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 |
|---|---|---|---|---|
| Cefazolin 10 mg/10 ml (dilution #2) IV desensitization - cnr HCPCS J0690 | $3.43 | $6.01 | $1.02 – $1.83 | 6 |
| Cefepime 1 gram solution for injection HCPCS J0692 | $6.03 | $10.58 | $1.78 – $6.00 | 6 |
| Cefoxitin 1 gram intravenous solution HCPCS J0694 | $25.02 | $43.89 | $6.94 – $29.08 | 6 |
| Ceftaroline fosamil 600 mg intravenous solution HCPCS J0712 | $0.69 | $1.20 | $0.60 – $1.20 | 3 |
| Ceftazidime 4.5 mg/0.2 ml intraocular injection - cnr HCPCS J0713 | $5.29 | $9.29 | $2.49 – $9.29 | 6 |
| Ceftriaxone 1 gram solution for injection HCPCS J0696 | $1.30 | $2.28 | $0.66 – $1.59 | 6 |
| #celiac hla-dq2 CPT 81377 | not published | not published | $99.48 – $365.70 | 10 |
| #celiac hla-dq8 CPT 81383 | not published | not published | $114.59 – $421.24 | 10 |
| Cell count body fluid CPT 89050 | $47.88 | $84.00 | $4.96 – $18.22 | 11 |
| Cell count w differential body fluid CPT 89051 | $51.30 | $90.00 | $5.88 – $21.62 | 11 |
| Cell cryopreserve/storage CPT 88240 | not published | not published | $10.00 – $50.45 | 11 |
| Cell enumeration & id CPT 86152 | not published | not published | $17.34 – $968.01 | 10 |
| Cell function assay w/stim CPT 86352 | $394.44 | $692.00 | $142.65 – $524.42 | 11 |
| Cell marker study CPT 88182 | not published | not published | $40.60 – $83.28 | 8 |
| Centralization wrist on ulna CPT 25335 | not published | not published | $977.82 – $3,368.66 | 7 |
| Cerclage cervix pregnancy abdominal 59325 CPT 59325 | not published | not published | $235.53 – $835.01 | 7 |
| Cerclage of uterine cervix nonob 57700 CPT 57700 | not published | not published | $376.46 – $1,217.25 | 7 |
| Cerebrospinal fld flw imag CPT 78645 | not published | not published | $28.04 – $67.73 | 7 |
| Certolizumab pegol 400 mg (200 mg x 2 vials) subcutaneous kit HCPCS J0717 | $22.82 | $40.03 | $6.86 – $20.00 | 7 |
| Cervical lymphadenectomy 38720 CPT 38720 | not published | not published | $1,387.70 – $4,801.35 | 7 |
| Cervical or vaginal cancer screening g0101 HCPCS G0101 | $67.83 | $119.00 | $29.10 – $75.80 | 6 |
| Cesarean section delivery only 59514 CPT 59514 | not published | not published | $885.84 – $2,369.03 | 7 |
| #cf-97variants CPT 81220 | not published | not published | $584.43 – $2,148.48 | 7 |
| Cftr gene dup/delet variants CPT 81222 | not published | not published | $456.82 – $1,679.37 | 7 |
| Cftr gene intron poly t CPT 81224 | not published | not published | $177.19 – $651.38 | 7 |
| Cftr gene known fam variants CPT 81221 | not published | not published | $102.08 – $375.27 | 7 |
| Change cystostomy tube; complex 51710 CPT 51710 | not published | not published | $83.47 – $480.79 | 7 |
| Change cystostomy tube simple CPT 51705 | $367.08 | $644.00 | $53.82 – $198.25 | 7 |
| Change gastric port open CPT 43888 | not published | not published | $474.89 – $1,639.95 | 7 |
| Change g-tube to g-j perc CPT 49446 | not published | not published | $149.20 – $3,287.40 | 7 |
| Change nephroureteral cath CPT 50387 | not published | not published | $84.95 – $2,005.50 | 7 |
| Change of ureter tube/stent CPT 50688 | not published | not published | $81.31 – $286.65 | 7 |
| Change of windpipe airway 31502 CPT 31502 | $331.74 | $582.00 | $36.05 – $126.56 | 7 |
