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 |
|---|---|---|---|---|
| Hla i typing complete hr CPT 81379 | not published | not published | $352.15 – $1,294.57 | 10 |
| Hla i typing complete lr CPT 81372 | not published | not published | $315.96 – $1,557.86 | 10 |
| Hla i typing high res 1 allele grp ea CPT 81381 | not published | not published | $135.28 – $655.81 | 10 |
| Hla i typing low res one locus ea CPT 81373 | not published | not published | $133.80 – $491.88 | 10 |
| Hla typing a b or c CPT 86813 | not published | not published | $60.90 – $223.88 | 11 |
| Hla typing dr/dq CPT 86816 | not published | not published | $31.68 – $116.46 | 11 |
| Hla x-match noncytotoxc addl CPT 86826 | not published | not published | $38.29 – $141.01 | 11 |
| Hla x-math non-cytotoxic CPT 86825 | not published | not published | $114.88 – $422.63 | 11 |
| Hlth bhv assmt/reassessment CPT 96156 | not published | not published | $95.73 – $326.85 | 6 |
| Hlth bhv ivntj fam 1st 30 CPT 96167 | not published | not published | $68.03 – $240.05 | 6 |
| Hlth bhv ivntj fam without pt ea CPT 96171 | not published | not published | $28.00 – $96.77 | 6 |
| Hlth bhv ivntj fam wo pt 1st CPT 96170 | not published | not published | $77.73 – $267.16 | 6 |
| Hlth bhv ivntj grp 1st 30 CPT 96164 | not published | not published | $10.11 – $32.96 | 6 |
| Hlth bhv ivntj indiv 1st 30 CPT 96158 | not published | not published | $64.30 – $223.99 | 6 |
| Home health care supervision CPT 99374 | not published | not published | $153.23 – $153.23 | 2 |
| Home health care supervision CPT 99375 | not published | not published | $89.64 – $229.66 | 6 |
| Home health re-certification physician g0179 HCPCS G0179 | $85.50 | $150.00 | $44.98 – $133.65 | 6 |
| Home/res vst est high mdm 60 CPT 99350 | $215.46 | $378.00 | $197.12 – $368.89 | 7 |
| Home/res vst est mod mdm 40 CPT 99349 | $148.77 | $261.00 | $135.40 – $234.44 | 7 |
| Home/res vst est sf mdm 20 CPT 99347 | $68.40 | $120.00 | $48.44 – $113.95 | 7 |
| Home/res vst new high mdm 75 CPT 99345 | $193.23 | $339.00 | $214.82 – $402.15 | 7 |
| Home/res vst new low mdm 30 CPT 99342 | not published | not published | $83.91 – $173.30 | 7 |
| Home/res vst new mod mdm 60 CPT 99344 | $143.07 | $251.00 | $151.79 – $333.70 | 7 |
| Home/res vst new sf mdm 15 CPT 99341 | $50.73 | $89.00 | $52.88 – $101.31 | 7 |
| Home vent mgmt supervision CPT 94005 | not published | not published | $305.38 – $305.38 | 2 |
| Home visit est patient 99348 CPT 99348 | $106.02 | $186.00 | $81.89 – $185.32 | 7 |
| Home visit new patient CPT 99343 | not published | not published | $239.57 – $267.97 | 3 |
| Homocysteine CPT 83090 | $38.76 | $68.00 | $18.82 – $69.17 | 11 |
| Homogenization tissue CPT 87176 | $22.80 | $40.00 | $6.17 – $22.70 | 11 |
| Homovanillic acid (hva) CPT 83150 | not published | not published | $19.96 – $86.50 | 11 |
| Hospice care supervision CPT 99377 | not published | not published | $153.23 – $153.23 | 2 |
| Hospice care supervision CPT 99378 | not published | not published | $89.64 – $229.66 | 6 |
| Hpa-15 genotyping CPT 81112 | not published | not published | $128.33 – $471.77 | 7 |
