Ascension Calumet Hospital, Inc.
614 Memorial Dr, Chilton, WI · Ascension · · NPI 1376541748
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| 11-desoxycortisol - sendout CPT 82634 | not published | not published | $30.74 – $113.02 | 11 |
| 17-hydroxypregnenolone CPT 84143 | not published | not published | $23.95 – $88.05 | 11 |
| 17-ketosteroids CPT 83586 | not published | not published | $13.44 – $49.41 | 11 |
| 1st hosp/birthing center care per day nml nb 99460 CPT 99460 | not published | not published | $98.16 – $210.84 | 7 |
| 1st inpatient critical care pr day age 28 days/less than 99468 CPT 99468 | not published | not published | $944.96 – $2,027.38 | 7 |
| 24 hr ambulatory b/p monitor CPT 93786 | not published | not published | $24.03 – $73.31 | 7 |
| 2nd order venous cath CPT 36012 | not published | not published | $173.22 – $3,196.95 | 7 |
| 3d ech img cgen car anomal CPT 93319 | not published | not published | $24.49 – $206.48 | 6 |
| 3-d radiotherapy plan CPT 77295 | not published | not published | $241.72 – $558.17 | 7 |
| 3d recon without postprocess indpndt CPT 76376 | $189.81 | $333.00 | $10.08 – $24.13 | 7 |
| 5' nucleotidase - sendout CPT 83915 | not published | not published | $11.71 – $43.04 | 11 |
| 88334 ap bill cytologic exam each additional site CPT 88334 | not published | not published | $23.29 – $63.16 | 8 |
| 99381 initial comp preventive med less than 1 year new CPT 99381 | $181.26 | $318.00 | $77.73 – $148.32 | 6 |
| 99382 initial comp preventive med 1 to 4 years new CPT 99382 | $189.24 | $332.00 | $83.01 – $155.05 | 6 |
| 99383 initial comp preventive med 5 to 11 years new CPT 99383 | $193.23 | $339.00 | $88.16 – $161.00 | 6 |
| 99391 periodic comp preventive med less than 1 year est CPT 99391 | $149.91 | $263.00 | $70.97 – $219.13 | 6 |
| 99392 periodic comp preventive med 1 to 4 years est CPT 99392 | $165.30 | $290.00 | $77.73 – $142.34 | 6 |
| 99393 periodic comp preventive med 5 to 11 years est CPT 99393 | $170.43 | $299.00 | $77.73 – $141.88 | 6 |
| 99394 periodic comp preventive med 12 to 17 years est CPT 99394 | $181.26 | $318.00 | $88.16 – $155.48 | 6 |
| 99397 periodic comp preventive med 65+ years est CPT 99397 | $220.59 | $387.00 | $103.87 – $181.46 | 6 |
| Aa graft w/bp/aortic root replace 33863 CPT 33863 | not published | not published | $3,054.75 – $11,007.15 | 7 |
| Abatacept (with maltose) 250 mg intravenous solution HCPCS J0129 | $79.80 | $140.00 | $49.13 – $140.00 | 7 |
| #a/b/c/c/h pnl-candida albicans ab CPT 86628 | $111.72 | $196.00 | $8.32 – $46.36 | 11 |
| Abd aorta w/runoff s&i CPT 75630 | not published | not published | $96.78 – $200.13 | 7 |
| Abd exp/postop hem/throm/infec 35840 CPT 35840 | not published | not published | $1,207.21 – $4,219.05 | 7 |
| Abd/low ext cath 1st CPT 36245 | not published | not published | $233.55 – $4,870.80 | 7 |
| Abd/low ext cath 2nd CPT 36246 | not published | not published | $247.09 – $3,106.24 | 7 |
| Abd/low ext cath 3rd CPT 36247 | not published | not published | $295.69 – $5,507.33 | 7 |
| Abd/low ext cath addl CPT 36248 | not published | not published | $48.77 – $501.11 | 7 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $1,006.05 | $1,765.00 | $70.54 – $170.92 | 7 |
| Abdominal CT scan (with contrast) CPT 74160 | $845.88 | $1,484.00 | $64.27 – $156.17 | 7 |
