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 |
|---|---|---|---|---|
| Axillary lymphadenect/superficial 38740 CPT 38740 | not published | not published | $711.00 – $2,462.55 | 7 |
| Azathioprine 50 mg tablet HCPCS J7500 | $2.95 | $5.18 | $2.84 – $5.18 | 4 |
| Azithromycin 500 mg intravenous solution HCPCS J0456 | $15.12 | $26.52 | $2.51 – $11.00 | 6 |
| Baclofen eval charges CPT 97750 | $76.38 | $134.00 | $42.51 – $67.99 | 7 |
| Bacterial meningitis antigen CPT 86403 | $53.01 | $93.00 | $12.12 – $44.54 | 11 |
| Bacterial vaginosis pcr CPT 87801 | $120.27 | $211.00 | $73.71 – $270.97 | 11 |
| Bactericidal level serum CPT 87197 | not published | not published | $15.77 – $57.98 | 11 |
| #bac vag cand-c. albicans naa CPT 87481 | not published | not published | $36.84 – $135.45 | 11 |
| Balloon dilate urtrl strix CPT 50706 | not published | not published | $184.07 – $3,459.94 | 6 |
| Bartholin gland cyst/marsupializat 56440 CPT 56440 | not published | not published | $189.31 – $654.34 | 7 |
| Bartonella dna pcr-sendout CPT 87471 | not published | not published | $36.84 – $135.45 | 11 |
| Basic vestibular evaluation CPT 92540 | not published | not published | $45.90 – $89.54 | 7 |
| B cells total count CPT 86355 | $119.70 | $210.00 | $39.62 – $145.64 | 11 |
| Bcg live 50 mg intravesical suspension HCPCS J9030 | $5.13 | $9.00 | $4.09 – $9.00 | 6 |
| Bckdhb gene CPT 81205 | not published | not published | $99.74 – $366.66 | 7 |
| Behavior counsel obesity 15min medicare g0447 HCPCS G0447 | $95.76 | $168.00 | $24.57 – $86.16 | 6 |
| Benign lesion paring 2-4 CPT 11056 | $116.85 | $205.00 | $23.06 – $128.62 | 7 |
| Benign lesion paring 4+ CPT 11057 | $132.24 | $232.00 | $30.20 – $144.32 | 7 |
| #_benzodiazconfur CPT 80346 | $70.11 | $123.00 | $31.67 – $36.77 | 3 |
| Beta 2 glycoprotein 1 antibody iga CPT 86146 | $67.83 | $119.00 | $8.32 – $98.24 | 11 |
| Beta-2 microglobulin CPT 82232 | $57.57 | $101.00 | $16.99 – $62.45 | 11 |
| Betamethasone acetate and sodium phos 6 mg/ml suspension for injection HCPCS J0702 | $25.34 | $44.46 | $8.97 – $15.83 | 6 |
| Bevacizumab 25 mg/ml intravenous solution HCPCS J9035 | $104.88 | $184.00 | $84.50 – $184.00 | 7 |
| Bevacizumab-awwb 25 mg/ml intravenous solution HCPCS Q5107 | $127.42 | $223.55 | $38.99 – $223.55 | 6 |
| Bfb train 1st 15min cntct 90912 CPT 90912 | $143.07 | $251.00 | $45.23 – $110.49 | 6 |
| Bfb train ea addl 15 min 90913 CPT 90913 | $71.25 | $125.00 | $25.43 – $107.32 | 6 |
| B-hexosaminidase ea assay CPT 83080 | not published | not published | $17.71 – $65.12 | 11 |
| Bilateral laminotomy addl lumbar 63044 CPT 63044 | not published | not published | $1,075.54 – $1,075.54 | 2 |
| Bilateral n blobk inj pudendal 64430 CPT 64430 | $459.99 | $807.00 | $56.96 – $327.64 | 7 |
| Bilateral n block inj occipital 64405 CPT 64405 | $420.66 | $738.00 | $52.75 – $254.51 | 7 |
| Bilateral n block inj trigeminal 64400 CPT 64400 | $462.84 | $812.00 | $51.60 – $381.64 | 7 |
| Bile acids cholylglycine CPT 82240 | not published | not published | $27.91 – $102.60 | 11 |
| Bile duct endoscopy add-on 47550 CPT 47550 | not published | not published | $161.08 – $579.23 | 7 |
