Gundersen Lutheran Medical Center
Listed in its price file as “Gundersen Luthern Medical Center Inc”.
Gundersen Lutheran Medical Center in La Crosse, WI publishes cash prices for 109 common procedures listed here, from its own machine-readable price file updated Jun 27, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Wisconsin median for 94 of 108 procedures and above it for 14. By typical cash price it ranks #9 of 103 Wisconsin hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.
1910 South Ave, La Crosse, WI 54601 Collected Sep 21, 2026 Source price file Check a bill from this hospital (608) 782-7300
Acute care hospital Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 520087 · CMS hospital register
Financial assistance
Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply
Gundersen Lutheran Medical Center is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.
You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.
Source: IRS, section 501(r) requirements for nonprofit hospitals.
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| C-peptide blood test CPT 84681 C-PEPTIDE | $52.00 | $130.00 | $4.28–$21.85 | 40% below | 60% |
| C-peptide blood test inpatient CPT 84681 C-PEPTIDE | $52.00 | $130.00 | $43.42–$126.10 | — | 60% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Balloon dilation of the maxillary sinus opening, one side CPT 31295 HCHG 31295 NASAL/SINUS ENDOSCOPY | $1,777.60 | $4,444.00 | $1,484.30–$4,310.68 | 7% below | 60% |
| Balloon dilation of the maxillary sinus opening, one side inpatient CPT 31295 HCHG 31295 NASAL/SINUS ENDOSCOPY | $1,777.60 | $4,444.00 | $1,484.30–$4,310.68 | — | 60% |
| Botox injections for chronic migraine CPT 64615 HCHG 64615 CHEMODENERVATION MUSCLE(S);MIGRAINE | $233.60 | $584.00 | $195.06–$566.48 | 68% below | 60% |
| Botox injections for chronic migraine inpatient CPT 64615 HCHG 64615 CHEMODENERVATION MUSCLE(S);MIGRAINE | $233.60 | $584.00 | $195.06–$566.48 | — | 60% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HCHG 27786 CLSD TX DISTAL FIB FX W/O MAN | $263.60 | $659.00 | $209.47–$7,135.00 | 52% below | 60% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HCHG 27786 CLSD TX DISTAL FIB FX W/O MAN | $263.60 | $659.00 | $220.11–$639.23 | — | 60% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HCHG 28470 CLSD TX METATARS FX W/O MAN,EA | $234.40 | $586.00 | $209.47–$7,135.00 | 61% below | 60% |
| Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HCHG 28470 CLSD TX METATARS FX W/O MAN,EA | $234.40 | $586.00 | $195.72–$568.42 | — | 60% |
| Carpal tunnel release, open surgery CPT 64721 HCHG 64721 REVISE NERVE AT WRIST | $2,148.80 | $5,372.00 | $586.16–$9,741.74 | 4% below | 60% |
| Carpal tunnel release, open surgery inpatient CPT 64721 HCHG 64721 REVISE NERVE AT WRIST | $2,148.80 | $5,372.00 | $1,794.25–$5,210.84 | — | 60% |
| Cervical biopsy CPT 57500 HCHG 57500 BIOPSY, SINGLE/MULT WWO FULG | $588.00 | $1,470.00 | $225.16–$7,135.00 | 1% below | 60% |
| Cervical biopsy inpatient CPT 57500 HCHG 57500 BIOPSY, SINGLE/MULT WWO FULG | $588.00 | $1,470.00 | $490.98–$1,425.90 | — | 60% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 HCHG 54161 CIRCUMCISION,SURG EXC >28 DAYS | $1,336.00 | $3,340.00 | $849.92–$9,365.00 | 44% above | 60% |
| Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 HCHG 54161 CIRCUMCISION,SURG EXC >28 DAYS | $1,336.00 | $3,340.00 | $1,115.56–$3,239.80 | — | 60% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HCHG 54150 CIRCUMCISION, CLAMP/OTH DEVICE W/REGIONAL | $290.00 | $725.00 | $849.92–$9,365.00 | 42% above | 60% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HCHG 54150 CIRCUMCISION, CLAMP/OTH DEVICE W/REGIONAL | $290.00 | $725.00 | $242.15–$703.25 | — | 60% |
| Circumcision, surgical, older than a newborn CPT 54160 HCHG 54160 PR CIRCUMCISION,SURGICAL EXCISION; NEONATE <28DAYS | $514.00 | $1,285.00 | $429.19–$1,246.45 | 31% below | 60% |
| Circumcision, surgical, older than a newborn inpatient CPT 54160 HCHG 54160 PR CIRCUMCISION,SURGICAL EXCISION; NEONATE <28DAYS | $514.00 | $1,285.00 | $429.19–$1,246.45 | — | 60% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HCHG 25600 CLS TX DISTAL RADIAL FX W/O MN | $268.40 | $671.00 | $209.47–$7,135.00 | 56% below | 60% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HCHG 25600 CLS TX DISTAL RADIAL FX W/O MN | $268.40 | $671.00 | $224.11–$650.87 | — | 60% |
| Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 HCHG 57460 LEEP PROCEDURE | $1,884.00 | $4,710.00 | $1,020.91–$9,365.00 | 119% above | 60% |
| Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 HCHG 57460 LEEP PROCEDURE | $1,884.00 | $4,710.00 | $1,573.14–$4,568.70 | — | 60% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HCHG 57454 COLPOSCOY WITH BIOPSY(S) | $275.20 | $688.00 | $225.16–$7,135.00 | 39% below | 60% |
| Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 HCHG 57454 COLPOSCOY WITH BIOPSY(S) | $275.20 | $688.00 | $229.79–$667.36 | — | 60% |
| Cystoscopy with ureteral stent placement CPT 52332 HCHG 52332 CYSTO W/INS STENT | $2,276.00 | $5,690.00 | $1,900.46–$5,519.30 | 48% below | 60% |
| Cystoscopy with ureteral stent placement inpatient CPT 52332 HCHG 52332 CYSTO W/INS STENT | $2,276.00 | $5,690.00 | $1,900.46–$5,519.30 | — | 60% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HCHG 52000 CYSTOURETHROSCOPY | $444.40 | $1,111.00 | $650.86–$7,135.00 | 55% below | 60% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HCHG 52000 CYSTOURETHROSCOPY | $444.40 | $1,111.00 | $371.07–$1,077.67 | — | 60% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 HCHG 58120 D&C,DIAGNOSTIC/THERAPUTIC | $1,882.40 | $4,706.00 | $1,020.91–$9,365.00 | 66% above | 60% |
