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 |
|---|---|---|---|---|
| Assay myeloperoxidase CPT 83876 | not published | not published | $48.55 – $196.32 | 11 |
| Assay of adp & amp CPT 82030 | not published | not published | $27.09 – $99.59 | 11 |
| Assay of androsterone CPT 82160 | not published | not published | $26.83 – $98.62 | 11 |
| Assay of blood lipoprotein CPT 83719 | not published | not published | $13.39 – $49.22 | 11 |
| Assay of bradykinin CPT 82286 | not published | not published | $5.42 – $23.01 | 11 |
| Assay of breath ethanol CPT 82075 | $47.31 | $83.00 | $17.23 – $115.80 | 11 |
| Assay of cathepsin-d CPT 82387 | not published | not published | $18.96 – $69.71 | 11 |
| Assay of chloramphenicol CPT 82415 | not published | not published | $13.30 – $48.91 | 11 |
| Assay of corticosterone CPT 82528 | not published | not published | $23.65 – $86.93 | 11 |
| Assay of digoxin free CPT 80163 | not published | not published | $13.94 – $51.26 | 10 |
| Assay of endocrine hormone CPT 84235 | not published | not published | $74.51 – $274.95 | 11 |
| Assay of estrogen CPT 84233 | not published | not published | $92.13 – $339.22 | 11 |
| Assay of etiocholanolone CPT 82696 | not published | not published | $27.55 – $101.29 | 11 |
| Assay of feces for trypsin CPT 84490 | not published | not published | $10.43 – $38.33 | 11 |
| Assay of feces porphyrins CPT 84126 | not published | not published | $36.44 – $150.96 | 11 |
| Assay of feces/urobilinogen CPT 84577 | not published | not published | $17.64 – $64.85 | 11 |
| Assay of fluoride CPT 82735 | not published | not published | $19.47 – $71.56 | 11 |
| Assay of galactose CPT 82760 | not published | not published | $11.76 – $43.23 | 11 |
| Assay of gdh enzyme CPT 82965 | not published | not published | $11.05 – $50.76 | 11 |
| Assay of glucosidase CPT 82963 | not published | not published | $22.55 – $82.91 | 11 |
| Assay of glutathione CPT 82978 | not published | not published | $16.22 – $59.64 | 11 |
| Assay of haptoglobins CPT 83012 | not published | not published | $24.59 – $103.80 | 11 |
| Assay of idh enzyme CPT 83570 | not published | not published | $9.29 – $34.16 | 11 |
| Assay of interleukin-6 (il-6) CPT 83529 | $37.62 | $66.00 | $18.13 – $66.66 | 7 |
| Assay of intrinsic factor CPT 83528 | not published | not published | $20.81 – $76.51 | 11 |
| Assay of lap enzyme CPT 83670 | not published | not published | $10.30 – $37.87 | 11 |
| Assay of leflunomide CPT 80193 | not published | not published | $40.50 – $148.88 | 7 |
| Assay of lrh hormone CPT 83727 | not published | not published | $18.05 – $66.35 | 11 |
| Assay of methemalbumin CPT 83857 | not published | not published | $11.28 – $41.46 | 11 |
| Assay of neonatal thyroxine CPT 84437 | not published | not published | $6.79 – $24.97 | 11 |
| Assay of osteocalcin CPT 83937 | not published | not published | $31.34 – $115.22 | 11 |
| Assay of phenylketones CPT 84035 | not published | not published | $4.18 – $15.36 | 11 |
| Assay of pregnanediol CPT 84135 | not published | not published | $22.33 – $82.10 | 11 |
| Assay of pregnanetriol CPT 84138 | not published | not published | $22.10 – $81.25 | 11 |
| Assay of procainamide w/metab CPT 80192 | not published | not published | $17.59 – $64.66 | 11 |
