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.
23 prices shown (filtered).
| Service | Code | List price | Cash price | Negotiated range | Allowed (median) | |
|---|---|---|---|---|---|---|
| HC AMIKACIN RANDOM ASSAY Inpatient | 80150 CPT | $128 | $70.40 | $76.80 – $113 | — | |
| HC AMIKACIN TROUGH ASSAY Inpatient | 80150 CPT | $185 | $102 | $111 – $163 | — | |
| HC AMIODARONE Inpatient | 80151 CPT | $50.00 | $27.50 | $30.00 – $44.00 | — | |
| HC ASSAY CARBAMAZEPINE TOTAL Inpatient | 80156 CPT | $82.00 | $45.10 | $49.20 – $72.16 | — | |
| HC BACTERIAL DETECTION PCR, INFC AGNT DTCT BY NA, MULT ORG, AMP PRB Inpatient | 87801 CPT | $581 | $320 | $349 – $511 | — | |
| HC CARBAMAZEPINE, -10, 11-EPOXIDE Inpatient | 80161 CPT | $73.00 | $40.15 | $43.80 – $64.24 | — | |
| HC CARBAMAZEPINE, TOTAL ASSAY Inpatient | 80156 CPT | $82.00 | $45.10 | $49.20 – $72.16 | — | |
| HC CYCLOSPORINE & METABOLITE + PARENT ASSAY Inpatient | 80158 CPT | $438 | $241 | $263 – $385 | — | |
| HC DIGOXIN TOTAL ASSAY Inpatient | 80162 CPT | $88.00 | $48.40 | $52.80 – $77.44 | — | |
| HC GABITRIL, TIAGABINE DRUG SCREEN, QUANT Inpatient | 80199 CPT | $168 | $92.40 | $101 – $148 | — | |
| HC HALOPERIDOL ASSAY Inpatient | 80173 CPT | $295 | $162 | $177 – $260 | — | |
| HC LEFLUNOMIDE Inpatient | 80193 CPT | $183 | $101 | $110 – $161 | — | |
| HC LITHIUM ASSAY Inpatient | 80178 CPT | $43.00 | $23.65 | $25.80 – $37.84 | — | |
| HC OB US, UTERUS, FETAL AND MATERNAL EVAL, LESS TH 14 WKS, SGL/1ST GEST Inpatient | 76801 CPT | $969 | $533 | $581 – $853 | — | |
| HC PHENOBARBITAL ASSAY Inpatient | 80184 CPT | $71.00 | $39.05 | $42.60 – $62.48 | — | |
| HC PHENYTOIN ASSAY TOTAL Inpatient | 80185 CPT | $87.00 | $47.85 | $52.20 – $76.56 | — | |
| HC PHENYTOIN, FREE, DRUG SCREEN Inpatient | 80186 CPT | $62.00 | $34.10 | $37.20 – $54.56 | — | |
| HC PRIMIDONE ASSAY Inpatient | 80188 CPT | $141 | $77.55 | $84.60 – $124 | — | |
| HC PROCAINAMIDE ASSAY Inpatient | 80192 CPT | $205 | $113 | $123 – $180 | — | |
| HC TACROLIMUS ASSAY Inpatient | 80197 CPT | $78.00 | $42.90 | $46.80 – $68.64 | — | |
| HC THEOPHYLLINE ASSAY Inpatient | 80198 CPT | $149 | $81.95 | $89.40 – $131 | — | |
| HC THYROID IMAGE I-123 Inpatient | 78013 CPT | $1,469 | $808 | $881 – $1,293 | — | |
| HC TRILEPTAL, OXCARBAZEPINE DRUG SCREEN, QUANT Inpatient | 80183 CPT | $69.00 | $37.95 | $41.40 – $60.72 | — |