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 |
|---|---|---|---|---|
| Small bowel endoscopy CPT 44382 | not published | not published | $76.87 – $1,042.50 | 7 |
| Small bowel endoscopy CPT 44384 | not published | not published | $156.96 – $561.08 | 6 |
| Small bowel endoscopy >2nd w/remove 44363 CPT 44363 | not published | not published | $197.68 – $701.81 | 7 |
| Small bowel endoscopy 44365 CPT 44365 | not published | not published | $188.00 – $666.30 | 7 |
| Small bowel endoscopy/biopsy CPT 44361 | not published | not published | $163.72 – $580.61 | 7 |
| Small bowel endoscopy/biopsy CPT 44377 | not published | not published | $307.62 – $1,096.58 | 7 |
| Small bowel endoscopy br/wa CPT 44380 | not published | not published | $59.84 – $666.23 | 7 |
| Small bowel endoscopy br/wa CPT 44381 | not published | not published | $87.92 – $3,576.68 | 6 |
| Small bowel endoscopy/stent 44370 CPT 44370 | not published | not published | $275.48 – $976.76 | 7 |
| Smallpox&monkeypox vac 0.5ml CPT 90611 | not published | not published | $0.02 – $0.02 | 2 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $35.91 | $63.00 | $5.66 – $20.81 | 11 |
| Smear gram stain CPT 87205 | $33.06 | $58.00 | $4.48 – $16.48 | 11 |
| Smear nasal eosinophil CPT 89190 | $18.24 | $32.00 | $6.08 – $22.35 | 11 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $22.80 | $40.00 | $6.29 – $23.12 | 11 |
| Smear wet mount CPT 87210 | $33.63 | $59.00 | $6.11 – $22.47 | 11 |
| Smn1 gene full gene sequence CPT 81336 | not published | not published | $316.42 – $1,163.21 | 7 |
| Smn1 gen nown famil seq vrnt CPT 81337 | not published | not published | $194.46 – $714.87 | 7 |
| Smpd1 gene common variants CPT 81330 | not published | not published | $49.35 – $181.42 | 7 |
| Snrpn/ube3a gene CPT 81331 | $221.16 | $388.00 | $53.62 – $197.13 | 7 |
| So airplane w/wo joint cf HCPCS L3674 | $2,955.45 | $5,185.00 | $1,077.71 – $1,077.71 | 2 |
| So cap design without jnts cf HCPCS L3671 | $2,252.64 | $3,952.00 | $821.53 – $821.53 | 2 |
| Sodium 24 hour urine CPT 84300 | $23.94 | $42.00 | $5.31 – $19.53 | 11 |
| Sodium chloride 0.9 % IV bolus HCPCS J7050 | $1.14 | $2.00 | $0.65 – $2.00 | 6 |
| Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous HCPCS J2916 | $14.25 | $25.00 | $2.94 – $22.93 | 6 |
| Sodium hyaluronate 20 mg/2 ml syringe HCPCS J7321 | $109.44 | $192.00 | $101.35 – $192.00 | 7 |
| Sodium serum/plasma/whole blood CPT 84295 | $19.38 | $34.00 | $5.05 – $18.57 | 11 |
| Somatosensory testing CPT 95927 | not published | not published | $28.94 – $90.96 | 7 |
| Sp bone agrft morsel add-on CPT 20937 | not published | not published | $163.48 – $582.75 | 7 |
| Sp bone agrft struct add-on CPT 20938 | not published | not published | $177.85 – $632.03 | 7 |
| Sp bone algrft morsel add-on CPT 20930 | not published | not published | $421.73 – $421.73 | 2 |
| Special physics consult CPT 77370 | not published | not published | $151.35 – $291.95 | 7 |
| Special pump services CPT 99190 | not published | not published | $1,400.81 – $1,400.81 | 2 |
| Special pump services CPT 99191 | not published | not published | $980.47 – $980.47 | 2 |
| Special pump services CPT 99192 | not published | not published | $701.21 – $701.21 | 2 |
| Special radiation dosimetry CPT 77331 | not published | not published | $44.10 – $49.34 | 7 |
| Special radiation treatment CPT 77470 | not published | not published | $60.61 – $114.61 | 7 |
| Special teletx port plan CPT 77321 | not published | not published | $53.75 – $103.91 | 7 |
| Specific gravity body fluid CPT 84315 | $7.41 | $13.00 | $3.44 – $12.66 | 11 |
| Specimen fat stain CPT 89125 | not published | not published | $6.17 – $22.70 | 11 |
| Speech audiometry complete CPT 92556 | $62.13 | $109.00 | $47.93 – $104.92 | 7 |
| Speech evaluation complex CPT 70371 | not published | not published | $44.30 – $103.25 | 7 |
| Speech recep thresh CPT 92555 | $41.04 | $72.00 | $30.81 – $66.45 | 7 |
| Sperm antibody test CPT 89325 | not published | not published | $11.20 – $41.19 | 11 |
| Sperm evaluation test CPT 89329 | not published | not published | $18.24 – $75.62 | 11 |
| Sperm identification CPT 89257 | not published | not published | $49.79 – $63.73 | 3 |
| Sperm isolation complex CPT 89261 | not published | not published | $49.79 – $63.73 | 3 |
| Sperm isolation simple CPT 89260 | not published | not published | $49.79 – $63.73 | 3 |
| Sperm washing 58323 CPT 58323 | not published | not published | $12.28 – $55.13 | 7 |
| Sphenoid sinus surgery CPT 31051 | not published | not published | $735.19 – $2,406.26 | 7 |
| Sphincteroplasty inc/prolapse adult 46750 CPT 46750 | not published | not published | $775.22 – $2,720.33 | 7 |
| Spinal bone allograftstructural 20931 CPT 20931 | not published | not published | $106.87 – $380.21 | 7 |
