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 |
|---|---|---|---|---|
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $21.27 | $37.31 | $5.63 – $25.72 | 6 |
| Leukacyte transfusion CPT 86950 | not published | not published | $20.38 – $103.51 | 3 |
| Leukocyte phagocytosis CPT 86344 | not published | not published | $10.91 – $40.11 | 11 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $356.13 | $624.80 | $233.37 – $466.96 | 7 |
| Leuprolide 3.75 mg intramuscular syringe kit HCPCS J1950 | $3,223.65 | $5,655.53 | $1,144.44 – $3,216.00 | 8 |
| Leuprolide acetate injeciton HCPCS J9218 | $31.92 | $56.00 | $7.21 – $56.00 | 6 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $0.19 | $0.34 | $0.09 – $0.34 | 6 |
| Levetiracetam therapeutic drug level CPT 80177 | $61.56 | $108.00 | $13.91 – $51.15 | 10 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $10.66 | $18.70 | $1.30 – $3.00 | 6 |
| L hrt cath chd nm/abn nt cnj CPT 93595 | not published | not published | $0.03 – $275.65 | 6 |
| Lidocaine therapeutic drug level CPT 80176 | not published | not published | $15.42 – $56.70 | 11 |
| Lift heel adj small gl60404sm HCPCS L3332 | $202.35 | $355.00 | $73.89 – $73.89 | 2 |
| Ligate esophagus veins CPT 43400 | not published | not published | $1,516.10 – $5,353.50 | 7 |
| Ligate leg veins open CPT 37761 | not published | not published | $530.12 – $1,900.80 | 7 |
| Ligate leg veins radical 37760 CPT 37760 | not published | not published | $561.28 – $2,182.69 | 7 |
| Ligate oviduct(s) add-on 58611 CPT 58611 | not published | not published | $77.00 – $277.35 | 7 |
| Ligate/staple esophagus CPT 43405 | not published | not published | $1,443.14 – $5,101.31 | 7 |
| Ligate/strip long leg vein CPT 37722 | $1,053.93 | $1,849.00 | $452.01 – $1,649.96 | 7 |
| Ligate/strip short leg vein CPT 37718 | $992.37 | $1,741.00 | $384.59 – $1,473.56 | 7 |
| Ligate/transect fallopian tubes 58600 CPT 58600 | not published | not published | $386.58 – $1,331.81 | 7 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | $344.28 | $604.00 | $207.95 – $701.76 | 7 |
| Ligation common iliac vein CPT 37660 | not published | not published | $1,304.88 – $4,618.43 | 7 |
| Ligation/divis of long saph vein 37700 CPT 37700 | not published | not published | $242.98 – $859.31 | 7 |
| Ligation external carotid artery 37600 CPT 37600 | not published | not published | $767.62 – $2,636.29 | 7 |
| Ligation internal/common carotid artery 37605 CPT 37605 | not published | not published | $714.40 – $2,559.86 | 7 |
| Ligation internal jugular vein 37565 CPT 37565 | not published | not published | $737.67 – $2,570.18 | 7 |
| Ligation major artery chest CPT 37616 | not published | not published | $1,117.60 – $3,880.20 | 7 |
| Ligation/major artery/extremity 37618 CPT 37618 | not published | not published | $394.57 – $1,368.53 | 7 |
| Ligation major artery neck CPT 37615 | not published | not published | $527.80 – $1,861.05 | 7 |
| Ligation nasal sinus artery CPT 30915 | not published | not published | $637.75 – $2,118.64 | 7 |
| Ligation of abdomen artery 37617 CPT 37617 | not published | not published | $1,313.01 – $4,686.45 | 7 |
| Ligation of femoral vein CPT 37650 | not published | not published | $448.17 – $1,594.09 | 7 |
| Ligation of inf vena cava CPT 37619 | not published | not published | $1,705.51 – $6,058.95 | 7 |
| Ligation of neck artery CPT 37606 | not published | not published | $726.96 – $2,442.75 | 7 |
| Ligation of salivary duct CPT 42665 | not published | not published | $231.31 – $1,249.69 | 7 |
| Ligation of shunt CPT 49428 | not published | not published | $432.69 – $1,520.55 | 7 |
| Ligation upper jaw artery CPT 30920 | not published | not published | $919.83 – $3,071.44 | 7 |
| Ligation vericose vein cluster(s) 1 leg CPT 37785 | $469.11 | $823.00 | $254.11 – $800.35 | 7 |
| Lig/band angioaccess av fistula CPT 37607 | not published | not published | $369.98 – $1,314.90 | 7 |
| Lig&div&compl strpg saph vn CPT 37735 | not published | not published | $566.83 – $2,017.88 | 7 |
| Limb exercise test CPT 95875 | not published | not published | $61.96 – $197.49 | 7 |
| Limb nerve surgery add-on CPT 64783 | not published | not published | $215.84 – $773.25 | 7 |
| Limited autopsy CPT 88036 | not published | not published | $132.60 – $135.64 | 3 |
| Limited autopsy CPT 88037 | not published | not published | $117.77 – $120.53 | 3 |
| Limited visual field xm CPT 92081 | not published | not published | $17.02 – $54.35 | 7 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $38.18 | $66.98 | $4.06 – $19.00 | 7 |
| Lipase CPT 83690 | $58.14 | $102.00 | $7.23 – $26.60 | 11 |
| Lip exc/transverse wedge/w closure 40510 CPT 40510 | not published | not published | $368.98 – $1,774.01 | 7 |
| Lipoprotein blood high res frac & quant CPT 83701 | not published | not published | $35.51 – $130.70 | 11 |