| Hpa-1 genotyping CPT 81105 | not published | not published | $128.33 – $471.77 | 7 |
| Hpa-2 genotyping CPT 81106 | not published | not published | $128.33 – $471.77 | 7 |
| Hpa-3 genotyping CPT 81107 | not published | not published | $128.33 – $471.77 | 7 |
| Hpa-4 genotyping CPT 81108 | not published | not published | $128.33 – $471.77 | 7 |
| Hpa-5 genotyping CPT 81109 | not published | not published | $128.33 – $471.77 | 7 |
| Hpa-6 genotyping CPT 81110 | not published | not published | $128.33 – $471.77 | 7 |
| Hpa-9 genotyping CPT 81111 | not published | not published | $128.33 – $471.77 | 7 |
| Hpv low-risk types CPT 87623 | not published | not published | $36.84 – $135.45 | 10 |
| Hpv types 16 & 18 only CPT 87625 | $80.37 | $141.00 | $42.58 – $156.52 | 10 |
| H pylori ag ia CPT 87339 | not published | not published | $16.80 – $61.76 | 11 |
| H pylori (c-13) blood CPT 83009 | not published | not published | $70.73 – $260.01 | 11 |
| H pylori (c-13) breath CPT 83013 | not published | not published | $70.73 – $260.01 | 11 |
| H pylori drug admin CPT 83014 | not published | not published | $8.25 – $30.34 | 11 |
| Hrdtry brst ca-rlatd do 5+ CPT 81432 | not published | not published | $713.00 – $2,621.13 | 7 |
| Hrdtry brst ca-rlatd dsordrs CPT 81433 | not published | not published | $460.88 – $1,694.27 | 7 |
| Hrdtry cardmypy gene panel CPT 81439 | not published | not published | $614.15 – $2,257.71 | 8 |
| Hrdtry perph neurphy panel CPT 81448 | not published | not published | $614.15 – $2,257.71 | 7 |
| Hsv dna dir probe CPT 87528 | not published | not published | $21.05 – $77.39 | 11 |
| Htt gene charac alleles CPT 81274 | not published | not published | $288.57 – $1,060.84 | 7 |
| Htt gene detc abnor alleles CPT 81271 | not published | not published | $143.85 – $528.82 | 7 |
| Human epididymis protein 4 (he4) CPT 86305 | $76.95 | $135.00 | $21.85 – $80.33 | 11 |
| Human ig IV CPT 90283 | not published | not published | $164.37 – $164.37 | 2 |
| Human ig sc CPT 90284 | not published | not published | $34.57 – $34.57 | 2 |
| Hyaluronidase 150 unit/ml injection solution HCPCS J3470 | $53.58 | $94.00 | $72.54 – $72.54 | 2 |
| Hydralazine 20 mg/ml injection solution HCPCS J0360 | $19.80 | $34.74 | $6.37 – $34.74 | 6 |
| Hydration IV infusion each additional hour CPT 96361 | $122.55 | $215.00 | $13.11 – $43.77 | 7 |
| Hydration IV infusion initial 31minutes - 1 hour CPT 96360 | $439.47 | $771.00 | $34.65 – $118.22 | 7 |
| Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J1720 | $37.57 | $65.92 | $24.74 – $35.00 | 6 |
| Hydroxyzine hcl 50 mg/ml intramuscular solution HCPCS J3410 | $10.83 | $19.00 | $17.04 – $19.00 | 5 |
| Hydrxycorticsterds 17- (17-ohcs) CPT 83491 | $30.78 | $54.00 | $18.80 – $69.09 | 11 |
| Hymenotomy CPT 56442 | not published | not published | $49.31 – $170.03 | 7 |
| Hyoid myotomy & suspension CPT 21685 | not published | not published | $1,028.51 – $3,551.89 | 7 |
| Hyperbaric oxygen therapy CPT 99183 | not published | not published | $109.35 – $441.09 | 7 |
| #hypersens-actinomyces ab CPT 86602 | not published | not published | $8.32 – $39.29 | 11 |
| Hyperthermia ext gen deep CPT 77605 | not published | not published | $101.69 – $255.85 | 7 |