| Spinal bone autograftlocal 20936 CPT 20936 | not published | not published | $448.95 – $448.95 | 2 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | not published | not published | $88.72 – $942.00 | 6 |
| Spirmtry w/brnchdil inf-2 yr CPT 94012 | not published | not published | $146.18 – $468.16 | 7 |
| Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 | $396.72 | $696.00 | $10.82 – $43.74 | 7 |
| Spirometry up to 2 yrs old CPT 94011 | not published | not published | $89.56 – $287.23 | 7 |
| Spleen imaging CPT 78185 | not published | not published | $17.18 – $45.42 | 7 |
| Splenectomy total open 38100 CPT 38100 | not published | not published | $1,150.79 – $4,063.80 | 7 |
| Splice spleen/kidney veins CPT 37181 | not published | not published | $2,295.58 – $8,144.55 | 7 |
| Splicing of ureters CPT 50770 | not published | not published | $1,196.64 – $4,218.41 | 7 |
| Splint dorsal bloc wh med perf 3.2mm lf polyflex ii HCPCS L3906 | $1,267.11 | $2,223.00 | $462.05 – $462.05 | 2 |
| Splint extn xsm w sof-stretch rolyan HCPCS L3925 | $164.16 | $288.00 | $59.89 – $59.89 | 2 |
| Splint finger frog med HCPCS L3927 | $103.74 | $182.00 | $31.92 – $31.92 | 2 |
| Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 % CPT 15120 | not published | not published | $716.92 – $3,062.10 | 7 |
| Split blood or products CPT 86985 | not published | not published | $20.38 – $34.97 | 3 |
| Splt agrft f/s/n/h/f/g/m ea CPT 15121 | not published | not published | $133.73 – $757.73 | 7 |
| Spontaneous nystagmus study CPT 92531 | not published | not published | $46.75 – $46.75 | 2 |
| Sprchoroidal spc njx rx agt CPT 67516 | not published | not published | $102.05 – $102.05 | 4 |
| Sputum specimen collection CPT 89220 | not published | not published | $20.46 – $39.89 | 8 |
| Srs cranial lesion complex CPT 61798 | not published | not published | $1,345.79 – $4,645.35 | 7 |
| Srs cranial lesion simple CPT 61796 | not published | not published | $999.77 – $3,420.49 | 7 |
| Srs cran les complex addl CPT 61799 | not published | not published | $286.43 – $1,011.49 | 7 |
| Srs cran les simple addl CPT 61797 | not published | not published | $207.22 – $731.81 | 7 |
| Srsf2 gene common variants CPT 81348 | not published | not published | $184.17 – $677.04 | 7 |
| Srs linear based CPT 77372 | not published | not published | $1,015.39 – $2,508.27 | 7 |
| Srs multisource CPT 77371 | not published | not published | $2,593.48 – $2,593.48 | 2 |
| Srs spinal lesion CPT 63620 | not published | not published | $1,101.61 – $3,772.84 | 7 |
| Srs spinal lesion addl CPT 63621 | not published | not published | $238.12 – $841.28 | 7 |
| Staggered spondaic word test CPT 92572 | not published | not published | $56.85 – $111.91 | 7 |
| Staging lapro hodgkins disease/lymphoma 49220 CPT 49220 | not published | not published | $2,018.28 – $4,343.64 | 3 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $178.41 | $313.00 | $118.83 – $299.57 | 6 |
| Staph a dna amp probe CPT 87640 | $108.87 | $191.00 | $36.84 – $135.45 | 11 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $212.61 | $373.00 | $110.86 – $363.32 | 7 |
| Stem cells total count CPT 86367 | not published | not published | $53.96 – $300.23 | 11 |
| Stenger test pure tone CPT 92565 | not published | not published | $22.24 – $50.16 | 7 |
| Stenger test speech CPT 92577 | not published | not published | $23.31 – $44.38 | 7 |
| Stent/athrectomy/fem/pop/unilat 37227 CPT 37227 | not published | not published | $694.39 – $52,834.76 | 7 |
| Stent iliac/open or perc/uni/init 37221 CPT 37221 | not published | not published | $475.69 – $14,168.78 | 7 |
| Stent iliac/open/perc/ea ad/ipsila 37223 CPT 37223 | not published | not published | $203.72 – $6,946.61 | 7 |
| Stent placemt retro carotid CPT 37217 | not published | not published | $1,043.18 – $3,771.68 | 6 |
| Stent/tib/peroneal/unilat/initial 37230 CPT 37230 | not published | not published | $671.93 – $37,062.00 | 7 |
| Stereotactic bx aspir/exc burr intracranial les 61750 CPT 61750 | not published | not published | $1,373.41 – $4,738.69 | 7 |
| Stereotactic radiation trmt CPT 77432 | not published | not published | $450.04 – $1,037.56 | 7 |
| Sternal debridement CPT 21627 | not published | not published | $562.39 – $1,913.89 | 7 |
| St evaluate speech sound production CPT 92522 | $168.15 | $295.00 | $120.61 – $258.13 | 6 |
| St evaluate speech sound production comprehensive/expressive CPT 92523 | $310.08 | $544.00 | $247.87 – $316.30 | 6 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $271.32 | $476.00 | $98.99 – $304.74 | 7 |
| St evaluation swallow function CPT 92610 | $410.97 | $721.00 | $76.08 – $289.43 | 7 |
| Stimulants synthetic CPT 80371 | not published | not published | $31.67 – $33.34 | 3 |
| Stimulation of spinal cord CPT 63610 | not published | not published | $554.59 – $1,939.91 | 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.