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 |
|---|---|---|---|---|
| Lutetium lu 177 vipivotide HCPCS A9607 | $287.85 | $505.00 | $371.66 – $371.66 | 2 |
| Lw ntsty Ultrasound stimj bone healg CPT 20979 | not published | not published | $32.79 – $193.16 | 7 |
| Lyme dis dna dir probe CPT 87475 | not published | not published | $21.05 – $77.39 | 11 |
| Lymphadenect/stage/pelv/paraaortic 38562 CPT 38562 | not published | not published | $730.77 – $2,531.36 | 7 |
| Lymphatics/lymph node imaging CPT 78195 | not published | not published | $59.04 – $142.82 | 7 |
| Lymphocyte culture mixed CPT 86821 | not published | not published | $38.39 – $188.59 | 11 |
| Lymphocyte transformation mitogen CPT 86353 | not published | not published | $51.48 – $189.26 | 11 |
| Lymphocytotoxicity assay CPT 86805 | not published | not published | $74.79 – $731.51 | 11 |
| Lymphocytotoxicity assay CPT 86806 | not published | not published | $49.97 – $183.70 | 11 |
| Lymph vessel x-ray arm/leg CPT 75801 | not published | not published | $43.22 – $102.00 | 7 |
| Lymph vessel x-ray arms/legs CPT 75803 | not published | not published | $59.35 – $143.54 | 7 |
| Lymph vessel x-ray trunk CPT 75805 | not published | not published | $41.04 – $99.42 | 7 |
| Lymph vessel x-ray trunk CPT 75807 | not published | not published | $55.31 – $136.18 | 7 |
| Lysis intranasal synechia 30560 CPT 30560 | not published | not published | $160.84 – $1,064.89 | 7 |
| Lysis of labial adhesions CPT 56441 | not published | not published | $163.82 – $596.40 | 7 |
| Lysis penil circumic lesion CPT 54162 | not published | not published | $210.77 – $938.96 | 7 |
| Macro exam dissect molec study ea CPT 88387 | not published | not published | $8.80 – $28.23 | 8 |
| Macroscopic exam arthropod CPT 87168 | $17.10 | $30.00 | $4.48 – $16.48 | 11 |
| Macroscopic exam parasite CPT 87169 | $17.10 | $30.00 | $4.53 – $16.64 | 11 |
| Magnesium CPT 83735 | $41.04 | $72.00 | $7.04 – $25.86 | 11 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $9.49 | $16.65 | $0.30 – $1.30 | 6 |
| Magnetic image bone marrow CPT 77084 | not published | not published | $80.98 – $196.47 | 7 |
| Makena, 10 mg HCPCS J1726 | $29.07 | $51.00 | $28.61 – $28.61 | 2 |
| Malaria antibody CPT 86750 | not published | not published | $13.85 – $50.91 | 11 |
| Male sling procedure CPT 53440 | not published | not published | $786.15 – $2,754.53 | 7 |
| Management of liver hemorrhage 47361 CPT 47361 | not published | not published | $2,989.14 – $10,680.00 | 7 |
| Manipulate finger w/anesth CPT 26340 | not published | not published | $386.60 – $1,235.96 | 7 |
| Manipulate wrist w/anesthes CPT 25259 | not published | not published | $465.88 – $1,533.64 | 7 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $127.68 | $224.00 | $41.40 – $92.24 | 7 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $127.68 | $224.00 | $26.29 – $79.50 | 7 |
| Manipulation of hip joint CPT 27275 | not published | not published | $193.61 – $655.95 | 7 |
| Manipulation of spine CPT 22505 | not published | not published | $132.95 – $464.44 | 7 |
| Manipulat palm cord post inj CPT 26341 | not published | not published | $82.41 – $384.41 | 7 |
| Manual diff wbc count b-coat CPT 85009 | not published | not published | $5.32 – $19.57 | 11 |
| Mapping functional cort/subcort ea add'l hr CPT 95962 | not published | not published | $167.29 – $289.06 | 7 |
| Mapping io sentinel lymph node CPT 38900 | not published | not published | $136.16 – $483.94 | 7 |
| Map tachycard site(s) CPT 93609 | not published | not published | $268.99 – $16,158.00 | 8 |
| Marsupialization liver lesion 47300 CPT 47300 | not published | not published | $1,141.32 – $3,990.90 | 7 |
| Mastectomy partial CPT 19301 | $983.25 | $1,725.00 | $667.57 – $1,388.26 | 7 |
| Mast mod rad CPT 19307 | $1,802.34 | $3,162.00 | $1,191.03 – $2,550.81 | 7 |
| Mastoidectomy CPT 69501 | not published | not published | $749.16 – $2,576.25 | 7 |
| Mastoidectomy complete 69502 CPT 69502 | not published | not published | $993.92 – $3,422.59 | 7 |
| Mastoids complete CPT 70130 | not published | not published | $17.20 – $42.07 | 7 |
| Mastoid surgery revision CPT 69603 | not published | not published | $1,353.80 – $4,535.18 | 7 |
| Mastopexy CPT 19316 | not published | not published | $818.20 – $2,773.95 | 7 |
| Mast radical CPT 19305 | not published | not published | $1,160.86 – $4,010.55 | 7 |
| Mast rad urban type CPT 19306 | not published | not published | $1,233.29 – $4,258.50 | 7 |
| Mast simple complete CPT 19303 | $1,557.24 | $2,732.00 | $966.47 – $2,148.30 | 7 |
| M.avium-intra dna amp prob CPT 87561 | not published | not published | $36.84 – $135.45 | 11 |
| M.avium-intra dna dir prob CPT 87560 | not published | not published | $28.65 – $105.34 | 11 |
| M.avium-intra dna quant CPT 87562 | not published | not published | $44.98 – $165.36 | 11 |
