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 |
|---|---|---|---|---|
| Partial removal of nose CPT 30150 | not published | not published | $842.07 – $2,832.19 | 7 |
| Partial removal of pancreas CPT 48145 | not published | not published | $1,625.62 – $5,749.76 | 7 |
| Partial removal of pancreas CPT 48150 | not published | not published | $3,100.98 – $10,968.04 | 7 |
| Partial removal of penis CPT 54120 | not published | not published | $662.61 – $2,309.59 | 7 |
| Partial removal of pharynx 42890 CPT 42890 | not published | not published | $1,478.83 – $5,143.01 | 7 |
| Partial removal of radius CPT 25151 | not published | not published | $615.46 – $2,094.04 | 7 |
| Partial removal of radius CPT 25230 | not published | not published | $459.69 – $1,553.33 | 7 |
| Partial removal of rectum CPT 45111 | not published | not published | $1,105.50 – $3,872.14 | 7 |
| Partial removal of rectum CPT 45114 | not published | not published | $1,805.22 – $6,387.79 | 7 |
| Partial removal of rectum CPT 45116 | not published | not published | $1,594.70 – $5,634.90 | 7 |
| Partial removal of rib CPT 21600 | not published | not published | $585.39 – $1,964.14 | 7 |
| Partial removal of sternum CPT 21620 | not published | not published | $512.42 – $1,790.06 | 7 |
| Partial removal of thyroid CPT 60220 | $1,412.46 | $2,478.00 | $728.31 – $1,534.40 | 7 |
| Partial removal of thyroid CPT 60225 | not published | not published | $965.71 – $3,324.83 | 7 |
| Partial removal of tibia CPT 27640 | not published | not published | $865.49 – $2,982.34 | 7 |
| Partial removal of toe CPT 28160 | not published | not published | $286.58 – $1,534.01 | 7 |
| Partial removal of tongue CPT 41120 | not published | not published | $1,110.84 – $3,851.03 | 7 |
| Partial removal of tongue CPT 41130 | not published | not published | $1,369.59 – $4,751.06 | 7 |
| Partial removal of ulna CPT 25119 | not published | not published | $529.89 – $1,785.68 | 7 |
| Partial removal of ulna CPT 25150 | not published | not published | $596.31 – $2,028.15 | 7 |
| Partial removal of ulna CPT 25240 | $610.47 | $1,071.00 | $456.74 – $928.09 | 7 |
| Partial removal of vaginal wall 57106 CPT 57106 | not published | not published | $564.17 – $1,866.56 | 7 |
| Partial removal tear gland CPT 68505 | not published | not published | $1,121.01 – $3,675.45 | 7 |
| Partial thyroid excision CPT 60210 | not published | not published | $725.82 – $2,513.44 | 7 |
| Partial thyroid lobect w/contratlat stot lobec 60212 CPT 60212 | not published | not published | $1,029.02 – $3,609.41 | 7 |
| Part removal hip bone deep CPT 27071 | not published | not published | $1,009.79 – $3,381.30 | 7 |
| Part removal of metatarsal CPT 28110 | $466.83 | $819.00 | $314.39 – $1,047.98 | 7 |
| Part removal of metatarsal CPT 28113 | $691.41 | $1,213.00 | $457.35 – $1,335.44 | 7 |
| Part removal of metatarsal 28112 CPT 28112 | not published | not published | $334.35 – $1,795.76 | 7 |
| Part remove hip bone super CPT 27070 | $1,173.63 | $2,059.00 | $920.68 – $1,828.48 | 7 |
| Passy muir valve metal trach HCPCS L8501 | $245.10 | $430.00 | $120.56 – $120.56 | 2 |
| Path clin consltj high 41-60 CPT 80505 | $278.16 | $488.00 | $94.24 – $133.09 | 6 |
| Path clin consltj mod 21-40 CPT 80504 | $278.16 | $488.00 | $50.24 – $73.54 | 6 |