| D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 HCHG 58120 D&C,DIAGNOSTIC/THERAPUTIC | $1,882.40 | $4,706.00 | $1,571.80–$4,564.82 | — | 60% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HCHG 17000 DEST BENIGN/PREMALIGN, 1ST LESION | $132.80 | $332.00 | $75.13–$7,135.00 | 26% below | 60% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HCHG 17000 DEST BENIGN/PREMALIGN, 1ST LESION | $132.80 | $332.00 | $110.89–$322.04 | — | 60% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 HCHG 69433 TYMPANOSTOMY-INSERT TUBE | $427.60 | $1,069.00 | $79.77–$7,135.00 | 18% below | 60% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 HCHG 69433 TYMPANOSTOMY-INSERT TUBE | $427.60 | $1,069.00 | $357.05–$1,036.93 | — | 60% |
| Earwax removal with instruments, one ear one side CPT 69210 HCHG 69210 REM IMPACTED CERUMEN, UNILATERAL | $53.20 | $133.00 | $58.28–$7,135.00 | 37% below | 60% |
| Earwax removal with instruments, one ear inpatient one side CPT 69210 HCHG 69210 REM IMPACTED CERUMEN, UNILATERAL | $53.20 | $133.00 | $44.42–$133.00 | — | 60% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HCHG 58100 ENDOMETRIAL SAMPLING | $307.60 | $769.00 | $189.86–$7,135.00 | 13% above | 60% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HCHG 58100 ENDOMETRIAL SAMPLING | $307.60 | $769.00 | $256.85–$745.93 | — | 60% |
| Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 HCHG 31256 NASAL ENDOSCOPY W/ANTROSTOMY | $2,214.00 | $5,535.00 | $1,165.41–$16,052.00 | 7% below | 60% |
| Endoscopic sinus surgery: opening the maxillary (cheek) sinus inpatient CPT 31256 HCHG 31256 NASAL ENDOSCOPY W/ANTROSTOMY | $2,214.00 | $5,535.00 | $1,848.69–$5,368.95 | — | 60% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HCHG 62321 PR INJ DIAG/THER SUBSTANCE W/CATH PLC, EPID/SUBARACH, | $496.00 | $1,240.00 | $414.16–$1,202.80 | 62% below | 60% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HCHG 62321 PR INJ DIAG/THER SUBSTANCE W/CATH PLC, EPID/SUBARACH, | $496.00 | $1,240.00 | $414.16–$1,202.80 | — | 60% |
| Eye injection into the vitreous (intravitreal injection) CPT 67028 HCHG 67028 INTRAVITREAL INJ PHARM AGENT | $266.40 | $666.00 | $126.47–$7,135.00 | 34% below | 60% |
| Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 HCHG 67028 INTRAVITREAL INJ PHARM AGENT | $266.40 | $666.00 | $222.44–$646.02 | — | 60% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HCHG 45330 SIGMOIDOSCOPY, FLEXIBLE, DIAG | $776.40 | $1,941.00 | $429.85–$7,135.00 | 9% below | 60% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 HCHG 45330 SIGMOIDOSCOPY, FLEXIBLE, DIAG | $776.40 | $1,941.00 | $648.29–$1,882.77 | — | 60% |
| Hammertoe correction surgery CPT 28285 HCHG 28285 CORRECTION; HAMMERTOE | $2,062.80 | $5,157.00 | $1,722.44–$5,002.29 | 24% below | 60% |
| Hammertoe correction surgery inpatient CPT 28285 HCHG 28285 CORRECTION; HAMMERTOE | $2,062.80 | $5,157.00 | $1,722.44–$5,002.29 | — | 60% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 HCHG 46221 HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S | $634.80 | $1,587.00 | $633.45–$7,135.00 | 51% below | 60% |
| Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HCHG 46221 HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S | $634.80 | $1,587.00 | $530.06–$1,539.39 | — | 60% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HCHG 58340 CATH FOR HYSTEROGRAPHY | $184.00 | $460.00 | $153.64–$446.20 | 45% below | 60% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HCHG 58340 CATH FOR HYSTEROGRAPHY | $184.00 | $460.00 | $153.64–$446.20 | — | 60% |
| IUD insertion (the device itself billed separately) CPT 58300 HCHG 58300 INSERT INTRAUTERINE DEVICE-IUD | $143.20 | $358.00 | $119.57–$347.26 | 53% below | 60% |
| IUD insertion (the device itself billed separately) inpatient CPT 58300 HCHG 58300 INSERT INTRAUTERINE DEVICE-IUD | $143.20 | $358.00 | $119.57–$347.26 | — | 60% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HCHG 10060 I&D ABSCESS SIMPLE | $134.00 | $335.00 | $111.89–$324.95 | 54% below | 60% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HCHG 10060 I&D ABSCESS SIMPLE | $134.00 | $335.00 | $111.89–$324.95 | — | 60% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HCHG 20550 INJ SGL TEND SHEATH OR LIG, APO | $206.80 | $517.00 | $106.73–$7,135.00 | 39% below | 60% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HCHG 20550 INJ SGL TEND SHEATH OR LIG, APO | $206.80 | $517.00 | $172.68–$501.49 | — | 60% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HCHG 20610 ARTHROCENTESIS, ASP/INJ, LRG JNT | $208.80 | $522.00 | $106.73–$7,135.00 | 52% below | 60% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HCHG 20610 ARTHROCENTESIS, ASP/INJ, LRG JNT | $208.80 | $522.00 | $174.35–$506.34 | — | 60% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HCHG 11981 INSERTION, DRUG-DELIVERY IMPLANT (IE, RESORB, BIODEGR | $126.80 | $317.00 | $75.13–$7,135.00 | 52% below | 60% |
| Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HCHG 11981 INSERTION, DRUG-DELIVERY IMPLANT (IE, RESORB, BIODEGR | $126.80 | $317.00 | $105.88–$307.49 | — | 60% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HCHG 20605 ARTHROCENTESIS,ASP/INJ, INT JNT | $206.00 | $515.00 | $106.73–$7,135.00 | 36% below | 60% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HCHG 20605 ARTHROCENTESIS,ASP/INJ, INT JNT | $206.00 | $515.00 | $172.01–$499.55 | — | 60% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HCHG 20600 ARTHORCENTESIS,ASP/INJ SM JNT | $205.60 | $514.00 | $106.73–$7,135.00 | 45% below | 60% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HCHG 20600 ARTHORCENTESIS,ASP/INJ SM JNT | $205.60 | $514.00 | $171.68–$498.58 | — | 60% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 HCHG 66821 YAG LASER SURGERY | $466.40 | $1,166.00 | $247.69–$7,135.00 | 60% below | 60% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 HCHG 66821 YAG LASER SURGERY | $466.40 | $1,166.00 | $389.44–$1,131.02 | — | 60% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HCHG 12031 REPAIR INTERMEDIATE WOUND, SCALP, AXILLAE, TRUNK, EXT | $315.20 | $788.00 | $168.63–$7,135.00 | 40% below | 60% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HCHG 12031 REPAIR INTERMEDIATE WOUND, SCALP, AXILLAE, TRUNK, EXT | $315.20 | $788.00 | $263.19–$764.36 | — | 60% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HCHG 62323 PR INJ DIAG/THER SUBSTANCE W/CATH PLC, EPID/SUBARACH, | $472.80 | $1,182.00 | $394.79–$1,146.54 | 59% below | 60% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HCHG 62323 PR INJ DIAG/THER SUBSTANCE W/CATH PLC, EPID/SUBARACH, | $472.80 | $1,182.00 | $394.79–$1,146.54 | — | 60% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HCHG 62322 PR INJ DIAG/THER SUBSTANCE W/CATH PLC | $471.20 | $1,178.00 | $393.45–$1,142.66 | 43% below | 60% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HCHG 62322 PR INJ DIAG/THER SUBSTANCE W/CATH PLC | $471.20 | $1,178.00 | $393.45–$1,142.66 | — | 60% |
| Miscarriage treatment with D&C, first trimester CPT 59820 HCHG 59820 TRMT MISSED AB,COMPLETE SURG,1ST TRIMESTER | $1,884.00 | $4,710.00 | $773.10–$9,365.00 | 62% above | 60% |
| Miscarriage treatment with D&C, first trimester inpatient CPT 59820 HCHG 59820 TRMT MISSED AB,COMPLETE SURG,1ST TRIMESTER | $1,884.00 | $4,710.00 | $1,573.14–$4,568.70 | — | 60% |
| Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals CPT 17311 HCHG 17311 MOHS FIRST STAGE, UP TO 5 BLOCKS | $1,213.60 | $3,034.00 | $402.54–$7,135.00 | 9% below | 60% |
| Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals inpatient CPT 17311 HCHG 17311 MOHS FIRST STAGE, UP TO 5 BLOCKS | $1,213.60 | $3,034.00 | $1,013.36–$2,942.98 | — | 60% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HCHG 11400 EXCISION BENIGN LESION, <0.5 CM | $482.80 | $1,207.00 | $403.14–$1,170.79 | 39% above | 60% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HCHG 11400 EXCISION BENIGN LESION, <0.5 CM | $482.80 | $1,207.00 | $403.14–$1,170.79 | — | 60% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HCHG 11440 EXCISION BENIGN LESION; <.5CM | $486.00 | $1,215.00 | $185.78–$7,135.00 | 6% below | 60% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HCHG 11440 EXCISION BENIGN LESION; <.5CM | $486.00 | $1,215.00 | $405.81–$1,178.55 | — | 60% |
| Nail removal (partial or complete), one nail CPT 11730 HCHG 11730 AVULSION NAIL PLATE | $159.20 | $398.00 | $28.58–$7,135.00 | 32% below | 60% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 HCHG 11730 AVULSION NAIL PLATE | $159.20 | $398.00 | $132.93–$386.06 | — | 60% |
| Occipital nerve block (injection for headaches) CPT 64405 HCHG 64405 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GRE | $221.60 | $554.00 | $172.61–$7,135.00 | 52% below | 60% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 HCHG 64405 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GRE | $221.60 | $554.00 | $185.04–$537.38 | — | 60% |
| Paracentesis with imaging guidance CPT 49083 HCHG 49083 ABD PARACENTESIS; W/IMAGING GUIDANCE | $593.20 | $1,483.00 | $495.32–$1,438.51 | 54% below | 60% |
| Paracentesis with imaging guidance inpatient CPT 49083 HCHG 49083 ABD PARACENTESIS; W/IMAGING GUIDANCE | $593.20 | $1,483.00 | $495.32–$1,438.51 | — | 60% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 HCHG 11750 REMOVAL NAIL BED PERMANENT | $289.20 | $723.00 | $185.78–$7,135.00 | 11% below | 60% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HCHG 11750 REMOVAL NAIL BED PERMANENT | $289.20 | $723.00 | $241.48–$701.31 | — | 60% |
| Removal of a breast lump, open surgery CPT 19120 HCHG 19120 EXCISION CYST BREAST | $2,285.20 | $5,713.00 | $571.19–$16,052.00 | 14% above | 60% |
| Removal of a breast lump, open surgery inpatient CPT 19120 HCHG 19120 EXCISION CYST BREAST | $2,285.20 | $5,713.00 | $1,908.14–$5,541.61 | — | 60% |
| Removal of a foreign object under the skin, simple CPT 10120 HCHG 10120 INC&REMOVAL FB SIMPLE | $288.80 | $722.00 | $75.13–$7,135.00 | 14% below | 60% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 HCHG 10120 INC&REMOVAL FB SIMPLE | $288.80 | $722.00 | $241.15–$700.34 | — | 60% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 HCHG G0121P COLORECTAL CANCER SCREENING; COLONOSCOPY (PT NOT MEE | $770.00 | $1,925.00 | $642.95–$1,867.25 | 60% below | 60% |
| Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 HCHG G0121P COLORECTAL CANCER SCREENING; COLONOSCOPY (PT NOT MEE | $770.00 | $1,925.00 | $642.95–$1,867.25 | — | 60% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 HCHG G0105P COLORECTAL CANCER SCREENING; COLONOSCOPY, HIGH RISK | $770.00 | $1,925.00 | $642.95–$1,867.25 | 59% below | 60% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 HCHG G0105P COLORECTAL CANCER SCREENING; COLONOSCOPY, HIGH RISK | $770.00 | $1,925.00 | $642.95–$1,867.25 | — | 60% |
| Short arm cast (elbow to hand) CPT 29075 HCHG 29075 APPLY SHORT ARM CAST | $240.00 | $600.00 | $200.40–$582.00 | 5% below | 60% |
