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 |
|---|---|---|---|---|
| Esophagomyotomy thoracic 43331 CPT 43331 | not published | not published | $1,323.12 – $4,690.91 | 7 |
| Esophagoplasty congenital CPT 43313 | not published | not published | $2,886.91 – $9,558.45 | 7 |
| Esophagosc dilate balloon 30 CPT 43214 | not published | not published | $198.47 – $702.75 | 6 |
| Esophagosc flex trnsn biopsy CPT 43198 | not published | not published | $100.91 – $771.38 | 6 |
| Esophagoscop mucosal resect CPT 43211 | not published | not published | $242.20 – $861.15 | 6 |
| Esophagoscop stent placement CPT 43212 | not published | not published | $191.70 – $679.76 | 6 |
| Esophagoscop ultrasound exam CPT 43231 | not published | not published | $162.80 – $585.08 | 7 |
| Esophagoscopy balloon <30mm CPT 43220 | not published | not published | $121.78 – $3,689.36 | 7 |
| Esophagoscopy control bleed CPT 43227 | not published | not published | $170.11 – $2,264.78 | 7 |
| Esophagoscopy flex biopsy CPT 43202 | not published | not published | $106.57 – $1,230.45 | 7 |
| Esophagoscopy/flex/diagnostic 43200 CPT 43200 | $132.24 | $232.00 | $90.62 – $876.90 | 7 |
| Esophagoscopy flex dx brush CPT 43197 | not published | not published | $83.89 – $698.25 | 6 |
| Esophagoscopy flex remove fb CPT 43215 | not published | not published | $144.54 – $1,393.50 | 7 |
| Esophagoscopy lesion ablate CPT 43229 | not published | not published | $202.62 – $2,534.03 | 6 |
| Esophagoscopy lesion removal CPT 43216 | not published | not published | $138.32 – $1,430.14 | 7 |
| Esophagoscopy retro balloon CPT 43213 | not published | not published | $264.17 – $4,471.54 | 6 |
| Esophagoscopy rigid balloon CPT 43195 | not published | not published | $192.08 – $662.85 | 6 |
| Esophagoscopy/rigid/diagnostic 43191 CPT 43191 | not published | not published | $161.39 – $556.46 | 6 |
| Esophagoscopy rigid trnso 43180 CPT 43180 | not published | not published | $570.35 – $1,969.24 | 6 |
| Esophagoscopy snare les remv CPT 43217 | not published | not published | $165.55 – $1,461.86 | 7 |
| Esophagoscopy w/us needle bx CPT 43232 | not published | not published | $205.62 – $733.58 | 7 |
| Esophagoscp guide wire dilat 43196 CPT 43196 | not published | not published | $203.88 – $708.60 | 6 |
| Esophagoscp rig trnso biopsy CPT 43193 | not published | not published | $175.80 – $609.08 | 6 |
| Esophagoscp rig trnso inject CPT 43192 | not published | not published | $176.51 – $610.35 | 6 |
| Esophagoscp rig trnso rem fb CPT 43194 | not published | not published | $195.21 – $691.20 | 6 |
| Esophagotomy thrc rmvl fb CPT 43045 | not published | not published | $1,293.16 – $4,560.98 | 7 |
| Esophagus endoscopy/ligation CPT 43205 | not published | not published | $145.92 – $516.64 | 7 |
| Esophagus motility study CPT 91010 | not published | not published | $68.44 – $222.17 | 7 |
| Esoph balloon distension tst CPT 91040 | not published | not published | $51.66 – $168.93 | 7 |
| Esoph egd dilation <30 mm CPT 43249 | not published | not published | $158.33 – $3,979.99 | 7 |
| Esoph endoscopy dilation CPT 43226 | not published | not published | $133.27 – $1,297.05 | 7 |
| Esoph fundoplasty lap 43327 CPT 43327 | not published | not published | $818.05 – $2,891.89 | 7 |
| Esoph fundoplasty thor 43328 CPT 43328 | not published | not published | $1,102.93 – $3,939.98 | 7 |
