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 |
|---|---|---|---|---|
| Mayo csmpu benzodiazepines definitive assay >=13 urine CPT 80347 | not published | not published | $36.77 – $132.32 | 3 |
| Mayo csmpu opiod/analogs definitive assay >=5 urine CPT 80364 | not published | not published | $91.49 – $91.49 | 2 |
| Mayo cyanide CPT 82600 | not published | not published | $20.37 – $74.88 | 11 |
| Mayo cytopathology in situ hybridization urinary tract 3-5 probes each specimen manual CPT 88120 | not published | not published | $61.40 – $134.69 | 8 |
| Mayo deoxyribonuclease antibody titer CPT 86215 | $46.17 | $81.00 | $13.91 – $51.15 | 11 |
| Mayo dhea (dehydroepiandrosterone) CPT 82626 | $90.06 | $158.00 | $26.53 – $97.54 | 11 |
| Mayo dihydrotestosterone CPT 82642 | $147.63 | $259.00 | $30.74 – $113.02 | 7 |
| Mayo dipstick analyte single step qualitative/semiqualitative synovial fluid CPT 83518 | not published | not published | $10.12 – $37.21 | 11 |
| Mayo efpo chloride stool CPT 82438 | not published | not published | $5.25 – $19.30 | 11 |
| Mayo estriol CPT 82677 | $84.93 | $149.00 | $25.39 – $93.33 | 11 |
| Mayo estrone CPT 82679 | $73.53 | $129.00 | $26.20 – $96.31 | 11 |
| Mayo ethosuximide therapeutic drug level CPT 80168 | $58.14 | $102.00 | $17.16 – $63.07 | 11 |
| Mayo everolimus therapeutic drug level CPT 80169 | not published | not published | $14.42 – $53.00 | 10 |
| Mayo factor ii CPT 85210 | $31.35 | $55.00 | $8.32 – $50.10 | 11 |
| Mayo factor v CPT 85220 | $63.27 | $111.00 | $18.53 – $68.13 | 11 |
| Mayo factor vii CPT 85230 | $63.84 | $112.00 | $18.80 – $69.09 | 11 |
| Mayo factor viii vw factor antigen CPT 85246 | $71.82 | $126.00 | $24.09 – $88.55 | 11 |
| Mayo factor viii vw factor multimetric analysis CPT 85247 | $69.54 | $122.00 | $24.09 – $88.55 | 11 |
| Mayo factor viii vw factor ristocetin cofactor CPT 85245 | $70.68 | $124.00 | $24.09 – $88.55 | 11 |
| Mayo factor x CPT 85260 | $63.84 | $112.00 | $18.80 – $69.09 | 11 |
| Mayo factor xi CPT 85270 | $63.84 | $112.00 | $18.80 – $69.09 | 11 |
| Mayo fat/lipids feces quantitative CPT 82710 | not published | not published | $17.64 – $64.85 | 11 |
| Mayo fbl culture fungi blood CPT 87103 | not published | not published | $12.89 – $78.98 | 11 |
| Mayo fdp/fsp paracoagulation CPT 85366 | not published | not published | $12.33 – $310.58 | 11 |
| Mayo ffspg allergen clam igg CPT 86001 | not published | not published | $4.64 – $30.19 | 11 |
| Mayo fibrinogen antigen CPT 85385 | not published | not published | $12.15 – $55.82 | 11 |
| Mayo gabapentin bld/srm/plasma therapeutic drug level CPT 80171 | $73.53 | $129.00 | $18.96 – $83.65 | 10 |
| Mayo hemosiderin qualitative urine CPT 83070 | $8.55 | $15.00 | $4.99 – $18.34 | 11 |
| Mayo hip12 infectious agent nucleic acid amplified probe hiv-1 rna qualitative CPT 87535 | $217.17 | $381.00 | $36.84 – $135.45 | 11 |
| Mayo hip12 infectious agent nucleic acid amplified probe hiv-2 CPT 87538 | $59.85 | $105.00 | $36.84 – $135.45 | 11 |
| Mayo hiser histoplasma antibodies immunodiffusion CPT 86698 | $34.77 | $61.00 | $14.48 – $53.23 | 11 |
| Mayo hla typing a/b/c single antigen CPT 86812 | $91.77 | $161.00 | $27.10 – $99.63 | 11 |
| Mayo hvdip HIV 1 antibody CPT 86701 | $15.39 | $27.00 | $9.33 – $34.32 | 11 |
| Mayo hvdip HIV 2 antibody CPT 86702 | $23.37 | $41.00 | $14.20 – $52.19 | 11 |
| Mayo hydroxyprogesterone 17-d CPT 83498 | $96.33 | $169.00 | $28.53 – $104.88 | 11 |
