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 |
|---|---|---|---|---|
| Lefort i-3/> piece without graft CPT 21143 | not published | not published | $5,217.90 – $5,217.90 | 1 |
| Lefort ii anterior intrusion CPT 21150 | not published | not published | $6,175.16 – $6,175.16 | 1 |
| Legion pneumo dna dir prob CPT 87540 | not published | not published | $20.05 – $89.70 | 17 |
| Legion pneumo dna quant CPT 87542 | not published | not published | $41.76 – $187.68 | 17 |
| Leg vein fusion 34530 CPT 34530 | not published | not published | $3,997.07 – $3,997.07 | 1 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $1,074.31 | $2,027.00 | $116.18 – $328.59 | 4 |
| Leishmania antibody CPT 86717 | not published | not published | $9.63 – $28.79 | 17 |
| Lengthening of hand tendon CPT 26478 | not published | not published | $2,234.87 – $2,234.87 | 1 |
| Lengthening of palate CPT 42227 | not published | not published | $3,143.16 – $3,143.16 | 1 |
| Lengthening of palate+pharyngeal flap 42226 CPT 42226 | not published | not published | $3,331.56 – $3,331.56 | 1 |
| Lengthening of thigh bone CPT 27466 | not published | not published | $4,259.21 – $4,259.21 | 1 |
| Lengthening of thigh tendon CPT 27393 | not published | not published | $1,825.24 – $1,825.24 | 1 |
| Lengthening of thigh tendons CPT 27394 | not published | not published | $2,317.60 – $2,317.60 | 1 |
| Lengthening of thigh tendons CPT 27395 | not published | not published | $3,183.97 – $3,183.97 | 1 |
| Lengthening or shortening - tibia and fibula 27715 CPT 27715 | not published | not published | $3,886.51 – $3,886.51 | 1 |
| Lengthen metacarpal/finger CPT 26568 | not published | not published | $3,223.91 – $3,223.91 | 1 |
| Lengthen radius or ulna CPT 25391 | not published | not published | $3,608.59 – $3,608.59 | 1 |
| Lengthen radius & ulna CPT 25393 | not published | not published | $4,173.98 – $4,173.98 | 1 |
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | $436.85 | $824.25 | $177.47 – $177.47 | 1 |
| Lens iol ant chamb 10.5 HCPCS V2630 | $174.90 | $330.00 | $177.47 – $177.47 | 1 |
| Leukacyte transfusion CPT 86950 | not published | not published | $21.83 – $241.98 | 11 |
| Leukocyte phagocytosis CPT 86344 | not published | not published | $10.39 – $35.40 | 17 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $0.19 | $0.35 | $0.06 – $0.20 | 10 |
| Levetiracetam therapeutic drug level CPT 80177 | $47.70 | $90.00 | $13.25 – $59.03 | 17 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $12.83 | $24.20 | $1.12 – $5.76 | 10 |
| L hrt cath chd nm/abn nt cnj CPT 93595 | not published | not published | $933.84 – $933.84 | 1 |
| Lidocaine therapeutic drug level CPT 80176 | $116.60 | $220.00 | $14.69 – $66.10 | 17 |
| Ligate esophagus veins CPT 43400 | not published | not published | $5,490.86 – $5,490.86 | 1 |
| Ligate leg veins open CPT 37761 | not published | not published | $2,014.24 – $2,014.24 | 1 |
| Ligate leg veins radical 37760 CPT 37760 | not published | not published | $2,255.31 – $2,255.31 | 1 |
| Ligate oviduct(s) add-on 58611 CPT 58611 | not published | not published | $279.38 – $279.38 | 1 |
| Ligate/staple esophagus CPT 43405 | not published | not published | $5,290.48 – $5,290.48 | 1 |
| Ligate/strip long leg vein CPT 37722 | not published | not published | $1,750.27 – $1,750.27 | 1 |
| Ligate/strip short leg vein CPT 37718 | not published | not published | $1,600.10 – $1,600.10 | 1 |
| Ligate/transect fallopian tubes 58600 CPT 58600 | not published | not published | $1,315.50 – $1,315.50 | 1 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | not published | not published | $1,122.73 – $1,122.73 | 1 |
| Ligation common iliac vein CPT 37660 | not published | not published | $4,211.73 – $4,211.73 | 1 |
| Ligation/divis of long saph vein 37700 CPT 37700 | not published | not published | $912.21 – $912.21 | 1 |
| Ligation external carotid artery 37600 CPT 37600 | not published | not published | $2,591.08 – $2,591.08 | 1 |
| Ligation internal/common carotid artery 37605 CPT 37605 | not published | not published | $2,924.95 – $2,924.95 | 1 |
| Ligation internal jugular vein 37565 CPT 37565 | not published | not published | $2,646.73 – $2,646.73 | 1 |
| Ligation major artery chest CPT 37616 | not published | not published | $3,995.87 – $3,995.87 | 1 |
| Ligation/major artery/extremity 37618 CPT 37618 | not published | not published | $1,402.11 – $1,402.11 | 1 |
| Ligation major artery neck CPT 37615 | not published | not published | $1,882.75 – $1,882.75 | 1 |
| Ligation nasal sinus artery CPT 30915 | not published | not published | $2,097.19 – $2,097.19 | 1 |
| Ligation of abdomen artery 37617 CPT 37617 | not published | not published | $4,856.05 – $4,856.05 | 1 |
| Ligation of femoral vein CPT 37650 | not published | not published | $1,858.14 – $1,858.14 | 1 |
| Ligation of inf vena cava CPT 37619 | not published | not published | $5,940.77 – $5,940.77 | 1 |