| Short arm cast (elbow to hand) inpatient CPT 29075 HCHG 29075 APPLY SHORT ARM CAST | $240.00 | $600.00 | $200.40–$582.00 | — | 60% |
| Short arm splint (forearm and hand) CPT 29125 HCHG 29125 APPLY SHORT ARM SPLINT | $118.40 | $296.00 | $98.86–$287.12 | 33% below | 60% |
| Short arm splint (forearm and hand) inpatient CPT 29125 HCHG 29125 APPLY SHORT ARM SPLINT | $118.40 | $296.00 | $98.86–$287.12 | — | 60% |
| Short leg cast (below the knee) CPT 29405 HCHG 29405 APPLY SHORT LEG CAST(KNEE-TOE) | $238.80 | $597.00 | $199.40–$579.09 | 2% above | 60% |
| Short leg cast (below the knee) inpatient CPT 29405 HCHG 29405 APPLY SHORT LEG CAST(KNEE-TOE) | $238.80 | $597.00 | $199.40–$579.09 | — | 60% |
| Short leg splint (calf to foot) CPT 29515 HCHG 29515 APPLY SHT LEG SPLT(CALF-FOOT) | $125.20 | $313.00 | $104.54–$303.61 | 40% below | 60% |
| Short leg splint (calf to foot) inpatient CPT 29515 HCHG 29515 APPLY SHT LEG SPLT(CALF-FOOT) | $125.20 | $313.00 | $104.54–$303.61 | — | 60% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HCHG 12001 SIMP LAC<2.6CM BDY/SCLP/HND/FT | $154.00 | $385.00 | $81.79–$7,135.00 | 53% below | 60% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HCHG 12001 SIMP LAC<2.6CM BDY/SCLP/HND/FT | $154.00 | $385.00 | $128.59–$373.45 | — | 60% |
| Skin biopsy, punch, one lesion CPT 11104 HCHG 11104 PUNCH BIOPSY SKIN; SINGLE LESION | $180.00 | $450.00 | $150.30–$436.50 | 25% below | 60% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 HCHG 11104 PUNCH BIOPSY SKIN; SINGLE LESION | $180.00 | $450.00 | $150.30–$436.50 | — | 60% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HCHG 11600 EXC MALIGN LESION, 0.5 CM OR LESS | $459.60 | $1,149.00 | $185.78–$7,135.00 | 25% above | 60% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 HCHG 11600 EXC MALIGN LESION, 0.5 CM OR LESS | $459.60 | $1,149.00 | $383.77–$1,114.53 | — | 60% |
| Skin tag removal, up to 15 tags CPT 11200 HCHG 11200 REMOVE SKIN TAGS;UP TO 15 | $154.00 | $385.00 | $75.13–$7,135.00 | 9% above | 60% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 HCHG 11200 REMOVE SKIN TAGS;UP TO 15 | $154.00 | $385.00 | $128.59–$373.45 | — | 60% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HCHG 62270 SPINAL PUNCTURE, LUMBAR,DIAGNOSTIC; | $471.20 | $1,178.00 | $328.50–$7,135.00 | 22% below | 60% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HCHG 62270 SPINAL PUNCTURE, LUMBAR,DIAGNOSTIC; | $471.20 | $1,178.00 | $393.45–$1,142.66 | — | 60% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HCHG 12002 SIMPLE LACERATION 2.6-7.5 CM | $160.00 | $400.00 | $81.79–$7,135.00 | 21% below | 60% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HCHG 12002 SIMPLE LACERATION 2.6-7.5 CM | $160.00 | $400.00 | $133.60–$388.00 | — | 60% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HCHG 12011 SIMP LAC FACE/CHIN/EARS <2.5CM | $161.20 | $403.00 | $81.79–$7,135.00 | 48% below | 60% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HCHG 12011 SIMP LAC FACE/CHIN/EARS <2.5CM | $161.20 | $403.00 | $134.60–$390.91 | — | 60% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 HCHG 11102 TANGENTIAL BIOPSY OF SKIN; SINGLE LESION | $132.80 | $332.00 | $110.89–$322.04 | 45% below | 60% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HCHG 11102 TANGENTIAL BIOPSY OF SKIN; SINGLE LESION | $132.80 | $332.00 | $110.89–$322.04 | — | 60% |
| Thoracentesis with imaging guidance CPT 32555 HCHG 32555 THORACENTESIS,ASP PLEURAL SPACE;W/IMAG GUID | $577.60 | $1,444.00 | $482.30–$1,400.68 | 52% below | 60% |
| Thoracentesis with imaging guidance inpatient CPT 32555 HCHG 32555 THORACENTESIS,ASP PLEURAL SPACE;W/IMAG GUID | $577.60 | $1,444.00 | $482.30–$1,400.68 | — | 60% |
| Trigger finger release surgery CPT 26055 HCHG 26055 TEND SHEATH INCISN TRIG FINGER | $1,177.20 | $2,943.00 | $573.99–$9,365.00 | 22% below | 60% |
| Trigger finger release surgery inpatient CPT 26055 HCHG 26055 TEND SHEATH INCISN TRIG FINGER | $1,177.20 | $2,943.00 | $982.96–$2,854.71 | — | 60% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HCHG 20552 INJ SLG/MULT TRIG PNT 1-2 MUSC | $208.00 | $520.00 | $106.73–$7,135.00 | 41% below | 60% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HCHG 20552 INJ SLG/MULT TRIG PNT 1-2 MUSC | $208.00 | $520.00 | $173.68–$504.40 | — | 60% |
| Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 HCHG 55250 VASECTOMY UNILATERAL/BILATERAL | $1,336.00 | $3,340.00 | $1,238.85–$9,365.00 | — | 60% |
| Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 HCHG 55250 VASECTOMY UNILATERAL/BILATERAL | $1,336.00 | $3,340.00 | $1,115.56–$3,239.80 | — | 60% |
| Vein ablation, radiofrequency, first vein CPT 36475 HCHG 36475 ENDOVEN ABLAT THERAPY 1ST VEIN | $2,423.20 | $6,058.00 | $1,138.37–$16,052.00 | 38% below | 60% |
| Vein ablation, radiofrequency, first vein inpatient CPT 36475 HCHG 36475 ENDOVEN ABLAT THERAPY 1ST VEIN | $2,423.20 | $6,058.00 | $2,023.37–$5,876.26 | — | 60% |
| Wart removal, up to 14 warts CPT 17110 HCHG 17110 DEST BENIGN LESIONS, UP TO 14 | $157.20 | $393.00 | $75.13–$7,135.00 | 20% below | 60% |
| Wart removal, up to 14 warts inpatient CPT 17110 HCHG 17110 DESTRUCTION OF WARTS-RETREATMENT | $73.60 | $184.00 | $61.46–$178.48 | — | 60% |
| Wart removal, up to 14 warts inpatient CPT 17110 HCHG 17110 DEST BENIGN LESIONS, UP TO 14 | $157.20 | $393.00 | $131.26–$381.21 | — | 60% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HCHG 11042 DEBRIDE SUBQ TISS 20 SQ CM/< | $240.00 | $600.00 | $200.40–$582.00 | 55% below | 60% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HCHG 11042 DEBRIDE SUBQ TISS 20 SQ CM/< | $240.00 | $600.00 | $200.40–$582.00 | — | 60% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Comprehensive eye exam, returning patient CPT 92014 HCHG 92014 COMP OPHTHAL EXAM ESTAB PATIENT | $25.60 | $64.00 | $21.38–$64.00 | 75% below | 60% |
