Tri-County Memorial Hospital Inc
Tri-County Memorial Hospital Inc in Whitehall, WI publishes cash prices for 43 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.
18601 Lincoln St, Whitehall, WI 54773 Collected Sep 23, 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 | $1,739.06 | $2,743.00 | 37% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HCHG 74177 CT ABD&PELVIS;W/CONTRAST | $1,739.06 | $2,743.00 | 37% |
| CT scan of the head or brain, no contrast dye CPT 70450 HCHG 70450 CT HEAD W/O IV CONT | $876.19 | $1,382.00 | 37% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HCHG 70450 CT HEAD W/O IV CONT | $876.19 | $1,382.00 | 37% |
| CT scan of the pelvis, with contrast dye CPT 72193 HCHG 72193 CT PELVIS W/IV CONT | $1,481.02 | $2,336.00 | 37% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HCHG 72193 CT PELVIS W/IV CONT | $1,481.02 | $2,336.00 | 37% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HCHG 73721 MRI LOWER EXT;W/O CONTRAST | $1,983.15 | $3,128.00 | 37% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HCHG 73721 MRI LOWER EXT;W/O CONTRAST | $1,983.15 | $3,128.00 | 37% |
| 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 | $3,199.16 | $5,046.00 | 37% |
| 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 | $3,199.16 | $5,046.00 | 37% |
| MRI of the brain, no contrast dye CPT 70551 HCHG 70551 MRI HEAD (3 SEQ) | $1,983.79 | $3,129.00 | 37% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HCHG 70551 MRI HEAD (3 SEQ) | $1,983.79 | $3,129.00 | 37% |
| MRI of the brain, with and without contrast dye CPT 70553 HCHG 70553 MRI HEAD W&WO CONTRAST | $3,387.46 | $5,343.00 | 37% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HCHG 70553 MRI HEAD W&WO CONTRAST | $3,387.46 | $5,343.00 | 37% |
| MRI of the lower back, no contrast dye CPT 72148 HCHG 72148 MRI-LUMBAR SPINE W/O CONTRAST | $1,983.79 | $3,129.00 | 37% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HCHG 72148 MRI-LUMBAR SPINE W/O CONTRAST | $1,983.79 | $3,129.00 | 37% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HCHG 76805 US OB-AFTER 1ST TRIMESTER | $606.74 | $957.00 | 37% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HCHG 76805 US OB-AFTER 1ST TRIMESTER | $606.74 | $957.00 | 37% |
| Screening mammogram, both breasts both sides CPT 77067 HCHG 77067 SCREENING MAMMOGRAPHY, BILATERAL, INCL CAD | $263.74 | $416.00 | 37% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HCHG 77067 SCREENING MAMMOGRAPHY, BILATERAL, INCL CAD | $263.74 | $416.00 | 37% |
| Sleep study in a lab (polysomnography) CPT 95810 HCHG 95810 POLYSOMNOGRAPHY 6/+ YRS | $2,440.90 | $3,850.00 | 37% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HCHG 95810 POLYSOMNOGRAPHY 6/+ YRS | $2,440.90 | $3,850.00 | 37% |
| Transvaginal pelvic ultrasound CPT 76830 HCHG 76830 US PELVIS TRANSVAG | $519.25 | $819.00 | 37% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HCHG 76830 US PELVIS TRANSVAG | $519.25 | $819.00 | 37% |
| Ultrasound of the abdomen, complete CPT 76700 HCHG 76700 US ABDOMEN (SPCFY) | $511.64 | $807.00 | 37% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HCHG 76700 US ABDOMEN (SPCFY) | $511.64 | $807.00 | 37% |
| X-ray of the lower back, 4 or more views CPT 72110 HCHG 72110 SPINE LUMBAR W/OBLIQ (4 VWS) | $319.54 | $504.00 | 37% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HCHG 72110 SPINE LUMBAR W/OBLIQ (4 VWS) | $319.54 | $504.00 | 37% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL | $43.75 | $69.00 | 37% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL | $43.75 | $69.00 | 37% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL (NMR) | $69.11 | $109.00 | 37% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $69.11 | $109.00 | 37% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL | $69.11 | $109.00 | 37% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL (NMR) | $69.11 | $109.00 | 37% |