| Esophgl motil w/stim/perfus CPT 91013 | not published | not published | $9.69 – $31.60 | 7 |
| Esoph imped function test CPT 91037 | not published | not published | $51.64 – $167.75 | 7 |
| Esoph imped funct test > 1hr CPT 91038 | not published | not published | $58.75 – $190.57 | 7 |
| Esoph optical endomicroscopy CPT 43206 | not published | not published | $137.46 – $1,040.03 | 6 |
| Esoph scope w/sclerosis inj CPT 43204 | not published | not published | $139.79 – $494.93 | 7 |
| Esoph scope w/submucous inj CPT 43201 | not published | not published | $107.05 – $876.41 | 7 |
| Esphg dstl 2/3 w/laps moblj 43287 CPT 43287 | not published | not published | $3,485.37 – $12,579.90 | 6 |
| Esphg thrsc moblj CPT 43288 | not published | not published | $3,678.61 – $13,290.64 | 6 |
| Esphg tot w/laps moblj CPT 43286 | not published | not published | $3,122.63 – $11,200.09 | 6 |
| Esphg tot w/thrcm CPT 43112 | not published | not published | $3,394.97 – $12,205.73 | 7 |
| Esrd home pt serv p mo 12-19 CPT 90965 | not published | not published | $529.64 – $1,509.17 | 7 |
| Esrd home pt serv p mo 20+ CPT 90966 | not published | not published | $312.03 – $790.31 | 7 |
| Esrd home pt serv p mo 2-11 CPT 90964 | not published | not published | $551.55 – $1,579.14 | 7 |
| Esrd home pt serv p mo <2yrs CPT 90963 | not published | not published | $643.63 – $1,806.41 | 7 |
| Esrd serv 1 visit p mo 20+ CPT 90962 | not published | not published | $215.38 – $610.50 | 7 |
| Esrd serv 1 visit p mo <2yrs CPT 90953 | not published | not published | $1,367.38 – $1,367.38 | 2 |
| Esrd serv 1 vst p mo 12-19 CPT 90959 | not published | not published | $345.96 – $981.75 | 7 |
| Esrd serv 2-3 vsts p mo <2yr CPT 90952 | not published | not published | $1,601.04 – $1,601.04 | 2 |
| Esrd serv 4 visits p mo <2yr CPT 90951 | not published | not published | $1,239.56 – $3,103.85 | 7 |
| Esrd serv 4 vsts p mo 2-11 CPT 90954 | not published | not published | $1,064.45 – $2,694.33 | 7 |
| Esrd srv 1 visit p mo 2-11 CPT 90956 | not published | not published | $369.87 – $1,056.35 | 7 |
| Esrd srv 2-3 vsts p mo 12-19 CPT 90958 | not published | not published | $530.83 – $1,451.81 | 7 |
| Esrd srv 2-3 vsts p mo 20+ CPT 90961 | not published | not published | $312.03 – $791.49 | 7 |
| Esrd srv 2-3 vsts p mo 2-11 CPT 90955 | not published | not published | $553.34 – $1,519.82 | 7 |
| Esrd srv 4 visits p mo 20+ CPT 90960 | not published | not published | $375.91 – $942.72 | 7 |
| Esrd srv 4 vsts p mo 12-19 CPT 90957 | not published | not published | $815.16 – $2,136.67 | 7 |
| Esrd svc pr day pt 12-19 CPT 90969 | not published | not published | $17.90 – $50.06 | 7 |
| Esrd svc pr day pt <2 CPT 90967 | not published | not published | $18.65 – $59.69 | 7 |
| Esrd svc pr day pt 20+ CPT 90970 | not published | not published | $10.05 – $26.74 | 7 |
| Esrd svc pr day pt 2-11 CPT 90968 | not published | not published | $18.27 – $52.42 | 7 |
| Essure 58565 CPT 58565 | not published | not published | $476.97 – $6,586.88 | 7 |
| Establish access to aorta CPT 36160 | not published | not published | $123.96 – $1,991.25 | 7 |
| Establish access to artery CPT 36100 | not published | not published | $146.58 – $1,872.53 | 7 |