| Biliary endo perq dx w/speci CPT 47552 | not published | not published | $282.82 – $1,014.75 | 7 |
| Biliary endoscopy thru skin CPT 47553 | not published | not published | $282.74 – $1,023.75 | 7 |
| Biliary endoscopy thru skin CPT 47554 | not published | not published | $453.69 – $1,806.15 | 7 |
| Biliary endoscopy thru skin CPT 47555 | not published | not published | $336.61 – $1,217.14 | 7 |
| Biliary endoscopy thru skin CPT 47556 | not published | not published | $381.20 – $1,378.69 | 7 |
| Bilicheck CPT 88720 | $18.24 | $32.00 | $5.27 – $19.38 | 11 |
| Bilirubin direct CPT 82248 | $19.38 | $34.00 | $5.27 – $19.38 | 11 |
| Bilirubin total CPT 82247 | $19.38 | $34.00 | $5.27 – $19.38 | 11 |
| Bilobectomy 32482 CPT 32482 | not published | not published | $1,555.84 – $5,541.75 | 7 |
| Binder abdominal lg 12 x 62-74 HCPCS L0625 | $111.15 | $195.00 | $55.19 – $55.19 | 2 |
| Biofeedback, pt CPT 90901 | $132.24 | $232.00 | $20.53 – $134.15 | 7 |
| Biopsy abdominal mass CPT 49180 | not published | not published | $85.15 – $625.09 | 7 |
| Biopsy arm/elbow soft tissue CPT 24066 | not published | not published | $442.35 – $2,235.71 | 7 |
| Biopsy, bone open deep CPT 20245 | not published | not published | $350.82 – $1,349.47 | 7 |
| Biopsy bone trocar/needle superficial CPT 20220 | not published | not published | $90.61 – $904.54 | 7 |
| Biopsy cervixsingle/multiple 57500 CPT 57500 | $418.38 | $734.00 | $77.89 – $520.01 | 7 |
| Biopsy conjunctiva CPT 68100 | not published | not published | $100.57 – $649.88 | 7 |
| Biopsy/excision of lymph node(s); open deep 38530 CPT 38530 | not published | not published | $581.80 – $2,008.54 | 7 |
| Biopsy external ear 69100 CPT 69100 | $331.74 | $582.00 | $48.44 – $224.74 | 7 |
| Biopsy eyelid & lid margin CPT 67810 | not published | not published | $71.04 – $657.68 | 7 |
| Biopsy eye muscle CPT 67346 | not published | not published | $202.60 – $701.10 | 7 |
| Biopsy finger joint lining CPT 26105 | not published | not published | $364.35 – $1,217.18 | 7 |
| Biopsy finger joint lining CPT 26110 | not published | not published | $347.73 – $1,162.76 | 7 |
| Biopsy forearm soft tissues CPT 25066 | not published | not published | $390.17 – $1,285.31 | 7 |
| Biopsy hand joint lining CPT 26100 | not published | not published | $362.14 – $1,208.78 | 7 |
| Biopsy(ies) & aspiration(s) bone marrow diagnostic (both sides) CPT 38222 | $2,242.95 | $3,935.00 | $78.71 – $635.06 | 6 |
| Biopsy knee joint lining CPT 27330 | not published | not published | $447.05 – $1,477.05 | 7 |
| Biopsy lower leg soft tissue CPT 27613 | not published | not published | $170.56 – $918.86 | 7 |
| Biopsy lower leg soft tissue 27610 CPT 27610 | $1,055.64 | $1,852.00 | $675.19 – $1,408.39 | 7 |
| Biopsy muscle percutaneous needle CPT 20206 | $2,704.08 | $4,744.00 | $59.55 – $867.41 | 7 |
| Biopsy needle liver percutaneous CPT 47000 | not published | not published | $90.73 – $1,137.00 | 7 |
| Biopsy needle lymph node superficial CPT 38505 | $1,794.36 | $3,148.00 | $89.08 – $454.46 | 7 |
| Biopsy of cornea CPT 65410 | not published | not published | $108.02 – $524.81 | 7 |
| Biopsy of epididymis CPT 54800 | not published | not published | $130.05 – $459.38 | 7 |
