Supplies, drugs & other prices at ThedaCare Medical Center New London
New London, WI · every code in this section with a posted price and a Medicare benchmark.
114 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Adm tocilizu covid-19 1st (M0249) range across 2 matching MRF lines |
$842.41–$892.98 | $1,504.30–$1,594.60 | varies |
| Adm tocilizu covid-19 2nd (M0250) range across 2 matching MRF lines |
$842.41–$892.98 | $1,504.30–$1,594.60 | varies |
| Admin hepatitis b vaccine (G0010) range across 4 matching MRF lines |
$70–$162.51 | $125–$290.20 | varies |
| Admin influenza virus vac (G0008) range across 7 matching MRF lines |
$57.79–$162.51 | $103.20–$290.20 | varies |
| Admin pneumococcal vaccine (G0009) range across 7 matching MRF lines |
$48.16–$162.51 | $86–$290.20 | varies |
| Alcohol/subs interv 15-30mn (G0396) range across 2 matching MRF lines |
$70.11–$74.42 | $125.20–$132.90 | varies |
| Alcohol/subs interv >30 min (G0397) range across 2 matching MRF lines |
$139.05–$143.42 | $248.30–$256.10 | varies |
| Alveoplasty w/ extraction (D7310) | $2,488.53 | $4,443.80 | 1.6× |
| Amalgam two surfaces permane (D2150) range across 2 matching MRF lines |
$356.89–$463.96 | $637.30–$828.50 | varies |
| Arthro/shoul surg; w/spacer (C9781) range across 3 matching MRF lines |
$12,719.06–$16,720.70 | $22,712.60–$29,858.40 | varies |
| Behavior counsel obesity 15m (G0447) range across 2 matching MRF lines |
$84.34–$94.30 | $150.60–$168.40 | varies |
| Brief chkin by md/qhp, 11-20 (G2252) range across 2 matching MRF lines |
$55.33–$58.30 | $98.80–$104.10 | varies |
| Brief chkin, 5-10, non-e/m (G2251) range across 2 matching MRF lines |
$27.27–$30.97 | $48.70–$55.30 | varies |
| Ca screen;flexi sigmoidscope (G0104) range across 2 matching MRF lines |
$1,083.43–$1,408.46 | $1,934.70–$2,515.10 | varies |
| Ca screen;pelvic/breast exam (G0101) range across 3 matching MRF lines |
$99.29–$155.40 | $177.30–$277.50 | varies |
| Catheterize for urine spec (P9612) range across 7 matching MRF lines |
$21.39–$65.69 | $38.20–$117.30 | varies |
| Colon ca scrn not hi rsk ind (G0121) range across 4 matching MRF lines |
$1,177.12–$2,233.78 | $2,102–$3,988.90 | varies |
| Colorectal scrn; hi risk ind (G0105) range across 3 matching MRF lines |
$1,741.38–$2,233.11 | $3,109.60–$3,987.70 | varies |
| Colpopexy, min/inv, ex-perit (C9778) range across 2 matching MRF lines |
$8,377.99–$8,629.32 | $14,960.70–$15,409.50 | varies |
| Compre ful bdy cptr mrkrls 3d knmtc&kin mtn alys (0693T) | $203.73 | $363.80 | 0.6× |
| Covid-19 lab test non-cdc (U0002) | $168 | $300 | 3.3× |
| Cyp1a2 gene analysis common variants (0031U) | $401.41 | $716.80 | 2.3× |
| Cysto impl 4 or more (C9740) range across 2 matching MRF lines |
$14,473.37–$14,907.59 | $25,845.30–$26,620.70 | varies |
| Cysto, litho, vacuum kidney (C9761) | $15,535.24 | $27,741.50 | 1.7× |
| Cystoscopy prostatic imp 1-3 (C9739) range across 3 matching MRF lines |
$8,958.82–$11,777.58 | $15,997.90–$21,031.40 | varies |
| Dental prophylaxis adult (D1110) range across 2 matching MRF lines |
$267.68–$275.69 | $478–$492.30 | varies |
| Depression screen annual (G0444) range across 2 matching MRF lines |
$33.99–$68.94 | $60.70–$123.10 | varies |
