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 syphilis test non-treponemal antibody qualitative vdrl CPT 86592 | $26.22 | $46.00 | $4.48 – $16.48 | 11 |
| Mayo tcgr analysis gene rearrangement trb@ abnormal clonal population(s) amplification CPT 81340 | not published | not published | $219.37 – $806.43 | 10 |
| Mayo tgrp testosterone free CPT 84402 | $75.24 | $132.00 | $26.74 – $98.31 | 11 |
| Mayo tgrp testosterone total CPT 84403 | $124.83 | $219.00 | $27.10 – $99.63 | 11 |
| Mayo thiopurine s-methyltransferase CPT 84433 | not published | not published | $23.28 – $85.58 | 7 |
| Mayo thyroglobulin CPT 84432 | $57.57 | $101.00 | $16.86 – $61.99 | 11 |
| Mayo ticks anaplasma phagocytophilum antibody igg CPT 86666 | $18.24 | $32.00 | $8.32 – $39.29 | 11 |
| Mayo ticks babesia microti antibody igg CPT 86753 | $43.89 | $77.00 | $8.32 – $47.83 | 11 |
| Mayo tramadol definitive assay w metabolite quantitative urine CPT 80373 | $243.96 | $428.00 | $29.42 – $31.67 | 3 |
| Mayo ttfb testosterone bioavailable direct CPT 84410 | $87.78 | $154.00 | $53.84 – $197.94 | 8 |
| Mayo tulab francisella tularensis antibody igg CPT 86668 | not published | not published | $14.87 – $54.66 | 11 |
| Mayo valpg valproic acid free therapeutic drug level CPT 80165 | $61.56 | $108.00 | $14.22 – $52.26 | 10 |
| Mayo vasoactive intestinal peptide CPT 84586 | $100.32 | $176.00 | $18.24 – $136.37 | 11 |
| Mayo vitamin b-2 (riboflavin) CPT 84252 | $162.45 | $285.00 | $21.25 – $78.13 | 11 |
| Mayo vitamin b3 (niacin) CPT 84591 | $71.82 | $126.00 | $16.60 – $65.85 | 11 |
| Mayo vitamin k CPT 84597 | $40.47 | $71.00 | $14.41 – $52.96 | 11 |
| Mayo zonisamide therapeutic drug level CPT 80203 | $52.44 | $92.00 | $13.91 – $51.15 | 10 |
| Maze/extensive/w/card/pulm bypass 33259 CPT 33259 | not published | not published | $838.36 – $2,960.66 | 7 |
| Mcoln1 gene CPT 81290 | not published | not published | $41.28 – $151.74 | 7 |
| Mcp joint arthroscopy dx CPT 29900 | not published | not published | $532.91 – $1,785.19 | 7 |
| Mcp joint arthroscopy surg CPT 29901 | not published | not published | $569.67 – $1,919.48 | 7 |
| Mcp joint arthroscopysurg 29902 CPT 29902 | not published | not published | $602.87 – $2,036.51 | 7 |
| Mcrscp xm hair pluck/clipped CPT 96902 | not published | not published | $74.36 – $74.36 | 2 |
| Mdfc flap w/prsrv vasc pedcl CPT 15730 | not published | not published | $962.48 – $5,460.08 | 6 |
| Meas lung vol thru 2 yrs CPT 94013 | not published | not published | $19.58 – $71.75 | 7 |
| Measure kidney pressure CPT 50396 | not published | not published | $120.58 – $432.38 | 7 |
| Measurement post void urine by ultrasound CPT 51798 | $111.72 | $196.00 | $11.90 – $42.60 | 7 |
| Measure ureter pressure CPT 50686 | not published | not published | $92.18 – $512.74 | 7 |
| #mec-opiates CPT 80356 | not published | not published | $31.67 – $36.29 | 3 |
| Mecp2 gene dup/delet variant CPT 81304 | not published | not published | $157.50 – $579.00 | 7 |
| Mecp2 gene full seq CPT 81302 | not published | not published | $554.26 – $2,037.58 | 7 |
| Mecp2 gene known variant CPT 81303 | not published | not published | $126.00 – $463.20 | 7 |
| Medial canthopexy CPT 21280 | not published | not published | $625.68 – $2,103.83 | 7 |
