healthcosts.net

Ascension Calumet Hospital, Inc.

614 Memorial Dr, Chilton, WI · Ascension · · NPI 1376541748

Source: hospital's published price file ↗ · Published Jan 1, 2026 · Ingested Sep 8, 2026

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
Destruction by injection tx of nerve 64630 CPT 64630 not published not published $198.02 – $877.58 7
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) CPT 64636 $1,318.98 $2,314.00 $61.37 – $624.15 7
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 $3,439.95 $6,035.00 $203.01 – $1,513.20 7
Destruction ciliary body CPT 66700 not published not published $414.56 – $1,647.64 7
Destruction ciliary body CPT 66720 not published not published $436.53 – $1,684.28 7
Destruction ciliary body CPT 66740 not published not published $414.56 – $1,601.40 7
Destruction cryosurgery anal lesion(s) simpl 46916 CPT 46916 not published not published $150.63 – $896.96 7
Destruction laser surgery anal lesions 46917 CPT 46917 not published not published $135.21 – $1,526.36 7
Destruction les conjunctiva CPT 68135 not published not published $158.30 – $574.84 7
Destruction mal lsn s/n/h/f/g 2.1-3cm CPT 17273 $494.19 $867.00 $144.52 – $458.03 7
Destruction mal lsn s/n/h/f/g 3.1-4cm CPT 17274 not published not published $176.33 – $891.34 7
Destruction mal lsn t/a/l 3.1-4cm CPT 17264 not published not published $137.79 – $747.68 7
Destruction mal lsn t/a/l >4cm CPT 17266 $506.16 $888.00 $161.41 – $511.66 7
Destruction penis lesion(s) chem 54050 CPT 54050 not published not published $113.81 – $489.79 7
Destruction penis lesion(s) exten 54065 CPT 54065 not published not published $182.35 – $800.25 7
Destruction premal lesions 15/> 17004 CPT 17004 $413.25 $725.00 $103.95 – $457.76 7
Destruction rectal tumor 45190 CPT 45190 not published not published $728.02 – $2,534.78 7
Destruction vag lesions complex 57065 CPT 57065 not published not published $195.10 – $800.85 7
Destruction vag lesions simple 57061 CPT 57061 not published not published $121.83 – $511.31 7
Destruct penis les/smp/electrodesi 54055 CPT 54055 $387.60 $680.00 $101.97 – $458.66 7
Detect agent nos dna dir CPT 87797 not published not published $28.69 – $115.92 11
Detect agnt mult dna direc CPT 87800 not published not published $45.85 – $168.57 11
Developmental screen/score/document 96110 CPT 96110 $21.66 $38.00 $12.25 – $31.64 6
Devel tst phys/qhp 1st hr CPT 96112 not published not published $132.26 – $456.30 6
Device intraute mirena HCPCS J7298 $898.89 $1,577.00 $1,432.21 – $1,432.21 2
Dev tst admin phys/qhp ea addl 30 min CPT 96113 not published not published $60.52 – $204.05 6
Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 $126.54 $222.00 $10.35 – $25.78 7
Dexamethasone 4 mg tablet HCPCS J8540 $7.08 $12.42 $0.11 – $1.24 6
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 $1.26 $2.21 $0.17 – $0.59 6
Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 $5.70 $10.00 $7.32 – $7.32 2
Dhea-s (dehydroepiand sulfate) CPT 82627 $79.23 $139.00 $23.34 – $85.81 11
Diabetes (HbA1c) Test CPT 83036 $50.16 $88.00 $10.20 – $37.48 11
Diag bronchoscope/catheter CPT 31643 not published not published $176.26 – $647.63 7
Diag laparo separate proc 49320 CPT 49320 $590.52 $1,036.00 $334.42 – $703.19 7
Diagnostic anoscopy CPT 46601 not published not published $97.33 – $521.51 6
Diagnostic anoscopy & biopsy CPT 46607 not published not published $128.78 – $729.94 6
Diagnostic anoscopy spx 46600 CPT 46600 $305.52 $536.00 $43.02 – $373.76 7
Diagnostic digital breast tomosynthesis bil CPT 77062 not published not published $122.36 – $122.36 2
Diagnostic digital breast tomosynthesis unil CPT 77061 not published not published $99.42 – $99.42 2
Diagnostic laryngoscopy 31505 CPT 31505 not published not published $52.27 – $315.08 7
Diagnostic laryngoscopy 31575 CPT 31575 $274.17 $481.00 $71.74 – $444.53 7
Diagnostic Mammogram (both breasts) CPT 77066 $725.61 $1,273.00 $50.39 – $122.36 6
Diagnostic Mammogram (one breast) CPT 77065 $581.40 $1,020.00 $41.04 – $99.42 6
Diagnostic radio unlisted proc CPT 76499 not published not published $182.03 – $182.03 2
Dialysis circuit perm vascular embolization 36909 CPT 36909 not published not published $199.69 – $7,275.15 6
Dialysis one evaluation CPT 90945 not published not published $90.79 – $285.27 7
Diathermy eg microwave CPT 97024 not published not published $8.35 – $12.99 7
Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 $27.99 $49.10 $8.45 – $16.00 6