| Abdominal CT scan (without contrast) CPT 74150 | $595.65 | $1,045.00 | $60.09 – $145.60 | 7 |
| Abdominal MRI (with and without contrast) CPT 74183 | $2,357.52 | $4,136.00 | $110.85 – $268.29 | 7 |
| Abdominal MRI (with contrast) CPT 74182 | not published | not published | $87.02 – $211.79 | 7 |
| Abdominal MRI (without contrast) CPT 74181 | $1,721.40 | $3,020.00 | $73.62 – $178.83 | 7 |
| Abdominal paracentesis w/image guidance CPT 49083 | $1,455.78 | $2,554.00 | $109.86 – $1,097.93 | 7 |
| Abdominal Ultrasound (complete) CPT 76700 | $791.16 | $1,388.00 | $40.68 – $99.42 | 7 |
| Abdominal Ultrasound (limited) CPT 76705 | $593.94 | $1,042.00 | $29.50 – $71.50 | 7 |
| Abdominoplasty 15830 CPT 15830 | not published | not published | $1,204.08 – $4,206.49 | 7 |
| Abd paracentesis/w/o image guide 49082 CPT 49082 | not published | not published | $75.33 – $740.78 | 7 |
| Abl1 gene CPT 81170 | not published | not published | $315.00 – $1,158.00 | 10 |
| Ablate arrhythmia add on CPT 93655 | not published | not published | $298.97 – $16,158.00 | 8 |
| Ablate atria lmtd endo 33265 CPT 33265 | not published | not published | $1,338.56 – $4,753.73 | 7 |
| Ablate atria w/bypass exten 33256 CPT 33256 | not published | not published | $1,883.82 – $6,781.58 | 7 |
| Ablate atria x10sv add-on 33258 CPT 33258 | not published | not published | $641.96 – $2,278.31 | 7 |
| Ablate atria x10sv endo 33266 CPT 33266 | not published | not published | $1,800.99 – $6,454.69 | 7 |
| Ablate bone tumor(s) cryo perq 20983 CPT 20983 | not published | not published | $351.75 – $20,877.38 | 6 |
| Ablate bone tumor(s) perq CPT 20982 | not published | not published | $372.09 – $13,993.58 | 7 |
| Ablate heart dysrhythm focus CPT 93650 | not published | not published | $568.81 – $16,158.00 | 8 |
| Ablate inf turbinate submuc 30802 CPT 30802 | not published | not published | $214.69 – $1,000.09 | 7 |
| Ablate inf turbinate superf 30801 CPT 30801 | not published | not published | $161.98 – $788.85 | 7 |
| Ablate pulm tumor perq crybl CPT 32994 | not published | not published | $447.46 – $20,001.45 | 6 |
| Ablate pulm tumor perq rf CPT 32998 | not published | not published | $448.17 – $12,783.45 | 7 |
| Ablation cryo pq liver tumor(s) CPT 47383 | not published | not published | $460.28 – $25,046.63 | 6 |
| Abltj mal prst8 tiss hifu CPT 55880 | not published | not published | $1,020.19 – $3,672.68 | 6 |
| Abobotulinumtoxina HCPCS J0586 | $11.40 | $20.00 | $9.02 – $20.00 | 7 |
| Abortion CPT 59850 | not published | not published | $392.03 – $1,344.71 | 7 |
| Abortion (mpr) CPT 59866 | not published | not published | $233.15 – $824.66 | 7 |
| Abrasion lesions add-on CPT 15787 | not published | not published | $17.54 – $148.28 | 7 |
| Abrasion lesion single CPT 15786 | not published | not published | $142.11 – $878.89 | 7 |
| Abscess drain retroperitoneal surg code CPT 49406 | not published | not published | $199.38 – $3,226.31 | 6 |
| Access & clsr pq fem art endogft dlvry w/img uni CPT 34713 | not published | not published | $118.09 – $435.94 | 6 |
| Access thoracic lymph duct CPT 38794 | not published | not published | $294.01 – $1,094.74 | 7 |
| Acetaminophen 10 mg/ml soln 100 ml glass cont HCPCS J0131 | $1.14 | $2.00 | $0.08 – $2.00 | 6 |
| Acetaminophen level CPT 80143 | $33.06 | $58.00 | $19.57 – $71.95 | 7 |
