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 ot prosthetic training/15 min CPT 97761 | $107.16 | $188.00 | $45.17 – $67.99 | 7 |
| Ghs ot sensory integrative tech/15min CPT 97533 | $83.79 | $147.00 | $58.70 – $62.97 | 7 |
| Ghs ot work hardening-additional hours CPT 97546 | $116.85 | $205.00 | $77.97 – $77.97 | 2 |
| Ghs pacing - transcutaneous CPT 92953 | $207.48 | $364.00 | $0.85 – $21.75 | 7 |
| Ghs paravert facet/nerve cerv ea add bil CPT 64492 | $1,007.19 | $1,767.00 | $62.92 – $350.59 | 7 |
| Ghs paravert facet/nerve lumb ea add bil CPT 64495 | $783.18 | $1,374.00 | $54.21 – $324.19 | 7 |
| Ghs path - pap (papanicolau) smear - vagina CPT 88141 | not published | not published | $25.87 – $74.19 | 8 |
| Ghs peritonsillar abscess i andd CPT 42700 | $379.62 | $666.00 | $143.84 – $623.71 | 7 |
| Ghs phenylketonurid CPT 84030 | not published | not published | $5.78 – $21.23 | 11 |
| Ghs picc line insert < 5 CPT 36568 | not published | not published | $93.88 – $655.94 | 7 |
| Ghs plngl fx pm cl CPT 26725 | $473.67 | $831.00 | $329.49 – $740.10 | 7 |
| Ghs plt ct-manual CPT 85032 | $7.41 | $13.00 | $4.53 – $16.64 | 11 |
| Ghs polysom <6 yrs 4/> parameters CPT 95782 | $1,874.73 | $3,289.00 | $131.82 – $424.87 | 7 |
| Ghs pos nystagmus CPT 92542 | not published | not published | $13.11 – $26.58 | 7 |
| Ghs ppd (tb intradermal) CPT 86580 | $20.63 | $36.20 | $7.60 – $18.71 | 8 |
| Ghs prostatic acid phosphatase (mayo) CPT 84066 | not published | not published | $10.14 – $37.29 | 11 |
| Ghs protein, misc fluid CPT 84160 | not published | not published | $5.73 – $21.65 | 11 |
| Ghs protoporphyrins fract CPT 84202 | not published | not published | $15.07 – $55.39 | 11 |
| Ghs pr without cont pulse ox CPT 94625 | $304.95 | $535.00 | $19.27 – $219.53 | 6 |
| Ghs pseudocholinesterase,dibucain-inhibi CPT 82638 | not published | not published | $12.86 – $47.29 | 11 |
| Ghs pt - work hardening/int 2hrs CPT 97545 | $233.70 | $410.00 | $194.98 – $194.98 | 2 |
| Ghs quinidine CPT 80194 | not published | not published | $15.33 – $56.36 | 11 |
| Ghs refill of implantable pump CPT 95990 | not published | not published | $95.52 – $291.36 | 7 |
| Ghs removal intranasal foreign body CPT 30300 | $305.52 | $536.00 | $130.74 – $535.50 | 7 |
| Ghs removal pharyngeal foreign body CPT 42809 | not published | not published | $132.99 – $728.85 | 7 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | $493.62 | $866.00 | $639.46 – $1,231.89 | 7 |
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | not published | not published | $522.78 – $1,769.18 | 7 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | not published | not published | $8.32 – $61.34 | 11 |
| Ghs reticulocyte count CPT 85044 | not published | not published | $4.53 – $16.64 | 11 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | not published | not published | $14.61 – $53.69 | 11 |
| Ghs sedimentation rate CPT 85651 | not published | not published | $4.48 – $16.48 | 11 |
| Ghs semen analysis fert CPT 89320 | not published | not published | $12.93 – $47.52 | 11 |
| Ghs semen analysis, post-vas CPT 89300 | not published | not published | $10.33 – $37.98 | 11 |
| Ghs sensitivity (per antimicro) CPT 87184 | $26.79 | $47.00 | $7.85 – $28.87 | 11 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $368.79 | $647.00 | $94.79 – $608.10 | 7 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | not published | not published | $127.63 – $765.53 | 7 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $645.81 | $1,133.00 | $116.31 – $717.23 | 7 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | not published | not published | $153.12 – $543.86 | 7 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $404.13 | $709.00 | $74.97 – $499.13 | 7 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $404.13 | $709.00 | $74.03 – $282.48 | 7 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $510.15 | $895.00 | $94.10 – $603.04 | 7 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | not published | not published | $144.53 – $819.30 | 7 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | not published | not published | $172.63 – $615.41 | 7 |
| Ghs sleep study unattended CPT 95800 | not published | not published | $42.05 – $139.60 | 7 |
| Ghs somatosensory testing lower extremit CPT 95926 | not published | not published | $28.94 – $92.14 | 7 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | not published | not published | $47.90 – $154.33 | 7 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $76.95 | $135.00 | $52.75 – $98.06 | 7 |
| Ghs sphenopalatine ganglion block CPT 64505 | not published | not published | $106.65 – $450.56 | 7 |
| Ghs spont nystagmus CPT 92541 | not published | not published | $13.11 – $22.53 | 7 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $214.89 | $377.00 | $112.08 – $361.29 | 7 |