| Complete blood count (CBC) with differential CPT 85025 BLOOD COUNT; COMPLETE (CBC) | $39.94 | $63.00 | 37% |
| Complete blood count (CBC) with differential CPT 85025 BLOOD COUNT; COMPLETE CBC | $39.94 | $63.00 | 37% |
| Complete blood count (CBC) with differential inpatient CPT 85025 BLOOD COUNT; COMPLETE (CBC) | $39.94 | $63.00 | 37% |
| Complete blood count (CBC) with differential inpatient CPT 85025 BLOOD COUNT; COMPLETE CBC | $39.94 | $63.00 | 37% |
| Complete blood count (CBC), no differential CPT 85027 BLOOD COUNT; COMPLETE (CBC) AUTOMATED | $33.60 | $53.00 | 37% |
| Complete blood count (CBC), no differential CPT 85027 HEMOGRAM W/O PLATELETS | $33.60 | $53.00 | 37% |
| Complete blood count (CBC), no differential inpatient CPT 85027 BLOOD COUNT; COMPLETE (CBC) AUTOMATED | $33.60 | $53.00 | 37% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HEMOGRAM W/O PLATELETS | $33.60 | $53.00 | 37% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL | $54.52 | $86.00 | 37% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL | $54.52 | $86.00 | 37% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $45.01 | $71.00 | 37% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $45.01 | $71.00 | 37% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $42.48 | $67.00 | 37% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $42.48 | $67.00 | 37% |
| Obstetric blood test panel CPT 80055 OBSTETRIC PANEL | $247.26 | $390.00 | 37% |
| Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL | $247.26 | $390.00 | 37% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PROSTATIC SPECIFIC ANTIGEN (PSA); FREE | $95.10 | $150.00 | 37% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PROSTATIC SPECIFIC ANTIGEN (PSA); FREE | $95.10 | $150.00 | 37% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATIC SPECIFIC ANTIGEN (PSA); TOTAL | $95.10 | $150.00 | 37% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATIC SPECIFIC ANTIGEN (PSA); TOTAL | $95.10 | $150.00 | 37% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME, PARTIAL (PTT); HEPARIN ABSORBED | $31.07 | $49.00 | 37% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD | $31.07 | $49.00 | 37% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME, PARTIAL (PTT) | $31.07 | $49.00 | 37% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME, PARTIAL (PTT) | $31.07 | $49.00 | 37% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME, PARTIAL (PTT); HEPARIN ABSORBED | $31.07 | $49.00 | 37% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD | $31.07 | $49.00 | 37% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $22.19 | $35.00 | 37% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME, WHOLE BLOOD | $22.19 | $35.00 | 37% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $22.19 | $35.00 | 37% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME, WHOLE BLOOD | $22.19 | $35.00 | 37% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE (TSH) | $86.86 | $137.00 | 37% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE (TSH) | $86.86 | $137.00 | 37% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS; AUTOMATED WITH MICROSCOPY | $16.48 | $26.00 | 37% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS; AUTOMATED W/MICROSCOPY | $16.48 | $26.00 | 37% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS; AUTOMATED W/MICROSCOPY | $16.48 | $26.00 | 37% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS; AUTOMATED WITH MICROSCOPY | $16.48 | $26.00 | 37% |