| Change stent via transureth CPT 50385 | not published | not published | $220.65 – $3,948.19 | 7 |
| Change ureter stent percut CPT 50382 | not published | not published | $256.52 – $4,019.33 | 7 |
| Chct for mal hyperthermia CPT 89049 | not published | not published | $15.07 – $629.49 | 8 |
| Chemical exfoliation acne 17360 CPT 17360 | not published | not published | $98.15 – $451.13 | 7 |
| Chemical peel face epiderm 15788 CPT 15788 | not published | not published | $231.09 – $1,566.11 | 7 |
| Chemical peel nonfacial 15793 CPT 15793 | not published | not published | $378.71 – $1,728.26 | 7 |
| Chemical peel nonfacial; epidermal CPT 15792 | not published | not published | $224.30 – $1,403.10 | 7 |
| Chemo adm cns w/lmbr punct CPT 96450 | not published | not published | $79.82 – $609.32 | 7 |
| Chemodener muscle larynx emg CPT 64617 | not published | not published | $112.34 – $584.85 | 6 |
| Chemodenerv 1 extrem 1-4 ea 64643 CPT 64643 | $574.56 | $1,008.00 | $70.92 – $330.11 | 6 |
| Chemodenerv 1 extrem 5/> ea 64645 CPT 64645 | not published | not published | $81.23 – $416.10 | 6 |
| Chemodenerv 1 extrem 5/> mus 64644 CPT 64644 | $985.53 | $1,729.00 | $117.74 – $609.23 | 6 |
| Chemodenerv 1 extremity 1-4 64642 CPT 64642 | $869.25 | $1,525.00 | $108.20 – $519.83 | 6 |
| Chemodenervation anal musc CPT 46505 | not published | not published | $261.87 – $1,075.09 | 7 |
| Chemodenervation/face muscl/unilat 64612 CPT 64612 | $550.62 | $966.00 | $123.70 – $477.45 | 7 |
| Chemodenervation nerve of eye muscle 67345 CPT 67345 | not published | not published | $224.33 – $874.76 | 7 |
| Chemodenerv eccrine glands CPT 64653 | not published | not published | $52.28 – $348.30 | 7 |
| Chemodenerv eccrine glands 64650 CPT 64650 | $275.31 | $483.00 | $41.85 – $290.89 | 7 |
| Chemodenerv musc migraine 64615 CPT 64615 | $449.73 | $789.00 | $120.27 – $518.40 | 7 |
| Chemodenerv musc neck dyston 64616 CPT 64616 | $819.09 | $1,437.00 | $108.41 – $460.46 | 6 |
| Chemodenerv saliv glands bilat 64611 CPT 64611 | not published | not published | $114.69 – $423.08 | 7 |
| Chemodenerv trunk musc 1-5 64646 CPT 64646 | not published | not published | $115.97 – $544.01 | 6 |
| Chemodenerv trunk musc 6/] 64647 CPT 64647 | not published | not published | $133.04 – $620.78 | 6 |
| Chemo extend IV infus w/pump HCPCS G0498 | $656.07 | $1,151.00 | $862.79 – $862.79 | 2 |
| Chemo ia infuse each addl hr CPT 96423 | not published | not published | $76.89 – $263.66 | 7 |
| Chemo ia infusion up to 1 hr CPT 96422 | not published | not published | $165.15 – $568.96 | 7 |
| Chemo ia push tecnique CPT 96420 | not published | not published | $108.05 – $345.21 | 7 |
| Chemo intralesional over 7 CPT 96406 | not published | not published | $46.98 – $433.13 | 7 |
| Chemo intralesional up to 7 96405 CPT 96405 | not published | not published | $30.46 – $282.66 | 7 |
| Chemotaxis assay CPT 86155 | not published | not published | $16.79 – $61.72 | 11 |
| Chemotherapy injection 96542 CPT 96542 | not published | not published | $44.40 – $444.43 | 7 |
| Chemotx admn pertl cav impl CPT 96446 | not published | not published | $20.26 – $670.57 | 7 |
| Chest 2 vws w oblique CPT 71048 | $224.58 | $394.00 | $15.61 – $39.93 | 6 |
