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Appleton Municipal Hospital

Minnesota · 1,500 published self-pay prices, from $50.15 to $59,877.

These items are published without a standard CPT or HCPCS code, so they cannot be reliably matched against the same service at another hospital. They are shown exactly as this facility published them, and are excluded from every median, average and comparison elsewhere on this site.

Showing the 300 lowest-priced of 1,500 published items.

ItemCash priceSetting
3D breast mammography of both breasts$51.85Outpatient
5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)$76.50Outpatient
5% DEXTROSE/WATER (500 ML = 1 UNIT)$76.50Outpatient
ACETAMINOPHEN 325 MG TABLET$255Outpatient
ACETAMINOPHEN 500 MG TABLET$255Outpatient
ACETAMINOPHEN 650 MG SUPPOS$128Outpatient
ACETAMINOPHEN-COD #3 TABLET$595Outpatient
ACETYLCYSTEINE 20% VIAL$178Outpatient
ACIDOPHILUS PROBIOTIC TABLET$306Outpatient
ACTIDOSE-AQUA 25 G/120 ML SUSP$714Outpatient
Activated protein resistance assay$148Outpatient
ACULAR LS 0.4% OPHTH SOL$722Outpatient
Acute hepatitis panel$316Outpatient
ADH (antidiuretic hormone) level$236Outpatient
ADHESIVE, LIQUID OR EQUAL, ANY TYPE, PER OZ$73.10Outpatient
Administration of additional new drug or substance into vein using push technique$474Outpatient
Administration of additional new drug or substance into vein, 1 hour or less$496Outpatient
Administration of chemotherapy into vein using push technique$649Outpatient
Administration of chemotherapy into vein, 1 hour or less$822Outpatient
Administration of chemotherapy into vein, each additional hour$315Outpatient
Administration of first vaccine or toxoid component with counseling (18 years or younger)$52.70Outpatient
Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle$205Outpatient
Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle$195Outpatient
Administration of prolonged chemotherapy into vein$366Outpatient
Administration of psychological or neuropsychological test by technician, first 30 minutes$81.60Outpatient
Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection$53.55Outpatient
Administration of seasonal dose by intramuscular injection, with counseling by physician or other qualified health care professional$53.55Outpatient
Administration of severe acute respiratory syndrome coronavirus 2 (COVID-19) vaccine by intramuscular injection, single dose$54.40Outpatient
Administration of vaccine$53.55Outpatient
Adrenocorticotropic hormone (ACTH) level$100Outpatient
ADVAIR 250-50 DISKUS$116Outpatient
Advance care planning, first 30 minutes$186Outpatient
ADVANCED LIFE SUPPORT, LEVEL 2 (ALS 2)$1,944Outpatient
AFFINITY, PER SQUARE CENTIMETER$910Outpatient
Age complicating anesthesia (younger than 1 year and older than 70 years)$284Outpatient
Albumin (protein) level$81.60Outpatient
Alcohols levels$184Outpatient
Aldosterone hormone level$129Outpatient
ALENDRONATE SODIUM 70 MG TAB$226Outpatient
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., EACH DRESSING$56.95Outpatient
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND FILLER, STERILE, PER 6 INCHES$51.85Outpatient
Alkaloids levels$70.55Outpatient
ALLOPURINOL 100 MG TABLET$595Outpatient
ALPRAZOLAM 0.25 MG TABLET$595Outpatient
AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY TRANSPORT, LEVEL 1 (ALS 1 - EMERGENCY)$2,046Outpatient
AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NON-EMERGENCY TRANSPORT, LEVEL 1 (ALS 1)$1,842Outpatient
AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS-EMERGENCY)$1,279Outpatient
AMBULANCE SERVICE, BASIC LIFE SUPPORT, NON-EMERGENCY TRANSPORT, (BLS)$1,126Outpatient
AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION$133Outpatient
Amino acid level, 6 or more amino acids, quantitative, each specimen$331Outpatient
AMITRIPTYLINE HCL 25 MG TAB$595Outpatient
AMLODIPINE BESYLATE 10 MG TAB$595Outpatient
AMLODIPINE BESYLATE 5 MG TAB$595Outpatient
Ammonia level$62.90Outpatient
AMOX-CLAV 200-28.5 MG/5 ML SUS$79.48Outpatient
AMOX-CLAV 500-125 MG TABLET$209Outpatient
AMOX-CLAV 875-125 MG TABLET$280Outpatient
AMOXICILLIN 500 MG CAPSULE$595Outpatient
AMOXICILLIN 875 MG TABLET$119Outpatient
Amplifed DNA or RNA probe detection of severe acute respiratory syndrome coronavirus 2 (Covid-19) antigen$212Outpatient
Amylase (enzyme) level$110Outpatient
Analgesics levels, 1 or 2$51.85Outpatient
Analysis for antibody (IgM) to Cytomegalovirus (CMV)$100Outpatient
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)$119Outpatient
Analysis for antibody to aspergillus (fungus)$110Outpatient
Analysis for antibody to Cytomegalovirus (CMV)$59.50Outpatient
Analysis for antibody to Ehrlichia (bacteria transmitted by ticks)$51.85Outpatient
Analysis for antibody to Epstein-Barr virus (mononucleosis virus), nuclear antigen$134Outpatient
Analysis for antibody to fungus$206Outpatient
Analysis for antibody to mumps virus$73.95Outpatient
Analysis for antibody to protozoa (parasite)$71.40Outpatient
Analysis for antibody to Rubella (German measles virus)$94.35Outpatient
Analysis for antibody to Rubeola (measles virus)$88.40Outpatient
Analysis for antibody to varicella-zoster virus (chicken pox)$162Outpatient
Analysis for detection of tumor marker$96.05Outpatient
Analysis of substance using immunoassay technique, multiple step method$51.00Outpatient
Analysis of voice and resonance production$426Outpatient
ANESTHESIA BLOCK PROCEDURE$946Outpatient
ANNUAL WELLNESS VISIT, INCLUDES A PERSONALIZED PREVENTION PLAN OF SERVICE (PPS), SUBSEQUENT VISIT$295Outpatient
ANNUAL WELLNESS VISIT; INCLUDES A PERSONALIZED PREVENTION PLAN OF SERVICE (PPS), INITIAL VISIT$401Outpatient
Antibody evaluation, each additional single antibody stain procedure$77.35Outpatient
Antibody evaluation, initial single antibody stain procedure$70.55Outpatient
ANTIEMETIC DRUG, ORAL, NOT OTHERWISE SPECIFIED$1,847Outpatient
Antiepileptics levels, 1-3$152Outpatient
Antithrombin III antigen (clotting inhibitor) activity$94.35Outpatient
ANUCORT-HC 25 MG SUPPOSITORY$751Outpatient
APLIGRAF, PER SQUARE CENTIMETER$111Outpatient
Apolipoprotein level$56.95Outpatient
Application of chemical to stop tissue regrowth in wound$190Outpatient
Application of electrical stimulation$71.40Outpatient
Application of electrical stimulation with therapist present, each 15 minutes$61.20Outpatient
Application of hot wax bath$76.50Outpatient
Application of mechanical traction$119Outpatient
Application of medication using electrical current, each 15 minutes$85.85Outpatient
Application of nonmoveable forearm to hand splint$178Outpatient
Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less$2,436Outpatient
Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less$2,343Outpatient
Application of ultrasound, each 15 minutes$90.95Outpatient
Application of vein wound compression bandages on lower leg, ankle, and foot$337Outpatient
Arsenic level$100Outpatient
Artery puncture collection of blood sample$169Outpatient
ARTHRITIS PAIN ER 650 MG TAB$128Outpatient
Ascorbic acid (Vitamin C) level, blood$89.25Outpatient
Aspiration and/or injection of cyst of tendon$382Outpatient
Aspiration and/or injection of fluid from large joint$378Outpatient
Aspiration and/or injection of fluid from medium joint$238Outpatient
