Moundview Memorial Hospital and Clinics, Inc.
Moundview Memorial Hospital and Clinics, Inc. in Friendship, WI publishes cash prices for 37 common procedures listed here, from its own machine-readable price file updated Jun 27, 2026. Click a procedure to compare it with other hospitals nearby.
402 W Lake St, Friendship, WI 53934 Collected Sep 22, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HCHG 74177 CT ABD&PELVIS;W/CONTRAST | $2,032.51 | $4,001.00 | 49% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HCHG 74177 CT ABD&PELVIS;W/CONTRAST | $2,032.51 | $4,001.00 | 49% |
| CT scan of the head or brain, no contrast dye CPT 70450 HCHG 70450 CT HEAD W/O IV CONT | $858.01 | $1,689.00 | 49% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HCHG 70450 CT HEAD W/O IV CONT | $858.01 | $1,689.00 | 49% |
| CT scan of the pelvis, with contrast dye CPT 72193 HCHG 72193 CT PELVIS W/IV CONT | $1,590.04 | $3,130.00 | 49% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HCHG 72193 CT PELVIS W/IV CONT | $1,590.04 | $3,130.00 | 49% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HCHG 77066 DIAGNOSTIC MAMMOGRAPHY, INCL CAD, BILATERAL | $341.88 | $673.00 | 49% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HCHG 77066 DIAGNOSTIC MAMMOGRAPHY, INCL CAD, BILATERAL | $341.88 | $673.00 | 49% |
| Diagnostic mammogram, one breast one side CPT 77065 HCHG 77065 DIAGNOSTIC MAMMOGRAPHY, INCL CAD, UNILATERAL | $274.83 | $541.00 | 49% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HCHG 77065 DIAGNOSTIC MAMMOGRAPHY, INCL CAD, UNILATERAL | $274.83 | $541.00 | 49% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HCHG 73721 MRI LOWER EXT;W/O CONTRAST | $1,493.52 | $2,940.00 | 49% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HCHG 73721 MRI LOWER EXT;W/O CONTRAST | $1,493.52 | $2,940.00 | 49% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HCHG 73723 MRI LOWER EXT;W/O,W/CONT | $2,182.37 | $4,296.00 | 49% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HCHG 73723 MRI LOWER EXT;W/O,W/CONT | $2,182.37 | $4,296.00 | 49% |
| MRI of the brain, no contrast dye CPT 70551 HCHG 70551 MRI HEAD (3 SEQ) | $1,633.73 | $3,216.00 | 49% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HCHG 70551 MRI HEAD (3 SEQ) | $1,633.73 | $3,216.00 | 49% |
| MRI of the brain, with and without contrast dye CPT 70553 HCHG 70553 MRI HEAD W&WO CONTRAST | $2,127.00 | $4,187.00 | 49% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HCHG 70553 MRI HEAD W&WO CONTRAST | $2,127.00 | $4,187.00 | 49% |
| MRI of the lower back, no contrast dye CPT 72148 HCHG 72148 MRI-LUMBAR SPINE W/O CONTRAST | $2,033.02 | $4,002.00 | 49% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HCHG 72148 MRI-LUMBAR SPINE W/O CONTRAST | $2,033.02 | $4,002.00 | 49% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HCHG 76805 US OB-AFTER 1ST TRIMESTER | $457.71 | $901.00 | 49% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HCHG 76805 US OB-AFTER 1ST TRIMESTER | $457.71 | $901.00 | 49% |
| Screening mammogram, both breasts both sides CPT 77067 HCHG 77067 SCREENING MAMMOGRAPHY, BILATERAL, INCL CAD | $179.32 | $353.00 | 49% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HCHG 77067 SCREENING MAMMOGRAPHY, BILATERAL, INCL CAD | $179.32 | $353.00 | 49% |
| Sleep study in a lab (polysomnography) CPT 95810 HCHG 95810 POLYSOMNOGRAPHY 6/+ YRS | $3,482.85 | $6,856.00 | 49% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HCHG 95810 POLYSOMNOGRAPHY 6/+ YRS | $3,482.85 | $6,856.00 | 49% |
| Transvaginal pelvic ultrasound CPT 76830 HCHG 76830 US PELVIS TRANSVAG | $498.86 | $982.00 | 49% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HCHG 76830 US PELVIS TRANSVAG | $498.86 | $982.00 | 49% |
| Ultrasound of the abdomen, complete CPT 76700 HCHG 76700 US ABDOMEN (SPCFY) | $695.96 | $1,370.00 | 49% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HCHG 76700 US ABDOMEN (SPCFY) | $695.96 | $1,370.00 | 49% |
| X-ray of the lower back, 4 or more views CPT 72110 HCHG 72110 SPINE LUMBAR W/OBLIQ (4 VWS) | $314.45 | $619.00 | 49% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HCHG 72110 SPINE LUMBAR W/OBLIQ (4 VWS) | $314.45 | $619.00 | 49% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL | $48.26 | $95.00 | 49% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL | $48.26 | $95.00 | 49% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL (NMR) | $76.71 | $151.00 | 49% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $76.71 | $151.00 | 49% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL (NMR) | $76.71 | $151.00 | 49% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL | $76.71 | $151.00 | 49% |