| Biopsy of foot joint lining CPT 28050 | not published | not published | $300.36 – $1,565.78 | 7 |
| Biopsy of foot joint lining CPT 28052 | not published | not published | $275.55 – $1,638.53 | 7 |
| Biopsy of heart lining CPT 93505 | not published | not published | $225.19 – $715.31 | 7 |
| Biopsy of hip joint CPT 27052 | not published | not published | $608.06 – $2,065.76 | 7 |
| Biopsy of inestine 44100 CPT 44100 | not published | not published | $110.01 – $394.65 | 7 |
| Biopsy of lip 40490 CPT 40490 | $340.86 | $598.00 | $72.42 – $288.17 | 7 |
| Biopsy of nail unit 11755 CPT 11755 | $368.22 | $646.00 | $63.89 – $298.82 | 7 |
| Biopsy of nerve CPT 64795 | not published | not published | $193.60 – $670.80 | 7 |
| Biopsy of ovary(s) 58900 CPT 58900 | not published | not published | $456.94 – $1,547.25 | 7 |
| Biopsy of penis CPT 54105 | not published | not published | $223.63 – $983.74 | 7 |
| Biopsy of penis 54100 CPT 54100 | $430.35 | $755.00 | $127.66 – $725.21 | 7 |
| Biopsy of prostate CPT 55700 | not published | not published | $134.49 – $904.09 | 7 |
| Biopsy of prostate CPT 55705 | not published | not published | $276.90 – $971.93 | 7 |
| Biopsy of rectum wall anal approach 45100 CPT 45100 | not published | not published | $316.50 – $1,076.89 | 7 |
| Biopsy of sacroiliac joint CPT 27050 | not published | not published | $430.00 – $1,441.05 | 7 |
| Biopsy of salivary gland 42400 CPT 42400 | not published | not published | $55.76 – $376.61 | 7 |
| Biopsy of salivary glnd;incisional 42405 CPT 42405 | not published | not published | $239.14 – $1,089.83 | 7 |
| Biopsy of tear gland CPT 68510 | not published | not published | $301.53 – $1,655.89 | 7 |
| Biopsy of tear sac CPT 68525 | not published | not published | $268.91 – $957.68 | 7 |
| Biopsy of testis CPT 54500 | not published | not published | $77.57 – $271.16 | 7 |
| Biopsy of testis CPT 54505 | not published | not published | $219.87 – $767.66 | 7 |
| Biopsy of toe joint lining CPT 28054 | not published | not published | $252.38 – $1,382.81 | 7 |
| Biopsy of upper nose/throat CPT 42804 | not published | not published | $131.07 – $719.29 | 7 |
| Biopsy of urethra CPT 53200 | not published | not published | $146.91 – $573.83 | 7 |
| Biopsy of wrist joint CPT 25100 | not published | not published | $372.28 – $1,245.04 | 7 |
| Biopsy oocyte polar body CPT 89291 | not published | not published | $76.99 – $180.91 | 3 |
| Biopsy oocyte polar body <=5 CPT 89290 | not published | not published | $76.99 – $180.91 | 3 |
| Biopsy/removal lymph nodes CPT 38525 | $723.33 | $1,269.00 | $448.69 – $937.94 | 7 |
| Biopsy/removal lymph nodes 38520 CPT 38520 | not published | not published | $480.16 – $1,653.34 | 7 |
| Biopsy renal percutaneous trocar/needle (both sides) CPT 50200 | not published | not published | $130.94 – $1,984.61 | 7 |
| Biopsy roof of mouth CPT 42100 | not published | not published | $116.79 – $537.79 | 7 |
| Biopsy skin incisional single lesion CPT 11106 | $375.63 | $659.00 | $58.53 – $278.25 | 6 |
| Biopsy/soft tissue/neck or thorax 21550 CPT 21550 | not published | not published | $163.84 – $954.08 | 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.