Aspiration and/or injection of fluid from small joint$226Outpatient
Aspiration of fluid from chest cavity$1,009Outpatient
ASPIRIN 325 MG TABLET$1,275Outpatient
ASPIRIN 81 MG CHEWABLE TABLET$765Outpatient
ASPIRIN EC 325 MG TABLET$255Outpatient
ASPIRIN EC 81 MG TABLET$765Outpatient
ATENOLOL 50 MG TABLET$595Outpatient
ATORVASTATIN 20 MG TABLET$595Outpatient
ATORVASTATIN 80 MG TABLET$119Outpatient
ATROPINE 1% EYE DROPS$102Outpatient
ATROVENT 17 MCG HFA INHALER$1,204Outpatient
Automated urinalysis test$57.00Outpatient
Automated white blood cell count$58.65Outpatient
AZITHROMYCIN 200 MG/5 ML SUSP$74.15Outpatient
AZITHROMYCIN 250 MG TABLET$298Outpatient
B COMPLEX CAPSULE$255Outpatient
BACITRACIN 500 UNIT/GRAM TOP PACK$367Outpatient
Bacterial blood culture$195Outpatient
Bacterial culture for anaerobic isolates$86.70Outpatient
Bacterial culture, any source, except blood, anaerobic$190Outpatient
BELLADONNA-OPIUM 16.2-30 SUPP$912Outpatient
Benzodiazepines levels, 13 or more$71.40Outpatient
BENZONATATE 100 MG CAPSULE$691Outpatient
Beta 2 glycoprotein 1 antibody (autoantibody) measurement$100Outpatient
Bilirubin level, direct$53.55Outpatient
Bilirubin level, total$66.30Outpatient
Biofeedback training for bowel or bladder control, each additional 15 minutes$114Outpatient
Biofeedback training for bowel or bladder control, initial 15 minutes$114Outpatient
Biopsy and scraping of cervix using an endoscope$351Outpatient
Biopsy of back of throat$1,968Outpatient
Biopsy of bladder using an endoscope$1,686Outpatient
Biopsy of cervix or removal of growth$238Outpatient
Biopsy of cervix using an endoscope$348Outpatient
Biopsy of cervix using an endoscope with loop electrode$800Outpatient
Biopsy of growth of external female genitals, first growth$260Outpatient
Biopsy of lining of uterus$337Outpatient
Biopsy of prostate gland$4,774Outpatient
Biopsy of related skin growth, each additional growth$68.85Outpatient
Biopsy of related skin growth, first growth$116Outpatient
Biopsy of vagina and cervix using an endoscope$386Outpatient
Biopsy of voice box using an endoscope$4,730Outpatient
Biopsy of voice box using an endoscope with mirror$4,730Outpatient
Biopsy of voice box using an endoscope with operating microscope or telescope$4,730Outpatient
BIOTIN 1,000 MCG TABLET$595Outpatient
BISACODYL 10 MG SUPPOSITORY$128Outpatient
BISACODYL EC 5 MG TABLET$255Outpatient
BISOPROLOL-HCTZ 10-6.25 MG TAB$279Outpatient
Blood bank physician services for investigation of transfusion reaction with written report$117Outpatient
Blood chloride level$99.45Outpatient
Blood count, hemoglobin$64.60Outpatient
Blood creatinine level$132Outpatient
Blood gases measurement, with O2 saturation$343Outpatient
Blood glucose (sugar) level$92.65Outpatient
Blood glucose (sugar) level after receiving dose of glucose$107Outpatient
Blood glucose (sugar) tolerance test, 3 specimens$173Outpatient
Blood group typing (ABO)$73.95Outpatient
Blood potassium level$120Outpatient
Blood sodium level$120Outpatient
Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)$98.60Outpatient
Blood test, basic group of blood chemicals (Calcium, total)$190Outpatient
Blood test, clotting time$76.50Outpatient
Blood test, comprehensive group of blood chemicals$264Outpatient
Blood test, lipids (cholesterol and triglycerides)$156Outpatient
Blood test, thyroid stimulating hormone (TSH)$170Outpatient
Blood typing for red blood cell antigens$72.25Outpatient
Blood typing for Rh (D) antigen$64.60Outpatient
Blood unit compatibility test, antiglobulin technique$63.75Outpatient
Blood unit compatibility test, immediate spin technique$159Outpatient
BLUDIGO 40 MG/5 ML AMPULE$1,326Outpatient
