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 |
|---|---|---|---|---|
| Biopsy thigh soft tissues CPT 27324 | not published | not published | $428.78 – $1,436.85 | 7 |
| Biopsy tongue anterior two-thirds CPT 41100 | not published | not published | $113.44 – $636.71 | 7 |
| Biopsy vaginal mucosa xtnsv CPT 57105 | not published | not published | $154.79 – $574.76 | 7 |
| Biopsy vestibule of mouth 40808 CPT 40808 | not published | not published | $94.63 – $580.99 | 7 |
| Biopsy vrt bdy open lmbr/crv CPT 20251 | not published | not published | $425.39 – $1,492.84 | 7 |
| Biopsy vrt bdy open thoracic CPT 20250 | not published | not published | $396.45 – $1,376.89 | 7 |
| Biotinidase - quest CPT 82261 | $29.07 | $51.00 | $17.71 – $65.12 | 11 |
| Bis xtracell fluid analysis CPT 93702 | $229.14 | $402.00 | $130.47 – $350.96 | 6 |
| Bladder irrigate/lavage/instill 51700 CPT 51700 | $526.11 | $923.00 | $30.85 – $180.76 | 7 |
| Bld exchange truj oth thn nb CPT 36455 | not published | not published | $121.78 – $441.90 | 7 |
| Bld prd mix CPT 86965 | not published | not published | $34.23 – $44.42 | 3 |
| Bld push tfuj 2 yr/< CPT 36440 | not published | not published | $52.82 – $189.11 | 7 |
| Bleomycin 15 unit solution for injection HCPCS J9040 | $37.62 | $66.00 | $34.41 – $66.00 | 6 |
| Blepharoplasty lower 15820 CPT 15820 | not published | not published | $550.92 – $2,087.89 | 7 |
| Blepharoplasty upper 15822 CPT 15822 | not published | not published | $423.06 – $1,646.70 | 7 |
| Blepharoplasty upper eyelid 15823 CPT 15823 | not published | not published | $586.56 – $2,238.53 | 7 |
| Blepharp lwr eyelid fat pad CPT 15821 | not published | not published | $585.09 – $2,231.93 | 7 |
| Blink reflex test CPT 95933 | not published | not published | $33.07 – $105.56 | 7 |
| Blm gene CPT 81209 | not published | not published | $41.28 – $151.74 | 7 |
| Block brachial plexus w/cath plmt w/img CPT 64416 | not published | not published | $80.73 – $238.50 | 7 |
| Block femoral nerve cont infusion cath w/img CPT 64448 | not published | not published | $75.42 – $227.74 | 7 |
| Block paracervical nrv CPT 64435 | not published | not published | $44.91 – $299.54 | 7 |
| Block plantar digital nerve CPT 64455 | $473.67 | $831.00 | $35.12 – $104.87 | 7 |
| Block tap inj(s) w/wo img bi CPT 64488 | not published | not published | $71.96 – $500.48 | 6 |
| Block tap inj(s) w/wo img uni CPT 64486 | not published | not published | $57.63 – $406.58 | 6 |
| Blood Clotting (PT/INR) Test CPT 85610 | $19.95 | $35.00 | $4.50 – $16.56 | 11 |
| Blood Clotting (PTT) Test CPT 85730 | $33.63 | $59.00 | $6.31 – $23.20 | 11 |
| Blood Count (CBC) Test CPT 85025 | $41.61 | $73.00 | $8.16 – $29.99 | 11 |
| Blood Count (CBC) Test (without differential) CPT 85027 | $34.20 | $60.00 | $6.79 – $24.97 | 11 |
| Blood count spun microhematocrit CPT 85013 | not published | not published | $3.39 – $27.02 | 11 |
| Blood Culture Test CPT 87040 | $112.29 | $197.00 | $10.84 – $39.84 | 11 |
| Blood draw capillary 36416 CPT 36416 | $25.08 | $44.00 | $3.00 – $6.80 | 4 |
| Blood gases o2 saturation direct measurement CPT 82805 | $100.32 | $176.00 | $40.58 – $304.05 | 11 |