| Comprehensive eye exam, returning patient CPT 92014 HCHG 92014 COMPREHENSIVE OPTOMETRY EXAM, EST PT | $53.60 | $134.00 | $44.76–$134.00 | 47% below | 60% |
| Comprehensive eye exam, returning patient inpatient CPT 92014 HCHG 92014 COMP OPHTHAL EXAM ESTAB PATIENT | $25.60 | $64.00 | $21.38–$64.00 | — | 60% |
| Comprehensive eye exam, returning patient inpatient CPT 92014 HCHG 92014 COMPREHENSIVE OPTOMETRY EXAM, EST PT | $53.60 | $134.00 | $44.76–$134.00 | — | 60% |
| Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 HCHG 92557 COMPREHENSIVE AUDIOMETRY-THRES | $104.80 | $262.00 | $34.35–$156.27 | 32% below | 60% |
| Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 HCHG 92557 COMPREHENSIVE AUDIOMETRY-THRES | $104.80 | $262.00 | $87.51–$254.14 | — | 60% |
| Eye exam, returning patient, intermediate CPT 92012 HCHG 92012 INTERMED OPHTHAL EXAM ESTAB PATIENT | $53.60 | $134.00 | $44.76–$134.00 | 44% below | 60% |
| Eye exam, returning patient, intermediate inpatient CPT 92012 HCHG 92012 INTERMED OPHTHAL EXAM ESTAB PATIENT | $53.60 | $134.00 | $44.76–$134.00 | — | 60% |
| Family therapy with the patient, 50 minutes CPT 90847 HCHG 90847 FAMILY PSYCHOTHERAPY W/PT PRESENT, 50 MIN | $113.20 | $283.00 | $66.72–$188.06 | 40% below | 60% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HCHG 90847 FAMILY PSYCHOTHERAPY W/PT PRESENT, 50 MIN | $113.20 | $283.00 | $94.52–$274.51 | — | 60% |
| Family therapy without the patient, 50 minutes CPT 90846 HCHG 90846 FAM PSYCHOTHERAPY W/O PATIENT, 50 MIN | $114.80 | $287.00 | $66.72–$188.06 | 37% below | 60% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HCHG 90846 FAM PSYCHOTHERAPY W/O PATIENT, 50 MIN | $114.80 | $287.00 | $95.86–$278.39 | — | 60% |
| Group psychotherapy session CPT 90853 HCHG 90853 GROUP PSYCHOTHERAPY | $56.80 | $142.00 | $84.93–$108.46 | 25% below | 60% |
| Group psychotherapy session inpatient CPT 90853 HCHG 90853 GROUP PSYCHOTHERAPY | $56.80 | $142.00 | $47.43–$137.74 | — | 60% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 HCHG 90791 PSYC DIAGNOSTIC EVAL MNTL | $100.80 | $252.00 | $103.29–$188.06 | 54% below | 60% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HCHG 90791 PSYC DIAGNOSTIC EVAL MNTL | $100.80 | $252.00 | $84.17–$244.44 | — | 60% |
| Psychiatric evaluation with medical services CPT 90792 HCHG 90792 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SVC | $144.00 | $360.00 | $103.29–$188.06 | 48% below | 60% |
| Psychiatric evaluation with medical services inpatient CPT 90792 HCHG 90792 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SVC | $144.00 | $360.00 | $120.24–$349.20 | — | 60% |
| Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 HCHG 96130 PSYCHOLOGICAL TESTING EVAL, PHYSICIAN/QHP, FIRST HOUR | $135.20 | $338.00 | $112.89–$327.86 | 46% below | 60% |
| Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 HCHG 96130 PSYCHOLOGICAL TESTING EVAL, PHYSICIAN/QHP, FIRST HOUR | $135.20 | $338.00 | $112.89–$327.86 | — | 60% |
| Psychotherapy for crisis, first 60 minutes CPT 90839 HCHG 90839 PSYCHOTHERAPY FOR CRISIS; 1ST 60 MIN | $99.60 | $249.00 | $62.88–$188.06 | 66% below | 60% |
| Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HCHG 90839 PSYCHOTHERAPY FOR CRISIS; 1ST 60 MIN | $99.60 | $249.00 | $83.17–$241.53 | — | 60% |
| Psychotherapy session, 30 minutes CPT 90832 HCHG 90832 PSYCHOTHERAPY 30 MIN MNTL | $52.40 | $131.00 | $55.89–$188.06 | 51% below | 60% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HCHG 90832 PSYCHOTHERAPY 30 MIN MNTL | $52.40 | $131.00 | $43.75–$127.07 | — | 60% |
| Psychotherapy session, 45 minutes CPT 90834 HCHG 90834 PSYCHOTHERAPY 45 MIN MNTL | $118.80 | $297.00 | $62.88–$188.06 | 16% below | 60% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HCHG 90834 PSYCHOTHERAPY 45 MIN MNTL | $118.80 | $297.00 | $99.20–$288.09 | — | 60% |
| Psychotherapy session, 60 minutes CPT 90837 HCHG 90837 PSYCHOTHERAPY 60 MIN MNTL | $104.00 | $260.00 | $62.88–$188.06 | 51% below | 60% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HCHG 90837 PSYCHOTHERAPY 60 MIN MNTL | $104.00 | $260.00 | $86.84–$252.20 | — | 60% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 HCHG 99406 SMOKING CESSAT COUNSELING 3-10 MIN | $46.40 | $116.00 | $9.60–$39.70 | 61% above | 60% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HCHG 99406 SMOKING CESSAT COUNSELING 3-10 MIN | $46.40 | $116.00 | $38.74–$112.52 | — | 60% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HCHG 99215 URGENT CARE OFFICE/OUTPATIENT VISIT EST 40 MIN MET/EX | $54.80 | $137.00 | $45.76–$137.00 | 81% below | 60% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HCHG 99215 OFFICE OUTPATIENT VISIT 40 MIN MET/EXCEEDED | $54.80 | $137.00 | $45.76–$137.00 | 81% below | 60% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HCHG 99215 OFFICE OUTPATIENT VISIT 40 MIN MET/EXCEEDED | $54.80 | $137.00 | $45.76–$137.00 | — | 60% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HCHG 99215 URGENT CARE OFFICE/OUTPATIENT VISIT EST 40 MIN MET/EX | $54.80 | $137.00 | $45.76–$137.00 | — | 60% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HCHG 99213 URGENT CARE OFFICE/OUTPATIENT VISIT EST 20 MIN MET/EX | $54.80 | $137.00 | $45.76–$137.00 | 67% below | 60% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HCHG 99213 OFFICE OUTPATIENT