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 |
|---|---|---|---|---|
| Fluorescein&icg angiography CPT 92242 | not published | not published | $57.55 – $183.43 | 6 |
| Fluorescent antibody titer dna CPT 86256 | $116.85 | $205.00 | $12.65 – $46.51 | 11 |
| Fluoroguide for spine inject 77003-26 CPT 77003 | not published | not published | $30.36 – $73.26 | 7 |
| Fluoroguide needle placement CPT 77002 | $247.95 | $435.00 | $28.35 – $67.88 | 7 |
| Fluoro polarize fetal lung CPT 83663 | not published | not published | $19.86 – $72.99 | 11 |
| Fluoroscopy up to 1 hour CPT 76000 | $270.18 | $474.00 | $15.48 – $36.50 | 7 |
| Fluorouracil 50 mg/ml intravenous solution (wrapper) HCPCS J9190 | $11.92 | $20.91 | $3.91 – $13.80 | 6 |
| Fluphenazine decanoate 25 mg/ml injection solution HCPCS J2680 | $15.39 | $27.00 | $13.82 – $27.00 | 6 |
| Flutemetamol f18 diagnostic HCPCS Q9982 | $4,560.00 | $8,000.00 | $3,668.97 – $6,534.00 | 3 |
| Fmri brain by phys/psych CPT 70555 | not published | not published | $126.15 – $308.64 | 7 |
| Fmri brain by tech CPT 70554 | not published | not published | $106.91 – $258.54 | 7 |
| Fna bx w/ct gdn 1st les CPT 10009 | not published | not published | $112.66 – $1,707.68 | 6 |
| Fna bx w/ct gdn ea addl CPT 10010 | not published | not published | $73.74 – $1,028.70 | 6 |
| Fna bx w/mr gdn 1st les CPT 10011 | not published | not published | $1,097.78 – $1,097.78 | 2 |
| Fna bx w/mr gdn ea addl CPT 10012 | not published | not published | $622.88 – $622.88 | 2 |
| Foam stability fetal lung CPT 83662 | not published | not published | $19.86 – $72.99 | 11 |
| Folic acid CPT 82746 | $61.56 | $108.00 | $15.44 – $56.74 | 11 |
| Follow-up angiography CPT 75898 | not published | not published | $90.22 – $209.81 | 7 |
| Follow-up surgery of eye CPT 66250 | not published | not published | $588.80 – $2,747.36 | 7 |
| Fondaparinux sodium HCPCS J1652 | $1.57 | $2.76 | $1.43 – $2.76 | 6 |
| Foot arch support remov prem HCPCS L3030 | $209.76 | $368.00 | $76.44 – $76.44 | 2 |
| Foot longitudinal arch suppo HCPCS L3010 | $478.80 | $840.00 | $174.54 – $174.54 | 2 |
| Foot X-ray CPT 73630 | $164.16 | $288.00 | $8.60 – $20.61 | 7 |
| Forehead flap w/vasc pedicle 15731 CPT 15731 | not published | not published | $1,039.69 – $4,044.19 | 7 |
| Forensic autopsy (necropsy) CPT 88040 | not published | not published | $737.20 – $753.85 | 3 |
| Forensic cytopathology CPT 88125 | not published | not published | $14.45 – $23.29 | 8 |
| Foreskn manip w/lss preputial ads+stretching 54450 CPT 54450 | not published | not published | $58.83 – $250.99 | 7 |
| Fosaprepitant 150 mg intravenous powder for solution HCPCS J1453 | $0.83 | $1.46 | $0.17 – $1.46 | 6 |
| Fosphenytoin 50 mg pe/ml injection (wrapper) HCPCS Q2009 | $21.65 | $37.99 | $13.81 – $13.81 | 2 |
| Fractionation ketosteroids CPT 83593 | not published | not published | $29.93 – $110.01 | 11 |
| Fracture assessment via dxa CPT 77086 | not published | not published | $8.60 – $20.61 | 6 |
| _fragile x methylation-sendout CPT 81244 | not published | not published | $47.13 – $173.28 | 7 |
| Fragmenting of kidney stone CPT 50590 | not published | not published | $1,553.39 – $2,690.48 | 3 |
| Free fascial flap microvasc CPT 15758 | not published | not published | $2,331.53 – $8,257.01 | 7 |
