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 |
|---|---|---|---|---|
| X-ray exam of eye sockets CPT 70200 | $158.47 | $299.00 | $48.30 – $245.18 | 6 |
| X-ray exam of femur 1 CPT 73551 | $155.82 | $294.00 | $28.74 – $204.00 | 6 |
| X-ray exam of jaw joint CPT 70328 | not published | not published | $31.22 – $204.00 | 6 |
| X-ray exam of jaw joint CPT 70332 | not published | not published | $106.16 – $517.79 | 6 |
| X-ray exam of mastoids CPT 70120 | $75.26 | $142.00 | $31.22 – $245.18 | 6 |
| X-ray exam of middle ear CPT 70134 | not published | not published | $60.44 – $1,086.50 | 6 |
| X-ray exam of penis CPT 74445 | not published | not published | $103.26 – $245.18 | 6 |
| X-ray exam of perineum CPT 74775 | not published | not published | $106.57 – $517.79 | 6 |
| X-ray exam of salivary gland CPT 70380 | not published | not published | $31.15 – $204.00 | 6 |
| X-ray exam of sinuses CPT 70210 | $147.87 | $279.00 | $29.98 – $204.00 | 6 |
| X-ray exam of tear duct CPT 70170 | not published | not published | $51.47 – $517.79 | 6 |
| X-ray exam of teeth CPT 70300 | not published | not published | $20.15 – $204.00 | 6 |
| X-ray exam of teeth CPT 70310 | not published | not published | $27.57 – $517.79 | 6 |
| X-ray exam si joints CPT 72200 | $112.89 | $213.00 | $29.98 – $245.18 | 6 |
| X-ray exam thorac spine4/>vw CPT 72074 | $163.24 | $308.00 | $37.33 – $245.18 | 6 |
| X-ray eye detection foreign body (both sides) CPT 70030 | $140.98 | $266.00 | $28.81 – $204.00 | 6 |
| X-ray facial bones complete > 3 views CPT 70150 | $158.47 | $299.00 | $45.82 – $245.18 | 6 |
| X-ray fallopian tube CPT 74742 | not published | not published | $100.64 – $204.00 | 2 |
| X-ray femur >=2 views (both sides) CPT 73552 | $182.85 | $345.00 | $32.40 – $204.00 | 6 |
| X-ray finger(s) >= 2 views (both sides) CPT 73140 | $155.82 | $294.00 | $23.84 – $204.00 | 6 |
| X-ray foot 2 views (both sides) CPT 73620 | $148.93 | $281.00 | $26.39 – $204.00 | 6 |
| X-ray forearm 2 views (both sides) CPT 73090 | $144.69 | $273.00 | $28.74 – $204.00 | 6 |
| X-ray hand 2 views (both sides) CPT 73120 | $139.92 | $264.00 | $28.74 – $245.18 | 6 |
| X-ray head for orthodontia CPT 70350 | not published | not published | $31.40 – $204.00 | 6 |
| X-ray heel/calcaneus > 2 views (both sides) CPT 73650 | $135.15 | $255.00 | $27.57 – $204.00 | 6 |
| X-ray hip uni w/wo pelvis min 4 views CPT 73503 | $226.84 | $428.00 | $48.92 – $245.18 | 6 |
| X-ray hip with pelvis when performed bilateral 2 views CPT 73521 | $175.96 | $332.00 | $39.71 – $245.18 | 6 |
| X-ray hip with pelvis when performed bilateral 3-4 views CPT 73522 | $215.18 | $406.00 | $51.41 – $245.18 | 6 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | $249.10 | $470.00 | $55.06 – $245.18 | 6 |
| X-ray hip with pelvis when performed unilateral 1 view left CPT 73501 | $131.44 | $248.00 | $32.40 – $204.00 | 6 |
| X-ray humerus >= 2 views left CPT 73060 | $147.87 | $279.00 | $28.74 – $204.00 | 6 |
| X-ray joint survey 1 view CPT 77077 | $156.88 | $296.00 | $55.06 – $245.18 | 6 |
| X-ray knee 1-2 views (both sides) CPT 73560 | $147.87 | $279.00 | $28.74 – $204.00 | 6 |
| X-ray knee 3 views (both sides) CPT 73562 | $152.64 | $288.00 | $32.40 – $204.00 | 6 |
| X-ray knee ap standing bilateral CPT 73565 | $138.86 | $262.00 | $29.91 – $204.00 | 6 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $156.88 | $296.00 | $27.57 – $204.00 | 6 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $156.88 | $296.00 | $38.50 – $245.18 | 6 |
| X-ray lumbosacral spine >= 4 views CPT 72110 | $163.24 | $308.00 | $53.89 – $245.18 | 6 |
| X-ray lumbosacral spine complete including bending views >= 6 views CPT 72114 | $171.19 | $323.00 | $56.30 – $245.18 | 6 |
| X-ray male genital tract CPT 74440 | not published | not published | $63.03 – $517.79 | 6 |
| X-ray mandible complete > 4 views CPT 70110 | $161.12 | $304.00 | $43.40 – $245.18 | 6 |
| X-ray mandible ltd <4 views CPT 70100 | $119.25 | $225.00 | $31.22 – $204.00 | 6 |
| X-ray measurement of pelvis CPT 74710 | not published | not published | $204.00 – $204.00 | 1 |
| X-ray nasal bones complete > 3 views CPT 70160 | $158.47 | $299.00 | $29.98 – $204.00 | 6 |
| X-ray neck soft tissue CPT 70360 | $138.86 | $262.00 | $28.81 – $204.00 | 6 |
| X-ray nose to rectum for foreign body child CPT 76010 | $156.88 | $296.00 | $31.22 – $204.00 | 6 |
| X-ray of mammary ducts CPT 77054 | not published | not published | $77.80 – $517.79 | 6 |
| X-ray optic foramina CPT 70190 | not published | not published | $38.47 – $204.00 | 6 |
| X-ray pelvis 1-2 views CPT 72170 | $130.91 | $247.00 | $29.98 – $245.18 | 6 |
