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 |
|---|---|---|---|---|
| Ghs ed peritoneal lavage w guidance if performed CPT 49084 | not published | not published | $105.81 – $383.18 | 7 |
| Ghs ed rmvl or bivalving cast CPT 29700 | not published | not published | $33.90 – $224.93 | 7 |
| Ghs ed therapeutic lp, drain csf w fluoro CPT 62329 | not published | not published | $106.50 – $1,157.81 | 6 |
| Ghs eeg cont rec w/video by tec min 8 chnls CPT 95700 | not published | not published | $855.48 – $855.48 | 2 |
| Ghs electrostagmgraphy CPT 92537 | not published | not published | $31.67 – $33.20 | 6 |
| Ghs elect torsion swing CPT 92546 | not published | not published | $15.93 – $50.80 | 7 |
| Ghs elect vertical elct CPT 92547 | not published | not published | $11.42 – $27.78 | 7 |
| Ghs epidermal shaving diameter >2.0 cm CPT 11303 | $311.79 | $547.00 | $74.02 – $345.97 | 7 |
| Ghs excision ingrown nail CPT 11765 | $319.20 | $560.00 | $99.52 – $371.28 | 7 |
| Ghs eye exam CPT 92002 | not published | not published | $48.75 – $278.31 | 7 |
| Ghs eyelid foreign body-embedded - bil CPT 67938 | not published | not published | $125.34 – $947.18 | 7 |
| Ghs fat & muscle CPT 89160 | not published | not published | $5.09 – $18.72 | 11 |
| Ghs fb removal foot - deep - left CPT 28192 | $432.63 | $759.00 | $331.83 – $1,067.13 | 7 |
| Ghs fb removal from muscle - complicated CPT 20525 | not published | not published | $256.08 – $1,718.51 | 7 |
| Ghs fb removal - incisional CPT 10121 | $726.75 | $1,275.00 | $192.00 – $609.69 | 7 |
| Ghs fb removal - non-incisional CPT 20520 | $476.52 | $836.00 | $155.76 – $763.80 | 7 |
| Ghs febrile agglutinns(mayo) CPT 86000 | not published | not published | $7.33 – $26.94 | 11 |
| Ghs fish cytogen CPT 88271 | not published | not published | $20.71 – $82.68 | 11 |
| Ghs fish hybrid in situ 100-300 CPT 88275 | not published | not published | $53.75 – $197.59 | 11 |
| Ghs flow volume loop CPT 94375 | $345.42 | $606.00 | $15.25 – $49.79 | 7 |
| Ghs gastric intub aspiration lavage CPT 43753 | not published | not published | $21.69 – $78.94 | 7 |
| Ghs hcv amplificaiton CPT 87521 | not published | not published | $36.84 – $135.45 | 11 |
| Ghs heavy metals bld (ars,lead,merc) CPT 82715 | not published | not published | $9.18 – $88.66 | 11 |
| Ghs hepatitis c virus (hcv riba) CPT 86804 | not published | not published | $16.26 – $59.79 | 11 |
| Ghs hgb stability-thal CPT 83068 | not published | not published | $9.94 – $36.55 | 11 |
| Ghs histoplasma antigen CPT 87385 | $85.50 | $150.00 | $13.91 – $51.15 | 11 |
| Ghs HIV antibody CPT 86703 | not published | not published | $14.40 – $52.92 | 11 |
| Ghs hla-dr/dq, multiple antigens CPT 86817 | not published | not published | $92.09 – $409.70 | 11 |
| Ghs i and d abscess/hematoma scrotum CPT 54700 | not published | not published | $223.30 – $777.79 | 7 |
| Ghs i and d perirectal abscess 46040 CPT 46040 | $1,935.15 | $3,395.00 | $441.56 – $1,179.91 | 7 |
| Ghs i and d pilonidal cyst complex CPT 10081 | $713.64 | $1,252.00 | $176.78 – $1,097.70 | 7 |
| Ghs i and d pilonidal cyst simple CPT 10080 | $454.29 | $797.00 | $110.75 – $471.89 | 7 |
| Ghs immun0electrophoresis CPT 86320 | not published | not published | $25.36 – $115.49 | 11 |
| Ghs incision thrombosed ext hemorrhoid CPT 46083 | $543.21 | $953.00 | $114.83 – $696.04 | 7 |