| Complete blood count (CBC) with differential CPT 85025 BLOOD COUNT; COMPLETE (CBC) | $44.20 | $87.00 | 49% |
| Complete blood count (CBC) with differential inpatient CPT 85025 BLOOD COUNT; COMPLETE (CBC) | $44.20 | $87.00 | 49% |
| Complete blood count (CBC), no differential CPT 85027 BLOOD COUNT; COMPLETE (CBC) AUTOMATED | $37.08 | $73.00 | 49% |
| Complete blood count (CBC), no differential inpatient CPT 85027 BLOOD COUNT; COMPLETE (CBC) AUTOMATED | $37.08 | $73.00 | 49% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL | $60.45 | $119.00 | 49% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL | $60.45 | $119.00 | 49% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $49.78 | $98.00 | 49% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $49.78 | $98.00 | 49% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $46.74 | $92.00 | 49% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $46.74 | $92.00 | 49% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PROSTATIC SPECIFIC ANTIGEN (PSA); FREE | $105.16 | $207.00 | 49% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PROSTATIC SPECIFIC ANTIGEN (PSA); FREE | $105.16 | $207.00 | 49% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATIC SPECIFIC ANTIGEN (PSA); TOTAL | $105.16 | $207.00 | 49% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATIC SPECIFIC ANTIGEN (PSA); TOTAL | $105.16 | $207.00 | 49% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME, PARTIAL (PTT) | $34.54 | $68.00 | 49% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD | $34.54 | $68.00 | 49% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD | $34.54 | $68.00 | 49% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME, PARTIAL (PTT) | $34.54 | $68.00 | 49% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $24.38 | $48.00 | 49% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $24.38 | $48.00 | 49% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE (TSH) | $96.01 | $189.00 | 49% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE (TSH) | $96.01 | $189.00 | 49% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS; AUTOMATED WITH MICROSCOPY | $18.29 | $36.00 | 49% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS; AUTOMATED WITH MICROSCOPY | $18.29 | $36.00 | 49% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS; AUTOMATED WO MICROSCOPY (UA DIP ONLY) | $7.11 | $14.00 | 49% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS; AUTOMATED WO MICROSCOPY (UA DIP ONLY) | $7.11 | $14.00 | 49% |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS; NON-AUTOMATED WO MICROSCOPY | $19.81 | $39.00 | 49% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS; NON-AUTOMATED WO MICROSCOPY | $19.81 | $39.00 | 49% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Colonoscopy with polyp removal CPT 45385 HCHG 45385P COLONOSCOPY W/REM POLYP,TUMOR,LESION-SNARE | $2,113.28 | $4,160.00 | 49% |
| Colonoscopy with polyp removal inpatient CPT 45385 HCHG 45385P COLONOSCOPY W/REM POLYP,TUMOR,LESION-SNARE | $2,113.28 | $4,160.00 | 49% |
| Colonoscopy with tissue sample CPT 45380 HCHG 45380P COLONOSCOPY W/BIOPSY, SGL OR MULT | $2,113.28 | $4,160.00 | 49% |
| Colonoscopy with tissue sample inpatient CPT 45380 HCHG 45380P COLONOSCOPY W/BIOPSY, SGL OR MULT | $2,113.28 | $4,160.00 | 49% |
| Colonoscopy, diagnostic CPT 45378 HCHG 45378P COLONOSCOPY; DIAGNOSTIC | $2,113.28 | $4,160.00 | 49% |
| Colonoscopy, diagnostic inpatient CPT 45378 HCHG 45378P COLONOSCOPY; DIAGNOSTIC | $2,113.28 | $4,160.00 | 49% |
| Upper endoscopy (EGD) with biopsy CPT 43239 HCHG 43239P EGD W/BIOPSY, SGL OR MULT | $1,774.44 | $3,493.00 | 49% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HCHG 43239P EGD W/BIOPSY, SGL OR MULT | $1,774.44 | $3,493.00 | 49% |
| Upper endoscopy (EGD), diagnostic CPT 43235 HCHG 43235P EGD; DIAGNOSTIC | $1,774.44 | $3,493.00 | 49% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HCHG 43235P EGD; DIAGNOSTIC | $1,774.44 | $3,493.00 | 49% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG 97110 THERAPUTIC PROCEDURE, EACH 15 MIN; THERAPUTIC EXERCIS | $73.66 | $145.00 | 49% |
Source file: https://bellin-ghs.pt.panaceainc.com/MRFDownload/bellin-ghs/gundersen-moundview