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.

12 prices shown (filtered).

Service	Code	List price	Cash price	Negotiated range	Allowed (median)
aminocaproic acid 500 MG Tab 30 Each Bottle Inpatient	0250 RC	$35.25	$19.39	$21.15 – $31.02	—
aspirin 325 MG Tab 500 Each Box Inpatient	0250 RC	$4.21	$2.32	$2.53 – $3.70	—
aspirin 81 MG Chew Tab 500 Each Disp Pack Inpatient	0250 RC	$4.23	$2.33	$2.54 – $3.72	—
bacitracin 500 UNIT/GM Ointment 3.5 g Tube Inpatient	0250 RC	$203	$112	$122 – $178	—
bacitracin/polymyxin B 500-10000 UNIT/GM Ointment 3.5 g Tube Inpatient	0250 RC	$100	$55.13	$60.14 – $88.20	—
ceFAZolin 500 MG Recon Soln 1 Each Vial Inpatient	J0690 HCPCS	$45.65	$25.11	$22.83 – $40.17	—
ciprofloxacin 500 MG Tab 100 Each Box Inpatient	0250 RC	$8.96	$4.93	$5.38 – $7.88	—
DAPTOmycin 500 mg Recon Soln 1 Each Vial Inpatient	J0878 HCPCS	$243	$133	$121 – $213	—
dicyclomine 10 MG/ML Solution 2 mL Vial Inpatient	J0500 HCPCS	$269	$148	$134 – $236	—
Etoposide 500 MG/25ML Solution 25 mL Vial Inpatient	J9181 HCPCS	$209	$115	$104 – $184	—
HC AUTOMATED DIFF WBC COUNT Inpatient	85004 CPT	$49.00	$26.95	$29.40 – $43.12	—
HC BLOOD SMEAR W MANUAL DIFFERENTIAL Inpatient	85007 CPT	$46.00	$25.30	$27.60 – $40.48	—