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  • $1.14 per page for the first 25 pages
  • $0.86 per page for pages 26 to 50
  • $0.56 per page for pages 51 to 100
  • $0.34 cents per page for pages 101 and above
  • $1.68 per page for microfiche or microfilm copies
  • $11.28 per image for a print of an x-ray
  • Actual shipping costs and any applicable taxes
  • The following apply to requests from anyone other than the patient or a person authorized by the patient:
    • $9.04 to certify the record
    • Retrieval fee of $21.28
  • Wis. Stat. ยง146.83 (adjusted based on CPI in 2020)
  • https://www.dhs.wisconsin.gov/wisact146/medical-records-fee.pdf