| Mayo immunoassay c1 esterase inhibitor antibody quantitative CPT 83520 | $142.50 | $250.00 | $18.13 – $66.66 | 11 |
| Mayo immunoassay infectious agent antibody quantitative diptheria igg CPT 86317 | $44.46 | $78.00 | $15.74 – $57.86 | 11 |
| Mayo immunoassay tumor antigen quantitative ca 27.29 CPT 86300 | $73.53 | $129.00 | $21.85 – $80.33 | 11 |
| Mayo immunoassay tumor antigen quantitative chromogranin a CPT 86316 | $73.53 | $129.00 | $21.85 – $80.33 | 11 |
| Mayo infectious agent antigen immunoassay direct optical observation cryptococcus CPT 87899 | $37.05 | $65.00 | $16.87 – $62.03 | 11 |
| Mayo infectious agent antigen immunoassay ql/sq multi step aspergillus bal CPT 87305 | not published | not published | $12.58 – $46.24 | 11 |
| Mayo infectious agent nucleic acid amplified probe enterovirus CPT 87498 | not published | not published | $36.84 – $135.45 | 11 |
| Mayo infectious agent nucleic acid amplified probe mycoplasma genitalium urine CPT 87563 | $59.85 | $105.00 | $36.84 – $135.45 | 7 |
| Mayo infectious agent nucleic acid amplified probe mycoplasma pneumoniae CPT 87581 | $72.39 | $127.00 | $36.84 – $135.45 | 11 |
| Mayo infectious agent nucleic acid quantification cytomegalovirus CPT 87497 | $125.40 | $220.00 | $44.98 – $165.36 | 11 |
| Mayo infectious disease hepatitis c chronic six biochemical assays CPT 81596 | $59.85 | $105.00 | $75.80 – $278.65 | 7 |
| Mayo infliximab therapeutic drug level CPT 80230 | $191.52 | $336.00 | $40.50 – $148.88 | 7 |
| Mayo inhab inhibin a CPT 86336 | $79.23 | $139.00 | $16.37 – $60.18 | 11 |
| Mayo insft insulin free CPT 83527 | not published | not published | $13.60 – $49.99 | 11 |
| Mayo insulin antibodies CPT 86337 | $75.81 | $133.00 | $22.48 – $82.64 | 11 |
| Mayo iodine CPT 83789 | $138.51 | $243.00 | $25.32 – $93.06 | 11 |
| Mayo itraconazole therapeutic drug level CPT 80189 | $100.32 | $176.00 | $28.47 – $104.64 | 7 |
| Mayo lacosamide therapeutic drug level CPT 80235 | $131.10 | $230.00 | $28.47 – $104.64 | 7 |
| Mayo lamotrigine therapeutic drug level CPT 80175 | $49.59 | $87.00 | $13.91 – $51.15 | 10 |
| Mayo ld_i lactate dehydrogenase isoenzymes CPT 83625 | not published | not published | $13.43 – $49.37 | 11 |
| Mayo legionella antibody CPT 86713 | not published | not published | $16.07 – $59.06 | 11 |
| Mayo leptospira antibody igm CPT 86720 | not published | not published | $8.32 – $62.53 | 11 |
| Mayo lipoprotein electrophoresis CPT 83700 | not published | not published | $11.82 – $43.46 | 11 |
| Mayo lywb borrelia burgdorferi (lyme disease) antibody igg confirmatory CPT 86617 | $55.86 | $98.00 | $16.26 – $59.79 | 11 |
| Mayo manganese CPT 83785 | not published | not published | $27.98 – $102.87 | 11 |
| Mayo metanephrines plasma CPT 83835 | $60.42 | $106.00 | $17.79 – $65.39 | 11 |
| Mayo methadone definitive assay confirmation urine CPT 80358 | $57.57 | $101.00 | $30.32 – $31.67 | 3 |
| Mayo mgle voltage-gated calcium channel antibody each CPT 86596 | not published | not published | $12.65 – $46.51 | 7 |
| Mayo mgrm acetylcholine receptor binding antibody CPT 86041 | not published | not published | $71.02 – $81.14 | 5 |
| Mayo microsomal antibody liver-kidney CPT 86376 | $56.43 | $99.00 | $15.28 – $56.16 | 11 |
| Mayo mitotane (lysodren) therapeutic drug level CPT 80299 | $31.92 | $56.00 | $19.57 – $71.95 | 11 |
| Mayo molecular pathology procedure level 2 apoe genotype CPT 81401 | not published | not published | $143.85 – $528.82 | 7 |