| Path clin consltj prolng svc CPT 80506 | not published | not published | $45.30 – $59.86 | 6 |
| Path clin consltj sf 5-20 CPT 80503 | $88.35 | $155.00 | $23.41 – $36.86 | 6 |
| Patient recorded spirometry CPT 94014 | not published | not published | $60.07 – $183.84 | 7 |
| Patient recorded spirometry CPT 94015 | not published | not published | $34.02 – $98.80 | 7 |
| Pca3/klk3 antigen CPT 81313 | not published | not published | $267.80 – $984.49 | 10 |
| Pdgfra gene CPT 81314 | not published | not published | $345.99 – $1,271.91 | 10 |
| Pdt dstr prmlg les phys/qhp CPT 96573 | not published | not published | $242.92 – $699.49 | 6 |
| Pedcle fh/ch/ch/m/n/ax/g/h/f CPT 15574 | not published | not published | $771.32 – $3,246.11 | 7 |
| Ped crit care age 2-5 init CPT 99475 | not published | not published | $585.87 – $1,235.27 | 7 |
| Ped crit care age 2-5 subsq CPT 99476 | not published | not published | $352.76 – $761.57 | 7 |
| Ped crit care transport CPT 99466 | not published | not published | $245.09 – $525.77 | 7 |
| Ped crit care transport addl CPT 99467 | not published | not published | $122.97 – $263.92 | 7 |
| Ped critical care initial CPT 99471 | not published | not published | $818.19 – $1,754.60 | 7 |
| Ped critical care subsq CPT 99472 | not published | not published | $417.10 – $885.69 | 7 |
| Ped home apnea mntr att only CPT 94775 | not published | not published | $150.44 – $150.44 | 2 |
| Ped home apnea mntr dl&alys CPT 94776 | not published | not published | $711.79 – $711.79 | 2 |
| Pedicle enel/ntroral 15576 CPT 15576 | not published | not published | $681.07 – $2,888.96 | 7 |
| Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector HCPCS J2506 | $957.24 | $1,679.37 | $85.45 – $1,554.72 | 7 |
| Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe HCPCS Q5108 | $622.70 | $1,092.46 | $135.04 – $1,092.46 | 6 |
| Pelvic CT scan (with and without contrast) CPT 72194 | not published | not published | $61.21 – $149.15 | 7 |
| Pelvic CT scan (with contrast) CPT 72193 | $823.08 | $1,444.00 | $58.62 – $141.78 | 7 |
| Pelvic CT scan (without contrast) CPT 72192 | $609.90 | $1,070.00 | $54.94 – $132.98 | 7 |
| Pelvic exenteration CPT 45126 | not published | not published | $2,800.94 – $9,963.79 | 7 |
| Pelvic MRI (with and without contrast) CPT 72197 | $2,014.38 | $3,534.00 | $110.85 – $268.29 | 7 |
| Pelvic MRI (with contrast) CPT 72196 | not published | not published | $87.02 – $211.79 | 7 |
| Pelvic MRI (without contrast) CPT 72195 | $1,411.32 | $2,476.00 | $73.97 – $178.84 | 7 |
| Pelvic Ultrasound (complete) CPT 76856 | $607.05 | $1,065.00 | $34.66 – $83.85 | 7 |
| Pelvic Ultrasound (limited) CPT 76857 | $470.25 | $825.00 | $24.95 – $56.35 | 7 |
| Pembrolizumab 25 mg/ml intravenous solution HCPCS J9271 | $93.73 | $164.44 | $53.57 – $164.44 | 7 |
| Peng benzathine/procaine inj HCPCS J0558 | $17.10 | $30.00 | $22.04 – $30.00 | 5 |
| Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe HCPCS J0561 | $21.66 | $38.00 | $11.14 – $38.00 | 7 |
| Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr HCPCS J2540 | $6.63 | $11.63 | $1.15 – $11.63 | 6 |
| Penicillin g procaine inj HCPCS J2510 | $42.75 | $75.00 | $29.31 – $75.00 | 5 |
| Penile injection CPT 54235 | $302.10 | $530.00 | $77.26 – $194.83 | 7 |
