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 |
|---|---|---|---|---|
| Face bone graft CPT 21210 | not published | not published | $803.01 – $7,254.08 | 7 |
| Facial bones <3 CPT 70140 | $88.35 | $155.00 | $10.06 – $24.95 | 7 |
| Facial nerve function test CPT 92516 | not published | not published | $23.89 – $224.97 | 7 |
| Factor ix CPT 85250 | $68.40 | $120.00 | $19.99 – $73.49 | 11 |
| Factor viii CPT 85240 | $26.79 | $47.00 | $10.01 – $69.09 | 11 |
| Fallopian tube recnl CPT 58345 | not published | not published | $300.57 – $1,031.81 | 7 |
| Family therapy without pt 50min 90846 CPT 90846 | not published | not published | $106.57 – $340.30 | 7 |
| Family therapy with patient 50 min 90847 CPT 90847 | not published | not published | $111.39 – $352.47 | 7 |
| Fam-trastuzumab deruxtecan-nxki 100 mg intravenous solution HCPCS J9358 | $43.39 | $76.13 | $36.93 – $76.13 | 6 |
| Fancc gene CPT 81242 | not published | not published | $38.45 – $141.35 | 7 |
| Fasciotomy hip/thigh any typ CPT 27025 | not published | not published | $962.57 – $3,275.25 | 7 |
| Fat/lipids feces qualitative CPT 82705 | $19.95 | $35.00 | $5.36 – $19.69 | 11 |
| Fatty acids nonesterified CPT 82725 | not published | not published | $19.04 – $72.45 | 11 |
| Fecal bilirubin test CPT 82252 | not published | not published | $4.79 – $17.60 | 11 |
| #fecal-sodium CPT 84302 | not published | not published | $5.10 – $18.76 | 11 |
| Feeding tube reposition CPT 74355 | not published | not published | $38.46 – $93.25 | 7 |
| Fees w/laryngeal sense i&r CPT 92617 | not published | not published | $43.27 – $137.70 | 7 |
| Fees w/laryngeal sense test CPT 92616 | not published | not published | $105.93 – $714.06 | 7 |
| Felbamate (felbatol(r)) - sendout CPT 80167 | not published | not published | $19.57 – $71.95 | 7 |
| Femoral endovas graft add-on 34813 CPT 34813 | not published | not published | $224.31 – $822.53 | 7 |
| Fem/popl revasc w/stent CPT 37226 | not published | not published | $500.43 – $36,487.65 | 7 |
| Feno poc CPT 95012 | not published | not published | $20.10 – $64.05 | 7 |
| Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper) HCPCS J3010 | $2.19 | $3.84 | $1.19 – $3.00 | 6 |
| Ferritin CPT 82728 | $57.00 | $100.00 | $14.31 – $52.61 | 11 |
| Fetal aneuploidy trisom risk CPT 81507 | not published | not published | $834.75 – $3,068.70 | 7 |
| Fetal biophys profile w/nst 76818 CPT 76818 | not published | not published | $54.02 – $128.81 | 7 |
| Fetal chrmoml microdeltj CPT 81422 | $1,297.89 | $2,277.00 | $797.00 – $2,929.93 | 8 |
| Fetal chrom aneuploidy gsa panel CPT 81420 | $1,297.89 | $2,277.00 | $797.00 – $2,929.93 | 7 |
| Fetal contract stress test 59020 - 26 CPT 59020 | not published | not published | $36.10 – $118.61 | 7 |
| Fetal cord puncture prenatal CPT 59012 | not published | not published | $196.40 – $697.05 | 7 |
| Fetal fibronectin CPT 82731 | $225.15 | $395.00 | $67.63 – $248.62 | 11 |
| Fetal fluid drainage w/us CPT 59074 | not published | not published | $301.45 – $1,348.58 | 7 |
| Fetal hemoglobin (kleihauer betke) CPT 85460 | not published | not published | $8.12 – $29.84 | 11 |
| Fetal hemoglobin rosette CPT 85461 | not published | not published | $9.49 – $36.13 | 11 |