| Ghs st - eval for alt comm CPT 92567 | $19.38 | $34.00 | $11.50 – $30.83 | 7 |
| Ghs strapping shoulder - 29240 CPT 29240 | not published | not published | $19.07 – $127.89 | 7 |
| Ghs st - re-eval for alt comm CPT 92597 | $80.37 | $141.00 | $78.51 – $142.23 | 7 |
| Ghs subcutaneous infus, for therapy ea. add. hr CPT 96370 | not published | not published | $17.18 – $50.13 | 7 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | not published | not published | $150.91 – $519.54 | 7 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $976.98 | $1,714.00 | $196.42 – $621.75 | 7 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $650.94 | $1,142.00 | $147.43 – $374.91 | 7 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | not published | not published | $322.79 – $1,150.13 | 7 |
| Ghs trypsin (fecal) CPT 84488 | not published | not published | $7.67 – $28.18 | 11 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $473.67 | $831.00 | $296.01 – $692.08 | 7 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | not published | not published | $244.78 – $1,082.10 | 7 |
| Ghs urine, hydroxproline total CPT 83505 | not published | not published | $25.52 – $93.80 | 11 |
| Ghs urine, porphyrins quant CPT 84120 | $64.98 | $114.00 | $15.45 – $56.78 | 11 |
| Ghs vaginal delivery only CPT 59409 | not published | not published | $788.43 – $2,110.56 | 7 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | not published | not published | $1,641.36 – $1,641.36 | 2 |
| Ghs windowing of cast CPT 29730 | not published | not published | $45.98 – $221.89 | 7 |
| Giardia ag if CPT 87269 | not published | not published | $14.29 – $52.53 | 11 |
| Giardia lamblia antibody CPT 86674 | not published | not published | $15.46 – $56.82 | 11 |
| Gi endoscopic ultrasound CPT 76975 | not published | not published | $43.41 – $102.80 | 7 |
| Gi inhouse confirmation CPT 87045 | $29.07 | $51.00 | $9.91 – $36.44 | 11 |
| Gingivoplasty each quadrant CPT 41872 | not published | not published | $320.95 – $1,622.33 | 7 |
| Gi protein loss CPT 78282 | not published | not published | $16.43 – $43.89 | 7 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | not published | not published | $119.70 – $432.30 | 7 |
| Gi trc img intral colon i&r CPT 91113 | not published | not published | $129.01 – $419.83 | 6 |
| Gi trc img intral esophagus CPT 91111 | not published | not published | $48.20 – $173.73 | 7 |
| Gi wireless capsule measure CPT 91112 | not published | not published | $112.34 – $364.64 | 7 |
| Gjb2 gene full sequence CPT 81252 | not published | not published | $106.18 – $390.32 | 7 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $64.60 – $237.47 | 7 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $36.75 – $135.10 | 7 |
| Glaucoma surgery CPT 66150 | not published | not published | $930.03 – $3,193.39 | 7 |
| Glaucoma surgery CPT 66155 | not published | not published | $929.66 – $3,190.73 | 7 |
| Glaucoma surgery CPT 66160 | not published | not published | $1,043.81 – $3,595.46 | 7 |
| Glaucoma surgery CPT 66170 | not published | not published | $1,157.43 – $3,982.58 | 7 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $288.99 | $507.00 | $234.45 – $507.00 | 7 |
| Glucagon plasma - sendout CPT 82943 | $29.64 | $52.00 | $14.11 – $55.16 | 11 |
| Glucagon tolerance panel CPT 80422 | not published | not published | $48.37 – $177.83 | 11 |
| Glucagon tolerance panel CPT 80424 | not published | not published | $53.03 – $194.93 | 11 |
| Glucagon tolerance test CPT 82946 | not published | not published | $10.63 – $68.59 | 11 |
| Glucose 1 hr post dose CPT 82950 | $27.93 | $49.00 | $4.99 – $18.34 | 11 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | not published | not published | $6.35 – $23.35 | 11 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $16.53 | $29.00 | $3.35 – $12.66 | 11 |
| Glucose blood quantitative CPT 82947 | $14.25 | $25.00 | $4.13 – $15.17 | 11 |
| Glucose body fluid CPT 82945 | $31.35 | $55.00 | $4.13 – $15.17 | 11 |
| Glucose monitoring continual min 72hr pt CPT 95249 | not published | not published | $69.00 – $175.96 | 6 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $46.74 | $82.00 | $13.51 – $49.68 | 11 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $14.82 | $26.00 | $4.12 – $15.13 | 11 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $113.43 | $199.00 | $19.51 – $71.72 | 11 |
| Gonadotropin hormone panel CPT 80426 | not published | not published | $155.83 – $572.86 | 11 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $66.12 | $116.00 | $19.45 – $71.49 | 11 |
| Gonioscopy CPT 92020 | not published | not published | $21.77 – $91.83 | 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.