healthcosts.net

Ascension Calumet Hospital, Inc.

614 Memorial Dr, Chilton, WI · Ascension · · NPI 1376541748

Source: hospital's published price file ↗ · Published Jan 1, 2026 · Ingested Sep 8, 2026

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
Infectious agent nucleic acid quantification hepatitis b CPT 87517 $178.98 $314.00 $44.98 – $165.36 11
Infectious agent nucleic acid quantification hepatitis c CPT 87522 $150.48 $264.00 $44.98 – $165.36 11
Infectious agent nucleic acid quantification hiv-1 CPT 87536 $295.83 $519.00 $89.36 – $328.49 11
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets CPT 87631 $234.84 $412.00 $149.76 – $550.55 11
Infliximab 100 mg intravenous solution HCPCS J1745 $72.96 $128.00 $45.70 – $128.00 7
Influenza dna amp prob addl CPT 87503 $39.90 $70.00 $29.70 – $112.79 11
Influenza virus vaccine, inact hemagglutinin tiv pf inj CPT 90673 $79.80 $140.00 $51.30 – $51.30 2
Influenza virus vaccine, live trivalent intranasal CPT 90660 $30.78 $54.00 $28.51 – $28.51 2
Infratemporal approach/skull CPT 61591 not published not published $3,126.68 – $10,891.35 7
Infratemporal approach/skull CPT 61590 not published not published $3,099.47 – $10,845.83 7
Infuse radioactive materials CPT 77750 not published not published $262.49 – $285.97 7
Ingest challenge ea addl 60 min CPT 95079 not published not published $72.53 – $282.60 7
Ingest challenge ini 120 min CPT 95076 not published not published $78.78 – $394.85 7
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis CPT 94642 not published not published $56.07 – $56.07 2
Initial hosp neonate 28 d/less than not critically ill 99477 CPT 99477 not published not published $358.11 – $769.55 7
Initial nursing facility care/day 35 minutes CPT 99305 $231.42 $406.00 $141.69 – $285.64 7
Initial nursing facility care/day 45 minutes CPT 99306 not published not published $193.62 – $367.59 7
Initial nursing facility care/day low severity 99304 CPT 99304 $165.30 $290.00 $85.11 – $198.56 7
Initial observation care CPT 99218 not published not published $181.42 – $204.08 3
Initial observation care CPT 99219 not published not published $246.99 – $279.42 3
Initial observation care CPT 99220 not published not published $338.70 – $382.02 3
Initiation & management bipap/cpap initial day CPT 94660 $547.77 $961.00 $39.06 – $209.66 7
Init nb em per day non-fac CPT 99461 not published not published $64.50 – $199.56 7
Init pm e/m new pat 65+ yrs CPT 99387 $274.17 $481.00 $129.66 – $264.87 6
Inj, clevidipine butyrate HCPCS C9248 $6.47 $11.36 $2.95 – $4.85 3
Inj cntr knee arthro incl ct/mri CPT 27369 $817.95 $1,435.00 $41.59 – $573.08 6
Inj disk cerv-thor ea lev CPT 62291 not published not published $149.63 – $1,223.70 7
Inj dupuytren cord w/enzyme CPT 20527 not published not published $67.46 – $303.71 7
Inj, durolane 1 mg HCPCS J7318 $16.53 $29.00 $8.78 – $29.00 6
Inj dx for sinogram CPT 20501 not published not published $37.76 – $500.63 7
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides) CPT 64454 $578.55 $1,015.00 $86.58 – $774.79 6
Injection arthrography hip without anesthesia (both sides) CPT 27093 $925.68 $1,624.00 $70.30 – $796.80 7
Injection carpal tunnel therapeutic (both sides) CPT 20526 $208.05 $365.00 $58.19 – $164.96 7
Injection during cath supravalvular aortography CPT 93567 not published not published $36.63 – $400.16 7
Injection epidural blood patch or clot CPT 62273 $1,100.10 $1,930.00 $118.55 – $628.05 7
Injection eye drug CPT 67028 not published not published $96.43 – $367.91 7
Injection for arthrography wrist (both sides) CPT 25246 $760.38 $1,334.00 $75.89 – $674.10 7
Injection for bladder x-ray CPT 51600 not published not published $44.98 – $753.64 7
Injection for hip x-ray CPT 27095 not published not published $83.97 – $1,064.55 7
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides) CPT 23350 $778.62 $1,366.00 $51.72 – $557.96 7
Injection for spleen x-ray CPT 38200 not published not published $134.92 – $494.03 7
Injection for tear sac x-ray CPT 68850 not published not published $54.24 – $229.91 7
Injection for ureter x-ray CPT 50684 not published not published $53.35 – $426.56 7
Injection for ureter x-ray CPT 50690 not published not published $72.91 – $395.55 7
Injection, fulvestrant HCPCS J9395 $39.39 $69.10 $11.70 – $69.10 6
Injection into brain canal CPT 61026 not published not published $110.07 – $377.55 7
Injection into brain canal CPT 61055 not published not published $119.72 – $437.78 7
Injection into hemorrhoid(s) CPT 46500 not published not published $194.38 – $1,085.93 7
Injection into spinal artery CPT 62294 not published not published $937.95 – $3,201.86 7
Injection into vocal cord CPT 31513 not published not published $136.35 – $468.53 7