| Ligation of neck artery CPT 37606 | not published | not published | $2,117.07 – $2,117.07 | 1 |
| Ligation of salivary duct CPT 42665 | not published | not published | $1,138.55 – $1,138.55 | 1 |
| Ligation of shunt CPT 49428 | not published | not published | $1,550.56 – $1,550.56 | 1 |
| Ligation upper jaw artery CPT 30920 | not published | not published | $3,041.67 – $3,041.67 | 1 |
| Ligation vericose vein cluster(s) 1 leg CPT 37785 | not published | not published | $1,293.94 – $1,293.94 | 1 |
| Lig/band angioaccess av fistula CPT 37607 | not published | not published | $1,374.51 – $1,374.51 | 1 |
| Lig&div&compl strpg saph vn CPT 37735 | not published | not published | $2,503.99 – $2,503.99 | 1 |
| Limb exercise test CPT 95875 | not published | not published | $151.93 – $212.70 | 4 |
| Limb nerve surgery add-on CPT 64783 | not published | not published | $818.66 – $818.66 | 1 |
| Limited autopsy CPT 88036 | not published | not published | $131.99 – $382.47 | 8 |
| Limited autopsy CPT 88037 | not published | not published | $117.58 – $339.96 | 8 |
| Limited visual field xm CPT 92081 | not published | not published | $54.67 – $80.75 | 4 |
| Lipase CPT 83690 | $46.64 | $88.00 | $6.89 – $30.71 | 17 |
| Lip exc/transverse wedge/w closure 40510 CPT 40510 | not published | not published | $1,782.83 – $1,782.83 | 1 |
| Lipoprotein blood high res frac & quant CPT 83701 | $81.09 | $153.00 | $33.86 – $110.95 | 17 |
| Lipoprotein blood quant CPT 83704 | $85.33 | $161.00 | $34.19 – $141.66 | 17 |
| Lipoprotein direct measurement hdl CPT 83718 | $29.15 | $55.00 | $8.19 – $36.60 | 17 |
| Lipoprotein direct measurement ldl CPT 83721 | $30.74 | $58.00 | $10.50 – $42.50 | 17 |
| Lipoprtn dir meas sd ldl chl CPT 83722 | not published | not published | $34.19 – $114.51 | 14 |
| Lip surgery procedure CPT 40799 | not published | not published | $225.49 – $315.69 | 3 |
| Listeria monocytogenes CPT 86723 | not published | not published | $9.63 – $31.00 | 17 |
| Lithium therapeutic drug level CPT 80178 | $34.98 | $66.00 | $6.61 – $29.50 | 17 |
| Lithotripsy transluminal coronary percutaneous CPT 92972 | not published | not published | $452.81 – $452.81 | 1 |
| Litt icr 1 traj 1 smpl les CPT 61736 | not published | not published | $3,411.94 – $3,411.94 | 1 |
| Litt icr mlt trj mlt/cplx ls CPT 61737 | not published | not published | $4,057.72 – $4,057.72 | 1 |
| Liver abs/cyst dr opn 1-2 stge CPT 47010 | not published | not published | $4,343.47 – $4,343.47 | 1 |
| Liver ds alys 3 bmrk srm alg CPT 81517 | not published | not published | $176.19 – $582.05 | 6 |
| Liver elastography 91200 CPT 91200 | not published | not published | $44.06 – $212.70 | 4 |
| Liver Function Test CPT 80076 | $51.94 | $98.00 | $8.17 – $36.60 | 17 |
| Liver hem/re-expl wnd/remove pack 47362 CPT 47362 | not published | not published | $5,215.88 – $5,215.88 | 1 |
| Liver imaging CPT 78201 | not published | not published | $72.31 – $1,101.15 | 5 |
| Liver imag w/vasclr flow CPT 78202 | not published | not published | $82.14 – $1,101.15 | 5 |
| Liver/spleen imag static only CPT 78215 | not published | not published | $82.73 – $848.52 | 5 |
| Liver/spleen imag w/vasclr flow CPT 78216 | not published | not published | $93.81 – $848.52 | 5 |
| Lmtd oph exam general anes CPT 92019 | not published | not published | $240.96 – $240.96 | 1 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | $2,422.41 – $2,422.41 | 1 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $5.91 | $11.14 | $1.04 – $4.12 | 10 |
| Loudness balance test CPT 92562 | not published | not published | $151.91 – $423.33 | 4 |
| Low back disk surgery CPT 63030 | not published | not published | $3,471.59 – $3,471.59 | 1 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $858.60 | $1,620.00 | $172.86 – $724.00 | 6 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $850.12 | $1,604.00 | $208.83 – $828.27 | 6 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $841.64 | $1,588.00 | $103.26 – $724.00 | 6 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $1,441.07 | $2,719.00 | $346.78 – $836.00 | 6 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $1,387.01 | $2,617.00 | $305.64 – $836.00 | 6 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $1,341.96 | $2,532.00 | $234.71 – $836.00 | 6 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $155.29 | $293.00 | $38.50 – $245.18 | 6 |
| Lower jaw bone graft CPT 21215 | not published | not published | $15,036.30 – $15,036.30 | 1 |
| Low frequency non-thermal Ultrasound CPT 97610 | not published | not published | $192.94 – $391.17 | 4 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | $2,593.36 – $2,593.36 | 1 |
| Lsh uterus above 250 g CPT 58543 | not published | not published | $2,997.06 – $2,997.06 | 1 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $2,962.22 – $2,962.22 | 1 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | $3,261.29 – $3,261.29 | 1 |
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.