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
Adj tis trans/see area/10.1-30sqcm 14041 CPT 14041 not published not published $800.99 – $3,358.01 7
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 $1.71 $3.00 $2.31 – $2.31 2
Administration chemotherapy IV infusion each additional hour CPT 96415 $127.11 $223.00 $29.45 – $101.54 7
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr CPT 96417 $245.67 $431.00 $67.55 – $227.54 7
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 $558.03 $979.00 $137.25 – $468.16 7
Administration chemotherapy IV push single/initial substance/drug CPT 96409 $430.92 $756.00 $106.02 – $360.82 7
Administration chemotherapy subcutaneous/im anti neoplastic hormonal CPT 96402 $128.82 $226.00 $37.66 – $106.33 7
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 $274.17 $481.00 $76.11 – $263.52 7
Administration immunization 1 vaccine CPT 90471 $66.12 $116.00 $22.16 – $48.27 7
Administration immunization each additional component CPT 90461 $18.24 $32.00 $9.33 – $19.15 7
Administration immunization each additional vaccine CPT 90472 $40.47 $71.00 $15.71 – $19.15 7
Administration immunization first component each vaccine CPT 90460 $26.22 $46.00 $22.71 – $39.26 7
Administration immunization intranasal/oral route 1 vaccine CPT 90473 $17.10 $30.00 $17.88 – $39.26 7
Administration immunization intranasal/oral route each additional vaccine CPT 90474 $15.39 $27.00 $12.85 – $19.15 7
Administration rsv monoclonal ab seasonal dose im w/counseling CPT 96380 $26.79 $47.00 $24.41 – $24.41 4
Administration vaccine hepatitis b HCPCS G0010 $47.88 $84.00 $32.30 – $48.27 6
Administration vaccine influenza virus HCPCS G0008 $66.12 $116.00 $32.30 – $48.27 6
Administration vaccine pneumococcal HCPCS G0009 $66.12 $116.00 $32.30 – $48.27 6
Administration vaccine rsv monoclonal ab seasonal dose im CPT 96381 not published not published $21.09 – $21.09 4
Adrenal cortex & medulla img CPT 78075 not published not published $37.36 – $90.87 7
Adrenalectomy expl w/exc retro tumor 60545 CPT 60545 not published not published $1,261.48 – $4,380.86 7
Advance care planning each additional 30 min 99498 CPT 99498 $145.92 $256.00 $77.21 – $164.55 6
Aep hearing status deter i&r CPT 92651 $482.79 $847.00 $88.92 – $308.02 6
Aep neurodiagnostic i&r CPT 92653 not published not published $89.12 – $298.69 6
Aep thrshld est mlt freq i&r CPT 92652 not published not published $120.42 – $406.45 6
_afb id by dna probe rflx ast CPT 87149 $63.27 $111.00 $21.05 – $77.39 11
#afb mycobacteria suscep. #1 CPT 87190 not published not published $4.12 – $28.22 11
_afb org id by sequencing rflx ast-sendout CPT 87153 not published not published $121.13 – $445.29 11
Aflibercept injection HCPCS J0178 $1,263.12 $2,216.00 $1,147.50 – $2,216.00 8
After cataract laser surgery CPT 66821 not published not published $331.10 – $1,208.81 7
Agalsidase beta 35 mg intravenous solution HCPCS J0180 $257.64 $452.00 $192.45 – $452.00 7
Air conduction bilat CPT 92552 $56.43 $99.00 $40.44 – $87.19 7
Air injection into abdomen 49400 CPT 49400 not published not published $92.31 – $528.15 7
Airway resistance by impulse oscillometry 94728 CPT 94728 $215.46 $378.00 $13.03 – $42.52 7
Albumin body fluid quantitative each specimen CPT 82042 $21.66 $38.00 $7.40 – $30.03 11
Albumin (human), 25%, 50ml HCPCS P9047 $113.33 $198.82 $62.55 – $198.82 7
Albumin (human), 5%, 250 ml HCPCS P9045 $112.60 $197.54 $64.04 – $197.54 7
Albumin ischemia modified CPT 82045 not published not published $35.64 – $131.01 11
Albumin (microalbumin) 24 hour urine quantitative CPT 82043 $31.35 $55.00 $6.07 – $22.31 11
Albumin serum plasma or whole blood CPT 82040 $19.38 $34.00 $5.20 – $19.11 11
Alcohol (ethanol) any specimen except urine/breath CPT 82077 $30.78 $54.00 $18.13 – $66.66 7
Alkaline phosphatase CPT 84075 $19.95 $35.00 $5.44 – $19.99 11
Allergen alpha lactalbumin ige CPT 86008 $59.28 $104.00 $18.83 – $69.21 7
Allergen egg white ige CPT 86003 $18.24 $32.00 $4.64 – $20.15 11
Allergen specific ige qual multi scrn ea CPT 86005 not published not published $8.37 – $30.76 11
Allergy injections; 2 or more 95117 CPT 95117 $30.78 $54.00 $12.97 – $33.97 7
Allergy injection; single 95115 CPT 95115 $23.37 $41.00 $10.83 – $29.34 7
Allergy Skin Testing CPT 95004 not published not published $3.71 – $13.53 7