| Hyperthermia ext gen supfc CPT 77600 | not published | not published | $76.34 – $182.15 | 7 |
| Hyperthermia gen intrcv prb CPT 77620 | not published | not published | $82.69 – $196.42 | 7 |
| Hyperthermia ntrstl prb 5/< CPT 77610 | not published | not published | $74.20 – $181.35 | 7 |
| Hyperthermia ntrstl prb>5 CPT 77615 | not published | not published | $104.19 – $244.77 | 7 |
| Hypnotherapy CPT 90880 | not published | not published | $93.81 – $363.28 | 7 |
| Hypothermia ill neonate CPT 99184 | not published | not published | $226.18 – $493.34 | 6 |
| Hysterectomy/bladder repair CPT 51925 | not published | not published | $1,115.96 – $3,834.41 | 7 |
| Hysterectomy/revise vagina 58275 CPT 58275 | not published | not published | $1,027.56 – $3,576.15 | 7 |
| Hysterectomy/revise vagina 58280 CPT 58280 | not published | not published | $1,096.39 – $3,826.76 | 7 |
| Hysteroplasty 58540 CPT 58540 | not published | not published | $949.63 – $3,310.05 | 7 |
| Hysterorrhaphy of ruptured uterus 59350 CPT 59350 | not published | not published | $270.72 – $966.71 | 7 |
| Hysterosalpingography s&i CPT 74740 | not published | not published | $19.41 – $46.48 | 7 |
| Hysteroscopy ablation CPT 58563 | not published | not published | $251.90 – $7,115.36 | 7 |
| Hysteroscopy biopsy CPT 58558 | not published | not published | $237.01 – $5,061.75 | 7 |
| Hysteroscopy dx sep proc CPT 58555 | not published | not published | $155.60 – $1,171.95 | 7 |
| Hysteroscopy lysis CPT 58559 | not published | not published | $290.71 – $1,037.03 | 7 |
| Hysteroscopy remove fb CPT 58562 | not published | not published | $227.09 – $1,427.59 | 7 |
| Hysteroscopy remove myoma CPT 58561 | not published | not published | $365.97 – $1,303.28 | 7 |
| Hysteroscopy resect septum CPT 58560 | not published | not published | $319.94 – $1,139.78 | 7 |
| Hysterotomy abdominal 59100 CPT 59100 | not published | not published | $851.61 – $2,945.51 | 7 |
| Hzv zoster vacc recombinant adjuvanted im inj CPT 90750 | $197.79 | $347.00 | $220.09 – $220.09 | 2 |
| I-123 sod iodide diag per 100 uci HCPCS A9516 | $106.02 | $186.00 | $132.39 – $132.39 | 2 |
| Iaadi respiratory synctial virus CPT 87280 | not published | not published | $14.09 – $51.80 | 11 |
| Iadna legionella pneumophila amplified probe tq CPT 87541 | not published | not published | $36.84 – $135.45 | 11 |
| Ia infect ag ab qual/semiquant sgl step CPT 86318 | $66.69 | $117.00 | $18.51 – $69.83 | 11 |
| Ia nfct ab sarscov2 covid19 CPT 86328 | not published | not published | $47.54 – $174.78 | 7 |
| Ibandronate 3 mg/3 ml intravenous syringe HCPCS J1740 | $38.76 | $68.00 | $34.86 – $68.00 | 6 |
| Ibmfs seq alys pnl 30 genes CPT 81441 | not published | not published | $2,570.99 – $9,451.44 | 7 |
| Icg angiography i&r uni/bi CPT 92240 | not published | not published | $48.89 – $156.26 | 7 |
| Icut allergy test-delayed CPT 95028 | not published | not published | $13.32 – $40.90 | 7 |
| Icut allergy test drug/bug CPT 95024 | not published | not published | $0.85 – $25.92 | 7 |
| Icut allergy titrate-airborn CPT 95027 | not published | not published | $5.13 – $15.51 | 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.