SelfPayRates
Hospital Appleton, WI

Ascension NE Wisconsin, Inc.

Ascension NE Wisconsin, Inc. in Appleton, WI publishes cash prices for 48 common procedures listed here, from its own machine-readable price file updated —. Click a procedure to compare it with other hospitals nearby.

1506 S. Oneida St Appleton WI 54915 Collected Sep 23, 2026 Source price file

Scans and imaging

ProcedureCash price List priceOff list
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN PELVIS W CONTRAST $808.26 $1,418.00 43%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD WO CONTRAST $698.25 $1,225.00 43%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST $428.64 $752.00 43%
Diagnostic mammogram, both breasts both sides CPT 77066 HC DX MAMMO INCL CAD BI $711.93 $1,249.00 43%
Diagnostic mammogram, one breast CPT 77065 HC DX MAMMO INCL CAD UNI $570.00 $1,000.00 43%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI JOINT LOWER EXTREMITY WO CONTRAST $926.82 $1,626.00 43%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI JOINT LOWER EXTREMITY W/WO CONTRAST $1,047.66 $1,838.00 43%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN WO CONTRAST $873.24 $1,532.00 43%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W/WO CONTRAST $1,171.92 $2,056.00 43%
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE WO CONTRAST $1,451.79 $2,547.00 43%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB 14 WKS / > SINGLE FETUS $180.69 $317.00 43%
Screening mammogram, both breasts both sides CPT 77067 HC SCREEN MAMMO BI INCL CAD $314.07 $551.00 43%
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMNOGRAM STUDY $3,550.53 $6,229.00 43%
Transvaginal pelvic ultrasound CPT 76830 HC US NON-OB TRANSVAGINAL $164.73 $289.00 43%
Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMINAL COMPLETE $428.64 $752.00 43%
X-ray of the lower back, 4 or more views CPT 72110 HC X-RAY EXAM L-2 SPINE 4/>VWS $156.18 $274.00 43%

Lab tests

ProcedureCash price List priceOff list
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL-CALCIUM, TOTAL $66.69 $117.00 43%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL $50.73 $89.00 43%
Complete blood count (CBC) with differential CPT 85025 HC COMPLETE CBC W/AUTO DIFFERENTIAL WBC $27.93 $49.00 43%
Complete blood count (CBC), no differential CPT 85027 HC COMPLETE CBC AUTOMATED $23.37 $41.00 43%
Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHENSIVE METABOLIC PANEL $78.66 $138.00 43%
Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL $64.98 $114.00 43%
Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL $64.98 $114.00 43%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE $44.46 $78.00 43%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL $21.09 $37.00 43%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA SCREENING $64.98 $114.00 43%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA OR WB $22.80 $40.00 43%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME - POC $13.68 $24.00 43%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME $13.68 $24.00 43%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC ASSAY THYROID STIM HORMONE-R $59.28 $104.00 43%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC ASSAY THYROID STIM HORMONE $59.28 $104.00 43%
Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS AUTOMATED W/SCOPE $18.24 $32.00 43%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTOMATED W/O SCOPE - POC $13.68 $24.00 43%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTOMATED W/O SCOPE $13.68 $24.00 43%
Urinalysis without microscope exam, manual CPT 81002 HC URINALYSIS NONAUTOMATED W/O SCOPE-POC $3.99 $7.00 43%

Surgery and procedures

ProcedureCash price List priceOff list
Left heart catheterization, diagnostic one side CPT 93452 HC LT HEART CATH W/ VENT $4,457.40 $7,820.00 43%
Lower-back epidural injection, with imaging guidance CPT 62323 HC NJX INTERLAMINAR LMBR/SAC W IMG $1,946.55 $3,415.00 43%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ AA&/STRD TRANSFORAMINAL EPIDURAL L/S $1,337.22 $2,346.00 43%
Removal of a breast lump, open surgery CPT 19120 HC PRO EXC BREAST TISSUE 1/> LESN $1,283.07 $2,251.00 43%
Upper endoscopy (EGD), diagnostic CPT 43235 HC EGD DIAGNOSTIC $1,588.59 $2,787.00 43%