| Acetone qualitative CPT 82009 | $25.08 | $44.00 | $4.75 – $17.45 | 11 |
| Acetylcholine receptor modulating antibody CPT 86043 | not published | not published | $46.51 – $53.14 | 5 |
| Acetylcholinesterase assay CPT 82013 | not published | not published | $12.90 – $47.44 | 11 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | $5.21 | $9.14 | $0.88 – $9.14 | 7 |
| Acetylcysteine non-comp unit HCPCS J7608 | $2.78 | $4.87 | $2.44 – $4.87 | 3 |
| Acid perfusion of esophagus CPT 91030 | not published | not published | $48.93 – $158.49 | 7 |
| Acne surgery 10040 CPT 10040 | $260.49 | $457.00 | $54.43 – $222.25 | 7 |
| Aco annual medicare visit (awv), initial g0438aco HCPCS G0438 | $273.60 | $480.00 | $182.28 – $374.21 | 6 |
| Aco annual medicare visit (awv), subsq g0439aco HCPCS G0439 | $220.02 | $386.00 | $143.29 – $253.19 | 6 |
| Aco ccm; at least 20 min 99490aco CPT 99490 | not published | not published | $53.13 – $90.54 | 6 |
| Aco ccm; ea addl 20 min 99439aco CPT 99439 | not published | not published | $37.06 – $85.34 | 6 |
| Aco cmplx chron care addl 20 min 99489aco CPT 99489 | not published | not published | $53.13 – $96.52 | 6 |
| Aco cmplx chron care without pt visit, 60 min 99487aco CPT 99487 | not published | not published | $95.72 – $199.24 | 6 |
| Aco cont gluc mnt phys/qhp eqp 95250aco CPT 95250 | not published | not published | $157.12 – $485.84 | 7 |
| Aco med nutria tx/group, ea 30 min 97804aco CPT 97804 | $42.75 | $75.00 | $17.02 – $56.34 | 7 |
| Acoustic immitance testing CPT 92570 | not published | not published | $31.10 – $109.95 | 7 |
| Acoustic refl threshold tst CPT 92568 | not published | not published | $15.93 – $52.36 | 7 |
| Acromp/acromionectomy prtl CPT 23130 | not published | not published | $649.32 – $2,195.36 | 7 |
| Actigraphy testing CPT 95803 | not published | not published | $44.86 – $150.31 | 7 |
| Actinotherapy uv light CPT 96900 | not published | not published | $26.53 – $72.16 | 7 |
| Acup 1/> w/estim 1st 15 min CPT 97813 | $54.15 | $95.00 | $35.43 – $55.94 | 6 |
| Acup 1/> wo estim 1st 15 min CPT 97810 | $49.59 | $87.00 | $32.50 – $48.90 | 6 |
| Acute hepatitis panel CPT 80074 | $192.66 | $338.00 | $50.01 – $183.85 | 11 |
| Acute venous thrombus image CPT 78456 | not published | not published | $49.78 – $119.24 | 7 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | $0.30 | $0.52 | $0.06 – $0.52 | 6 |
| #acylcarnitineprfl CPT 82017 | $63.84 | $112.00 | $17.71 – $65.12 | 11 |
| Acylcarnitines qual CPT 82016 | not published | not published | $17.31 – $63.65 | 11 |
| Adding walker to prev cast CPT 29440 | not published | not published | $29.72 – $157.65 | 7 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | $2.35 | $4.13 | $0.65 – $2.00 | 6 |
| Adenovirus ag ia CPT 87301 | not published | not published | $12.58 – $46.24 | 11 |
| Adenovirus antibody,serum - quest CPT 86603 | not published | not published | $8.32 – $49.68 | 11 |
| Adenovirus assay w/optic CPT 87809 | not published | not published | $17.15 – $83.99 | 11 |
| Adhesiolysis tube ovary 58740 CPT 58740 | not published | not published | $930.17 – $3,218.06 | 7 |
| Adh-sendout CPT 84588 | $99.18 | $174.00 | $35.64 – $131.01 | 11 |
| Adjmt/revj ext fixj sys anes CPT 20693 | not published | not published | $470.43 – $1,598.33 | 7 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.