult dna direc CPT 87800 | $102.82 | $194.00 | $43.67 – $180.61 | 17 |
| Developmental screen/score/document 96110 CPT 96110 | not published | not published | $28.59 – $28.59 | 1 |
| Devel tst phys/qhp 1st hr CPT 96112 | not published | not published | $151.93 – $452.95 | 4 |
| Dev tst admin phys/qhp ea addl 30 min CPT 96113 | not published | not published | $201.96 – $201.96 | 1 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | not published | not published | $37.33 – $204.00 | 6 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $0.04 | $0.08 | $0.03 – $0.08 | 2 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $1.43 | $2.69 | $0.13 – $0.34 | 10 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $72.61 | $137.00 | $22.23 – $100.33 | 17 |
| Diabetes (HbA1c) Test CPT 83036 | $38.16 | $72.00 | $9.71 – $43.68 | 17 |
| Diag bronchoscope/catheter CPT 31643 | not published | not published | $655.77 – $655.77 | 1 |
| Diag laparo separate proc 49320 CPT 49320 | not published | not published | $1,178.05 – $1,178.05 | 1 |
| Diagnostic anoscopy CPT 46601 | not published | not published | $387.48 – $542.47 | 4 |
| Diagnostic anoscopy & biopsy CPT 46607 | not published | not published | $696.58 – $696.58 | 1 |
| Diagnostic anoscopy spx 46600 CPT 46600 | not published | not published | $125.16 – $320.26 | 4 |
| Diagnostic digital breast tomosynthesis bil CPT 77062 | not published | not published | $164.00 – $263.00 | 3 |
| Diagnostic digital breast tomosynthesis unil CPT 77061 | not published | not published | $139.04 – $205.70 | 3 |
| Diagnostic laryngoscopy 31505 CPT 31505 | not published | not published | $188.51 – $303.25 | 4 |
| Diagnostic laryngoscopy 31575 CPT 31575 | not published | not published | $188.51 – $416.16 | 4 |
| Diagnostic Mammogram (both breasts) CPT 77066 | not published | not published | $44.99 – $263.00 | 7 |
| Diagnostic Mammogram (one breast) CPT 77065 | not published | not published | $36.64 – $205.70 | 7 |
| Diagnostic radio unlisted proc CPT 76499 | $123.49 | $233.00 | $85.50 – $182.03 | 4 |
| Dialysis circuit perm vascular embolization 36909 CPT 36909 | $4,560.65 | $8,605.00 | $7,050.97 – $7,050.97 | 1 |
| Dialysis one evaluation CPT 90945 | not published | not published | $285.80 – $578.87 | 4 |
| Diathermy eg microwave CPT 97024 | not published | not published | $6.69 – $20.81 | 4 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $26.35 | $49.71 | $4.26 – $26.08 | 10 |
| Diffusing capacity CPT 94729 | $214.12 | $404.00 | $30.80 – $30.80 | 1 |
| Digital analysis of eeg CPT 95957 | not published | not published | $353.46 – $353.46 | 1 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $105.19 | $198.48 | $4.71 – $47.82 | 11 |
| Digoxin total therapeutic drug level CPT 80162 | $56.18 | $106.00 | $13.28 – $59.03 | 17 |
| Dilate biliary duct/ampulla CPT 47542 | $1,276.77 | $2,409.00 | $1,854.07 – $1,854.07 | 1 |
| Dilate esophagus CPT 43453 | not published | not published | $3,502.51 – $3,502.51 | 1 |
| Dilate esophagus 1/mult pass CPT 43450 | not published | not published | $767.22 – $1,274.55 | 4 |
| Dilate ic vasospasm ea add vsl diff territory CPT 61642 | $1,340.37 | $2,529.00 | $1,670.52 – $1,670.52 | 1 |
| Dilate ic vasospasm ea add vsl same territory CPT 61641 | $696.95 | $1,315.00 | $835.15 – $835.15 | 1 |
| Dilate ic vasospasm init CPT 61640 | $1,394.43 | $2,631.00 | $2,376.87 – $2,376.87 | 1 |
| Dilate tear duct opening CPT 68801 | not published | not published | $364.79 – $542.47 | 4 |
| Dilate urethra stricture CPT 53600 | not published | not published | $236.16 – $330.62 | 4 |
| Dilate urethra stricture CPT 53601 | not published | not published | $125.16 – $293.70 | 4 |
| Dilate urethra stricture CPT 53605 | not published | not published | $237.27 – $237.27 | 1 |
| Dilate urethra stricture CPT 53621 | not published | not published | $236.16 – $397.25 | 4 |