Injection intraop add-on CPT 48400 not published not published $104.44 – $376.01 7
Injection jaw joint x-ray CPT 21116 not published not published $46.53 – $719.74 7
Injection of sinus tract CPT 20500 not published not published $94.53 – $415.20 7
Injection,onabotulinumtoxina HCPCS J0585 $11.56 $20.28 $6.83 – $16.00 7
Injection px peyronie ds CPT 54200 not published not published $92.70 – $404.63 7
Injection radioactive tracer sentinel node (both sides) CPT 38792 $1,071.60 $1,880.00 $33.07 – $301.24 7
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left CPT 64447 $1,016.31 $1,783.00 $66.30 – $324.90 7
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides) CPT 64450 $1,047.66 $1,838.00 $43.70 – $208.18 7
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides) CPT 64483 $836.76 $1,468.00 $117.30 – $862.20 7
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level CPT 64491 $1,007.19 $1,767.00 $61.85 – $348.00 7
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level CPT 64490 $1,344.06 $2,358.00 $110.75 – $693.41 7
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance CPT 64494 $783.18 $1,374.00 $53.14 – $324.19 7
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level CPT 64493 $1,344.06 $2,358.00 $95.27 – $632.63 7
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance CPT 62321 $1,946.55 $3,415.00 $112.86 – $944.74 6
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance CPT 62323 $1,946.55 $3,415.00 $104.29 – $933.45 6
Injection(s) tendon sheath/ligament aponeurosis single (both sides) CPT 20550 $542.64 $952.00 $40.26 – $127.08 7
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s) CPT 20552 $473.67 $831.00 $38.44 – $121.19 7
Injection(s) trigger point(s) single/multiple >= 3 muscle(s) CPT 20553 $534.66 $938.00 $43.70 – $141.44 7
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug CPT 96375 $189.24 $332.00 $16.34 – $53.10 7
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug CPT 96376 $189.24 $332.00 $32.21 – $32.21 2
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug CPT 96374 $189.24 $332.00 $39.07 – $128.10 7
Injection therapeutic/prophylactic/diagnostic subcutaneous/im CPT 96372 $129.39 $227.00 $15.38 – $52.60 7
Injection treatment of eye CPT 66020 not published not published $139.10 – $706.24 7
Injection treatment of eye CPT 66030 not published not published $118.20 – $631.95 7
Injection treatment of nerve CPT 64605 not published not published $415.42 – $2,236.88 7
Injection treatment of nerve CPT 64610 not published not published $475.58 – $2,729.63 7
Injection treatment of nerve CPT 64681 not published not published $230.52 – $2,022.64 7
Injection treatment of nose CPT 30200 not published not published $62.91 – $404.48 7
Inject sacroiliac joint CPT 27096 $1,248.87 $2,191.00 $87.23 – $591.26 7
Inject/treat eye socket CPT 67500 not published not published $67.70 – $266.36 7
Inject/treat eye socket CPT 67505 not published not published $75.79 – $302.33 7
Inject/treat eye socket CPT 67515 not published not published $49.40 – $232.54 7
Inj epidural sgl cerv-thor without img CPT 62320 $987.24 $1,732.00 $103.37 – $596.93 6
Inj epidural sgl lumb-sacral without img CPT 62322 $1,268.82 $2,226.00 $82.72 – $546.38 6
Inj for ext venography CPT 36005 not published not published $47.38 – $1,079.51 7
Inj for mammo ductogram CPT 19030 not published not published $78.52 – $615.56 7
Inj hrt cath w/s&i nonsel p-art angrp CPT 93568 not published not published $45.73 – $436.22 7
Inj hrt cath w/s&i sel hrt ang CPT 93563 not published not published $51.74 – $186.47 7
Inj hrt cath w/s&i sel hrt art CPT 93564 not published not published $53.85 – $193.20 7
Inj hrt cath w/s&i sel left vent CPT 93565 not published not published $26.19 – $144.73 7
Inj hrt cath w/s&i sel right vent CPT 93566 not published not published $25.82 – $475.46 7
Inj hydroxyprogst capoat nos HCPCS J1729 $14.25 $25.00 $14.60 – $14.60 2
Inj/inf neurolyt sbst spinal canal lesion 62282 CPT 62282 not published not published $149.88 – $1,122.49 7
Inj intralesional <= 7 lsn(s) CPT 11900 $283.29 $497.00 $31.19 – $122.98 7
Inj intralesional > 7 lsns CPT 11901 $197.79 $347.00 $47.58 – $152.91 7
Inj ivig privigen 500 mg HCPCS J1459 $57.00 $100.00 $44.74 – $100.00 7
Inj naloxone hydrochloride HCPCS J2310 $18.24 $32.00 $13.32 – $32.00 6
Inj nephrosto/ureterogram w/img exstng access CPT 50431 not published not published $68.54 – $945.23 6
Inj non-compmd foam sclrsnt mlt trncl veins same leg CPT 36466 not published not published $149.81 – $6,095.63 6
Inj non-compmd foam sclrsnt sgl trncl vein CPT 36465 not published not published $117.55 – $5,493.41 6

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.