| Lipoprotein blood quant CPT 83704 | $95.19 | $167.00 | $35.90 – $131.97 | 11 |
| Lipoprotein direct measurement hdl CPT 83718 | $30.78 | $54.00 | $8.60 – $31.61 | 11 |
| Lipoprotein direct measurement ldl CPT 83721 | $35.34 | $62.00 | $11.03 – $40.53 | 11 |
| Lipoprtn dir meas sd ldl chl CPT 83722 | not published | not published | $35.90 – $131.97 | 7 |
| Listeria monocytogenes CPT 86723 | not published | not published | $8.32 – $50.91 | 11 |
| Lithium therapeutic drug level CPT 80178 | $30.78 | $54.00 | $6.94 – $25.51 | 11 |
| Lithotripsy transluminal coronary percutaneous CPT 92972 | not published | not published | $151.63 – $151.63 | 4 |
| Litt icr 1 traj 1 smpl les CPT 61736 | not published | not published | $1,159.29 – $3,379.16 | 6 |
| Litt icr mlt trj mlt/cplx ls CPT 61737 | not published | not published | $1,383.52 – $4,014.56 | 6 |
| Liver abs/cyst dr opn 1-2 stge CPT 47010 | not published | not published | $1,217.33 – $4,278.90 | 7 |
| Liver ds alys 3 bmrk srm alg CPT 81517 | not published | not published | $1,943.12 – $2,219.99 | 5 |
| Liver elastography 91200 CPT 91200 | not published | not published | $11.16 – $47.22 | 6 |
| Liver Function Test CPT 80076 | $95.76 | $168.00 | $8.58 – $31.54 | 11 |
| Liver hem/re-expl wnd/remove pack 47362 CPT 47362 | not published | not published | $1,447.75 – $5,114.55 | 7 |
| Liver image (3d) with flow CPT 78206 | not published | not published | $105.78 – $204.11 | 3 |
| Liver imaging CPT 78201 | not published | not published | $21.29 – $51.86 | 7 |
| Liver imaging (3d) CPT 78205 | not published | not published | $77.98 – $147.64 | 3 |
| Liver imag w/vasclr flow CPT 78202 | not published | not published | $24.97 – $58.98 | 7 |
| Liver/spleen imag static only CPT 78215 | not published | not published | $24.22 – $58.88 | 7 |
| Liver/spleen imag w/vasclr flow CPT 78216 | not published | not published | $27.56 – $66.89 | 7 |
| Lmtd oph exam general anes CPT 92019 | not published | not published | $77.41 – $243.97 | 7 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | $742.14 | $1,302.00 | $494.59 – $1,477.82 | 7 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $1.71 | $3.00 | $1.41 – $2.75 | 6 |
| Loudness balance test CPT 92562 | not published | not published | $51.50 – $143.95 | 7 |
| Low back disk surgery CPT 63030 | not published | not published | $921.87 – $3,368.63 | 7 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | not published | not published | $63.91 – $154.48 | 7 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $823.08 | $1,444.00 | $61.57 – $149.15 | 7 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $709.08 | $1,244.00 | $50.39 – $122.36 | 7 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $2,448.72 | $4,296.00 | $115.76 – $280.34 | 7 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $2,221.86 | $3,898.00 | $90.07 – $217.97 | 7 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $1,945.98 | $3,414.00 | $75.07 – $181.49 | 7 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $210.90 | $370.00 | $11.54 – $27.63 | 7 |
| Lower jaw bone graft CPT 21215 | not published | not published | $834.46 – $15,060.60 | 7 |
| Low frequency non-thermal Ultrasound CPT 97610 | not published | not published | $19.32 – $388.80 | 6 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | $760.32 – $2,631.83 | 7 |
| Lsh uterus above 250 g CPT 58543 | not published | not published | $872.96 – $3,035.36 | 7 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $861.47 – $2,992.16 | 7 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | $937.43 – $3,270.30 | 7 |
| L/s ratio fetal lung CPT 83661 | not published | not published | $23.09 – $84.88 | 11 |
| Lumbar diskogram s&i CPT 72295 | not published | not published | $42.14 – $103.77 | 7 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | $1,585.51 – $5,538.34 | 7 |
| Lung function test (mbc/mvv) CPT 94200 | $179.55 | $315.00 | $2.70 – $14.60 | 7 |
| Lung Function Test (Spirometry) CPT 94010 | $119.70 | $210.00 | $8.60 – $28.09 | 7 |
| Lung perfusion imaging CPT 78580 | $661.20 | $1,160.00 | $36.65 – $89.18 | 7 |
| Lung transplant double CPT 32853 | not published | not published | $4,456.14 – $15,975.68 | 7 |
| Lung transplant single CPT 32851 | not published | not published | $3,193.38 – $11,431.91 | 7 |
| Lung transplant with bypass CPT 32852 | not published | not published | $3,451.93 – $12,418.16 | 7 |
| Lung transplant with bypass CPT 32854 | not published | not published | $4,717.45 – $16,963.91 | 7 |
| Lung volume reduction 32491 CPT 32491 | not published | not published | $1,451.73 – $5,143.01 | 7 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | $314.78 | $552.25 | $275.55 – $552.25 | 6 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | $72.17 | $126.62 | $54.89 – $126.62 | 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.