| Ghs indirect laryngoscopy/w fb removal CPT 31511 | not published | not published | $139.78 – $763.50 | 7 |
| Ghs inf midline insertion CPT 36140 | not published | not published | $87.18 – $1,736.85 | 7 |
| Ghs inhibitor screen CPT 85335 | not published | not published | $13.51 – $49.68 | 11 |
| Ghs init tx 1st degree burn CPT 16000 | $207.48 | $364.00 | $46.68 – $264.38 | 7 |
| Ghs inj neurolytic intercostal nerve CPT 64620 | $802.56 | $1,408.00 | $186.51 – $761.66 | 7 |
| Ghs inj neurolytic other perph nerve CPT 64640 | $1,077.87 | $1,891.00 | $125.29 – $345.20 | 7 |
| Ghs inj tendon origin/insertion CPT 20551 | $420.66 | $738.00 | $40.13 – $131.52 | 7 |
| Ghs inj transforaminal cerv ea add bil CPT 64480 | $504.45 | $885.00 | $63.94 – $461.74 | 7 |
| Ghs inj transforaminal cerv single bil CPT 64479 | $890.34 | $1,562.00 | $137.56 – $929.55 | 7 |
| Ghs insertion of needle - bone CPT 36680 | $621.87 | $1,091.00 | $59.94 – $212.25 | 7 |
| Ghs intermed repair 12.6 - 20.0 cm-12035 CPT 12035 | $1,047.66 | $1,838.00 | $249.22 – $1,388.18 | 7 |
| Ghs intermed repair 20.1 - 30.0 cm-12036 CPT 12036 | $873.81 | $1,533.00 | $288.44 – $930.17 | 7 |
| Ghs intermed repair over 30 cm - 12037 CPT 12037 | not published | not published | $334.36 – $1,747.31 | 7 |
| Ghs intro needle/intracath vein - 36000 CPT 36000 | not published | not published | $101.85 – $101.85 | 2 |
| Ghs irrigate corpora cavernosa for priapism CPT 54220 | not published | not published | $137.97 – $766.61 | 7 |
| Ghs IV inf sq injection, on-body injector CPT 96377 | $171.00 | $300.00 | $19.66 – $65.13 | 6 |
| Ghs IV thrombolytics - cerebral CPT 37195 | not published | not published | $1,472.89 – $1,472.89 | 2 |
| Ghs lac repair mouth.ant tong 2.5cm/less CPT 41250 | $305.52 | $536.00 | $159.82 – $615.02 | 7 |
| Ghs layer closure 2.5 cm or less - 12031 CPT 12031 | $532.38 | $934.00 | $159.35 – $527.39 | 7 |
| Ghs layer closure 2.5 cm or less - 12041 CPT 12041 | $501.03 | $879.00 | $152.50 – $687.86 | 7 |
| Ghs layer closure 2.5cm or less - 12051 CPT 12051 | $543.21 | $953.00 | $177.75 – $787.65 | 7 |
| Ghs layer closure 2.6 - 5.0 cm - 12052 CPT 12052 | $782.61 | $1,373.00 | $209.44 – $936.91 | 7 |
| Ghs layer closure 2.6 - 7.5 cm - 12042 CPT 12042 | $702.24 | $1,232.00 | $205.85 – $1,089.79 | 7 |
| Ghs layer closure 5.1 - 7.5 cm - 12053 CPT 12053 | $780.33 | $1,369.00 | $225.52 – $1,291.99 | 7 |
| Ghs layer closure 7.6 - 12.5 cm - 12034 CPT 12034 | $658.92 | $1,156.00 | $214.85 – $951.52 | 7 |
| Ghs layer closure 7.6 - 12.5 cm - 12044 CPT 12044 | $698.82 | $1,226.00 | $223.67 – $986.52 | 7 |
| Ghs layer closure 7.6 - 12.5 cm - 12054 CPT 12054 | not published | not published | $228.60 – $1,355.14 | 7 |
| Ghs layered repair 12.6 - 20.0 cm -12045 CPT 12045 | not published | not published | $283.19 – $1,465.28 | 7 |
| Ghs layered repair 12.6 - 20.0 cm -12055 CPT 12055 | not published | not published | $311.20 – $1,751.81 | 7 |
| Ghs layered repair 20.1 - 30.0 cm -12046 CPT 12046 | not published | not published | $322.56 – $1,745.93 | 7 |
| Ghs layered repair 20.1 - 30.0 cm -12056 CPT 12056 | not published | not published | $396.65 – $2,057.14 | 7 |
| Ghs layered repair over 30.0 cm -12047 CPT 12047 | not published | not published | $357.21 – $1,913.21 | 7 |