| Mediastinoscpy w/lmph nod bx CPT 39402 | not published | not published | $394.77 – $1,410.15 | 6 |
| Mediastinoscpy w/medstnl bx 39401 CPT 39401 | not published | not published | $303.65 – $1,078.39 | 6 |
| Medical services after hrs CPT 99050 | not published | not published | $58.51 – $58.51 | 2 |
| Med physic dos eval rad exps CPT 76145 | not published | not published | $950.63 – $2,079.01 | 6 |
| Medroxyprogesterone 150 mg/ml im injection (wrapper) HCPCS J1050 | $1.14 | $2.00 | $0.84 – $0.84 | 2 |
| Med serv 10pm-8am 24 hr fac CPT 99053 | not published | not published | $58.51 – $58.51 | 2 |
| Med serv eve/wkend/holiday CPT 99051 | not published | not published | $58.51 – $58.51 | 2 |
| Meg evoked each addl CPT 95967 | not published | not published | $180.17 – $626.08 | 7 |
| Meg evoked single CPT 95966 | not published | not published | $207.98 – $716.05 | 7 |
| Meg spontaneous CPT 95965 | not published | not published | $435.28 – $1,413.25 | 7 |
| Meniscal trnspl knee w/scpe CPT 29868 | not published | not published | $1,710.19 – $5,959.16 | 7 |
| Meperidine (pf) 25 mg/ml injection (wrapper) HCPCS J2175 | $11.40 | $20.00 | $9.13 – $9.82 | 6 |
| Meperidine/promethazine inj HCPCS J2180 | $4.56 | $8.00 | $4.93 – $4.93 | 2 |
| Meropenem 1 gram intravenous solution HCPCS J2185 | $5.02 | $8.80 | $0.50 – $8.04 | 6 |
| Mesh/prosth/ pelvic floor rpr/vag 57267 CPT 57267 | not published | not published | $256.48 – $918.68 | 7 |
| Metabolic Blood Panel (Basic) CPT 80048 | $98.04 | $172.00 | $8.88 – $32.66 | 11 |
| Metabolic Blood Panel (Comprehensive) CPT 80053 | $115.71 | $203.00 | $11.09 – $40.76 | 11 |
| Metabolic panel ionized ca CPT 80047 | $98.04 | $172.00 | $12.10 – $53.00 | 11 |
| Metatarsal joint implant HCPCS L8641 | $2,821.50 | $4,950.00 | $349.34 – $349.34 | 2 |
| Methotrexate sodium 2.5 mg tablet HCPCS J8610 | $2.59 | $4.54 | $0.36 – $4.54 | 6 |
| Methotrexate sodium (pf) 1 gram solution for injection HCPCS J9260 | $4.56 | $8.00 | $3.26 – $8.00 | 6 |
| Methotrexate therapeutic drug level CPT 80204 | not published | not published | $40.50 – $148.88 | 7 |
| Methylergonovine 0.2 mg/ml (1 ml) injection solution HCPCS J2210 | $49.56 | $86.94 | $29.53 – $49.00 | 6 |
| Methylnaltrexone 12 mg/0.6 ml subcutaneous injection (wrapper) HCPCS J2212 | $2.39 | $4.18 | $2.85 – $2.85 | 2 |
| Methylphenidate CPT 80360 | not published | not published | $29.42 – $31.67 | 3 |
| Methylprednisolone acetate 40 mg/ml suspension for injection HCPCS J1010 | $1.14 | $2.00 | $0.18 – $0.22 | 2 |
| Metoclopramide in d5w IV syringe 0.2 mg/ml (neo/ped) - cnr HCPCS J2765 | $2.28 | $4.00 | $1.43 – $4.00 | 6 |
| Metronidazole 500 mg/100 ml in sodium chlor(iso) intravenous piggyback HCPCS J1836 | $4.99 | $8.76 | $0.03 – $8.76 | 6 |
| Metyrapone panel CPT 80436 | not published | not published | $95.72 – $351.88 | 11 |
| Mgmt promoter methylation analysis CPT 81287 | not published | not published | $87.24 – $481.11 | 10 |
| Microalbumin urine screen CPT 82044 | not published | not published | $4.34 – $24.05 | 11 |
| Microbe susceptible mlc CPT 87187 | not published | not published | $14.83 – $155.06 | 11 |
| Microdissection laser CPT 88380 | not published | not published | $55.83 – $171.27 | 8 |
