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 |
|---|---|---|---|---|
| Ghs sp train/fitting sp device - kx CPT 92609 | not published | not published | $97.86 – $368.80 | 4 |
| Ghs st - eval for alt comm CPT 92567 | not published | not published | $38.11 – $53.35 | 4 |
| Ghs strapping shoulder - 29240 CPT 29240 | not published | not published | $105.97 – $175.22 | 4 |
| Ghs st - re-eval for alt comm CPT 92597 | $209.35 | $395.00 | $69.04 – $240.92 | 4 |
| Ghs subcutaneous infus, for therapy ea. add. hr CPT 96370 | not published | not published | $44.80 – $62.72 | 4 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | not published | not published | $204.58 – $629.10 | 4 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | not published | not published | $594.39 – $1,040.37 | 4 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | not published | not published | $387.95 – $599.90 | 4 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | not published | not published | $816.50 – $816.50 | 1 |
| Ghs trypsin (fecal) CPT 84488 | not published | not published | $7.30 – $33.05 | 17 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | not published | not published | $232.93 – $1,142.54 | 4 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | not published | not published | $232.93 – $1,084.65 | 4 |
| Ghs urine, hydroxproline total CPT 83505 | not published | not published | $24.30 – $108.61 | 17 |
| Ghs urine, porphyrins quant CPT 84120 | $64.13 | $121.00 | $14.71 – $66.10 | 17 |
| Ghs vaginal delivery only CPT 59409 | not published | not published | $2,919.47 – $2,919.47 | 1 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | not published | not published | $515.22 – $2,486.42 | 4 |
| Ghs windowing of cast CPT 29730 | not published | not published | $153.22 – $235.66 | 4 |
| Giardia ag if CPT 87269 | not published | not published | $13.61 – $54.30 | 17 |
| Giardia lamblia antibody CPT 86674 | $64.13 | $121.00 | $14.72 – $66.10 | 17 |
| Gi endoscopic ultrasound CPT 76975 | not published | not published | $143.97 – $519.00 | 6 |
| Gi inhouse confirmation CPT 87045 | $53.53 | $101.00 | $9.44 – $42.50 | 17 |
| Gingivoplasty each quadrant CPT 41872 | not published | not published | $1,368.69 – $1,368.69 | 1 |
| Gi protein loss CPT 78282 | not published | not published | $64.89 – $848.52 | 5 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | $1,381.71 | $2,607.00 | $641.75 – $1,274.55 | 4 |
| Gi trc img intral colon i&r CPT 91113 | not published | not published | $422.42 – $1,239.41 | 4 |
| Gi trc img intral esophagus CPT 91111 | not published | not published | $176.46 – $1,274.55 | 4 |
| Gi wireless capsule measure CPT 91112 | not published | not published | $369.27 – $1,274.55 | 4 |
| Gjb2 gene full sequence CPT 81252 | not published | not published | $101.12 – $331.70 | 14 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $61.52 – $201.86 | 14 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $35.00 – $114.50 | 14 |
| Glaucoma surgery CPT 66150 | not published | not published | $3,198.06 – $3,198.06 | 1 |
| Glaucoma surgery CPT 66155 | not published | not published | $3,196.72 – $3,196.72 | 1 |
| Glaucoma surgery CPT 66160 | not published | not published | $3,607.06 – $3,607.06 | 1 |
| Glaucoma surgery CPT 66170 | not published | not published | $3,529.18 – $3,529.18 | 1 |
| Glucagon plasma - sendout CPT 82943 | not published | not published | $14.29 – $46.37 | 17 |
| Glucagon tolerance panel CPT 80422 | not published | not published | $46.07 – $231.36 | 17 |
| Glucagon tolerance panel CPT 80424 | not published | not published | $50.50 – $231.36 | 17 |
| Glucagon tolerance test CPT 82946 | not published | not published | $12.29 – $41.76 | 17 |
| Glucose 1 hr post dose CPT 82950 | $24.38 | $46.00 | $4.75 – $21.25 | 17 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | not published | not published | $6.05 – $27.15 | 17 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $10.60 | $20.00 | $3.28 – $10.63 | 17 |
| Glucose blood quantitative CPT 82947 | $25.97 | $49.00 | $3.93 – $17.70 | 17 |
| Glucose body fluid CPT 82945 | $6.36 | $12.00 | $3.93 – $17.70 | 17 |
| Glucose monitoring continual min 72hr pt CPT 95249 | not published | not published | $57.68 – $180.06 | 4 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $53.53 | $101.00 | $12.87 – $57.86 | 17 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $18.02 | $34.00 | $3.92 – $17.70 | 17 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $64.13 | $121.00 | $18.58 – $83.80 | 17 |
| Gonadotropin hormone panel CPT 80426 | not published | not published | $148.41 – $638.63 | 17 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $64.13 | $121.00 | $18.52 – $82.63 | 17 |
| Gonioscopy CPT 92020 | not published | not published | $88.81 – $175.22 | 4 |