| Ghs layered repair over 3.0 cm -12057 CPT 12057 | not published | not published | $431.96 – $2,183.21 | 7 |
| Ghs leukocyte alkaline phos (mayo) CPT 85540 | not published | not published | $9.03 – $33.20 | 11 |
| Ghs mbp CPT 83873 | not published | not published | $18.06 – $66.39 | 11 |
| Ghs moderate sedation < 5 yr, 30 min CPT 99151 | $395.01 | $693.00 | $25.43 – $242.38 | 6 |
| Ghs moderate sedation < 5 yr, 30 min, other CPT 99155 | $494.19 | $867.00 | $85.56 – $277.06 | 6 |
| Ghs moderate sedation, > 5 yr, 30 min, other CPT 99156 | $417.81 | $733.00 | $77.88 – $255.80 | 6 |
| Ghs moderate sedation ea addtl 15 min CPT 99153 | $135.09 | $237.00 | $12.02 – $33.97 | 6 |
| Ghs moderate sedation ea addtl 15 min, other CPT 99157 | $189.24 | $332.00 | $62.23 – $84.28 | 6 |
| Ghs musc test done w/n test comp CPT 95886 | $235.41 | $413.00 | $47.77 – $154.70 | 7 |
| Ghs musc tst done w/nerv tst lim CPT 95885 | not published | not published | $19.59 – $62.77 | 7 |
| Ghs musc tst done w/n tst non ext CPT 95887 | not published | not published | $38.97 – $127.16 | 7 |
| Ghs myocardial strain img spckl track CPT 93356 | $897.18 | $1,574.00 | $12.05 – $130.77 | 6 |
| Ghs nailbed repair/nail removal CPT 11760 | $589.38 | $1,034.00 | $115.56 – $520.02 | 7 |
| Ghs nerve blk intercostal, ea addtl level CPT 64421 | $657.21 | $1,153.00 | $26.04 – $345.18 | 7 |
| Ghs nerve blk intercostal, single level CPT 64420 | $463.41 | $813.00 | $61.12 – $364.16 | 7 |
| Ghs nerve block axillary nerve CPT 64417 | $351.69 | $617.00 | $66.86 – $499.05 | 7 |
| Ghs nerve block brachial plexus CPT 64415 | not published | not published | $72.87 – $413.55 | 7 |
| Ghs nerve block celiac plexus CPT 64530 | $1,791.51 | $3,143.00 | $99.65 – $785.89 | 7 |
| Ghs nerve block interscaline CPT 64510 | $1,007.19 | $1,767.00 | $81.22 – $506.40 | 7 |
| Ghs nerve block lumbar or thoracic symp CPT 64520 | $1,344.06 | $2,358.00 | $89.75 – $780.45 | 7 |
| Ghs nerve block sciatic nerve CPT 64445 | $1,118.34 | $1,962.00 | $75.31 – $457.76 | 7 |
| Ghs nerve block suprascapular CPT 64418 | $454.29 | $797.00 | $57.83 – $316.29 | 7 |
| Ghs ng placement w fluoro guidance CPT 43752 | not published | not published | $41.07 – $149.51 | 7 |
| Ghs o2 saturation CPT 82810 | not published | not published | $10.26 – $37.71 | 11 |
| Ghs o2 uptake rest & exercise CPT 94680 | not published | not published | $13.15 – $42.52 | 7 |
| Ghs o2 uptake rest & indirect CPT 94690 | not published | not published | $3.80 – $12.41 | 7 |
| Ghs opcc repair cvp without subq port CPT 36575 | not published | not published | $34.41 – $583.91 | 7 |
| Ghs opcc repair cvp w subq port CPT 36576 | not published | not published | $185.23 – $1,221.49 | 7 |
| Ghs optokenetic CPT 92544 | not published | not published | $9.66 – $19.70 | 7 |
| Ghs oscillating trac CPT 92545 | not published | not published | $9.63 – $18.33 | 7 |
| Ghs osteopathic manipulative tx, 1-2 regions CPT 98925 | $74.10 | $130.00 | $24.30 – $63.87 | 7 |
| Ghs osteopathic manipulative tx, 3-4 regions CPT 98926 | not published | not published | $36.95 – $149.94 | 7 |
| Ghs ot dds rom CPT 95851 | not published | not published | $8.23 – $71.99 | 7 |
| Ghs ot group caregiver training CPT 97552 | $35.91 | $63.00 | $11.55 – $11.55 | 4 |
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.