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.

70 prices shown (filtered).

Service	Code	List price	Cash price	Negotiated range	Allowed (median)
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	—
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	—
atenolol 50 MG Tab 100 Each Box Inpatient	0250 RC	$8.30	$4.57	$4.98 – $7.30	—
azaCITIDine 100 MG Recon Susp 1 Each Vial Inpatient	J9025 HCPCS	$876	$482	$438 – $771	—
bacitracin/polymyxin B 500-10000 UNIT/GM Ointment 3.5 g Tube Inpatient	0250 RC	$100	$55.13	$60.14 – $88.20	—
benzonatate 100 MG Cap 100 Each Box Inpatient	0250 RC	$9.53	$5.25	$5.72 – $8.39	—
benztropine 1 MG Tab 100 Each Bottle Inpatient	0250 RC	$8.53	$4.70	$5.12 – $7.51	—
bethanechol 25 MG Tab 100 Each Bottle Inpatient	0250 RC	$9.51	$5.24	$5.71 – $8.37	—
bevacizumab 100 MG/4ML Solution 4 mL Vial Inpatient	J9035 HCPCS	$3,611	$1,986	$1,806 – $3,178	—
bevacizumab-bvzr 100 mg/4mL Solution 4 mL Vial Inpatient	Q5118 HCPCS	$2,785	$1,532	$1,393 – $2,451	—
butalbital/acetaminophen/caffeine 50-325-40 mg Tab 100 Each Bottle Inpatient	0250 RC	$10.47	$5.76	$6.28 – $9.21	—
butalbital/aspirin/caffeine 50-325-40 MG Cap 100 Each Bottle Inpatient	0250 RC	$11.30	$6.22	$6.78 – $9.94	—
carBAMazepine 100 MG TABLET SR 12 HR 100 Each Bottle Inpatient	0250 RC	$9.75	$5.37	$5.85 – $8.58	—
carbidopa-levodopa 25-100 mg Tab CR 100 Each Box Inpatient	0250 RC	$9.25	$5.09	$5.55 – $8.14	—
carvedilol 3.125 MG Tab 100 Each Box Inpatient	0250 RC	$8.27	$4.55	$4.96 – $7.28	—
cephALEXin 250 MG/5ML Recon Susp 100 mL Bottle Inpatient	0250 RC	$83.90	$46.15	$50.34 – $73.83	—
chlordiazePOXIDE 25 mg capsule Cap 100 Each Bottle Inpatient	0250 RC	$10.42	$5.74	$6.25 – $9.17	—
ciprofloxacin 500 MG Tab 100 Each Box Inpatient	0250 RC	$8.96	$4.93	$5.38 – $7.88	—
CISplatin 100 MG/100ML Solution 100 mL Vial Inpatient	J9060 HCPCS	$224	$123	$112 – $197	—
clonazePAM 0.5 mg Tab 100 Each Box Inpatient	0250 RC	$11.33	$6.24	$6.80 – $9.97	—
clopidogrel 75 mg Tab 100 Each Box Inpatient	0250 RC	$8.85	$4.87	$5.31 – $7.79	—
cloZAPine 100 MG Tab 100 Each Box Inpatient	0250 RC	$11.97	$6.59	$7.18 – $10.53	—
colchicine 0.6 MG Tab 100 Each Bottle Inpatient	0250 RC	$9.46	$5.21	$5.68 – $8.32	—
cortisone 25 MG Tab 100 Each Bottle Inpatient	0250 RC	$14.50	$7.98	$8.70 – $12.76	—
cyanocobalamin 100 MCG Tab 130 Each Bottle Inpatient	0250 RC	$4.05	$2.23	$2.43 – $3.56	—
cyanocobalamin 100 MCG Tab 50 Each Box Inpatient	0250 RC	$8.61	$4.74	$5.17 – $7.58	—
cyclobenzaprine 10 MG Tab 100 Each Bottle Inpatient	0250 RC	$8.18	$4.50	$4.91 – $7.20	—