| Maxillofacial fixation CPT 21100 | not published | not published | $379.56 – $2,430.38 | 7 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $25.08 | $44.00 | $15.18 – $55.82 | 11 |
| Mayo aathr protein s free CPT 85306 | $64.41 | $113.00 | $16.09 – $59.14 | 11 |
| Mayo activated protein c resistance assay CPT 85307 | $90.06 | $158.00 | $16.09 – $59.14 | 11 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | not published | not published | $40.50 – $148.88 | 7 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | $40.47 | $71.00 | $20.06 – $77.36 | 3 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $62.13 | $109.00 | $31.67 – $32.09 | 3 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $52.44 | $92.00 | $15.52 – $57.05 | 11 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $62.13 | $109.00 | $31.67 – $55.75 | 3 |
| Mayo alpha 1 antitrypsin CPT 82103 | $49.02 | $86.00 | $14.11 – $51.88 | 11 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $66.12 | $116.00 | $15.83 – $58.21 | 11 |
| Mayo amphu amphetamines definitive assay 3 or 4 urine CPT 80325 | not published | not published | $28.86 – $74.66 | 3 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | not published | not published | $28.93 – $31.67 | 3 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $208.05 | $365.00 | $127.71 – $469.49 | 10 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $274.17 | $481.00 | $96.24 – $353.81 | 10 |
| Mayo analysis gene smn1 dosage/deletion CPT 81329 | $234.27 | $411.00 | $143.85 – $528.82 | 7 |
| Mayo analysis microarray cytogenomic copy number/snp variants CPT 81229 | $1,059.06 | $1,858.00 | $1,218.00 – $4,477.60 | 7 |
| Mayo androstenedione CPT 82157 | $102.60 | $180.00 | $30.74 – $113.02 | 11 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $53.01 | $93.00 | $15.33 – $56.36 | 11 |
| Mayo antithrombin iii antigen CPT 85301 | not published | not published | $11.35 – $41.73 | 11 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $33.63 | $59.00 | $8.32 – $58.09 | 11 |
| Mayo avwpr vw factor activity CPT 85397 | $53.01 | $93.00 | $32.40 – $119.12 | 11 |
| Mayo babpb infectious agent nucleic acid amplified probe babesia microti CPT 87469 | not published | not published | $36.84 – $135.45 | 7 |
| Mayo barbiturates definitive assay confirmation urine CPT 80345 | $62.13 | $109.00 | $21.27 – $31.67 | 3 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $21.66 | $38.00 | $8.32 – $39.29 | 11 |
| Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 | $420.66 | $738.00 | $152.08 – $559.08 | 10 |
| Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative CPT 81208 | not published | not published | $225.35 – $828.43 | 10 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | not published | not published | $8.32 – $49.79 | 11 |
| Mayo bnzu sedative hypnotics definitive urine CPT 80368 | not published | not published | $31.67 – $31.88 | 3 |
| Mayo bordetella pertussis antibody igg CPT 86615 | $27.36 | $48.00 | $8.32 – $50.91 | 11 |
| Mayo brcmg brucella antibody igm CPT 86622 | not published | not published | $8.32 – $34.47 | 11 |
| Mayo c1 esterase inhibitor CPT 83883 | $130.53 | $229.00 | $14.28 – $52.50 | 11 |
| Mayo cannabinoids natural definitive assay thc confirmation urine CPT 80349 | $63.84 | $112.00 | $31.67 – $33.34 | 3 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $115.71 | $203.00 | $17.71 – $65.12 | 11 |
| Mayo cd20b mononuclear cell antigen nos quantitative each CPT 86356 | $79.23 | $139.00 | $28.12 – $103.37 | 11 |
| Mayo cdcom hla class ii typing low resolution one locus each CPT 81376 | not published | not published | $128.33 – $471.77 | 10 |
| Mayo ceruloplasmin CPT 82390 | $39.33 | $69.00 | $11.28 – $41.46 | 11 |
| Mayo chemiluminescent parathyroid related peptide CPT 82397 | $75.81 | $133.00 | $14.83 – $54.50 | 11 |
| Mayo chikv chikungunya antibodies igg CPT 86790 | $43.89 | $77.00 | $8.32 – $49.72 | 11 |
| Mayo chlap chlamydia pneumoniae antibody igg CPT 86631 | $21.66 | $38.00 | $8.32 – $45.63 | 11 |
| Mayo chlap chlamydia pneumoniae antibody igm CPT 86632 | $21.66 | $38.00 | $8.32 – $48.94 | 11 |
| Mayo chrcb tissue culture non-neoplastic disorders lymphocyte CPT 88230 | $242.25 | $425.00 | $71.24 – $449.65 | 11 |
| Mayo chromium CPT 82495 | $57.00 | $100.00 | $10.41 – $78.28 | 11 |
| Mayo cocaine definitive assay confirmation urine CPT 80353 | $76.38 | $134.00 | $28.13 – $31.67 | 3 |
| Mayo coccidioides antibody CPT 86635 | $19.95 | $35.00 | $8.32 – $44.27 | 11 |
| Mayo cocou cortisone urine CPT 82542 | $290.13 | $509.00 | $25.29 – $92.99 | 11 |
| Mayo cortisol free CPT 82530 | $49.59 | $87.00 | $17.55 – $64.50 | 11 |
| Mayo covid-19 antibody nucleocapsid total CPT 86769 | $90.63 | $159.00 | $44.24 – $162.62 | 7 |
| Mayo coxiella brunetii (q fever) igg antibody CPT 86638 | not published | not published | $8.32 – $46.78 | 11 |
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.