VISIT 20 MIN MET/EXCEEDED | $54.80 | $137.00 | $45.76–$137.00 | 67% below | 60% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HCHG 99213 OFFICE OUTPATIENT VISIT 20 MIN MET/EXCEEDED | $54.80 | $137.00 | $45.76–$137.00 | — | 60% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HCHG 99213 URGENT CARE OFFICE/OUTPATIENT VISIT EST 20 MIN MET/EX | $54.80 | $137.00 | $45.76–$137.00 | — | 60% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HCHG 99214 OFFICE OUTPATIENT VISIT 30 MIN MET/EXCEEDED | $54.80 | $137.00 | $45.76–$137.00 | 71% below | 60% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HCHG 99214 URGENT CARE OFFICE/OUTPATIENT VISIT EST 30 MIN MET/EX | $54.80 | $137.00 | $45.76–$137.00 | 71% below | 60% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HCHG 99214 OFFICE OUTPATIENT VISIT 30 MIN MET/EXCEEDED | $54.80 | $137.00 | $45.76–$137.00 | — | 60% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HCHG 99214 URGENT CARE OFFICE/OUTPATIENT VISIT EST 30 MIN MET/EX | $54.80 | $137.00 | $45.76–$137.00 | — | 60% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HCHG 99212 URGENT CARE OFFICE/OUTPATIENT VISIT EST PT 10 MIN MET | $54.80 | $137.00 | $45.76–$137.00 | 43% below | 60% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HCHG 99212 OFFICE OUTPATIENT VISIT 10 MIN MET/EXCEEDED | $54.80 | $137.00 | $45.76–$137.00 | 43% below | 60% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HCHG 99212 URGENT CARE OFFICE/OUTPATIENT VISIT EST PT 10 MIN MET | $54.80 | $137.00 | $45.76–$137.00 | — | 60% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HCHG 99212 OFFICE OUTPATIENT VISIT 10 MIN MET/EXCEEDED | $54.80 | $137.00 | $45.76–$137.00 | — | 60% |
| TMS (transcranial magnetic stimulation), first session with mapping CPT 90867 HCHG 90867 TRANSCRANIAL MAGNETIC STIMULATION TREATMENT (TMS); IN | $256.00 | $640.00 | $207.23–$314.01 | 36% below | 60% |
| TMS (transcranial magnetic stimulation), first session with mapping inpatient CPT 90867 HCHG 90867 TRANSCRANIAL MAGNETIC STIMULATION TREATMENT (TMS); IN | $256.00 | $640.00 | $213.76–$620.80 | — | 60% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARIVAX (PF) 1/350 UNIT/0.5 ML SC SUSR | $184.70 | $461.75 | $154.22–$447.90 | 13% above | 60% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARIVAX (PF) 1/350 UNIT/0.5 ML SC SUSR | $184.70 | $461.75 | $154.22–$447.90 | 13% above | 60% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARIVAX (PF) 1/350 UNIT/0.5 ML SC SUSR | $184.70 | $461.75 | $154.22–$447.90 | — | 60% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARIVAX (PF) 1/350 UNIT/0.5 ML SC SUSR | $184.70 | $461.75 | $154.22–$447.90 | — | 60% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 QUADRACEL (PF) 15 LF-48 MCG- 5 LF UNIT/0.5ML IM SUSP | $58.92 | $147.30 | $49.20–$142.88 | 30% below | 60% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 QUADRACEL (PF) 15 LF-48 MCG- 5 LF UNIT/0.5ML IM SUSP | $58.92 | $147.30 | $49.20–$142.88 | 30% below | 60% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 QUADRACEL (PF) 15 LF-48 MCG- 5 LF UNIT/0.5ML IM SYRG | $60.00 | $150.00 | $50.10–$145.50 | 29% below | 60% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 QUADRACEL (PF) 15 LF-48 MCG- 5 LF UNIT/0.5ML IM SYRG | $60.00 | $150.00 | $50.10–$145.50 | 29% below | 60% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 QUADRACEL (PF) 15 LF-48 MCG- 5 LF UNIT/0.5ML IM SUSP | $58.92 | $147.30 | $49.20–$142.88 | — | 60% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 QUADRACEL (PF) 15 LF-48 MCG- 5 LF UNIT/0.5ML IM SUSP | $58.92 | $147.30 | $49.20–$142.88 | — | 60% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 QUADRACEL (PF) 15 LF-48 MCG- 5 LF UNIT/0.5ML IM SYRG | $60.00 | $150.00 | $50.10–$145.50 | — | 60% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 QUADRACEL (PF) 15 LF-48 MCG- 5 LF UNIT/0.5ML IM SYRG | $60.00 | $150.00 | $50.10–$145.50 | — | 60% |
| DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 PENTACEL (PF) 15LF-48MCG-62DU -10 MCG/0.5ML IM KIT | $109.00 | $272.50 | $91.02–$264.33 | 7% below | 60% |
| DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 PENTACEL (PF) 15LF-48MCG-62DU -10 MCG/0.5ML IM KIT | $109.00 | $272.50 | $91.02–$264.33 | 7% below | 60% |
| DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 PENTACEL (PF) 15LF-48MCG-62DU -10 MCG/0.5ML IM KIT | $109.00 | $272.50 | $91.02–$264.33 | — | 60% |
| DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 PENTACEL (PF) 15LF-48MCG-62DU -10 MCG/0.5ML IM KIT | $109.00 | $272.50 | $91.02–$264.33 | — | 60% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 GARDASIL 9 (PF) 0.5 ML IM SYRG | $269.04 | $672.60 | $224.65–$652.42 | 16% below | 60% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 GARDASIL 9 (PF) 0.5 ML IM SYRG | $269.04 | $672.60 | $224.65–$652.42 | 16% below | 60% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 GARDASIL 9 (PF) 0.5 ML IM SYRG | $269.04 | $672.60 | $224.65–$652.42 | — | 60% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 GARDASIL 9 (PF) 0.5 ML IM SYRG | $269.04 | $672.60 | $224.65–$652.42 | — | 60% |
| Hepatitis A vaccine, adult dose CPT 90632 VAQTA (PF) 50 UNIT/ML IM SYRG | $78.46 | $196.15 | $65.51–$190.27 | 40% below | 60% |