Doctor visits and therapy

ProcedureCash price List priceOff list
Family therapy with the patient, 50 minutes CPT 90847 HC PHP FAMILY PSYTX W/PT 73-74 MIN $725.04 $1,272.00 43%
Family therapy with the patient, 50 minutes CPT 90847 HC TELEHEALTH MH OUTPT FAMILY PSYTX W/ PT 26-29 MI $725.04 $1,272.00 43%
Family therapy with the patient, 50 minutes CPT 90847 HC TELEHEALTH AODA OUTPT FAMILY PSYTX W/ PT 30 MIN $725.04 $1,272.00 43%
Family therapy with the patient, 50 minutes CPT 90847 HC TELEHEALTH MH OUTPT FAMILY PSYTX W/ PT 45 MIN $725.04 $1,272.00 43%
Family therapy with the patient, 50 minutes CPT 90847 HC TELEHEALTH MH OUTPT FAMILY PSYTX W/ PT 60 MIN $725.04 $1,272.00 43%
Family therapy with the patient, 50 minutes CPT 90847 HC TELEHEALTH AODA OUTPT FAMILY PSYTX W/ PT 45 MIN $725.04 $1,272.00 43%
Family therapy with the patient, 50 minutes CPT 90847 HC TELEHEALTH AODA OUTPT FAMILY PSYTX W/ PT 60 MIN $725.04 $1,272.00 43%
Family therapy with the patient, 50 minutes CPT 90847 HC PHP FAMILY PSYTX W/PT 26-30 MIN $725.04 $1,272.00 43%
Family therapy with the patient, 50 minutes CPT 90847 HC PHP FAMILY PSYTX W/PT 31-36 MIN $725.04 $1,272.00 43%
Family therapy with the patient, 50 minutes CPT 90847 HC PHP FAMILY PSYTX W/PT 37-42 MIN $725.04 $1,272.00 43%
Family therapy with the patient, 50 minutes CPT 90847 HC PHP FAMILY PSYTX W/PT 43-48 MIN $725.04 $1,272.00 43%
Family therapy with the patient, 50 minutes CPT 90847 HC PHP FAMILY PSYTX W/PT 49-54 MIN $725.04 $1,272.00 43%
Family therapy with the patient, 50 minutes CPT 90847 HC PHP FAMILY PSYTX W/PT 61-66 MIN $725.04 $1,272.00 43%
Family therapy with the patient, 50 minutes CPT 90847 HC PHP FAMILY PSYTX W/PT 67-72 MIN $725.04 $1,272.00 43%
Family therapy with the patient, 50 minutes CPT 90847 HC MH OUTPT FAMILY PSYTX W/ PT 50MIN $725.04 $1,272.00 43%
Family therapy with the patient, 50 minutes CPT 90847 HC AODA OUTPT FAMILY PSYTX W/PT 50 MIN $725.04 $1,272.00 43%
Family therapy without the patient, 50 minutes CPT 90846 HC TELEHEALTH AODA OUTPT FAMILY PSYTX W/O PT 60 MI $725.04 $1,272.00 43%
Family therapy without the patient, 50 minutes CPT 90846 HC TELEHEALTH MH OUTPT FAMILY PSYTX W/O PT 26-29 M $725.04 $1,272.00 43%
Family therapy without the patient, 50 minutes CPT 90846 HC PHP FAMILY PSYTX W/O PT 55-60 MIN $725.04 $1,272.00 43%
Family therapy without the patient, 50 minutes CPT 90846 HC PHP FAMILY PSYTX W/O PT 61-66 MIN $725.04 $1,272.00 43%
Family therapy without the patient, 50 minutes CPT 90846 HC PHP FAMILY PSYTX W/O PT 67-72 MIN $725.04 $1,272.00 43%
Family therapy without the patient, 50 minutes CPT 90846 HC PHP FAMILY PSYTX W/O PT 73-74 MIN $725.04 $1,272.00 43%
Family therapy without the patient, 50 minutes CPT 90846 HC TELEHEALTH AODA OUTPT FAMILY PSYTX W/O PT 45 MI $725.04 $1,272.00 43%
Family therapy without the patient, 50 minutes CPT 90846 HC TELEHEALTH AODA OUTPT FAMILY PSYTX W/O PT 26-29 $725.04 $1,272.00 43%
Family therapy without the patient, 50 minutes CPT 90846 HC TELEHEALTH MH OUTPT FAMILY PSYTX W/O PT 30 MIN $725.04 $1,272.00 43%
Family therapy without the patient, 50 minutes CPT 90846 HC TELEHEALTH AODA OUTPT FAMILY PSYTX W/O PT 30 MI $725.04 $1,272.00 43%
Family therapy without the patient, 50 minutes CPT 90846 HC PHP FAMILY PSYTX W/O PT 26-30 MIN $725.04 $1,272.00 43%
Family therapy without the patient, 50 minutes CPT 90846 HC PHP FAMILY PSYTX W/O PT 31-36 MIN $725.04 $1,272.00 43%
Family therapy without the patient, 50 minutes CPT 90846 HC PHP FAMILY PSYTX W/O PT 37-42 MIN $725.04 $1,272.00 43%