Dicyclomine injection HCPCS J0500 $153.53 $269.35 $30.52 – $269.35 6
Diffusing capacity CPT 94729 $208.05 $365.00 $9.35 – $30.52 7
Digital analysis of eeg CPT 95957 not published not published $107.99 – $345.78 7
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 $8.55 $15.00 $5.80 – $13.16 7
Digoxin total therapeutic drug level CPT 80162 $76.38 $134.00 $13.94 – $51.26 11
Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 $248.66 $436.24 $65.13 – $436.24 6
Dilate biliary duct/ampulla CPT 47542 not published not published $137.79 – $1,895.85 6
Dilate esophagus CPT 43453 not published not published $89.88 – $3,216.00 7
Dilate esophagus 1/mult pass CPT 43450 $117.99 $207.00 $82.88 – $623.29 7
Dilate ic vasospasm ea add vsl diff territory CPT 61642 not published not published $337.42 – $1,223.44 6
Dilate ic vasospasm ea add vsl same territory CPT 61641 not published not published $168.71 – $611.70 6
Dilate ic vasospasm init CPT 61640 not published not published $480.17 – $1,740.98 6
Dilate tear duct opening CPT 68801 not published not published $85.06 – $335.36 7
Dilate urethra stricture CPT 53600 $283.29 $497.00 $65.52 – $178.61 7
Dilate urethra stricture CPT 53601 not published not published $55.14 – $294.11 7
Dilate urethra stricture CPT 53605 not published not published $65.75 – $236.29 7
Dilate urethra stricture CPT 53621 not published not published $74.19 – $507.75 7
Dilation/female urethra/initial 53660 CPT 53660 not published not published $43.28 – $256.69 7
Dilation of anal sphincter CPT 45905 not published not published $177.35 – $605.63 7
Dilation of cervical canal 57800 CPT 57800 not published not published $49.93 – $253.28 7
Dilation of rectal stricture 45910 CPT 45910 not published not published $201.02 – $692.18 7
Dilation of salivary duct CPT 42660 not published not published $88.28 – $434.44 7
Dilation of urethra CPT 53661 not published not published $41.87 – $252.90 7
Dilation of urethra CPT 53665 not published not published $39.08 – $140.18 7
Dilation of vagina CPT 57400 not published not published $134.04 – $475.31 7
Dilation salivary duct 42650 CPT 42650 not published not published $62.18 – $284.96 7
Dilation/urethral strict/male/ini 53620 CPT 53620 not published not published $89.98 – $537.90 7
Dilat xst trc ndurlgc px CPT 50436 not published not published $153.96 – $554.96 6
Dilat xst trc new access rcs CPT 50437 not published not published $255.48 – $929.89 6
Dimethyl sulfoxide 50% 50 ml HCPCS J1212 $864.69 $1,517.00 $526.66 – $1,517.00 8
Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 $7.33 $12.86 $1.19 – $2.00 6
Diphtheria-tetanus toxoids 0.5 ml (peds) CPT 90702 $71.82 $126.00 $29.07 – $29.07 2
Dir nsl mucous membrane test CPT 95065 not published not published $30.81 – $83.76 7
Disability dlco CPT 94727 $182.40 $320.00 $12.67 – $41.37 7
Disaccharidases CPT 82657 $224.58 $394.00 $23.28 – $85.58 11
Disarticulation sho sec clsr CPT 23921 not published not published $497.44 – $1,677.90 7
Discectomy ant dcmprn cord thoracic 1 ntrspc 63077 CPT 63077 not published not published $1,493.41 – $5,231.55 7
Discectomy ant dcmprn cord thoracic ea ntrsp 63078 CPT 63078 not published not published $195.08 – $691.01 7
Discography cerv/thor spine CPT 72285 not published not published $59.80 – $144.63 7
Dise eval slp do brth flx dx CPT 42975 not published not published $100.99 – $418.31 6
Dissolve clot heart vessel CPT 92975 not published not published $365.38 – $1,191.75 7
Dist revas ligation hemo CPT 36838 not published not published $1,100.42 – $3,988.69 7
Diverticulectomy/hypophar/esoph 43130 CPT 43130 not published not published $820.19 – $2,812.65 7
Division of fallopian tube 58605 CPT 58605 not published not published $351.74 – $1,206.26 7
#d/lmeth-l-methamphetamine CPT 80374 not published not published $28.93 – $31.67 3
Dlyd plmt xtn prosth ea addl CPT 34711 not published not published $281.44 – $1,039.13 6
Dmd dup/delet analysis CPT 81161 not published not published $147.15 – $1,076.94 10
Dmpk gene detc abnor allele CPT 81234 not published not published $143.85 – $528.82 7
Dna antibody native/double stranded CPT 86225 $49.59 $87.00 $14.43 – $53.04 11
Dna gardnerella CPT 87510 not published not published $21.05 – $77.39 11
Dna probe chlamydia CPT 87490 not published not published $23.89 – $87.82 11
Dna probe gc CPT 87590 not published not published $28.22 – $103.76 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.