| Hepatitis A vaccine, adult dose CPT 90632 VAQTA (PF) 50 UNIT/ML IM SYRG | $78.46 | $196.15 | $65.51–$190.27 | 40% below | 60% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 VAQTA (PF) 50 UNIT/ML IM SYRG | $78.46 | $196.15 | $65.51–$190.27 | — | 60% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 VAQTA (PF) 50 UNIT/ML IM SYRG | $78.46 | $196.15 | $65.51–$190.27 | — | 60% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 VAQTA (PF) 25 UNIT/0.5 ML IM SYRG | $37.10 | $92.75 | $30.98–$89.97 | 29% below | 60% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 VAQTA (PF) 25 UNIT/0.5 ML IM SYRG | $37.10 | $92.75 | $30.98–$89.97 | 29% below | 60% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 VAQTA (PF) 25 UNIT/0.5 ML IM SYRG | $37.10 | $92.75 | $30.98–$89.97 | — | 60% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 VAQTA (PF) 25 UNIT/0.5 ML IM SYRG | $37.10 | $92.75 | $30.98–$89.97 | — | 60% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 ENGERIX-B (PF) 20 MCG/ML IM SYRG | $67.64 | $169.10 | $56.48–$164.03 | 41% below | 60% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 ENGERIX-B (PF) 20 MCG/ML IM SYRG | $67.64 | $169.10 | $56.48–$164.03 | 41% below | 60% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 ENGERIX-B (PF) 20 MCG/ML IM SYRG | $67.64 | $169.10 | $56.48–$164.03 | — | 60% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 ENGERIX-B (PF) 20 MCG/ML IM SYRG | $67.64 | $169.10 | $56.48–$164.03 | — | 60% |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HEPLISAV-B (PF) 20 MCG/0.5 ML IM SYRG | $141.94 | $354.85 | $118.52–$344.20 | 34% below | 60% |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HEPLISAV-B (PF) 20 MCG/0.5 ML IM SYRG | $141.94 | $354.85 | $118.52–$344.20 | 34% below | 60% |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 HEPLISAV-B (PF) 20 MCG/0.5 ML IM SYRG | $141.94 | $354.85 | $118.52–$344.20 | — | 60% |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 HEPLISAV-B (PF) 20 MCG/0.5 ML IM SYRG | $141.94 | $354.85 | $118.52–$344.20 | — | 60% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 ENGERIX-B PEDIATRIC (PF) 10 MCG/0.5 ML IM SYRG | $27.24 | $68.10 | $22.75–$66.06 | 52% below | 60% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 ENGERIX-B PEDIATRIC (PF) 10 MCG/0.5 ML IM SYRG | $27.24 | $68.10 | $22.75–$66.06 | 52% below | 60% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 ENGERIX-B PEDIATRIC (PF) 10 MCG/0.5 ML IM SYRG | $27.24 | $68.10 | $22.75–$66.06 | — | 60% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 ENGERIX-B PEDIATRIC (PF) 10 MCG/0.5 ML IM SYRG | $27.24 | $68.10 | $22.75–$66.06 | — | 60% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUZONE HIGHDOSE QUAD 23-24 PF 240 MCG/0.7 ML IM SYRG | $67.86 | $169.65 | $56.66–$164.56 | 14% below | 60% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUZONE HIGHDOSE QUAD 23-24 PF 240 MCG/0.7 ML IM SYRG | $67.86 | $169.65 | $56.66–$164.56 | 14% below | 60% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUZONE HIGHDOSE QUAD 23-24 PF 240 MCG/0.7 ML IM SYRG | $67.86 | $169.65 | $56.66–$164.56 | — | 60% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUZONE HIGHDOSE QUAD 23-24 PF 240 MCG/0.7 ML IM SYRG | $67.86 | $169.65 | $56.66–$164.56 | — | 60% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 M-M-R II (PF) 1/000-12/500 TCID50/0.5 ML SC SOLR | $90.52 | $226.30 | $75.58–$219.51 | 41% below | 60% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 M-M-R II (PF) 1/000-12/500 TCID50/0.5 ML SC SOLR | $90.52 | $226.30 | $75.58–$219.51 | 41% below | 60% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 M-M-R II (PF) 1/000-12/500 TCID50/0.5 ML SC SOLR | $90.52 | $226.30 | $75.58–$219.51 | — | 60% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 M-M-R II (PF) 1/000-12/500 TCID50/0.5 ML SC SOLR | $90.52 | $226.30 | $75.58–$219.51 | — | 60% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 PROQUAD (PF) 10EXP3-4.3-3- 3.99 TCID50/0.5 SC SUSR | $262.84 | $657.10 | $219.47–$637.39 | 4% above | 60% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 PROQUAD (PF) 10EXP3-4.3-3- 3.99 TCID50/0.5 SC SUSR | $262.84 | $657.10 | $219.47–$637.39 | 4% above | 60% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 PROQUAD (PF) 10EXP3-4.3-3- 3.99 TCID50/0.5 SC SUSR | $262.84 | $657.10 | $219.47–$637.39 | — | 60% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 PROQUAD (PF) 10EXP3-4.3-3- 3.99 TCID50/0.5 SC SUSR | $262.84 | $657.10 | $219.47–$637.39 | — | 60% |
| Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENQUADFI (PF) 10 MCG/0.5 ML IM SOLN | $165.32 | $413.30 | $138.04–$400.90 | 19% below | 60% |
| Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENQUADFI (PF) 10 MCG/0.5 ML IM SOLN | $165.32 | $413.30 | $138.04–$400.90 | 19% below | 60% |
| Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENQUADFI (PF) 10 MCG/0.5 ML IM SOLN | $165.32 | $413.30 | $138.04–$400.90 | — | 60% |
| Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENQUADFI (PF) 10 MCG/0.5 ML IM SOLN | $165.32 | $413.30 | $138.04–$400.90 | — | 60% |
| Meningococcal B vaccine (Trumenba) CPT 90621 TRUMENBA 120 MCG/0.5 ML IM SYRG | $190.42 | $476.05 | $159.00–$461.77 | 1% below | 60% |
| Meningococcal B vaccine (Trumenba) CPT 90621 TRUMENBA 120 MCG/0.5 ML IM SYRG | $190.42 | $476.05 | $159.00–$461.77 | 1% below | 60% |
| Meningococcal B vaccine (Trumenba) inpatient CPT 90621 TRUMENBA 120 MCG/0.5 ML IM SYRG | $190.42 | $476.05 | $159.00–$461.77 | — | 60% |