| Fetal lung maturity assess lam body dnst CPT 83664 | not published | not published | $20.29 – $74.58 | 11 |
| Fetal monitor/interpret only CPT 59051 | not published | not published | $40.77 – $145.28 | 7 |
| Fetal monitor w/report CPT 59050 | not published | not published | $48.52 – $175.46 | 7 |
| Fetal non stress test CPT 59025 | $150.48 | $264.00 | $28.86 – $63.35 | 7 |
| Fetal scalp blood sampling 59030 CPT 59030 | not published | not published | $109.07 – $389.18 | 7 |
| Fetal shunt placement w/us CPT 59076 | not published | not published | $507.18 – $1,803.79 | 7 |
| #_fet/norfentcnfrmur CPT 80354 | $64.41 | $113.00 | $31.67 – $33.34 | 3 |
| Fibrin degradation d dimer quantitative CPT 85379 | $41.61 | $73.00 | $10.69 – $39.29 | 11 |
| Fibrin degradation products CPT 85362 | not published | not published | $7.23 – $26.60 | 11 |
| Fibrin degrade semiquant CPT 85378 | not published | not published | $10.21 – $37.52 | 11 |
| Fibrin degradj d-dimer CPT 85380 | not published | not published | $10.69 – $39.29 | 11 |
| Fibrinogen activity CPT 85384 | $42.18 | $74.00 | $10.21 – $37.52 | 11 |
| Fibrinogen test CPT 85370 | not published | not published | $11.59 – $47.98 | 11 |
| Fibrinolysins/coagulopathy screen interpretation/report CPT 85390 | not published | not published | $7.39 – $59.75 | 11 |
| Fibrinolytic antiplasmin CPT 85410 | not published | not published | $8.10 – $29.76 | 11 |
| Fibrinolytic plasmin CPT 85400 | not published | not published | $8.10 – $29.76 | 11 |
| Fibrinolytic plasminogen CPT 85415 | not published | not published | $18.05 – $66.35 | 11 |
| Fibrinolytic plasminogen CPT 85421 | not published | not published | $10.69 – $39.29 | 11 |
| Fibrinolytic plasminogen xcpt antgnc asa CPT 85420 | not published | not published | $6.86 – $25.21 | 11 |
| Fibula bone graft microvasc CPT 20955 | not published | not published | $2,520.20 – $8,886.26 | 7 |
| Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr HCPCS J1442 | $1.71 | $3.00 | $1.17 – $3.00 | 7 |
| Filleted finger/toe flap CPT 14350 | not published | not published | $715.03 – $2,511.00 | 7 |
| Filtered speech hearing test CPT 92571 | not published | not published | $32.95 – $87.20 | 7 |
| Filters elec/combo vad, rep HCPCS Q0500 | $573.05 | $1,005.35 | $30.63 – $30.63 | 2 |
| Fimbrioplasty 58760 CPT 58760 | not published | not published | $850.54 – $2,959.35 | 7 |
| Fine needle aspiration biopsy w/fluor gdn;1st lesion 10007 CPT 10007 | not published | not published | $92.32 – $1,079.93 | 6 |
| Fine needle aspiration biopsy w/fluor gdn; ea addtl 10008 CPT 10008 | not published | not published | $52.62 – $613.16 | 6 |
| Fine needle aspiration biopsy without img gdn; ea addtl 10004 CPT 10004 | not published | not published | $44.27 – $186.26 | 6 |
| Fine needle aspiration biopsy w/us gdn; ea addtl 10006 CPT 10006 | $909.72 | $1,596.00 | $52.07 – $217.61 | 6 |
| Fine needle asp without image guide 10021 CPT 10021 | $645.81 | $1,133.00 | $56.54 – $332.20 | 7 |
| Finger joint sz00 swanson w/grommets HCPCS L8630 | $751.46 | $1,318.35 | $448.30 – $448.30 | 2 |
| Finger tendon transfer CPT 26497 | not published | not published | $949.90 – $3,150.41 | 7 |
| Finger tendon transfer CPT 26498 | not published | not published | $1,228.37 – $4,131.79 | 7 |