| Freeing of bowel adhesion 44005 CPT 44005 | $2,128.95 | $3,735.00 | $1,092.09 – $2,326.73 | 7 |
| Free jejunum flap microvasc CPT 43496 | not published | not published | $8,207.78 – $8,207.78 | 2 |
| Free myo/skin flap microvasc CPT 15756 | not published | not published | $2,350.87 – $8,247.11 | 7 |
| Free omental flap microvasc CPT 49906 | not published | not published | $7,236.98 – $7,236.98 | 2 |
| Free/remove chest lining 32320 CPT 32320 | not published | not published | $1,586.30 – $5,588.36 | 7 |
| Free skin flap microvasc CPT 15757 | not published | not published | $2,340.28 – $8,209.91 | 7 |
| Frenectomy 41115 CPT 41115 | not published | not published | $154.74 – $922.28 | 7 |
| Frenotomy 40806 CPT 40806 | not published | not published | $31.08 – $362.66 | 7 |
| Frenulotomy of penis CPT 54164 | not published | not published | $205.79 – $703.84 | 7 |
| Fresh frozen plasma thawing ea un CPT 86927 | not published | not published | $20.38 – $26.94 | 3 |
| Frozen blood freeze/thaw CPT 86932 | not published | not published | $66.34 – $135.17 | 3 |
| Frozen blood prep CPT 86930 | not published | not published | $66.34 – $159.28 | 3 |
| Frozen blood thaw CPT 86931 | not published | not published | $66.34 – $119.58 | 3 |
| Frozen cell preparation CPT 88241 | not published | not published | $10.00 – $46.67 | 11 |
| Fructosamine glycated protein CPT 82985 | $60.42 | $106.00 | $16.91 – $64.69 | 11 |
| Fth/gft fr n/e/e/l each addl CPT 15261 | not published | not published | $139.30 – $759.26 | 7 |
| Fth/gft fr trnk each addl CPT 15201 | not published | not published | $77.27 – $527.33 | 7 |
| Ftl cgen abnor 3 proteins CPT 81509 | not published | not published | $1,561.74 – $5,741.25 | 7 |
| Ftl cgen abnor five anal CPT 81512 | not published | not published | $73.00 – $268.35 | 7 |
| Ftl cgen abnor four anal CPT 81511 | not published | not published | $161.18 – $592.51 | 7 |
| Ftl cgen abnor three anal CPT 81510 | not published | not published | $58.32 – $214.38 | 7 |
| Ftl cgen abnor two proteins CPT 81508 | not published | not published | $57.02 – $209.60 | 7 |
| Full field erg w/i&r CPT 92273 | not published | not published | $38.69 – $125.09 | 6 |
| Full mouth x-ray of teeth CPT 70320 | not published | not published | $11.54 – $28.47 | 7 |
| Full thick gft/nose/ear/lid/lip/20sqcm or< 15260 CPT 15260 | not published | not published | $890.68 – $3,634.65 | 7 |
| Full thick gft/scalp/arm/leg/20sqcm or< 15220 CPT 15220 | not published | not published | $639.55 – $2,784.64 | 7 |
| Full thick gft/scalp/arm/leg/add 20sqcm 15221 CPT 15221 | not published | not published | $70.15 – $487.84 | 7 |
| Full thick gft w/close donor fccmnaghf <=20sqcm 15240 CPT 15240 | not published | not published | $836.52 – $3,365.51 | 7 |
| Functional brain mapping CPT 96020 | not published | not published | $167.07 – $333.76 | 7 |
| Fundus photography with i&r 92250 CPT 92250 | not published | not published | $22.17 – $72.34 | 7 |
| Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr HCPCS J1940 | $2.67 | $4.69 | $0.68 – $3.00 | 6 |
| Fuse bile ducts and bowel 47785 CPT 47785 | not published | not published | $3,210.22 – $11,429.74 | 7 |
| Fuse esophagus & intestine CPT 43340 | not published | not published | $1,376.28 – $4,852.91 | 7 |
