Visits & medical services prices at Gundersen Tri-county Hospital and Clinics

Whitehall, WI · every code in this section with a posted price and a Medicare benchmark.

185 codes. Prices are the hospital's own posted facility charges.

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ProcedurePosted cashPosted gross× Medicare
Admn Sarscov2 Vacc 1 Dose (90480)
range across 2 matching MRF lines		 $12.68–$37.41 $20–$59 varies
Aep Hearing Status Deter Broadband Stimuli I&R (92651)
range across 2 matching MRF lines		 $113.49–$218.73 $179–$345 varies
Aep neurodiagnostic i&r (92653)
range across 2 matching MRF lines		 $110.32–$414 $174–$653 varies
Aep threshold estimation mlt frequencies i&r (92652)
range across 2 matching MRF lines		 $149.62–$414 $236–$653 varies
Airway Inhalation Treatment (94640) $200.34 $316 0.9×
Analyze neurostim no prog (95970) $195.27 $308 1.5×
Ant sgm imaging w/microscopy endothelial analy (92286) $187.66 $296 1.5×
Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) $35.50 $56 2.5×
Application on-body injector (96377) $109.68 $173 2.4×
Assessment of aphasia per hr (96105) $366.45 $578 3.8×
Audiometry Air & Bone (92553) $152.16 $240 1.2×
Basic vestibular evaluation (92540) $349.33 $551 1.7×
Behavral qualit analys voice (92524) $311.29 $491 2.8×
Breath hydrogen/methane test (91065) $41.84 $66 0.2×
Brief Emotional/Behav Assmt (96127) $52.62 $83 1.5×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $354.41 $559 1.0×
Caloric vestibular test w/rec bi monothermal (92538)
range across 2 matching MRF lines		 $20.29–$218.73 $32–$345 varies
Caloric Vstblr Test W/Rec (92537)
range across 2 matching MRF lines		 $39.31–$218.73 $62–$345 varies
Canalith repositioning proc (95992) $121.73 $192 3.0×
Cardiac Stress Tst,Tracing Only (93017) $556.02 $877 2.7×
Cardiopulmonary resuscitation (92950) $2,082.69 $3,285 9.9×
Cardioversion (92960) $707.54 $1,116 1.1×
Cervical & Ocular Vemp Testing W/I&R (92519)
range across 2 matching MRF lines		 $80.52–$414 $127–$653 varies
Cervical Vemp Testing W/I&R (92517)
range across 2 matching MRF lines		 $54.52–$218.73 $86–$345 varies
Chemo Anti-Neopl Sq/Im (96401) $153.43 $242 2.2×
Chemo Hormon Antineopl Sq/Im (96402) $153.43 $242 2.2×
Chemo IV infusion addl hr (96415) $162.30 $256 2.3×
Chemo IV push addl drug (96411) $145.82 $230 2.1×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $212.39 $335 3.0×
Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) $466.62 $736 1.5×
Chemotx admn IV push tq 1/1st sbst/drug (96409) $466.62 $736 1.5×
Chest Wall Manipulation (94668) $121.09 $191 0.9×
Cmptr ophth dx img ant segmt (92132) $90.66 $143 1.6×
Color/duplex Doppler, complete (93975) $670.14 $1,057 2.9×
Color/duplex Doppler, limited (93976) $811.52 $1,280 8.0×
Community/Work Reintegration Trainj Ea 15 Min (97537) $84.96 $134 2.7×
Comprehensive Hearing Test (92557) $133.77 $211 1.1×
Computerized Ophthalmic Imaging Retina (92134) $45.01 $71 0.8×
Cont gluc mntr physician/qhp provided equiptment (95250) $317.63 $501 2.5×
Cont Gluc Mntr Pt Prov Eqp (95249) $142.02 $224 2.5×
Continuous Pulse Ox (94762) $394.35 $622 3.2×
Corneal Topography (92025) $83.69 $132 1.5×
Cpap Ventilation Cpap Initiation&Mgmt (94660)
range across 2 matching MRF lines		 $200.34–$307.49 $316–$485 varies
Cpt initial (94667) $121.09 $191 0.9×
Critical care first hour (99291) $1,446.79 $2,282 1.8×
Debridement Open Wound 20 Sq Cm< (97597) $215.56 $340 1.1×
Distrt prod evokd otoacoustic emsns comp/dx eval (92588) $202.88 $320 0.6×
Dup-scan aorta ivc iliac vascl/bpgs complete (93978) $522.42 $824 2.3×
Dup-scan lxtr art/artl bpgs compl bi study (93925) $670.14 $1,057 2.9×
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) $425.41 $671 4.2×
Dup-Scan Xtr Veins Complete Bilateral Study (93970) $980.16 $1,546 4.2×
Dup-scan xtr veins unilateral/limited study (93971) $710.08 $1,120 7.0×
Duplex up extrem art bilat (93930) $947.83 $1,495 4.1×
Duplex up extrem art unilat/ltd (93931) $425.41 $671 4.2×