BRIDION 200 MG/2 ML VIAL$430Outpatient
BRILINTA 60 MG TABLET$1,496Outpatient
BUDESONIDE-FORMOTEROL 80-4.5$749Outpatient
BUMETANIDE 1 MG TABLET$745Outpatient
BUPROPION HCL SR 150 MG TABLET$595Outpatient
BUPROPION HCL XL 150 MG TABLET$178Outpatient
C-peptide (protein) level$158Outpatient
CALCITRIOL 0.25 MCG CAPSULE$178Outpatient
CALCIUM 600-VIT D3 400 TABLET$255Outpatient
CALCIUM ACETATE 667 MG CAPSULE$298Outpatient
CALCIUM CARBONATE 200 MG CALCIUM (500 MG) ORAL CHEW TAB$382Outpatient
Calcium level, ionized$116Outpatient
Calcium level, total$123Outpatient
CARBIDOPA-LEVO ER 25-100 TAB$595Outpatient
CARBIDOPA-LEVODOPA 25-250 MG ORAL TABLET$595Outpatient
CARBIDOPA-LEVODOPA 25-250 TAB$595Outpatient
Carbon dioxide (bicarbonate) level$68.00Outpatient
Carboxyhemoglobin (protein) level$69.70Outpatient
Carcinoembryonic antigen (CEA) protein level$243Outpatient
CARDENE-NACL 20 MG/200 ML SOLN$166Outpatient
Cardiolipin antibody (tissue antibody) measurement$57.80Outpatient
CARVEDILOL 25 MG TABLET$595Outpatient
CARVEDILOL 3.125 MG TABLET$595Outpatient
CAST SUPPLIES, SHORT ARM SPLINT, ADULT (11 YEARS +), FIBERGLASS$90.10Outpatient
CAST SUPPLIES, SHORT LEG CAST, ADULT (11 YEARS +), FIBERGLASS$275Outpatient
CASTELLANI PAINT 1.5%$68.31Outpatient
Catecholamines (organic nitrogen) level$110Outpatient
CATHETERIZATION FOR COLLECTION OF SPECIMEN, SINGLE PATIENT, ALL PLACES OF SERVICE$105Outpatient
CEFDINIR 250 MG/5 ML SUSP$211Outpatient
CEFPODOXIME 100 MG TABLET$372Outpatient
CEFUROXIME AXETIL 250 MG TAB$243Outpatient
CEFUROXIME AXETIL 500 MG TAB$443Outpatient
Cell examination of specimen, concentration technique$122Outpatient
CEPACOL THROAT 15-2.6 MG LOZ$95.20Outpatient
CEPHALEXIN 250 MG CAPSULE$595Outpatient
CEPHALEXIN 250 MG/5 ML SUSP$61.20Outpatient
CEROVITE SENIOR TABLET$153Outpatient
Ceruloplasmin (protein) level$184Outpatient
CETACAINE SPRAY$211Outpatient
CETIRIZINE HCL 10 MG TABLET$255Outpatient
Change of breathing tube in windpipe$314Outpatient
Chemical analysis using chromatography technique$164Outpatient
CHLORDIAZEPOXIDE 25 MG CAPSULE$595Outpatient
CHLORTHALIDONE 25 MG TABLET$191Outpatient
Cholesterol level$111Outpatient
Chromosome analysis for genetic defects, analyze 100-300 cells$354Outpatient
Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month$73.10Outpatient
Chronic care management services for two or more chronic conditions, first 30 minutes provided personally by health care professional, per calendar month$119Outpatient
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month$105Outpatient
CIPROFLOX-DEXAMETH OTIC SUSP$593Outpatient
CIPROFLOXACIN 0.3% EYE DROP$53.19Outpatient
CIPROFLOXACIN HCL 250 MG TAB$1,225Outpatient
CIPROFLOXACIN HCL 500 MG TAB$595Outpatient
CISATRACURIUM 20 MG/10 ML VIAL$76.25Outpatient
CITALOPRAM HBR 10 MG TABLET$595Outpatient
Citrate level$133Outpatient
CLARITHROMYCIN 500 MG TABLET$997Outpatient
CLONAZEPAM 0.5 MG TABLET$595Outpatient
CLONIDINE 0.1 MG/DAY PATCH$366Outpatient
CLONIDINE HCL 0.1 MG TABLET$595Outpatient
CLOPIDOGREL 75 MG TABLET$595Outpatient
Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation$1,420Outpatient
CLOTRIMAZOLE-BETAMETHASONE CRM$79.65Outpatient
Coagulation function measurement, D-dimer; quantitative$159Outpatient
Coagulation function screening test with interpretation and report$73.10Outpatient
COCAINE HYDROCHLORIDE NASAL SOLUTION (GOPRELTO), 1 MG$975Outpatient
COLCHICINE 0.6 MG TABLET$1,675Outpatient
COLLAGEN BASED WOUND FILLER, DRY FORM, STERILE, PER GRAM OF COLLAGEN$73.10Outpatient
COLLAGEN DRESSING, STERILE, SIZE 16 SQ. IN. OR LESS, EACH$53.55Outpatient
Collection of blood sample from central venous tube$119Outpatient
