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.
10 prices shown (filtered).
| Service | Code | List price | Cash price | Negotiated range | Allowed (median) | |
|---|---|---|---|---|---|---|
| fluciclovine F-18 9-221 MCI/ML Solution 1 millicurie Inpatient | A9588 HCPCS | $1,252 | $689 | $626 – $1,102 | — | |
| gadobutrol 1 mmol/mL Solution 2 mL Vial Inpatient | A9585 HCPCS | $63.10 | $34.71 | $31.55 – $55.53 | — | |
| gadobutrol 1 mmol/mL Solution 7.5 mL Vial Inpatient | A9585 HCPCS | $223 | $123 | $111 – $196 | — | |
| HC APPL MULTI-LAYER COMPRESSION SYS, UPR ARM, FOREARM, HAND, AND FINGERS Inpatient | 29584 CPT | $370 | $204 | $222 – $326 | — | |
| HC CERIBELL, EEG EXTENDED MONITORING, 41-60 MIN Inpatient | 95812 CPT | $933 | $513 | $560 – $821 | — | |
| HC CERIBELL, EEG, INCL RECORDING AWAKE AND DROWSY Inpatient | 95816 CPT | $848 | $466 | $509 – $746 | — | |
| HC OT, APPL MULTI-LAYER COMPRESSION SYS, LEG, INCL ANKLE AND FOOT Inpatient | 29581 CPT | $552 | $304 | $331 – $486 | $220 | |
| HC OT, APPL MULTI-LAYER COMPRESSION SYS, UPR ARM, FOREARM, HAND, & FINGERS Inpatient | 29584 CPT | $289 | $159 | $173 – $254 | — | |
| HC OT, STRAPPING, UNNA BOOT Inpatient | 29580 CPT | $593 | $326 | $356 – $522 | — | |
| HC POLYSOMNOGRAPY W CPAP OR BIPAP Inpatient | 95811 CPT | $5,550 | $3,053 | $3,330 – $4,884 | — |