| Blood gases ph venous CPT 82800 | $31.35 | $55.00 | $11.55 – $42.46 | 11 |
| Blood occult fecal hemoglobin immunoassay qualitative 1-3 simultaneous determinations diagnostic CPT 82274 | $49.02 | $86.00 | $16.72 – $61.45 | 11 |
| Blood occult feces 1-3 determinations other than neoplasm screening qualitative CPT 82272 | $19.38 | $34.00 | $4.44 – $16.33 | 11 |
| Blood occult feces colorectal neoplasm screening qualitative CPT 82270 | $17.10 | $30.00 | $4.60 – $16.91 | 11 |
| Blood occult peroxidase activity qualitative gastric CPT 82271 | $13.11 | $23.00 | $4.65 – $20.54 | 11 |
| Blood smear interpretation CPT 85060 | not published | not published | $25.00 – $56.81 | 8 |
| Blood smear microscopic w manual differential wbc count CPT 85007 | $13.68 | $24.00 | $3.99 – $14.67 | 11 |
| Blood split unit HCPCS P9011 | $288.99 | $507.00 | $211.86 – $211.86 | 2 |
| Blood typing abo CPT 86900 | $74.10 | $130.00 | $3.14 – $11.54 | 11 |
| Blood typing ag donor ea ag CPT 86902 | $209.76 | $368.00 | $5.47 – $24.51 | 11 |
| Blood typing patient serum CPT 86904 | $99.75 | $175.00 | $13.61 – $63.07 | 11 |
| Blood typing rbc ag non abo/rh ea CPT 86905 | $205.20 | $360.00 | $4.02 – $14.78 | 11 |
| Blood typing rh (d) CPT 86901 | $22.80 | $40.00 | $3.14 – $11.54 | 11 |
| Blood typing rh phenotype complete reference CPT 86906 | $26.22 | $46.00 | $8.14 – $29.92 | 11 |
| Blood volume CPT 78122 | not published | not published | $21.66 – $52.45 | 7 |
| Bone biopsy open superficial CPT 20240 | not published | not published | $146.32 – $531.56 | 7 |
| Bone Density Scan (DEXA) CPT 77080 | $255.36 | $448.00 | $10.35 – $24.13 | 7 |
| Bone imaging multiple areas CPT 78305 | not published | not published | $41.07 – $100.37 | 7 |
| Bone/joint imaging ltd area CPT 78300 | $453.15 | $795.00 | $30.98 – $75.89 | 7 |
| Bone marrow;aspiration only 38220 CPT 38220 | $134.52 | $236.00 | $70.59 – $358.80 | 7 |
| Bone marrow biopsyneedle/trocar 38221 CPT 38221 | $1,311.00 | $2,300.00 | $73.93 – $575.29 | 7 |
| Bone marrow harvest allogen CPT 38230 | not published | not published | $204.07 – $727.65 | 7 |
| Bone marrow harvest autolog CPT 38232 | not published | not published | $193.87 – $716.40 | 7 |
| Bone marrow imaging body CPT 78104 | not published | not published | $39.12 – $95.41 | 7 |
| Bone marrow imaging ltd CPT 78102 | not published | not published | $26.46 – $65.10 | 7 |
| Bone marrow imaging mult CPT 78103 | not published | not published | $32.37 – $86.38 | 7 |
| Bone marrow interpretation CPT 85097 | $1,100.10 | $1,930.00 | $49.79 – $202.20 | 8 |
| Bone/skin graft great toe CPT 20973 | not published | not published | $3,049.95 – $10,716.49 | 7 |
| Bone/skin graft metatarsal CPT 20972 | not published | not published | $2,889.11 – $10,146.45 | 7 |
| Bone survey-lead poisoning CPT 77074 | not published | not published | $22.36 – $54.39 | 7 |
| Boot softgait shrt m HCPCS L4387 | $435.48 | $764.00 | $158.84 – $158.84 | 2 |
| Borrelia antibody CPT 86619 | not published | not published | $14.05 – $51.65 | 11 |
| Borrelia burgdorferi (lyme disease) antibody nonspecific CPT 86618 | $54.15 | $95.00 | $17.88 – $65.74 | 11 |
| Borrelia miyamotoi amp prb CPT 87478 | not published | not published | $36.84 – $135.45 | 7 |