| Establish brain cavity shunt CPT 62223 | not published | not published | $1,026.72 – $3,545.25 | 7 |
| Establish brain cavity shunt CPT 62180 | not published | not published | $1,558.78 – $5,377.50 | 7 |
| Establish brain cavity shunt CPT 62190 | not published | not published | $919.69 – $3,129.60 | 7 |
| Establish brain cavity shunt CPT 62192 | not published | not published | $981.10 – $3,327.19 | 7 |
| Establish brain cavity shunt CPT 62200 | not published | not published | $1,344.05 – $4,630.35 | 7 |
| Establish brain cavity shunt CPT 62220 | not published | not published | $960.23 – $3,357.15 | 7 |
| Established Patient Office Visit (level 1) CPT 99211 | $108.30 | $190.00 | $9.33 – $38.15 | 7 |
| Established Patient Office Visit (level 2) CPT 99212 | $133.38 | $234.00 | $37.18 – $81.77 | 7 |
| Established Patient Office Visit (level 3) CPT 99213 | $149.34 | $262.00 | $69.68 – $135.99 | 7 |
| Established Patient Office Visit (level 4) CPT 99214 | $200.07 | $351.00 | $102.92 – $199.84 | 7 |
| Established Patient Office Visit (level 5) CPT 99215 | $267.33 | $469.00 | $152.42 – $267.40 | 7 |
| Estim aid bone healg invasiv CPT 20975 | not published | not published | $177.04 – $621.23 | 7 |
| Estradiol total CPT 82670 | $99.18 | $174.00 | $29.34 – $107.85 | 11 |
| Estrogens total-sendout CPT 82672 | not published | not published | $22.79 – $83.76 | 11 |
| Etanercept injection HCPCS J1438 | $609.90 | $1,070.00 | $481.83 – $481.83 | 1 |
| Ethmoidectomy extranasal total 31205 CPT 31205 | not published | not published | $1,005.11 – $3,377.89 | 7 |
| Ethylene glycol -sendout CPT 82693 | $25.65 | $45.00 | $8.09 – $57.51 | 11 |
| Etonogestrel implant system HCPCS J7307 | $864.69 | $1,517.00 | $1,462.83 – $1,462.83 | 2 |
| Etoposide 20 mg/ml intravenous solution HCPCS J9181 | $2.31 | $4.05 | $1.08 – $4.05 | 6 |
| Euflexxa inj per dose HCPCS J7323 | $191.52 | $336.00 | $172.40 – $336.00 | 7 |
| Euglobulin lysis CPT 85360 | not published | not published | $8.83 – $32.46 | 11 |
| Evacuate mole of uterus CPT 59870 | not published | not published | $545.90 – $1,781.03 | 7 |
| Eval aud funcj ea addl 15 CPT 92627 | not published | not published | $18.85 – $71.89 | 7 |
| Eval aud rehab status/first hr 92626 CPT 92626 | not published | not published | $79.80 – $301.23 | 7 |
| Eval/fit voice prosthesis iii, st CPT 92607 | $153.33 | $269.00 | $134.52 – $244.43 | 7 |
| Evaluation cervical mucus CPT 89330 | not published | not published | $7.97 – $40.07 | 11 |
| Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen CPT 84112 | not published | not published | $92.13 – $378.70 | 11 |
| Evaluation heart device CPT 93640 | not published | not published | $174.02 – $16,158.00 | 8 |
| Evaluation of speech fluency 92521 CPT 92521 | $210.90 | $370.00 | $144.55 – $320.66 | 6 |
| Evaluation psychiatric diagnostic CPT 90791 | $371.64 | $652.00 | $161.88 – $476.78 | 7 |
| Evasc prlng admn rx agnt 1st CPT 61650 | not published | not published | $563.11 – $1,969.69 | 6 |
| Evasc prlng admn rx agnt add CPT 61651 | not published | not published | $240.06 – $843.19 | 6 |
| Evasc repair of iliac artery; endograft 34718 CPT 34718 | not published | not published | $1,192.34 – $4,326.90 | 6 |
| Evasc rpr a-ao ndgft 34701 CPT 34701 | not published | not published | $1,192.88 – $4,345.35 | 6 |
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.