| Mayo mpl sequence analysis exon 10 CPT 81339 | not published | not published | $194.46 – $714.87 | 7 |
| Mayo muramidase CPT 85549 | $55.29 | $97.00 | $19.69 – $72.38 | 11 |
| Mayo muscle-specific kinase (musk) antibody CPT 86366 | not published | not published | $71.02 – $81.14 | 5 |
| Mayo mycophenolic acid therapeutic drug level CPT 80180 | not published | not published | $18.95 – $69.67 | 10 |
| Mayo myoglobin CPT 83874 | $70.11 | $123.00 | $13.57 – $49.87 | 11 |
| Mayo nickel CPT 83885 | $42.18 | $74.00 | $25.74 – $94.61 | 11 |
| Mayo opatu opiates definitive assay >=1 CPT 80361 | $95.76 | $168.00 | $31.67 – $47.74 | 3 |
| Mayo opatu opioid/analogs definitive assay 1 or 2 CPT 80362 | not published | not published | $31.67 – $40.69 | 3 |
| Mayo opatu oxycodone definitive assay CPT 80365 | $195.51 | $343.00 | $31.67 – $36.29 | 3 |
| Mayo organic acid methylmalonic single quantitative CPT 83921 | $159.60 | $280.00 | $22.27 – $81.87 | 11 |
| Mayo organic acids qualitative each specimen CPT 83919 | not published | not published | $17.27 – $63.50 | 11 |
| Mayo oxalate 24 hour urine CPT 83945 | $58.71 | $103.00 | $15.17 – $55.78 | 11 |
| Mayo pancreatic elastase fecal qualitative or semi quantitative CPT 82656 | not published | not published | $12.11 – $44.51 | 11 |
| Mayo parvs parvovirus b19 antibody igg CPT 86747 | $43.89 | $77.00 | $15.78 – $58.02 | 11 |
| Mayo paval fluorescent antibody screen agna type 1 CPT 86255 | $54.72 | $96.00 | $12.65 – $46.51 | 11 |
| Mayo pborb infectious agent nucleic acid amplified probe borrelia burgdorferi (lyme) CPT 87476 | not published | not published | $36.84 – $135.45 | 11 |
| Mayo phospholipid neutralization hexagonal lupus anticoagulant CPT 85598 | $54.72 | $96.00 | $18.88 – $69.40 | 11 |
| Mayo pntft phenytoin free therapeutic drug level CPT 80186 | $41.61 | $73.00 | $14.45 – $53.11 | 11 |
| Mayo pqnu porphobilinogen urine quantitative 24 hour urine CPT 84110 | $48.45 | $85.00 | $8.86 – $32.58 | 11 |
| Mayo pregnenolone CPT 84140 | $63.27 | $111.00 | $21.70 – $79.79 | 11 |
| Mayo prmb primidone therapeutic drug level CPT 80188 | $49.59 | $87.00 | $17.42 – $64.04 | 11 |
| Mayo proinsulin CPT 84206 | $71.82 | $126.00 | $25.47 – $103.02 | 11 |
| Mayo psaft prostate specific antigen free CPT 84154 | $65.55 | $115.00 | $19.31 – $70.99 | 11 |
| Mayo radioimmunoassay procollagen i intact n-terminal antibody quantitative CPT 83519 | $846.45 | $1,485.00 | $19.32 – $71.02 | 11 |
| Mayo rbcme osmotic fragility rbc incubated CPT 85557 | not published | not published | $14.03 – $51.57 | 11 |
| Mayo receptor assay transferrin soluble CPT 84238 | $62.70 | $110.00 | $38.40 – $141.16 | 11 |
| Mayo renin CPT 84244 | $78.66 | $138.00 | $23.09 – $84.88 | 11 |
| Mayo repu protein electrophoresis urine CPT 84166 | $63.84 | $112.00 | $18.72 – $68.82 | 11 |
| Mayo selenium CPT 84255 | $91.20 | $160.00 | $26.81 – $98.55 | 11 |
| Mayo semb semen analysis volume/count/motility/differential strict morphologic criteria CPT 89322 | not published | not published | $16.28 – $59.83 | 11 |
| Mayo serotonin CPT 84260 | not published | not published | $32.53 – $119.58 | 11 |
| Mayo sfgp rickettsia rickettsii antibody igg CPT 86757 | $68.97 | $121.00 | $20.32 – $74.69 | 11 |
| Mayo sirolimus therapeutic drug level CPT 80195 | $65.55 | $115.00 | $14.42 – $53.00 | 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.