| Chest apical lordotic proj CPT 71047 | $178.98 | $314.00 | $14.11 – $33.80 | 6 |
| Chest CT scan (with and without contrast) CPT 71270 | $1,097.25 | $1,925.00 | $63.04 – $168.57 | 7 |
| Chest CT scan (with contrast) CPT 71260 | $914.28 | $1,604.00 | $58.97 – $152.64 | 7 |
| Chest CT scan (without contrast) CPT 71250 | $722.19 | $1,267.00 | $54.56 – $141.78 | 7 |
| Chest X-ray CPT 71046 | $156.18 | $274.00 | $11.18 – $26.78 | 6 |
| Chest X-ray (single view) CPT 71045 | $120.27 | $211.00 | $8.97 – $22.35 | 6 |
| Chg pr pul rehab for copd patients CPT 94626 | $361.95 | $635.00 | $28.63 – $251.64 | 6 |
| Chg radiologic exam esophagus double contrast CPT 74221 | not published | not published | $35.15 – $85.61 | 6 |
| Chimerism anal no cell selec CPT 81267 | not published | not published | $217.83 – $800.80 | 10 |
| Chimerism anal w/cell select CPT 81268 | not published | not published | $273.83 – $1,006.65 | 10 |
| Chlamydia culture CPT 87110 | $69.54 | $122.00 | $20.58 – $75.66 | 11 |
| Chlamydia trachomatis ag if CPT 87270 | not published | not published | $12.58 – $46.24 | 11 |
| Chlamydia type CPT 87140 | not published | not published | $5.85 – $21.50 | 11 |
| Chlnggrphy intraop addl s&i CPT 74301 | not published | not published | $10.45 – $25.87 | 7 |
| Chloride CPT 82435 | $17.67 | $31.00 | $4.83 – $17.76 | 11 |
| Chloride 24 hour urine CPT 82436 | $19.38 | $34.00 | $6.04 – $22.20 | 11 |
| Chlorpromazine 0.125 mg/ml IV syringe - cnr HCPCS J3230 | $47.31 | $83.00 | $44.49 – $83.00 | 6 |
| Chmotx admn plrl cav thrcnts CPT 96440 | not published | not published | $143.20 – $3,001.22 | 7 |
| Cholangiogram percutaneous compl CPT 47532 | not published | not published | $214.91 – $3,095.78 | 6 |
| Cholangiography and/or pancreatography intraoperative supervision & interpretation CPT 74300 | $546.63 | $959.00 | $13.88 – $43.85 | 7 |
| Cholecystectomy expl duct 47612 CPT 47612 | not published | not published | $1,269.51 – $4,492.28 | 7 |
| Cholecystectomy w/cholangiography 47605 CPT 47605 | not published | not published | $1,129.78 – $3,967.65 | 7 |
| Cholecystoenterostomy direct 47720 CPT 47720 | not published | not published | $1,158.84 – $4,077.64 | 7 |
| Cholecystostomy complete w/supervision & interpretation CPT 47490 | not published | not published | $345.96 – $1,229.74 | 7 |
| Cholesterol CPT 82465 | $17.10 | $30.00 | $4.57 – $16.79 | 11 |
| Cholesterol (Lipid) Test CPT 80061 | $75.24 | $132.00 | $14.06 – $51.69 | 11 |
| Cholinesterase CPT 82480 | not published | not published | $8.26 – $30.38 | 11 |
| Cholinesterase challenge CPT 95857 | not published | not published | $29.89 – $181.24 | 7 |
| Chorion biopsy CPT 59015 | not published | not published | $128.59 – $543.53 | 7 |
| Chorionic gonadotropin/1000u HCPCS J0725 | $30.21 | $53.00 | $22.63 – $53.00 | 7 |
| Chrom analysis CPT 88273 | not published | not published | $36.55 – $134.37 | 11 |
| Chromatogram assay sugars CPT 84375 | not published | not published | $8.32 – $150.54 | 11 |
| Chromatography CPT 83021 | not published | not published | $18.96 – $69.71 | 11 |
| Chromogenic substrate assay CPT 85130 | not published | not published | $12.48 – $45.90 | 11 |
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.