| Bortezomib 3.5 mg (2.5 mg/ml) solution for subcutaneous injection HCPCS J9041 | $10.10 | $17.72 | $2.68 – $17.72 | 6 |
| (both sides) smear without diff wbc count CPT 85008 | not published | not published | $3.60 – $13.24 | 11 |
| Bowel imaging CPT 78290 | not published | not published | $33.57 – $81.27 | 7 |
| Brace afo lg left 6607 HCPCS L1930 | $691.98 | $1,214.00 | $252.39 – $252.39 | 2 |
| Brace ank air stirrup univ HCPCS L4350 | $265.62 | $466.00 | $96.94 – $96.94 | 2 |
| Brace ankle stablizing lg HCPCS L1902 | $205.20 | $360.00 | $74.78 – $74.78 | 2 |
| Brace back epic lo 627 HCPCS L0642 | $601.92 | $1,056.00 | $411.77 – $411.77 | 2 |
| Brace back epic tslo 456 HCPCS L0457 | $1,455.78 | $2,554.00 | $996.39 – $996.39 | 2 |
| Brace knee playmaker ii x-rom hook and loop xl HCPCS L1833 | $1,131.45 | $1,985.00 | $690.06 – $690.06 | 2 |
| Brace m arm board HCPCS L3809 | $625.29 | $1,097.00 | $227.97 – $227.97 | 2 |
| Brace wrist classic lft sm HCPCS L3908 | $183.54 | $322.00 | $66.85 – $66.85 | 2 |
| Brachioplasty 15836 CPT 15836 | not published | not published | $827.56 – $2,681.59 | 7 |
| Brach/thor cath 1st CPT 36215 | not published | not published | $214.25 – $3,928.46 | 7 |
| Brach/thor cath 2nd CPT 36216 | not published | not published | $267.37 – $4,138.84 | 7 |
| Brach/thor cath 3rd CPT 36217 | not published | not published | $324.95 – $6,868.46 | 7 |
| Brach/thor cath addl CPT 36218 | not published | not published | $51.66 – $831.64 | 7 |
| Brachytx isodose complex CPT 77318 | not published | not published | $163.12 – $376.54 | 6 |
| Brachytx isodose intermed CPT 77317 | not published | not published | $103.47 – $239.15 | 6 |
| Brachytx isodose plan simple CPT 77316 | not published | not published | $78.98 – $182.80 | 6 |
| Braf gene CPT 81210 | $389.31 | $683.00 | $184.17 – $677.04 | 10 |
| Brain biopsy w/ct/mr guide CPT 61751 | not published | not published | $1,362.53 – $4,654.54 | 7 |
| Brain cavity shunt w/scope CPT 62201 | not published | not published | $1,198.23 – $4,082.10 | 7 |
| Brain flow imaging only CPT 78610 | not published | not published | $14.88 – $36.48 | 7 |
| Brain image < 4 views CPT 78600 | not published | not published | $22.00 – $53.54 | 7 |
| Brain image 4+ views CPT 78605 | not published | not published | $26.91 – $65.00 | 7 |
| Brain image w/flow < 4 views CPT 78601 | not published | not published | $25.33 – $61.51 | 7 |
| Brain image w/flow 4 + views CPT 78606 | not published | not published | $31.72 – $76.83 | 7 |
| Brain MRA (blood vessel MRI, with and without contrast) CPT 70546 | $1,963.65 | $3,445.00 | $74.72 – $205.38 | 7 |
| Brain MRA (blood vessel MRI, with contrast) CPT 70545 | not published | not published | $60.46 – $146.50 | 7 |
| Brain MRA (blood vessel MRI, without contrast) CPT 70544 | $1,897.53 | $3,329.00 | $60.46 – $146.50 | 7 |
| Brain MRI (with and without contrast) CPT 70553 | $2,608.32 | $4,576.00 | $115.40 – $280.34 | 7 |
| Brain MRI (with contrast) CPT 70552 | $2,068.53 | $3,629.00 | $89.95 – $217.97 | 7 |
| Brain MRI (without contrast) CPT 70551 | $1,943.70 | $3,410.00 | $74.72 – $181.49 | 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.