Allg patch or app # of tests 95044 CPT 95044 not published not published $5.12 – $16.60 7
Allgrft implnt knee w/scope CPT 29867 not published not published $1,318.95 – $4,559.85 7
All tstg perq&iq drugs/biol CPT 95018 not published not published $7.48 – $69.56 7
All tstg perq&iq w/venoms CPT 95017 not published not published $3.80 – $27.45 7
Alpha-fetoprotein afp-l3 frac & total CPT 82107 not published not published $67.63 – $248.62 11
Alpha-fetoprotein amniotic CPT 82106 not published not published $17.85 – $65.62 11
Alpha-fetoprotein tumor marker CPT 82105 $59.28 $104.00 $17.61 – $64.73 11
Alprostadil for injection HCPCS J0270 $7.98 $14.00 $0.59 – $0.59 2
Alteplase 100 mg infusion from pyxis vial HCPCS J2997 $146.07 $256.26 $93.49 – $255.91 7
Alt/sgpt CPT 84460 $20.52 $36.00 $5.57 – $20.46 11
Aluminum - quest CPT 82108 not published not published $26.75 – $98.35 11
Alveoloplasty each quadrant CPT 41874 not published not published $258.83 – $1,433.33 7
Alys cplx sp/pn npgt w/prgrm CPT 95972 $336.87 $591.00 $41.87 – $222.91 7
Amantadine (symmetrel)-sendout CPT 80375 not published not published $30.24 – $31.67 3
Ambl bp mntr w/sw a/r CPT 93788 not published not published $5.83 – $15.45 7
Amino acid screen, urine CPT 82128 not published not published $14.56 – $53.54 11
Amino acid single qual CPT 82127 not published not published $14.89 – $54.73 11
Amino acids quant 2-5 CPT 82136 not published not published $20.59 – $75.69 11
Aminolevulinic acid delta CPT 82135 not published not published $17.27 – $63.50 11
Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 $36.61 $64.24 $14.75 – $64.24 6
Amiodarone 50 mg/ml intravenous solution HCPCS J0282 $3.89 $6.82 $1.35 – $1.35 2
Amitriptyline (elavil) -sendout CPT 80335 $66.12 $116.00 $31.67 – $33.24 3
Ammonia CPT 82140 $57.00 $100.00 $15.30 – $56.24 11
Amniocentesisdiagnostic 59000 CPT 59000 not published not published $79.45 – $424.95 7
Amniocentesis therapeutic CPT 59001 not published not published $174.22 – $616.43 7
Amniotic fluid scan CPT 82143 not published not published $9.82 – $36.09 11
Amp f/th 1/2 jt/phalanx w/neurect local flap CPT 26952 not published not published $723.80 – $2,374.13 7
Amphetamine confirm urine -sendout CPT 80324 $194.94 $342.00 $28.86 – $31.67 3
Amphetamines 5 or more CPT 80326 $62.13 $109.00 $28.86 – $53.00 3
Ampicillin 1 gram solution for injection HCPCS J0290 $3.31 $5.80 $1.33 – $3.00 6
Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 $6.38 $11.19 $2.87 – $7.00 6
Amp metatarsal w/toe single 28810 CPT 28810 not published not published $442.09 – $1,542.90 7
Amp thigh through femur re-amp 27596 CPT 27596 not published not published $717.28 – $2,518.84 7
Amputate hand at wrist CPT 25922 not published not published $678.62 – $2,251.88 7
Amputate metacarpal bone 26910 CPT 26910 not published not published $802.98 – $2,645.81 7
Amputate thigh through femur 27590 CPT 27590 not published not published $781.59 – $2,786.48 7
Amputation follow-up surgery CPT 24925 not published not published $597.99 – $2,028.08 7
Amputation follow-up surgery CPT 25907 not published not published $644.40 – $2,193.79 7
Amputation follow-up surgery CPT 25909 not published not published $714.97 – $2,447.70 7
Amputation follow-up surgery CPT 25929 not published not published $628.24 – $2,135.36 7
Amputation follow-up surgery CPT 25931 not published not published $839.36 – $2,759.85 7
Amputation follow-up surgery CPT 27594 not published not published $515.28 – $1,813.24 7
Amputation follow-up surgery CPT 27884 not published not published $586.89 – $2,023.13 7
Amputation leg thr tib/fib 27880 CPT 27880 not published not published $896.84 – $3,194.18 7
Amputation leg; tib/fib f/u 27886 CPT 27886 not published not published $656.35 – $2,315.89 7
Amputation of foot at ankle CPT 27889 not published not published $647.59 – $2,260.61 7
Amputation of lower leg CPT 27882 not published not published $591.54 – $2,097.30 7
Amputation of midtarsal 28800 CPT 28800 not published not published $557.57 – $1,946.10 7
Amputation thru metatarsal CPT 28805 not published not published $738.59 – $2,620.05 7
Amputation toe interphalangeal joint CPT 28825 $1,798.92 $3,156.00 $180.59 – $1,223.50 7
Amputation toe metatarsophalangeal joint CPT 28820 $1,739.64 $3,052.00 $185.16 – $1,286.09 7
Amylase CPT 82150 $48.45 $85.00 $6.80 – $25.01 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.