Froedtert Holy Family Memorial Hospital — price list

← Hospital overviewVerified from Froedtert Holy Family Memorial Hospital’s published price file

Includes cash prices, list prices, insurance-negotiated rates. Open any row for plan-level negotiated rates. This is public hospital price transparency data, not a guaranteed estimate of your bill.

Showing the first 1,500 prices from a large file. Search a procedure or code below to narrow the list.

How to read these columns

List: The hospital’s full undiscounted (gross) charge — rarely what anyone actually pays.
Cash: The discounted self-pay price for paying directly, without insurance.
Negotiated: Rates agreed with insurers; open a row for plan-level detail. Your share depends on your benefits.

These are the hospital’s published reference prices, not a personalized estimate of your bill.

1,500 prices shown.

Service	Code	List price	Cash price	Negotiated range	Allowed (median)
0.45% NaCl 0.45 % Solution 1,000 mL Flex Cont Inpatient	0258 RC	$134	$73.70	$80.40 – $118	—
0.45% NaCl with KCl 20 mEq solution 1000 mL 20-0.45 MEQ/L-% Solution 1,000 mL Flex Cont Inpatient	0250 RC	$148	$81.40	$88.80 – $130	—
abatacept 25 mg/mL Recon Soln 1 Each Vial Inpatient	J0129 HCPCS	$8,340	$4,587	$4,170 – $7,339	—
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY Inpatient	770 MS-DRG	—	—	$7,018 – $29,544	—
acetaminophen 160 MG/5ML Solution 15.6 mL Oral Syringe Inpatient	0250 RC	$4.49	$2.47	$2.69 – $3.95	—
acetaminophen 325 MG Suppos 12 Each Box Inpatient	0250 RC	$4.83	$2.66	$2.90 – $4.25	—
acetylcysteine 200 MG/ML Solution 30 mL Vial Inpatient	J0132 HCPCS	$1,049	$577	$525 – $923	—
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC Inpatient	289 MS-DRG	—	—	$11,947 – $50,292	—
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC Inpatient	122 MS-DRG	—	—	$5,500 – $23,153	—
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC Inpatient	285 MS-DRG	—	—	$4,192 – $17,646	—
adenosine 12 MG/4ML Solution 4 mL Vial Inpatient	J0153 HCPCS	$195	$107	$97.40 – $171	—
AFTERCARE WITHOUT CC/MCC Inpatient	950 MS-DRG	—	—	$4,394 – $18,495	—
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC Inpatient	560 MS-DRG	—	—	$7,882 – $33,179	—
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC Inpatient	561 MS-DRG	—	—	$5,627 – $23,686	—
albendazole 200 MG Tab 2 Each Bottle Inpatient	0250 RC	$77.00	$42.35	$46.20 – $67.76	—
albuterol (2.5 mg/3mL) 0.083% Nebu Soln 3 mL Plas Cont Inpatient	0250 RC	$8.99	$4.95	$5.39 – $7.91	—
albuterol HFA 108 (90 Base) MCG/ACT Aero Soln 8 g Inhaler Inpatient	0250 RC	$99.52	$54.74	$59.71 – $87.58	—
alemtuzumab 12 MG/1.2ML Solution 1.2 mL Vial Inpatient	J0202 HCPCS	$125,171	$68,844	$62,586 – $110,151	—
ALLERGIC REACTIONS WITH MCC Inpatient	915 MS-DRG	—	—	$11,770 – $49,547	—
allopurinol 150 mg half tablet Tab 0.5 tablet Packet Inpatient	0250 RC	$8.10	$4.46	$4.86 – $7.13	—
aminocaproic acid 500 MG Tab 30 Each Bottle Inpatient	0250 RC	$35.25	$19.39	$21.15 – $31.02	—
amiodarone 450 MG/9ML Solution 9 mL Vial Inpatient	J0282 HCPCS	$83.05	$45.68	$41.53 – $73.08	—
amoxicillin 400 MG/5ML Recon Susp 100 mL Bottle Inpatient	0250 RC	$29.45	$16.20	$17.67 – $25.92	—
amoxicillin/clavulanate 250-62.5 mg/5 mL Recon Susp 100 mL Bottle Inpatient	0250 RC	$370	$204	$222 – $326	—
amphetamine/dextroamphetamine 10 MG CAPSULE SR 24 HR 100 Each Bottle Inpatient	0250 RC	$11.31	$6.23	$6.79 – $9.95	—
amphetamine/dextroamphetamine 5 MG Tab 100 Each Bottle Inpatient	0250 RC	$11.95	$6.58	$7.17 – $10.52	—
amphotericin B - conventional Recon Soln 1 Each Vial Inpatient	J0285 HCPCS	$327	$180	$164 – $288	—
ampicillin/sulbactam 3 (2-1) g Recon Soln 1 Each Vial Inpatient	J0295 HCPCS	$56.65	$31.16	$28.33 – $49.85	—
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC Inpatient	617 MS-DRG	—	—	$13,091 – $55,107	—
anifrolumab-fnia 300 MG/2ML Solution 2 mL Vial Inpatient	J0491 HCPCS	$22,679	$12,474	$11,340 – $19,958	—