Collection of blood sample from implanted device$119Outpatient
COLORECTAL CANCER SCREENING; FECAL OCCULT BLOOD TEST, IMMUNOASSAY, 1-3 SIMULTANEOUS$137Outpatient
COMBIVENT RESPIMAT 20-100 MCG$1,248Outpatient
Complete blood cell count (red cells, white blood cell, platelets), automated test$105Outpatient
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$169Outpatient
Complete ultrasound of abdomen and pelvis artery and vein blood flow$921Outpatient
Complete ultrasound of aorta, vena cava, groin vessels or bypass grafts$691Outpatient
Complete ultrasound scan behind abdominal cavity$847Outpatient
Complete ultrasound scan of 1 breast$506Outpatient
Complete ultrasound scan of abdomen$911Outpatient
Complete ultrasound scan of joint$212Outpatient
Complete ultrasound scan of pelvis$676Outpatient
Complete X-ray of body bones$493Outpatient
COMPLETED EARLY PERIODIC SCREENING DIAGNOSIS AND TREATMENT (EPSDT) SERVICE (LIST IN ADDITION TO CODE FOR APPROPRIATE EVALUATION AND MANAGEMENT SERVICE)$89.25Outpatient
Complex chronic care management services for two or more chronic conditions, each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month$105Outpatient
Complex chronic care management services for two or more chronic conditions, first 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month$133Outpatient
Complex control of nose bleed$212Both
Complicated insertion of bladder tube$334Outpatient
COMPRO 25 MG SUPPOSITORY$417Outpatient
Concentration of specimen for infectious agents$152Outpatient
Cone biopsy of cervix and vagina using an endoscope with loop electrode$852Outpatient
Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria)$136Outpatient
CONSTULOSE 10 GM/15 ML SOLN$186Outpatient
CONTACT LAYER, STERILE, MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING$64.60Outpatient
CONTROL BLEEDING$284Both
Copper level$118Outpatient
Cortisol (hormone) measurement, free$55.25Outpatient
Cortisol (hormone) measurement, total$166Outpatient
Creatine kinase (cardiac enzyme) level, MB fraction only$207Outpatient
Creatine kinase (cardiac enzyme) level, total$156Outpatient
Critical care, each additional 30 minutes$770Both
Critical care, first 30-74 minutes$2,634Both
Cryofibrinogen (protein) level$87.55Outpatient
Cryoglobulin (protein) measurement$105Outpatient
CT scan head or brain with contrast$1,944Outpatient
CT scan head or brain without contrast$1,587Outpatient
CT scan of abdomen and pelvis before and after contrast$4,984Outpatient
CT scan of abdomen and pelvis with contrast$3,373Outpatient
CT scan of abdomen and pelvis without contrast$3,153Outpatient
CT scan of abdomen before and after contrast$3,974Outpatient
CT scan of abdomen with contrast$2,102Outpatient
CT scan of abdomen without contrast$2,102Outpatient
CT scan of abdominal aorta and both leg arteries with contrast$4,400Outpatient
CT scan of arm before and after contrast$1,848Outpatient
CT scan of arm with contrast$1,720Outpatient
CT scan of arm without contrast$1,740Outpatient
CT scan of blood vessels of abdomen and pelvis with contrast$3,879Outpatient
CT scan of blood vessels of abdomen with contrast$3,007Outpatient
CT scan of blood vessels of chest with contrast$2,508Outpatient
CT scan of blood vessels of head with contrast$2,456Outpatient
CT scan of blood vessels of lower leg with contrast$3,786Outpatient
CT scan of blood vessels of neck with contrast$2,353Outpatient
CT scan of chest before and after contrast$2,102Outpatient
CT scan of chest with contrast$2,102Outpatient
CT scan of chest without contrast$2,102Outpatient

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