Family therapy without the patient, 50 minutes CPT 90846 HC TELEHEALTH MH OUTPT FAMILY PSYTX W/O PT 60 MIN $725.04 $1,272.00 43%
Family therapy without the patient, 50 minutes CPT 90846 HC TELEHEALTH MH OUTPT FAMILY PSYTX W/O PT 45 MIN $725.04 $1,272.00 43%
Family therapy without the patient, 50 minutes CPT 90846 HC PHP FAMILY PSYTX W/O PT 43-48 MIN $725.04 $1,272.00 43%
Family therapy without the patient, 50 minutes CPT 90846 HC PHP FAMILY PSYTX W/O PT 49-54 MIN $725.04 $1,272.00 43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 16-18 MIN $33.63 $59.00 43%
Group psychotherapy session CPT 90853 HC TELEHEALTH AODA OUTPT GROUP PSYCHOTHERAPY 30 MI $58.14 $102.00 43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 25-30 MIN $67.26 $118.00 43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 31-36 MIN $67.26 $118.00 43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 19-24 MIN $67.26 $118.00 43%
Group psychotherapy session CPT 90853 HC TELEHEALTH AODA OUTPT GROUP PSYCHOTHERAPY 45 MI $71.25 $125.00 43%
Group psychotherapy session CPT 90853 HC AODA OUTPT GROUP PSYCHOTHERAPY 45 MIN $71.25 $125.00 43%
Group psychotherapy session CPT 90853 HC IOP AODA GROUP PSYCHOTHERAPY 60 MIN $94.62 $166.00 43%
Group psychotherapy session CPT 90853 HC AODA OUTPT GROUP PSYCHOTHERAPY 60 MIN $94.62 $166.00 43%
Group psychotherapy session CPT 90853 HC TELEHEALTH MH OUTPT GROUP PSYCHOTHERAPY 60 MIN $94.62 $166.00 43%
Group psychotherapy session CPT 90853 HC TELEHEALTH AODA OUTPT GROUP PSYCHOTHERAPY 60 MI $94.62 $166.00 43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 43-48 MIN $100.32 $176.00 43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 37-42 MIN $100.32 $176.00 43%
Group psychotherapy session CPT 90853 HC TELEHEALTH MH OUTPT GROUP PSYCHOTHERAPY 90 MIN $110.01 $193.00 43%
Group psychotherapy session CPT 90853 HC TELEHEALTH MH OUTPT GROUP PSYCHOTHERAPY 120 MIN $125.97 $221.00 43%
Group psychotherapy session CPT 90853 HC AODA OUTPT GROUP PSYCHOTHERAPY 90 MIN $132.24 $232.00 43%
Group psychotherapy session CPT 90853 HC IOP AODA GROUP PSYCHOTHERAPY 90 MIN $132.24 $232.00 43%
Group psychotherapy session CPT 90853 HC TELEHEALTH AODA OUTPT GROUP PSYCHOTHERAPY 90 MI $132.24 $232.00 43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 49-54 MIN $133.95 $235.00 43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 61-66 MIN $133.95 $235.00 43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 55-60 MIN $133.95 $235.00 43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 67-72 MIN $167.58 $294.00 43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 73-78 MIN $167.58 $294.00 43%
Group psychotherapy session CPT 90853 HC TELEHEALTH AODA OUTPT GROUP PSYCHOTHERAPY 120 M $176.70 $310.00 43%
Group psychotherapy session CPT 90853 HC IOP AODA GROUP PSYCHOTHERAPY 120 MIN $176.70 $310.00 43%
Group psychotherapy session CPT 90853 HC AODA OUTPT GROUP PSYCHOTHERAPY 120 MIN $176.70 $310.00 43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 85-90 MIN $201.21 $353.00 43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 91-96 MIN $201.21 $353.00 43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 79-84 MIN $201.21 $353.00 43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 103-108 MIN $234.84 $412.00 43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 97-102 MIN $234.84 $412.00 43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 109-114 MIN $267.90 $470.00 43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 115-120 MIN $267.90 $470.00 43%
Group psychotherapy session CPT 90853 HC IOP AODA GROUP PSYCHOTHERAPY 180 MIN $359.10 $630.00 43%