| Diab manage trn per indiv (G0108) range across 4 matching MRF lines |
$92.79–$204.46 | $165.70–$365.10 | varies |
| Diab manage trn ind/group (G0109) range across 4 matching MRF lines |
$29.18–$58.13 | $52.10–$103.80 | varies |
| Direct refer hospital observ (G0379) range across 2 matching MRF lines |
$248.14–$255.58 | $443.10–$456.40 | varies |
| Ekg tracing for initial prev (G0404) range across 3 matching MRF lines |
$27.27–$81.82 | $48.70–$146.10 | varies |
| Elec stim other than wound (G0283) range across 3 matching MRF lines |
$53.93–$87.08 | $96.30–$155.50 | varies |
| Excision of rectal tumor, transanal endoscopic microsurgical approach (ie, TEMS), including muscularis propria (ie,… (0184T) range across 2 matching MRF lines |
$8,827.56–$9,092.38 | $15,763.50–$16,236.40 | varies |
| Extraction erupted tooth/exr (D7140) range across 2 matching MRF lines |
$1,207.86–$1,570.24 | $2,156.90–$2,804 | varies |
| Extrnl counterpulse, per tx (G0166) | $216.55 | $386.70 | 1.7× |
| Facility svs dental rehab (G0330) range across 3 matching MRF lines |
$3,377.64–$4,722.54 | $6,031.50–$8,433.10 | varies |
| Fecal microbiota prep instil (G0455) range across 2 matching MRF lines |
$1,479.86–$1,524.26 | $2,642.60–$2,721.90 | varies |
| Group behave couns 2-10 (G0473) range across 2 matching MRF lines |
$43.06–$46.82 | $76.90–$83.60 | varies |
| Group mnt 2 or more 30 mins (G0271) range across 5 matching MRF lines |
$30.02–$63.06 | $53.60–$112.60 | varies |
| Home sleep test/type 3 porta (G0399) range across 3 matching MRF lines |
$354.14–$545.16 | $632.40–$973.50 | varies |
| Home sleep test/type 4 porta (G0400) range across 2 matching MRF lines |
$321.72–$418.26 | $574.50–$746.90 | varies |
| Ig paraprotein qual imprcip&ms bld/ur w/isotype (0077U) | $148.74 | $265.60 | 3.4× |
| Init/sub psych care m 1st 30 (G2214) range across 2 matching MRF lines |
$83.72–$132.22 | $149.50–$236.10 | varies |
| Initial preventive exam (G0402) range across 2 matching MRF lines |
$258.89–$328.05 | $462.30–$585.80 | varies |
| Inj for sacroiliac jt anesth (G0260) range across 3 matching MRF lines |
$1,113.62–$1,265.88 | $1,988.60–$2,260.50 | varies |
| Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space;… (0449T) range across 3 matching MRF lines |
$8,924.16–$11,732.06 | $15,936–$20,950.10 | varies |
| Insertion of sinus tarsi implant (0335T) range across 3 matching MRF lines |
$10,984.62–$16,720.70 | $19,615.40–$29,858.40 | varies |
| Intens behave ther cardio dx (G0446) range across 2 matching MRF lines |
$84.34–$95.59 | $150.60–$170.70 | varies |
| Jak2 Gene Analysis Trgt Seq Alys Exons 12-15 (0027U) | $243.77 | $435.30 | 2.0× |
| Liver Dis 10 Assays Serum Algorithm W/Nash (0003M) | $1,421.28 | $2,538 | 2.8× |
| Mnt subs tx for change dx (G0270) range across 5 matching MRF lines |
$35.67–$120.46 | $63.70–$215.10 | varies |
| Mra w/o cont, chest (C8910) range across 2 matching MRF lines |
$1,515.53–$1,742.89 | $2,706.30–$3,112.30 | varies |
| Mra w/o cont, lwr ext (C8913) range across 2 matching MRF lines |
$1,515.53–$1,742.89 | $2,706.30–$3,112.30 | varies |
| Mra w/o cont, pelvis (C8919) range across 2 matching MRF lines |
$1,515.53–$1,742.89 | $2,706.30–$3,112.30 | varies |
| Mra w/o fol w/cont, lwr ext (C8914) | $1,711.47 | $3,056.20 | 5.0× |