| Urinalysis with microscope exam, manual CPT 81000 URINALYSIS; NON-AUTOMATED W/MICROSCOPY | $20.92 | $33.00 | 37% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS; NON-AUTOMATED W/MICROSCOPY | $20.92 | $33.00 | 37% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS; AUTOMATED WO MICROSCOPY (UA DIP ONLY) | $11.41 | $18.00 | 37% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS; AUTOMATED WO MICROSCOPY (DIPSTICK ONLY) | $11.41 | $18.00 | 37% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS; AUTOMATED WO MICROSCOPY (DIPSTICK ONLY) | $11.41 | $18.00 | 37% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS; AUTOMATED WO MICROSCOPY (UA DIP ONLY) | $11.41 | $18.00 | 37% |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS; NON-AUTOMATED WO MICROSCOPY | $17.75 | $28.00 | 37% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS; NON-AUTOMATED WO MICROSCOPY | $17.75 | $28.00 | 37% |
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 | $2,630.47 | $4,149.00 | 37% |
| Colonoscopy with polyp removal inpatient CPT 45385 HCHG 45385P COLONOSCOPY W/REM POLYP,TUMOR,LESION-SNARE | $2,630.47 | $4,149.00 | 37% |
| Colonoscopy with tissue sample CPT 45380 HCHG 45380P COLONOSCOPY W/BIOPSY, SGL OR MULT | $2,248.16 | $3,546.00 | 37% |
| Colonoscopy with tissue sample inpatient CPT 45380 HCHG 45380P COLONOSCOPY W/BIOPSY, SGL OR MULT | $2,248.16 | $3,546.00 | 37% |
| Colonoscopy, diagnostic CPT 45378 HCHG 45378P COLONOSCOPY; DIAGNOSTIC | $1,990.76 | $3,140.00 | 37% |
| Colonoscopy, diagnostic inpatient CPT 45378 HCHG 45378P COLONOSCOPY; DIAGNOSTIC | $1,990.76 | $3,140.00 | 37% |
| Upper endoscopy (EGD) with biopsy CPT 43239 HCHG 43239P EGD W/BIOPSY, SGL OR MULT | $1,708.00 | $2,694.00 | 37% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HCHG 43239P EGD W/BIOPSY, SGL OR MULT | $1,708.00 | $2,694.00 | 37% |
| Upper endoscopy (EGD), diagnostic CPT 43235 HCHG 43235P EGD; DIAGNOSTIC | $1,538.08 | $2,426.00 | 37% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HCHG 43235P EGD; DIAGNOSTIC | $1,538.08 | $2,426.00 | 37% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Family therapy with the patient, 50 minutes CPT 90847 HCHG 90847 FAMILY PSYCHOTHERAPY W/PT PRESENT, 50 MIN | $170.55 | $269.00 | 37% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HCHG 90847 FAMILY PSYCHOTHERAPY W/PT PRESENT, 50 MIN | $170.55 | $269.00 | 37% |
| Family therapy without the patient, 50 minutes CPT 90846 HCHG 90846 FAM PSYCHOTHERAPY W/O PATIENT, 50 MIN | $170.55 | $269.00 | 37% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HCHG 90846 FAM PSYCHOTHERAPY W/O PATIENT, 50 MIN | $170.55 | $269.00 | 37% |
| Group psychotherapy session CPT 90853 HCHG 90853 GROUP PSYCHOTHERAPY | $88.76 | $140.00 | 37% |
| Group psychotherapy session inpatient CPT 90853 HCHG 90853 GROUP PSYCHOTHERAPY | $88.76 | $140.00 | 37% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG 97110 THERAPUTIC PROCEDURE, EACH 15 MIN; THERAPUTIC EXERCIS | $93.20 | $147.00 | 37% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG 97110 THERAPUTIC PROCEDURE, 15 MIN; THERAPUTIC EXERCISE, 1: | $93.20 | $147.00 | 37% |
| Psychotherapy session, 30 minutes CPT 90832 HCHG 90832 PSYCHOTHERAPY 30 MIN MNTL | $96.37 | $152.00 | 37% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HCHG 90832 PSYCHOTHERAPY 30 MIN MNTL | $96.37 | $152.00 | 37% |
| Psychotherapy session, 45 minutes CPT 90834 HCHG 90834 PSYCHOTHERAPY 45 MIN ALC | $146.45 | $231.00 | 37% |
| Psychotherapy session, 45 minutes CPT 90834 HCHG 90834 PSYCHOTHERAPY 45 MIN DRUG | $146.45 | $231.00 | 37% |
| Psychotherapy session, 45 minutes CPT 90834 HCHG 90834 PSYCHOTHERAPY 45 MIN MNTL | $146.45 | $231.00 | 37% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HCHG 90834 PSYCHOTHERAPY 45 MIN ALC | $146.45 | $231.00 | 37% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HCHG 90834 PSYCHOTHERAPY 45 MIN MNTL | $146.45 | $231.00 | 37% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HCHG 90834 PSYCHOTHERAPY 45 MIN DRUG | $146.45 | $231.00 | 37% |
| Psychotherapy session, 60 minutes CPT 90837 HCHG 90837 PSYCHOTHERAPY 60 MIN MNTL | $170.55 | $269.00 | 37% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HCHG 90837 PSYCHOTHERAPY 60 MIN MNTL | $170.55 | $269.00 | 37% |
Source file: https://bellin-ghs.pt.panaceainc.com/MRFDownload/bellin-ghs/gundersen-tricounty