| Dilation/female urethra/initial 53660 CPT 53660 | not published | not published | $151.93 – $255.36 | 4 |
| Dilation of anal sphincter CPT 45905 | not published | not published | $617.39 – $617.39 | 1 |
| Dilation of cervical canal 57800 CPT 57800 | not published | not published | $217.68 – $217.68 | 1 |
| Dilation of rectal stricture 45910 CPT 45910 | not published | not published | $708.40 – $708.40 | 1 |
| Dilation of salivary duct CPT 42660 | $333.37 | $629.00 | $463.90 – $692.29 | 4 |
| Dilation of urethra CPT 53661 | not published | not published | $125.16 – $250.32 | 4 |
| Dilation of urethra CPT 53665 | not published | not published | $141.55 – $141.55 | 1 |
| Dilation of vagina CPT 57400 | not published | not published | $488.07 – $488.07 | 1 |
| Dilation salivary duct 42650 CPT 42650 | not published | not published | $310.30 – $310.30 | 1 |
| Dilation/urethral strict/male/ini 53620 CPT 53620 | not published | not published | $421.53 – $907.38 | 4 |
| Dilat xst trc ndurlgc px CPT 50436 | $3,632.62 | $6,854.00 | $560.40 – $560.40 | 1 |
| Dilat xst trc new access rcs CPT 50437 | $6,110.90 | $11,530.00 | $936.16 – $936.16 | 1 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $1.63 | $3.07 | $0.90 – $2.33 | 10 |
| Diphtheria-tetanus toxoids 0.5 ml (peds) CPT 90702 | not published | not published | $27.75 – $225.76 | 3 |
| Dir nsl mucous membrane test CPT 95065 | not published | not published | $38.11 – $83.30 | 4 |
| Disability dlco CPT 94727 | $292.03 | $551.00 | $41.68 – $212.70 | 4 |
| Disaccharidases CPT 82657 | $153.17 | $289.00 | $22.17 – $81.45 | 17 |
| Disarticulation sho sec clsr CPT 23921 | not published | not published | $1,696.22 – $1,696.22 | 1 |
| Discectomy ant dcmprn cord thoracic 1 ntrspc 63077 CPT 63077 | not published | not published | $5,342.22 – $5,342.22 | 1 |
| Discectomy ant dcmprn cord thoracic ea ntrsp 63078 CPT 63078 | not published | not published | $685.28 – $685.28 | 1 |
| Discography cerv/thor spine CPT 72285 | $1,023.96 | $1,932.00 | $175.40 – $3,947.38 | 3 |
| Dise eval slp do brth flx dx CPT 42975 | not published | not published | $422.12 – $422.12 | 1 |
| Dissolve clot heart vessel CPT 92975 | $1,579.93 | $2,981.00 | $1,280.95 – $1,280.95 | 1 |
| Dist revas ligation hemo CPT 36838 | not published | not published | $4,181.14 – $4,181.14 | 1 |
| Diverticulectomy/hypophar/esoph 43130 CPT 43130 | not published | not published | $2,887.17 – $2,887.17 | 1 |
| Division of fallopian tube 58605 CPT 58605 | not published | not published | $1,188.75 – $1,188.75 | 1 |
| #d/lmeth-l-methamphetamine CPT 80374 | not published | not published | $30.99 – $81.45 | 6 |
| Dlyd plmt xtn prosth ea addl CPT 34711 | $1,631.87 | $3,079.00 | $1,074.25 – $1,074.25 | 1 |
| Dmd dup/delet analysis CPT 81161 | not published | not published | $170.25 – $655.65 | 17 |
| Dmpk gene detc abnor allele CPT 81234 | not published | not published | $137.00 – $448.57 | 14 |
| Dna antibody native/double stranded CPT 86225 | $51.94 | $98.00 | $13.74 – $61.38 | 17 |
| Dna gardnerella CPT 87510 | not published | not published | $20.05 – $89.70 | 17 |
| Dna probe chlamydia CPT 87490 | not published | not published | $22.75 – $89.70 | 17 |
| Dna probe gc CPT 87590 | not published | not published | $26.88 – $89.70 | 17 |
| Dna trichomonas CPT 87660 | not published | not published | $20.05 – $89.70 | 17 |
| Doppler echo complete CPT 93320 | $801.36 | $1,512.00 | $62.12 – $62.12 | 1 |
| Doppler intravascular pressure flow initial vessel CPT 93571 | $1,345.14 | $2,538.00 | $315.04 – $315.04 | 1 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $864.96 | $1,632.00 | $74.56 – $212.70 | 4 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $682.64 | $1,288.00 | $41.82 – $175.22 | 4 |
| Dpyd gene common variants CPT 81232 | not published | not published | $174.81 – $573.69 | 14 |
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.