| Mra w/o fol w/cont, pelvis (C8920) range across 2 matching MRF lines |
$1,515.53–$1,742.89 | $2,706.30–$3,112.30 | varies |
| Mra, w/o dye, upper extr (C8935) range across 2 matching MRF lines |
$1,818.77–$2,091.60 | $3,247.80–$3,735 | varies |
| Mra, w/o&w/dye, spinal canal (C8933) range across 2 matching MRF lines |
$1,818.77–$2,091.60 | $3,247.80–$3,735 | varies |
| Mra, w/o&w/dye, upper extr (C8936) range across 2 matching MRF lines |
$1,818.77–$2,091.60 | $3,247.80–$3,735 | varies |
| Mri w/cont, breast, bi (C8906) range across 2 matching MRF lines |
$727.66–$836.81 | $1,299.40–$1,494.30 | varies |
| Mri w/cont, breast, uni (C8903) range across 5 matching MRF lines |
$380.52–$534.91 | $679.50–$955.20 | varies |
| Mri w/o fol w/cont, breast, (C8908) range across 3 matching MRF lines |
$1,681.29–$2,766.68 | $3,002.30–$4,940.50 | varies |
| Mri w/o fol w/cont, brst, un (C8905) range across 2 matching MRF lines |
$727.66–$836.81 | $1,299.40–$1,494.30 | varies |
| Ncntc R-T Fluor Wnd Img 1st (0598T) range across 3 matching MRF lines |
$597.13–$784.95 | $1,066.30–$1,401.70 | varies |
| Neuro csf prion prtn qual (0035U) | $897.90 | $1,603.40 | 1.7× |
| Njx bone sub matrl into subchondral bone defect (0707T) range across 2 matching MRF lines |
$5,380.37–$5,541.76 | $9,607.80–$9,896 | varies |
| Njx platelet plasma (0232T) range across 3 matching MRF lines |
$476–$689.02 | $850–$1,230.40 | varies |
| Non-ophthalmic fva (C9733) range across 2 matching MRF lines |
$700–$721 | $1,250–$1,287.50 | varies |
| Obtaining screen pap smear (Q0091) range across 2 matching MRF lines |
$36.29–$86.13 | $64.80–$153.80 | varies |
| Onc merkel cell carc detcj antb serum reprtd +/- (0059U) | $536.03 | $957.20 | 1.7× |
| Onc Merkel Cll Carc Srm Quan (0058U) | $536.03 | $957.20 | 1.7× |
| Open tx iliac spine uni/bil (G0412) | $3,567.31 | $6,370.20 | 0.5× |
| Open tx post pelvic fxcture (G0415) | $6,697.21 | $11,959.30 | 2.1× |
| Oth resp proc, group (G0239) range across 3 matching MRF lines |
$69.38–$72.35 | $123.90–$129.20 | varies |
| Oth resp proc, indiv (G0238) range across 3 matching MRF lines |
$37.58–$59.86 | $67.10–$106.90 | varies |
| Pef bronch ablt 3d nav ebus (C8005) | $29,400.84 | $52,501.50 | 1.8× |
| Pelvic ring fracture uni/bil (G0413) range across 4 matching MRF lines |
$5,225.14–$16,244.70 | $9,330.60–$29,008.40 | varies |
| Pelvic ring fx treat int fix (G0414) | $4,931.47 | $8,806.20 | 0.7× |
| Pemivibart infusion (M0224) | $756.84 | $1,351.50 | 1.8× |
| Perc d-e cor revasc chro sin (C9607) | $12,357.52 | $22,067 | 0.7× |
| Perc d-e cor revasc t cabg s (C9604) | $7,781.59 | $13,895.70 | 0.7× |
| Perc d-e cor stent ather s (C9602) | $12,357.52 | $22,067 | 0.7× |
| Perc drug-el cor stent sing (C9600) range across 2 matching MRF lines |
$9,514.96–$10,015.99 | $16,991–$17,885.70 | varies |
| Periodic oral evaluation (D0120) range across 2 matching MRF lines |
$62.61–$64.51 | $111.80–$115.20 | varies |
| Perq Sacral Augmt Bilat Inj (0201T) range across 3 matching MRF lines |
$10,930.47–$11,258.41 | $19,518.70–$20,104.30 | varies |
| Perq Sacral Augmt Unilat Inj (0200T) range across 2 matching MRF lines |
$11,857.50–$12,213.21 | $21,174.10–$21,809.30 | varies |
| Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) likely a partial charge, not the full procedure |
$3,153.92 | $5,632 | 0.3× |
| Ppps, initial visit (G0438) | $327.38 | $584.60 | 1.9× |
| Ppps, subseq visit (G0439) | $256.54 | $458.10 | 1.9× |
| Rem imp tooth w mucoper flp (D7210) range across 2 matching MRF lines |
$1,207.86–$1,244.10 | $2,156.90–$2,221.60 | varies |
| Remot img sub by pt, non e/m (G2250) range across 2 matching MRF lines |
$20.10–$26.77 | $35.90–$47.80 | varies |
| Removal and reinsertion of sinus tarsi implant (0511T) range across 3 matching MRF lines |
$14,075.66–$18,504.19 | $25,135.10–$33,043.20 | varies |
| Revasc intra lithotrip-ather (C9766) range across 2 matching MRF lines |
$19,834.92–$20,429.98 | $35,419.50–$36,482.10 | varies |
| Revasc intra lithotrip-stent (C9765) range across 2 matching MRF lines |
$19,834.92–$20,429.98 | $35,419.50–$36,482.10 | varies |
| Revasc intravasc lithotripsy (C9764) range across 2 matching MRF lines |
$12,443.98–$12,817.28 | $22,221.40–$22,888 | varies |
| Revasc lith-sten-ath tib/per (C9775) range across 2 matching MRF lines |
$29,752.41–$30,644.99 | $53,129.30–$54,723.20 | varies |
| Revasc lithotr-ather tib/per (C9774) range across 2 matching MRF lines |
$29,752.41–$30,644.99 | $53,129.30–$54,723.20 | varies |
| Revasc lithotr-stent tib/per (C9773) range across 2 matching MRF lines |
$29,752.41–$30,644.99 | $53,129.30–$54,723.20 | varies |
| Revasc lithotrip tibi/perone (C9772) range across 2 matching MRF lines |
$18,665.75–$19,225.75 | $33,331.70–$34,331.70 | varies |
| Revasc lithotrip-stent-ather (C9767) range across 2 matching MRF lines |
$19,834.92–$20,429.98 | $35,419.50–$36,482.10 | varies |
| Screen pap by tech w md supv (P3000) | $43.06 | $76.90 | 2.3× |
| Spine device implant surgery (C9757) | $21,616.28 | $38,600.50 | 1.7× |
| Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) | $5,425.50 | $9,688.40 | 1.0× |
| Therapeutic procd strg endur (G0237) range across 3 matching MRF lines |
$29.90–$34.33 | $53.40–$61.30 | varies |
| Tomosynthesis, mammo (G0279) range across 3 matching MRF lines |
$57.68–$115.64 | $103–$206.50 | varies |
| Trauma respons w/hosp criti (G0390) range across 19 matching MRF lines |
$6,112.74–$15,074.75 | $10,915.60–$26,919.20 | varies |
| Trim nail(s) (G0127) range across 2 matching MRF lines |
$26.66–$84.28 | $47.60–$150.50 | varies |
| Trluml Perip Athrc Brchiocph (0237T) range across 3 matching MRF lines |
$4,756.47–$21,625.41 | $8,493.70–$38,616.80 | varies |
| Trluml Perip Athrc Iliac Art (0238T) range across 3 matching MRF lines |
$3,949.06–$11,142.66 | $7,051.90–$19,897.60 | varies |
| Unsched dialysis esrd pt hos (G0257) range across 5 matching MRF lines |
$896.78–$983.02 | $1,601.40–$1,755.40 | varies |
| Visit esketamine 56m or less (G2082) range across 2 matching MRF lines |
$76.05–$1,811.38 | $135.80–$3,234.60 | varies |
| Visit esketamine, > 56m (G2083) range across 2 matching MRF lines |
$2,572.70 | $135.80–$4,594.10 | 1.6× |
| Visit to determ ldct elig (G0296) range across 2 matching MRF lines |
$50.57–$55.83 | $90.30–$99.70 | varies |
| Wet mounts/ w preparations (Q0111) | $22.85 | $40.80 | 1.2× |
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.