| Microdissection manual CPT 88381 | $132.24 | $232.00 | $24.88 – $144.22 | 8 |
| Microfluid analy tears CPT 83861 | not published | not published | $23.60 – $86.77 | 11 |
| Microsatellite instability CPT 81301 | not published | not published | $365.99 – $1,345.44 | 10 |
| Microsurg tehniq require use oper micro (add-on)69990 CPT 69990 | not published | not published | $205.50 – $726.94 | 7 |
| Microvolt t-wave assess CPT 93025 | not published | not published | $39.63 – $124.69 | 7 |
| Midazolam 1 mg/ml injection solution HCPCS J2250 | $1.22 | $2.14 | $0.22 – $1.22 | 6 |
| Middle cerebral artery echo CPT 76821 | not published | not published | $35.98 – $85.31 | 7 |
| Mitochondrial gene CPT 81440 | not published | not published | $3,490.20 – $12,830.64 | 7 |
| Mitomycin 40 mg intravenous solution HCPCS J9280 | $118.56 | $208.00 | $39.63 – $208.00 | 7 |
| Mitral valve replacement w/bypass 33430 CPT 33430 | not published | not published | $2,735.79 – $9,791.29 | 7 |
| Mlh1 gene CPT 81288 | not published | not published | $167.62 – $742.36 | 10 |
| Mlh1 gene dup/delete variant CPT 81294 | not published | not published | $199.91 – $781.26 | 10 |
| Mlh1 gene full seq CPT 81292 | not published | not published | $677.52 – $2,607.04 | 10 |
| Mlh1 gene known variants CPT 81293 | not published | not published | $271.60 – $1,277.66 | 10 |
| Mlt fam grp bhv train 1st 60 CPT 96202 | not published | not published | $22.93 – $80.65 | 6 |
| Mlt fam grp bhv train ea add CPT 96203 | not published | not published | $6.26 – $20.82 | 6 |
| Mlt osteot rlgnm imed rd hum CPT 24410 | not published | not published | $1,093.49 – $3,772.09 | 7 |
| Mnl appl strs jt radiography CPT 77071 | not published | not published | $57.89 – $124.79 | 7 |
| Mnl prep&insj dp rx dlvr dev CPT 20700 | not published | not published | $85.55 – $300.83 | 6 |
| Mnl prep&insj i-artic rx dev CPT 20704 | not published | not published | $151.16 – $520.50 | 6 |
| Mnl prep&insj imed rx dev CPT 20702 | not published | not published | $143.85 – $499.65 | 6 |
| Mnpj anes sho jt fixj aprats CPT 23700 | $290.70 | $510.00 | $205.10 – $423.08 | 7 |
| Mnpj elbow under anes CPT 24300 | not published | not published | $473.85 – $1,539.26 | 7 |
| Mnpj of tmj w/anesth CPT 21073 | not published | not published | $253.67 – $1,397.48 | 7 |
| Mnt subs tx for change dx HCPCS G0270 | $51.87 | $91.00 | $30.18 – $81.64 | 6 |
| Mobilization of colon 44139 CPT 44139 | $264.48 | $464.00 | $118.92 – $426.75 | 7 |
| Modification of contact lens CPT 92325 | not published | not published | $43.65 – $143.95 | 7 |
| Modified maze/limited 33254 CPT 33254 | not published | not published | $1,339.16 – $4,731.86 | 7 |
| Modified maze/limited /w other op 33257 CPT 33257 | not published | not published | $577.22 – $2,040.04 | 7 |
| Mog-igg1 antb flo cytmtry ea CPT 86363 | not published | not published | $16.63 – $145.64 | 7 |
| Monovisc inj per dose HCPCS J7327 | $945.06 | $1,658.00 | $1,010.35 – $1,658.00 | 8 |
| Mopath procedure level 1 CPT 81400 | $221.16 | $388.00 | $67.16 – $246.89 | 7 |
| Mopath procedure level 3 CPT 81402 | not published | not published | $157.85 – $580.27 | 7 |
| Mopath procedure level 5 CPT 81404 | $221.16 | $388.00 | $288.57 – $1,060.84 | 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.