| Assay of progesterone CPT 84234 | not published | not published | $68.12 – $250.44 | 11 |
| Assay of prostaglandin CPT 84150 | $258.78 | $454.00 | $35.70 – $161.23 | 11 |
| Assay of PSA complexed CPT 84152 | not published | not published | $19.31 – $70.99 | 11 |
| Assay of quinine CPT 84228 | not published | not published | $12.21 – $44.89 | 11 |
| Assay of rbc pg6d enzyme CPT 84085 | not published | not published | $9.64 – $36.44 | 11 |
| Assay of salicylate CPT 80179 | $33.06 | $58.00 | $19.57 – $71.95 | 7 |
| Assay of semen fructose CPT 82757 | not published | not published | $8.91 – $66.93 | 11 |
| Assay of sialic acid CPT 84275 | not published | not published | $14.11 – $51.88 | 11 |
| Assay of silica CPT 84285 | not published | not published | $26.47 – $97.31 | 11 |
| Assay of somatostatin CPT 84307 | not published | not published | $12.69 – $70.56 | 11 |
| Assay of thiocyanate CPT 84430 | not published | not published | $12.21 – $44.89 | 11 |
| Assay of troponin qual CPT 84512 | not published | not published | $10.59 – $38.95 | 11 |
| Assay of tyrosine CPT 84510 | not published | not published | $11.16 – $41.03 | 11 |
| Assay of urine sulfate CPT 84392 | $22.80 | $40.00 | $5.76 – $21.19 | 11 |
| Assay of urine urobilinogen CPT 84580 | not published | not published | $10.03 – $36.86 | 11 |
| Assay of urine urobilinogen CPT 84583 | not published | not published | $6.35 – $23.35 | 11 |
| Assay phosphatidylglycerol CPT 84081 | not published | not published | $17.35 – $63.77 | 11 |
| Assay phosphohexose enzymes CPT 84087 | not published | not published | $11.27 – $41.42 | 11 |
| Assay rbc glutathione CPT 82979 | not published | not published | $9.85 – $36.44 | 11 |
| Assay toxin or antitoxin CPT 87230 | not published | not published | $20.73 – $76.20 | 11 |
| Assess aphasia/interp/rpt/per hr 96105 CPT 96105 | $246.81 | $433.00 | $103.93 – $343.17 | 7 |
| Assess care plan pt w/cog impair 99483 CPT 99483 | not published | not published | $204.88 – $570.94 | 6 |
| Assess cyst contrast inject CPT 49424 | not published | not published | $38.24 – $613.65 | 7 |
| Assessment leukocyte fecal qualitative/semiquantitative CPT 89055 | not published | not published | $4.48 – $16.48 | 11 |
| Asses tinnit/pitch/loud/match/mask 92625 CPT 92625 | not published | not published | $65.13 – $234.84 | 7 |
| Assist-bilat spinal disk surgery add-on 63035 CPT 63035 | not published | not published | $226.99 – $658.16 | 7 |
| Assistive tech assessment, ot CPT 97755 | $132.24 | $232.00 | $47.14 – $73.31 | 7 |
| Assist oocyte fertilization CPT 89280 | not published | not published | $76.99 – $697.65 | 3 |
| Assist oocyte fertilization CPT 89281 | not published | not published | $76.99 – $180.91 | 3 |
| Ast/sgot CPT 84450 | $19.95 | $35.00 | $5.44 – $19.99 | 11 |
| Atezolizumab 60 mg/ml intravenous solution (wrapper) HCPCS J9022 | $146.89 | $257.71 | $115.67 – $257.71 | 6 |
| Athrectomy fem/pop/unilateral 37225 CPT 37225 | not published | not published | $580.73 – $41,085.98 | 7 |
| Athrectomy tib/pero/unilat/ini ves 37229 CPT 37229 | not published | not published | $675.94 – $41,229.23 | 7 |
| Atomic absorption CPT 82190 | not published | not published | $16.70 – $61.37 | 11 |