Ear and throat examination (92502) $836.88 $1,320 1.6×
ECG/monitoring and analysis (93271) $350.60 $553 3.8×
Echo Congenital Complete (93303) $1,796.76 $2,834 3.4×
Echo Heart Xthoracic,Limited (93308) $906.62 $1,430 3.9×
Echo transesophageal (93312) $908.52 $1,433 1.7×
Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351) $1,752.38 $2,764 3.3×
Elec alys implt brn npgt prgrmg 1st 15 min (95983) $91.30 $144 1.0×
Electrical Stimulation Ea 15 Min (97032) $56.43 $89 3.8×
Electrocardiogram Tracing (93005) $136.94 $216 2.4×
Emergency Dept Visit Level 2 (99282) $301.78 $476 2.0×
Emergency Dept Visit Level 3 (99283) $443.17 $699 1.7×
Emergency Dept Visit Level 4 (99284) $717.05 $1,131 1.8×
Er level 1 (99281) $168.64 $266 2.1×
Er level v (99285) $1,078.43 $1,701 1.9×
Evaluate pt use of inhaler (94664) $200.34 $316 0.9×
Evaluate Speech Production (92522) $300.52 $474 2.7×
Evaluate Swallowing Function (92610) $318.27 $502 3.8×
Evaluation of speech fluency (92521) $369.62 $583 2.8×
External ECG rec>48hr<7d recording (93242) $64.03 $101 1.8×
External ECG rec>7d<15d recording (93246) $60.23 $95 1.7×
External Ecg Scanning Analysis Report (93226) $313.83 $495 5.5×
Extracranial Bilat Study (93880) $1,053.07 $1,661 4.5×
Fluorescein angiography (92235) $254.23 $401 1.2×
Fundus photography (92250) $67.84 $107 0.5×
Gastroesophag Reflx Test W/Cath Ph Eltrd Plcmt (91034) $231.41 $365 0.6×
Gastroesophag reflx test w/telemtry ph eltrd (91035) $379.13 $598 0.5×
Gi tract capsule endoscopy (91110) $439.36 $693 0.5×
Holter monitor recording (93225) $418.44 $660 3.2×
Im Adm Intransl/Oral 1 Vaccine (90473)
range across 2 matching MRF lines		 $12.68–$69.74 $20–$110 varies
Immunization administration (90471)
range across 11 matching MRF lines		 $12.68–$88.76 $20–$140 varies
Iontophoresis 15 min (97033) $92.56 $146 4.9×
Irrig Drug Delivery Device (96523) $83.69 $132 1.5×
IV infusion hydration each additional hour (96361) $85.59 $135 1.9×
IV infusion hydration initial 31 min-1 hour (96360) $284.03 $448 1.4×
IV infusion ther proph addl sequential to 1 hr (96367) $138.85 $219 2.0×
IV infusion therapy prophylaxis/dx ea hour (96366) $95.10 $150 2.1×
IV push initial (96374) $232.68 $367 1.1×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $34.87 $55 1.1×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $41.21 $65 1.1×
Medical nutrition therapy grp2/ indiv ea 30 mi (97804) $19.02 $30 1.1×
Motility study esophagus (91010) $366.45 $578 1.0×
Motion Fluoroscopy/Swallow (92611) $349.33 $551 3.8×
Multiple Family Group Psychotherapy (90849) $72.91 $115 0.4×
Nasopharyngoscopy (92511) $271.99 $429 1.4×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $206.68 $326 1.1×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $396.88 $626 1.0×
Neuromuscular Reeducation (97112) $95.73 $151 2.9×
Nonphysician Telephone Assessment 11-20 Min (98967) $62.13 $98 2.5×
Nonphysician Telephone Assessment 21-30 Min (98968) $94.47 $149 2.7×
Nonphysician Telephone Assessment 5-10 Min (98966) $31.70 $50 2.3×
Ocular Vemp Testing W/I&R (92518)
range across 2 matching MRF lines		 $54.52–$218.73 $86–$345 varies
Oph bmtry prtl coher intrfrmtry io lens pwr cal (92136) $261.84 $413 2.0×
Optokinetic Nystagmus Test (92544) $107.78 $170 0.9×
Oral Function Therapy (92526) $296.08 $467 3.5×
Oral Speech Device Eval (92597) $296.08 $467 4.2×
Orthc/Prostc Mgmt Sbsq Enc (97763) $130.60 $206 2.6×
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) $121.73 $192 2.6×
Oscillating Tracking Test (92545) $95.73 $151 0.5×
Ot Contrast Bath Ea 15 Min (97034) $51.35 $81 3.7×
Ot eval high complexity (97167) $282.13 $445 2.8×
Ot Eval Low Complex (97165) $211.12 $333 2.1×
Ot Eval Moderate Complexity (97166) $247.89 $391 2.5×
Ot manual therapy 15 min (97140) $88.13 $139 3.2×
Ot paraffin bath (97018) $31.07 $49 5.2×
Ot Prosthetic Training, Each 15 Min (97761) $103.98 $164 2.6×
Ot Re-Eval Est Plan Care (97168) $155.33 $245 2.3×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798)
range across 2 matching MRF lines		 $251.06–$277.69 $396–$438 varies
Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) $220.63 $348 1.8×
Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) $200.34 $316 0.9×
Peripheral arterial disease rehab per session (93668) $199.71 $315 3.5×
Phlebotomy therapeutic (99195) $275.16 $434 2.1×
Phys/qhp svcs op pulm rehab w/cont oximtry mntr (94626) $118.56 $187 2.1×
Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) $118.56 $187 2.1×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $2,517.61 $3,971 3.0×
Positional nystagmus test (92542) $101.44 $160 0.8×
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $48.82 $77 1.1×
Prof svcs allg immntx x w/prv allgic xtrcs njxs (95117) $52.62 $83 1.2×
Psych diag eval w/med srvcs (90792) $236.48 $373 1.4×
Psychiatric diagnostic evaluation (90791) $228.24 $360 1.3×
Psytx Crisis Initial 60 Min (90839) $323.97 $511 1.9×
Pt Eval High Complex (97163) $247.26 $390 2.5×
Pt eval low complex 20 min (97161) $176.25 $278 1.8×
Pt Eval Mod Complex (97162) $213.02 $336 2.2×
Pt gait training 15 min (97116) $80.52 $127 2.8×
Pt mechanical traction (97012) $47.55 $75 3.3×
Pt Re-Eval Est Plan Care (97164) $146.45 $231 2.2×
Pulmonary service/procedure (94799)
range across 4 matching MRF lines		 $147.09–$152.16 $232–$240 varies
Pulmonary Stress Testing (94618) $121.09 $191 0.9×
Pure Tone Audiometry Air (92552)
range across 4 matching MRF lines		 $11.41–$121.09 $18–$191 varies
Refill&Maintenance Pump Drug Dlvr Spinal/Brain (95990) $347.43 $548 1.1×
Remote 30 Day Ecg Rev/Report (93270) $208.59 $329 5.8×
Remote 30 Day Ecg Tech Supp (93229) $322.07 $508 0.9×
Rhythm Ecg 1-3 Leads Tracing Only W/O I&R (93041) $77.35 $122 1.3×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $206.68 $326 1.1×
Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) $507.83 $801 4.2×
Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) $163.57 $258 3.4×
Self Care Mngment Training (97535) $97.64 $154 3.0×
Sensormotor xm w/mlt meas ocular devij w/i&r spx (92060) $161.04 $254 2.8×
Sensory Integration Ea 15 Min (97533) $128.07 $202 2.1×
Sleep study unattended (95806) $713.25 $1,125 3.4×
Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) $713.25 $1,125 3.4×
Speech Audiometry Complete (92556)
range across 2 matching MRF lines		 $57.69–$149.62 $91–$236 varies
Speech audiometry threshold (92555) $95.73 $151 1.7×
Speech sound lang comprehen (92523) $624.49 $985 2.8×
Spirometry (94010) $198.44 $313 0.9×
Spontaneous Nystagmus Test (92541) $148.36 $234 1.1×
Standardized Cognitive Performance Testing (96125) $355.04 $560 3.5×
Stress Tte Only (93350) $1,416.99 $2,235 2.7×
Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) $75.45 $119 3.4×
Ther Ivntj Ea Addl 15 Min (97130) $75.45 $119 3.6×
Ther Px 1/> Areas Each 15 Minutes Massage (97124) $72.28 $114 2.4×
Ther/Proph/Diag Inj Sc/Im (96372) $75.45 $119 1.1×
Ther/Proph/Diag Iv Inf Init (96365) $305.59 $482 1.5×
Therapeutic Activities (97530) $97.64 $154 2.8×
Tobacco Use Cessation Intensive >10 Minutes (99407) $118.56 $187 3.3×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $62.13 $98 1.7×
Tte w/doppler, complete (93306) $2,040.21 $3,218 3.8×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $268.18 $423 3.5×
Tx/Pro/Dx Inj New Drug Addon (96375) $117.29 $185 2.6×
Tympanometry (92567) $38.67 $61 1.1×
Upr/L Xtremity Art 2 Levels (93922) $405.13 $639 3.1×
Vasopneumatic device (97016) $68.47 $108 5.7×
Vent Mgmt Inpat Init Day (94002) $776.02 $1,224 1.3×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $581.38 $917 1.0×
Visual Field Exam Extended (92083) $101.44 $160 0.8×
Visual field xm uni/bi w/interp intermed exam (92082) $82.42 $130 1.4×
Visual field xm uni/bi w/interpretj limited exam (92081) $62.13 $98 1.1×
Vital capacity, total (94150) $152.16 $240 1.2×
Wheelchair Mgmt Ea 15 Min (97542) $89.39 $141 2.9×
Whirlpool Therapy (97022) $64.03 $101 4.1×
Xtrnl Ocular Photog W/I&R Docmt Medical Progre (92285) $27.26 $43 0.8×

A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.