| Goniotomy CPT 65820 | not published | not published | $2,731.81 – $2,731.81 | 1 |
| Graft hand or finger tendon CPT 26416 | not published | not published | $2,582.95 – $2,582.95 | 1 |
| Graft repair of spine defect 63710 CPT 63710 | not published | not published | $3,878.42 – $3,878.42 | 1 |
| Great toe-hand transfer CPT 26551 | not published | not published | $10,361.46 – $10,361.46 | 1 |
| Great toe with reduction 28495 CPT 28495 | not published | not published | $232.93 – $650.36 | 4 |
| Grfg autol fat lipo 25 cc/< CPT 15773 | not published | not published | $2,112.63 – $2,112.63 | 1 |
| Grfg autol fat lipo 50 cc/< CPT 15771 | not published | not published | $2,092.87 – $2,092.87 | 1 |
| Grfg autol fat lipo ea addl CPT 15772 | not published | not published | $658.87 – $658.87 | 1 |
| Grfg autol soft tiss dir exc CPT 15769 | not published | not published | $1,749.78 – $1,749.78 | 1 |
| Group behave couns 2-10 HCPCS G0473 | $100.17 | $189.00 | $19.17 – $19.17 | 1 |
| Group mnt 2 or more 30 mins HCPCS G0271 | $31.27 | $59.00 | $24.05 – $24.05 | 1 |
| Group train without patient HCPCS G0543 | $35.51 | $67.00 | $33.06 – $33.06 | 1 |
| Growth hormone antibody CPT 86277 | not published | not published | $15.74 – $70.83 | 17 |
| Growth hormone panel CPT 80428 | not published | not published | $66.70 – $352.94 | 17 |
| Growth hormone panel CPT 80430 | not published | not published | $129.33 – $352.94 | 17 |
| Growth stimulation gene 2 CPT 83006 | not published | not published | $36.40 – $177.66 | 17 |
| Grp adapt bhv tx by phy/qhp CPT 97158 | not published | not published | $16.32 – $40.50 | 4 |
| Grp adapt bhv tx by tech CPT 97154 | not published | not published | $14.18 – $40.50 | 4 |
| Gstrct prtl dstl w/roux-en-y rcnstj 43633 CPT 43633 | not published | not published | $6,913.63 – $6,913.63 | 1 |
| Gstr rstcv oth/thn v-band CPT 43843 | not published | not published | $4,603.16 – $4,603.16 | 1 |
| Gstr rstcv px shrt roux-en-y CPT 43846 | not published | not published | $5,802.57 – $5,802.57 | 1 |
| Gstr rstcv px sm int rcnstj CPT 43847 | not published | not published | $6,414.82 – $6,414.82 | 1 |
| Gstr rstcv px v-banded gstp CPT 43842 | not published | not published | $4,380.25 – $4,380.25 | 1 |
| Gstrst open wo constj tube CPT 43830 | not published | not published | $2,523.98 – $2,523.98 | 1 |
| G-tube reposition CPT 43761 | $501.91 | $947.00 | $236.16 – $427.42 | 4 |
| Gu dilat ureter/urethra s&i CPT 74485 | $1,080.67 | $2,039.00 | $89.39 – $4,034.23 | 3 |
| Guided cath fluid drainage 10030 CPT 10030 | not published | not published | $683.20 – $2,808.02 | 4 |
| Guide endoanchr sg-64 aaa 62cm HCPCS L8670 | $2,721.47 | $5,134.85 | $829.96 – $829.96 | 1 |
| Guid loc target vol rad tx CPT 77387 | not published | not published | $85.56 – $85.56 | 1 |
| Gum graft CPT 41870 | not published | not published | $1,104.12 – $1,104.12 | 1 |
| Gynecomastia (males) 19300 CPT 19300 | not published | not published | $1,879.29 – $1,879.29 | 1 |
| Hair removal by electrolysis 17380 CPT 17380 | not published | not published | $271.77 – $832.15 | 4 |
| Hair trnspl 1-15 punch grfts CPT 15775 | not published | not published | $387.95 – $1,088.15 | 4 |
| Hair trnspl >15 punch grafts CPT 15776 | not published | not published | $387.95 – $1,806.33 | 4 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $8.98 | $16.94 | $0.99 – $7.11 | 10 |
| Handle/convey/speciman/office-lab 99000 CPT 99000 | not published | not published | $7.21 – $18.43 | 4 |
| Hand tendon/muscle transfer CPT 26494 | not published | not published | $2,834.58 – $2,834.58 | 1 |
| Hand tendon reconstruction CPT 26500 | not published | not published | $2,243.45 – $2,243.45 | 1 |
| Hand tendon reconstruction CPT 26502 | not published | not published | $2,536.88 – $2,536.88 | 1 |
| Hand X-ray CPT 73130 | $171.19 | $323.00 | $29.98 – $204.00 | 6 |
| Haptoglobin quantitative CPT 83010 | $50.88 | $96.00 | $12.58 – $56.65 | 17 |
| Harvest allogeneic stem cell CPT 38205 | not published | not published | $306.31 – $306.31 | 1 |
| Harvest auto stem cells CPT 38206 | not published | not published | $308.84 – $308.84 | 1 |
| Harvest cultured skin graft 15040 CPT 15040 | not published | not published | $924.70 – $924.70 | 1 |
| Harvest eye tissue alograft CPT 68371 | not published | not published | $1,508.41 – $1,508.41 | 1 |
| Harvest femoropopliteal vein 35572 CPT 35572 | not published | not published | $1,261.90 – $1,261.90 | 1 |
| Harvest stem cell concentrte CPT 38215 | not published | not published | $181.39 – $594.31 | 4 |
| Harvest vein for bypass 35500 CPT 35500 | not published | not published | $1,161.26 – $1,161.26 | 1 |
| Hast w/i&r phys/qhp CPT 94452 | $295.21 | $557.00 | $48.93 – $175.22 | 4 |
| Hast w/oxygen titrate CPT 94453 | not published | not published | $64.06 – $175.22 | 4 |
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.