| Fistula repair & colostomy CPT 57307 | not published | not published | $1,131.16 – $3,837.49 | 7 |
| Fistula repair transperine 57308 CPT 57308 | not published | not published | $697.07 – $2,400.49 | 7 |
| Fit aphakia spectcl monofocl CPT 92352 | not published | not published | $143.55 – $143.55 | 2 |
| Fit aphakia spectcl multifoc CPT 92353 | not published | not published | $165.99 – $165.99 | 2 |
| Fitg c-lens keratoconus 1st CPT 92072 | not published | not published | $100.81 – $429.02 | 7 |
| Fitg spect low vis 1system CPT 92354 | not published | not published | $42.08 – $42.08 | 2 |
| Fitg spect lw vis cmpnd lens CPT 92355 | not published | not published | $65.61 – $65.61 | 2 |
| Fit spectacles bifocal CPT 92341 | not published | not published | $24.32 – $132.23 | 6 |
| Fit spectacles monofocal CPT 92340 | not published | not published | $19.04 – $114.62 | 6 |
| Fit spectacles multifocal CPT 92342 | not published | not published | $27.62 – $141.86 | 6 |
| Fitting of diaphragm/cap 57170 CPT 57170 | not published | not published | $48.27 – $254.70 | 7 |
| Fixation of ankle joint CPT 27860 | $479.94 | $842.00 | $172.74 – $614.85 | 7 |
| Fixation of knee joint CPT 27570 | $201.21 | $353.00 | $161.93 – $327.75 | 7 |
| Fixation of shoulder blade CPT 23400 | not published | not published | $1,006.11 – $3,469.65 | 7 |
| Fix g/colon tube w/device CPT 49460 | not published | not published | $51.67 – $2,668.73 | 7 |
| Fixtn pq skel dstl rad fx/epiphysl sep CPT 25606 | $941.07 | $1,651.00 | $704.82 – $1,432.41 | 7 |
| Flecainide (tambocor)-sendout CPT 80181 | $66.12 | $116.00 | $19.57 – $71.95 | 7 |
| Fl exam g/colon tube w contrast CPT 49465 | not published | not published | $31.35 – $557.44 | 7 |
| Flexible Sigmoidoscopy CPT 45330 | $61.56 | $108.00 | $58.84 – $636.08 | 7 |
| Flexor-plasty elbow CPT 24330 | not published | not published | $748.85 – $2,564.10 | 7 |
| Flexor-plasty elbw w/advmnt CPT 24331 | not published | not published | $816.34 – $2,806.88 | 7 |
| Floor of mouth biopsy 41108 CPT 41108 | not published | not published | $96.74 – $565.54 | 7 |
| Flow cytometry interp 16 or more CPT 88189 | not published | not published | $49.79 – $251.70 | 8 |
| Flow cytometry marker each additional CPT 88185 | $80.37 | $141.00 | $23.29 – $125.85 | 8 |
| Flow cytometry one marker technical component CPT 88184 | $195.51 | $343.00 | $23.29 – $206.82 | 8 |
| #flow interp 9 - 15 markers CPT 88188 | not published | not published | $49.79 – $206.94 | 8 |
| Flt3 gene CPT 81245 | not published | not published | $173.79 – $638.87 | 10 |
| Flt3 gene analysis CPT 81246 | not published | not published | $87.15 – $320.38 | 10 |
| Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback HCPCS J1450 | $22.57 | $39.60 | $3.23 – $39.60 | 6 |
| Fluidotherapy charges pt CPT 97022 | $64.98 | $114.00 | $21.76 – $48.46 | 7 |
| Fluid pressure muscle 20950 CPT 20950 | not published | not published | $91.79 – $943.43 | 7 |
| Fluorescein angioscopy i&r CPT 92230 | not published | not published | $36.65 – $253.80 | 7 |
| Fluorescein angrph mltiframe CPT 92235 | not published | not published | $45.21 – $145.14 | 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.