| Fuse esophagus & intestine CPT 43341 | not published | not published | $1,382.34 – $4,903.43 | 7 |
| Fuse esophagus & stomach CPT 43320 | not published | not published | $1,393.12 – $4,915.13 | 7 |
| Fuse gallbladder & bowel CPT 47740 | not published | not published | $1,313.55 – $4,634.10 | 7 |
| Fuse gallbladder & bowel CPT 47741 | not published | not published | $1,473.27 – $5,204.51 | 7 |
| Fuse/graft added joint CPT 26863 | not published | not published | $230.15 – $810.90 | 7 |
| Fuse liver duct & intestine CPT 47802 | not published | not published | $1,522.08 – $5,382.98 | 7 |
| Fuse liver ducts & bowel CPT 47765 | not published | not published | $2,999.66 – $10,678.99 | 7 |
| Fuse pancreas and bowel CPT 48548 | not published | not published | $1,663.34 – $5,867.63 | 7 |
| Fuse pancreas cyst and bowel CPT 48540 | not published | not published | $1,301.92 – $4,610.48 | 7 |
| Fuse pancreas cyst and bowel 48520 CPT 48520 | not published | not published | $1,098.81 – $3,857.81 | 7 |
| Fuse upper gi structures CPT 47721 | not published | not published | $1,354.34 – $4,778.21 | 7 |
| Fusion/graft of finger joint CPT 26862 | not published | not published | $811.13 – $2,661.68 | 7 |
| Fusion/graft of hand joint CPT 26844 | not published | not published | $904.46 – $2,988.23 | 7 |
| Fusion of ankle joint open CPT 27870 | $1,834.26 | $3,218.00 | $1,047.87 – $2,237.95 | 7 |
| Fusion of big toe joint CPT 28750 | $1,020.87 | $1,791.00 | $608.55 – $1,836.50 | 7 |
| Fusion of big toe joint CPT 28755 | $739.29 | $1,297.00 | $356.66 – $1,144.94 | 7 |
| Fusion of facial/other nerve CPT 64866 | not published | not published | $1,283.92 – $4,582.35 | 7 |
| Fusion of finger jnt add-on CPT 26861 | not published | not published | $103.19 – $368.44 | 7 |
| Fusion of finger joint CPT 26860 | not published | not published | $652.24 – $2,097.00 | 7 |
| Fusion of finger tendons CPT 26471 | not published | not published | $700.23 – $2,275.84 | 7 |
| Fusion of finger tendons CPT 26474 | not published | not published | $690.90 – $2,228.51 | 7 |
| Fusion of foot bones CPT 28730 | $1,419.30 | $2,490.00 | $762.25 – $1,601.34 | 7 |
| Fusion of foot bones CPT 28735 | not published | not published | $814.72 – $2,816.21 | 7 |
| Fusion of foot bones CPT 28740 | $1,080.15 | $1,895.00 | $650.66 – $1,892.63 | 7 |
| Fusion of hand joint CPT 26843 | not published | not published | $824.29 – $2,704.46 | 7 |
| Fusion of knee CPT 27580 | not published | not published | $1,519.78 – $5,212.54 | 7 |
| Fusion of knuckle CPT 26850 | not published | not published | $777.24 – $2,546.14 | 7 |
| Fusion of knuckle joint CPT 26516 | not published | not published | $785.99 – $2,584.65 | 7 |
| Fusion of knuckle joints CPT 26517 | not published | not published | $910.21 – $3,009.04 | 7 |
| Fusion of knuckle joints CPT 26518 | not published | not published | $921.36 – $3,048.08 | 7 |
| Fusion of knuckle with graft CPT 26852 | not published | not published | $880.15 – $2,909.55 | 7 |
| Fusion of skull arteries CPT 61711 | not published | not published | $2,516.91 – $8,718.53 | 7 |
| Fusion of spermatic ducts CPT 54900 | not published | not published | $835.70 – $2,930.36 | 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.