| Penile vascular study CPT 93980 | not published | not published | $63.63 – $197.16 | 7 |
| Penile vascular study CPT 93981 | not published | not published | $22.13 – $71.83 | 7 |
| Penile venous occlusion CPT 37790 | not published | not published | $508.01 – $1,778.66 | 7 |
| Penis plastic surgery CPT 54360 | not published | not published | $753.32 – $2,638.31 | 7 |
| Penis study CPT 54240 | not published | not published | $66.86 – $135.30 | 7 |
| Perc cryo ablate renal tum CPT 50593 | not published | not published | $470.50 – $15,831.45 | 7 |
| Perc rf ablate renal tumor CPT 50592 | not published | not published | $353.08 – $11,709.56 | 7 |
| Percut ablate liver rf CPT 47382 | not published | not published | $754.58 – $16,085.78 | 7 |
| Pericardial drain w/cath pq w/ct guid CPT 33019 | not published | not published | $214.17 – $804.68 | 6 |
| Pericardiectomy/sub or com/w bypas 33031 CPT 33031 | not published | not published | $2,414.32 – $8,649.53 | 7 |
| Pericardiocentesis wwo imaging CPT 33016 | not published | not published | $229.53 – $832.09 | 6 |
| Pericardiotomy/clot/for bod remove 33020 CPT 33020 | not published | not published | $814.02 – $2,890.43 | 7 |
| Peri-implt capslc brst compl CPT 19371 | not published | not published | $737.19 – $2,836.09 | 7 |
| Perineoplasty rpr per nonob CPT 56810 | not published | not published | $285.01 – $966.83 | 7 |
| Peripheral vascular rehab CPT 93668 | $93.48 | $164.00 | $15.47 – $49.42 | 6 |
| Peri-proc device eval icd CPT 93287 | not published | not published | $22.97 – $77.67 | 7 |
| Peri-proc device eval pm CPT 93286 | not published | not published | $15.59 – $52.05 | 7 |
| Peritoneal cath sub q resv per CPT 49419 | not published | not published | $420.68 – $1,550.78 | 7 |
| Peritoneogram rs&i CPT 74190 | not published | not published | $23.26 – $56.57 | 7 |
| Perit-vens shunt pat tst CPT 78291 | not published | not published | $44.49 – $104.83 | 7 |
| Perq art m-thrombect &/nfs CPT 61645 | not published | not published | $824.30 – $2,924.40 | 6 |
| Perq clsr tcat l atr apndge CPT 33340 | not published | not published | $762.90 – $2,780.25 | 6 |
| Perq dev breast 1st mr guide CPT 19287 | not published | not published | $130.38 – $2,837.33 | 6 |
| Perq dev breast 1st strtctc CPT 19283 | not published | not published | $102.49 – $991.76 | 6 |
| Perq nl/pl lithotrp cplx>2cm CPT 50081 | not published | not published | $1,167.11 – $4,671.45 | 7 |
| Perq nl/pl lithotrp smpl<2cm CPT 50080 | not published | not published | $726.18 – $3,178.31 | 7 |
| Perq p-art revsc 1 abnor bi CPT 33903 | not published | not published | $859.62 – $3,126.04 | 6 |
| Perq p-art revsc 1 abnor uni CPT 33902 | not published | not published | $729.34 – $2,652.04 | 6 |
| Perq p-art revsc 1 nm nt bi CPT 33901 | not published | not published | $755.28 – $2,746.31 | 6 |
| Perq p-art revsc 1 nm nt uni CPT 33900 | not published | not published | $574.72 – $2,089.09 | 6 |
| Perq p-art revsc each addl CPT 33904 | not published | not published | $288.34 – $1,048.50 | 6 |
| Perq plmt bile duct stent CPT 47538 | not published | not published | $238.80 – $15,649.39 | 6 |
| Perq plmt bile duct stent CPT 47539 | not published | not published | $432.72 – $17,251.01 | 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.