| X-ray pelvis complete > 3 views CPT 72190 | $158.47 | $299.00 | $37.29 – $245.18 | 6 |
| Xray place dist ext thor ao CPT 75959 | not published | not published | $204.00 – $575.36 | 2 |
| Xray place prox ext thor ao CPT 75958 | not published | not published | $204.00 – $659.99 | 2 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $217.30 | $410.00 | $60.55 – $828.27 | 6 |
| X-ray ribs 2 views left CPT 71100 | $158.47 | $299.00 | $38.50 – $204.00 | 6 |
| X-ray ribs 3 views bilateral CPT 71110 | $177.55 | $335.00 | $47.06 – $245.18 | 6 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $158.47 | $299.00 | $46.58 – $245.18 | 6 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $177.55 | $335.00 | $56.30 – $245.18 | 6 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $156.88 | $296.00 | $32.46 – $245.18 | 6 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $156.88 | $296.00 | $29.98 – $204.00 | 6 |
| X-ray scapula complete (both sides) CPT 73010 | $146.81 | $277.00 | $31.15 – $245.18 | 6 |
| X-ray sella turcica CPT 70240 | not published | not published | $33.64 – $204.00 | 6 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $146.81 | $277.00 | $26.32 – $204.00 | 6 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $156.88 | $296.00 | $43.40 – $204.00 | 6 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $292.56 | $552.00 | $90.08 – $1,086.50 | 6 |
| X-ray skull < 4 views CPT 70250 | $147.87 | $279.00 | $43.37 – $245.18 | 6 |
| X-ray skull > 4 views complete CPT 70260 | $156.88 | $296.00 | $59.96 – $245.18 | 6 |
| X-ray slg plne bdy sect without urogr CPT 76100 | not published | not published | $103.26 – $245.18 | 6 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | $189.21 | $357.00 | $80.25 – $401.74 | 6 |
| X-ray small intestine follow-through study CPT 74248 | $106.00 | $200.00 | $119.30 – $119.30 | 1 |
| X-ray spine single view CPT 72020 | $125.61 | $237.00 | $26.32 – $204.00 | 6 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $156.88 | $296.00 | $38.50 – $204.00 | 6 |
| X-ray sternum > 2 views CPT 71120 | $147.87 | $279.00 | $34.88 – $204.00 | 6 |
| X-ray surgical specimen CPT 76098 | $292.56 | $552.00 | $14.36 – $1,086.50 | 7 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | $166.42 | $314.00 | $91.22 – $401.74 | 6 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | $156.88 | $296.00 | $43.37 – $204.00 | 6 |
| X-ray thoracic spine 2 views CPT 72070 | $135.15 | $255.00 | $38.50 – $245.18 | 6 |
| X-ray thoracic spine 3 views CPT 72072 | $161.12 | $304.00 | $37.33 – $245.18 | 6 |
| X-ray thoracolumbar spine >=2 views CPT 72080 | not published | not published | $37.33 – $204.00 | 6 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $171.19 | $323.00 | $45.33 – $204.00 | 6 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views CPT 72082 | $228.96 | $432.00 | $55.06 – $245.18 | 6 |
| X-ray tibia/fibula 2 views (both sides) CPT 73590 | $158.47 | $299.00 | $28.74 – $204.00 | 6 |
| X-ray toe(s) > 2 views (both sides) CPT 73660 | $138.86 | $262.00 | $22.67 – $204.00 | 6 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 | not published | not published | $117.61 – $401.74 | 6 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 | $192.39 | $363.00 | $118.78 – $401.74 | 6 |
| X-ray upper gi delay w/kub CPT 74241 | not published | not published | $204.00 – $204.00 | 1 |
| X-ray upper gi&small intest CPT 74245 | not published | not published | $204.00 – $204.00 | 1 |
| X-ray wrist 2 views (both sides) CPT 73100 | $135.15 | $255.00 | $28.74 – $204.00 | 6 |
| X-ray xm phrnx&/crv esoph c+ CPT 74210 | not published | not published | $61.24 – $401.74 | 6 |
| Xtrnl ecg rec>48hr<7d CPT 93241 | not published | not published | $389.67 – $389.67 | 1 |
| Xtrnl ecg rec up to 48 hrs CPT 93224 | not published | not published | $299.95 – $299.95 | 1 |
| Xylose absorption test blood &/or urine CPT 84620 | $48.76 | $92.00 | $12.91 – $53.13 | 17 |
| Yersinia antibody CPT 86793 | not published | not published | $9.63 – $31.00 | 17 |
| Zika virus dna/rna amp probe CPT 87662 | not published | not published | $51.31 – $207.76 | 14 |
| Zika virus igm antibody CPT 86794 | not published | not published | $16.85 – $68.47 | 14 |
| Ziprasidone 20 mg/ml (final concentration) intramuscular solution HCPCS J3486 | $50.51 | $95.31 | $8.84 – $40.03 | 10 |
| Zoster vaccine-live inj CPT 90736 | not published | not published | $219.35 – $726.48 | 3 |
| Zrsr2 gene common variants CPT 81360 | not published | not published | $193.25 – $454.14 | 13 |
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.