| Atropine 0.1 mg/ml injection syringe HCPCS J0461 | $0.38 | $0.67 | $0.12 – $0.42 | 6 |
| Attach bladder/urethra comp 51841 CPT 51841 | not published | not published | $842.46 – $2,890.76 | 7 |
| Attach bladder/urethra simple 51840 CPT 51840 | not published | not published | $726.89 – $2,483.81 | 7 |
| Attach ocular implant CPT 65140 | not published | not published | $988.34 – $3,152.93 | 7 |
| Attn at delivery+ 1 stabilization of newborn 99464 CPT 99464 | not published | not published | $76.78 – $164.96 | 7 |
| Aud brainstem implt programg CPT 92640 | not published | not published | $100.36 – $381.43 | 7 |
| Audiometry air + bone CPT 92553 | $70.68 | $124.00 | $49.00 – $105.92 | 7 |
| Auditory function 60 min CPT 92620 | not published | not published | $84.73 – $313.83 | 7 |
| Augmentation cheek bone CPT 21270 | not published | not published | $773.72 – $3,660.26 | 7 |
| Augmentation lower jaw bone CPT 21125 | not published | not published | $706.51 – $10,386.34 | 7 |
| Augmentation lower jaw bone CPT 21127 | not published | not published | $817.34 – $14,785.91 | 7 |
| Augmentation of facial bones CPT 21208 | not published | not published | $780.08 – $6,252.11 | 7 |
| Augumentation percutaneous vertebral inc cavity creation ea addl thoracic/lumbar vertebral body CPT 22515 | not published | not published | $217.87 – $13,524.41 | 6 |
| Augumentation percutaneous vertebral including cavity creation 1 vertebral body thoracic CPT 22513 | not published | not published | $518.50 – $24,227.40 | 6 |
| Autgrft implnt knee w/scope CPT 29866 | not published | not published | $1,090.12 – $3,748.88 | 7 |
| Autochondrocyte implant knee CPT 27412 | not published | not published | $1,689.00 – $5,882.96 | 7 |
| Autoimmune rheumatoid arthr anl 12 mrk ia CPT 81490 | not published | not published | $882.68 – $3,244.91 | 7 |
| Autologous blood op salvage CPT 86891 | not published | not published | $20.38 – $190.95 | 3 |
| Autologous blood process CPT 86890 | $258.78 | $454.00 | $66.34 – $135.17 | 3 |
| Automated diff wbc count CPT 85004 | $11.40 | $20.00 | $6.79 – $24.97 | 11 |
| Autonomic nrv adrenrg inervj CPT 95922 | not published | not published | $49.01 – $161.70 | 7 |
| Autonomic nrv parasym inervj CPT 95921 | not published | not published | $47.13 – $131.21 | 7 |
| Autonomic nrv syst funj test CPT 95923 | not published | not published | $47.25 – $153.42 | 7 |
| Avelumab 20 mg/ml intravenous solution HCPCS J9023 | $154.65 | $271.31 | $127.25 – $271.31 | 6 |
| Av fistula revision CPT 36833 | not published | not published | $785.17 – $2,833.24 | 7 |
| Av fuse uppr arm basilic CPT 36819 | not published | not published | $709.37 – $2,556.23 | 7 |
| Av fuse uppr arm cephalic CPT 36818 | not published | not published | $671.53 – $2,418.86 | 7 |
| Av fusion direct any site CPT 36821 | not published | not published | $642.51 – $2,322.04 | 7 |
| Av fusion/forearm vein 36820 CPT 36820 | not published | not published | $706.96 – $2,550.79 | 7 |
| Avul nail plate addl CPT 11732 | $123.69 | $217.00 | $17.75 – $83.33 | 7 |
| Avulsion nail plate partial/complete simple single nail plate CPT 11730 | $305.52 | $536.00 | $56.67 – $258.55 | 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.