New patient office visit, about 30 minutes CPT 99203 HC PRO OFFICE O/P NEW LOW 30 MIN OR > $200.07 $351.00 43%
New patient office visit, about 45 minutes CPT 99204 HC PRO OFFICE O/P NEW MOD 45 MIN OR > $306.09 $537.00 43%
New patient office visit, about 60 minutes CPT 99205 HC PRO OFFICE O/P NEW HI 60 MIN OR > $380.76 $668.00 43%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC OT THERAPEUTIC EXERCISES / 15 MIN $74.10 $130.00 43%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC PT THERAPEUTIC EXERCISES / 15 MIN $74.10 $130.00 43%
Psychotherapy session, 30 minutes CPT 90832 HC PHP PSYTX W PT 25-30 MINUTES $314.07 $551.00 43%
Psychotherapy session, 30 minutes CPT 90832 HC MH OUTPT PSYTX W PT 30 MIN $314.07 $551.00 43%
Psychotherapy session, 30 minutes CPT 90832 HC AODA OUTPT PSYTX W/PT 30 MIN $314.07 $551.00 43%
Psychotherapy session, 30 minutes CPT 90832 HC PHP PSYTX W PT 31-36 MINUTES $314.07 $551.00 43%
Psychotherapy session, 30 minutes CPT 90832 HC PHP PSYTX W PT 19-24 MINUTES $314.07 $551.00 43%
Psychotherapy session, 30 minutes CPT 90832 HC PHP PSYTX W PT 16-18 MINUTES $314.07 $551.00 43%
Psychotherapy session, 30 minutes CPT 90832 HC AODA IOP PSYTX W/PT 30 MIN $314.07 $551.00 43%
Psychotherapy session, 30 minutes CPT 90832 HC TELEHEALTH AODA OUTPT PSYTX W/PT 30 MIN $314.07 $551.00 43%
Psychotherapy session, 30 minutes CPT 90832 HC TELEHEALTH MH OUTPT PSYTX W PT 30 MIN $314.07 $551.00 43%
Psychotherapy session, 45 minutes CPT 90834 HC MH OUTPT PSYTX W PT 45 MIN $440.61 $773.00 43%
Psychotherapy session, 45 minutes CPT 90834 HC AODA OUTPT PSYTX W/PT 45 MIN $440.61 $773.00 43%
Psychotherapy session, 45 minutes CPT 90834 HC PHP PSYTX W PT 49-54 MINUTES $440.61 $773.00 43%
Psychotherapy session, 45 minutes CPT 90834 HC PHP PSYTX W PT 43-48 MINUTES $440.61 $773.00 43%
Psychotherapy session, 45 minutes CPT 90834 HC PHP PSYTX W PT 37-42 MINUTES $440.61 $773.00 43%
Psychotherapy session, 45 minutes CPT 90834 HC AODA IOP PSYTX W/PT 45 MIN $440.61 $773.00 43%
Psychotherapy session, 45 minutes CPT 90834 HC TELEHEALTH AODA OUTPT PSYTX W/PT 45 MIN $440.61 $773.00 43%
Psychotherapy session, 45 minutes CPT 90834 HC TELEHEALTH MH OUTPT PSYTX W PT 45 MIN $440.61 $773.00 43%
Psychotherapy session, 60 minutes CPT 90837 HC AODA IOP PSYTX W/PT 60 MIN $507.30 $890.00 43%
Psychotherapy session, 60 minutes CPT 90837 HC TELEHEALTH MH OUTPT PSYTX W PT 60 MIN $507.30 $890.00 43%
Psychotherapy session, 60 minutes CPT 90837 HC MH OUTPT PSYTX W PT 60 MIN $507.30 $890.00 43%
Psychotherapy session, 60 minutes CPT 90837 HC AODA OUTPT PSYTX W/PT 60 MIN $507.30 $890.00 43%
Psychotherapy session, 60 minutes CPT 90837 HC PHP PSYTX W PT 85-90 MINUTES $507.30 $890.00 43%
Psychotherapy session, 60 minutes CPT 90837 HC PHP PSYTX W PT 79-84 MINUTES $507.30 $890.00 43%
Psychotherapy session, 60 minutes CPT 90837 HC PHP PSYTX W PT 73-78 MINUTES $507.30 $890.00 43%
Psychotherapy session, 60 minutes CPT 90837 HC PHP PSYTX W PT 67-72 MINUTES $507.30 $890.00 43%
Psychotherapy session, 60 minutes CPT 90837 HC PHP PSYTX W PT 61-66 MINUTES $507.30 $890.00 43%
Psychotherapy session, 60 minutes CPT 90837 HC PHP PSYTX W PT 55-60 MINUTES $507.30 $890.00 43%
Specialist consultation, low complexity or 30+ minutes CPT 99243 HC PRO OFFICE CONSULT NEW/EST LOW $251.37 $441.00 43%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC PRO OFFICE CONSULT NEW/EST MOD $373.35 $655.00 43%

Source file: https://healthcare.ascension.org/-/media/project/ascension/healthcare/price-transparency-files/wi-csv/390816818-1407803638_ascension-ne-wisconsin-inc-fka-st-elizabeth-hospital-inc_standardcharges.csv