| Meningococcal B vaccine (Trumenba) inpatient CPT 90621 TRUMENBA 120 MCG/0.5 ML IM SYRG | $190.42 | $476.05 | $159.00–$461.77 | — | 60% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PREVNAR 13 (PF) 0.5 ML IM SYRG | $240.14 | $600.35 | $200.52–$582.34 | 18% below | 60% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PREVNAR 13 (PF) 0.5 ML IM SYRG | $240.14 | $600.35 | $200.52–$582.34 | 18% below | 60% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PREVNAR 13 (PF) 0.5 ML IM SYRG | $240.14 | $600.35 | $200.52–$582.34 | — | 60% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PREVNAR 13 (PF) 0.5 ML IM SYRG | $240.14 | $600.35 | $200.52–$582.34 | — | 60% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PREVNAR 20 (PF) 0.5 ML IM SYRG | $269.42 | $673.55 | $224.97–$653.34 | 8% below | 60% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PREVNAR 20 (PF) 0.5 ML IM SYRG | $269.42 | $673.55 | $224.97–$653.34 | 8% below | 60% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PREVNAR 20 (PF) 0.5 ML IM SYRG | $269.42 | $673.55 | $224.97–$653.34 | — | 60% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PREVNAR 20 (PF) 0.5 ML IM SYRG | $269.42 | $673.55 | $224.97–$653.34 | — | 60% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOVAX-23 25 MCG/0.5 ML IJ SYRG | $124.58 | $311.45 | $104.02–$302.11 | 12% below | 60% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOVAX-23 25 MCG/0.5 ML IJ SYRG | $124.58 | $311.45 | $104.02–$302.11 | 12% below | 60% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOVAX-23 25 MCG/0.5 ML IJ SYRG | $124.58 | $311.45 | $104.02–$302.11 | — | 60% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOVAX-23 25 MCG/0.5 ML IJ SYRG | $124.58 | $311.45 | $104.02–$302.11 | — | 60% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 BEYFORTUS 50 MG/0.5 ML IM SYRG | $526.68 | $1,316.70 | $439.78–$1,316.70 | 49% below | 60% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 BEYFORTUS 50 MG/0.5 ML IM SYRG | $526.68 | $1,316.70 | $439.78–$1,316.70 | 49% below | 60% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 BEYFORTUS 50 MG/0.5 ML IM SYRG | $526.68 | $1,316.70 | $439.78–$1,316.70 | — | 60% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 BEYFORTUS 50 MG/0.5 ML IM SYRG | $526.68 | $1,316.70 | $439.78–$1,316.70 | — | 60% |
| Rabies vaccine, one dose CPT 90675 RABAVERT (PF) 2.5 UNIT IM SUSR | $403.30 | $1,008.25 | $336.76–$978.00 | 31% below | 60% |
| Rabies vaccine, one dose CPT 90675 RABAVERT (PF) 2.5 UNIT IM SUSR | $403.30 | $1,008.25 | $52.93–$338.91 | 31% below | 60% |
| Rabies vaccine, one dose CPT 90675 JYNNEOS (PF) 0.5X TO 3.95X 10EXP8 UNIT/0.5 SC SUSP | $423.48 | $1,058.70 | $52.93–$338.91 | 27% below | 60% |
| Rabies vaccine, one dose CPT 90675 JYNNEOS (PF) 0.5X TO 3.95X 10EXP8 UNIT/0.5 SC SUSP | $423.48 | $1,058.70 | $353.61–$1,026.94 | 27% below | 60% |
| Rabies vaccine, one dose inpatient CPT 90675 RABAVERT (PF) 2.5 UNIT IM SUSR | $403.30 | $1,008.25 | $336.76–$978.00 | — | 60% |
| Rabies vaccine, one dose inpatient CPT 90675 RABAVERT (PF) 2.5 UNIT IM SUSR | $403.30 | $1,008.25 | $336.76–$978.00 | — | 60% |
| Rabies vaccine, one dose inpatient CPT 90675 JYNNEOS (PF) 0.5X TO 3.95X 10EXP8 UNIT/0.5 SC SUSP | $423.48 | $1,058.70 | $353.61–$1,026.94 | — | 60% |
| Rabies vaccine, one dose inpatient CPT 90675 JYNNEOS (PF) 0.5X TO 3.95X 10EXP8 UNIT/0.5 SC SUSP | $423.48 | $1,058.70 | $353.61–$1,026.94 | — | 60% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TENIVAC (PF) 5-2 LF UNIT/0.5 ML IM SYRG | $38.76 | $96.90 | $32.36–$93.99 | 6% below | 60% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TENIVAC (PF) 5-2 LF UNIT/0.5 ML IM SYRG | $38.76 | $96.90 | $32.36–$93.99 | 6% below | 60% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TENIVAC (PF) 5-2 LF UNIT/0.5 ML IM SYRG | $38.76 | $96.90 | $32.36–$93.99 | — | 60% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TENIVAC (PF) 5-2 LF UNIT/0.5 ML IM SYRG | $38.76 | $96.90 | $32.36–$93.99 | — | 60% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 BOOSTRIX TDAP 2.5-8-5 LF-MCG-LF/0.5ML IM SYRG | $45.28 | $113.20 | $37.81–$109.80 | 45% below | 60% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 BOOSTRIX TDAP 2.5-8-5 LF-MCG-LF/0.5ML IM SYRG | $45.28 | $113.20 | $37.81–$109.80 | 45% below | 60% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 ADACEL(TDAP ADOLESN/ADULT)(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG | $51.32 | $128.30 | $42.85–$124.45 | 37% below | 60% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 ADACEL(TDAP ADOLESN/ADULT)(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG | $51.32 | $128.30 | $42.85–$124.45 | 37% below | 60% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 BOOSTRIX TDAP 2.5-8-5 LF-MCG-LF/0.5ML IM SYRG | $45.28 | $113.20 | $37.81–$109.80 | — | 60% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 BOOSTRIX TDAP 2.5-8-5 LF-MCG-LF/0.5ML IM SYRG | $45.28 | $113.20 | $37.81–$109.80 | — | 60% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 ADACEL(TDAP ADOLESN/ADULT)(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG | $51.32 | $128.30 | $42.85–$124.45 | — | 60% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 ADACEL(TDAP ADOLESN/ADULT)(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG | $51.32 | $128.30 | $42.85–$124.45 | — | 60% |
Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More
Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More
List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More
Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More
Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.
Off list How much lower the cash price is than the list price.
No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More
At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More
Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.
Source file: https://bellin-ghs.pt.panaceainc.com/MRFDownload/bellin-ghs/gundersen-lutheran