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 |
|---|---|---|---|---|
| Trichomonas assay w/optic CPT 87808 | not published | not published | $16.05 – $59.02 | 11 |
| #tricyclicantidprssnt CPT 80337 | $165.30 | $290.00 | $33.24 – $59.44 | 3 |
| Triglycerides CPT 84478 | $21.66 | $38.00 | $6.03 – $22.16 | 11 |
| Trimethobenzamide hcl inj HCPCS J3250 | $51.87 | $91.00 | $62.93 – $91.00 | 6 |
| Trim nondyst nails CPT 11719 | $54.15 | $95.00 | $7.89 – $36.30 | 7 |
| Trluml dil aq o/f can without st CPT 66174 | not published | not published | $661.00 – $3,446.25 | 7 |
| Trluml dil aq o/f can w/st CPT 66175 | not published | not published | $766.94 – $3,609.45 | 7 |
| Trml dstrj ios bvn 1st 2 l/s CPT 64628 | not published | not published | $431.81 – $1,654.31 | 6 |
| Trml dstrj ios bvn ea addl CPT 64629 | not published | not published | $203.10 – $767.33 | 6 |
| Trmt of fracture (femoral shaft) 27500 CPT 27500 | not published | not published | $505.90 – $1,864.76 | 7 |
| Trnscath plc stent crv crtd without prtct CPT 37216 | not published | not published | $1,027.22 – $3,634.43 | 6 |
| Trnscath plc stent crv crtd w/prtct CPT 37215 | not published | not published | $957.68 – $3,499.24 | 7 |
| Trnscath plc stnt ante carotid art CPT 37218 | not published | not published | $807.79 – $2,880.15 | 6 |
| Trnscath plc vas stent w/s&i ea addl artery CPT 37237 | not published | not published | $203.83 – $6,785.66 | 6 |
| Trnscath plc vas stent w/s&i ea addl vein CPT 37239 | not published | not published | $147.26 – $5,344.54 | 6 |
| Trnscath plc vas stent w/s&i ini vein CPT 37238 | not published | not published | $300.65 – $11,551.46 | 6 |
| Trnscath retrv pq vasc fb w/guide CPT 37197 | not published | not published | $298.66 – $5,829.60 | 7 |
| Trnscath tx thromblytc artery non-intracrn ini day CPT 37211 | not published | not published | $380.57 – $1,381.65 | 7 |
| Trnscath tx thromblytc art/ven sbsq day CPT 37213 | not published | not published | $228.47 – $839.89 | 7 |
| Trnscath tx thromblytc cath rmv sbsq day CPT 37214 | not published | not published | $120.15 – $441.75 | 7 |
| Trnscath tx thromblytc vein ini day CPT 37212 | not published | not published | $334.10 – $1,216.16 | 7 |
| Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm CPT 14301 | $1,028.28 | $1,804.00 | $901.87 – $2,359.99 | 7 |
| Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/< CPT 14302 | $510.72 | $896.00 | $218.45 – $783.56 | 7 |
| Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/< CPT 14060 | not published | not published | $699.98 – $2,788.16 | 7 |
| Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm CPT 14061 | not published | not published | $860.00 – $3,613.84 | 7 |
| Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm CPT 14021 | not published | not published | $742.73 – $3,125.21 | 7 |
| Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm CPT 14001 | not published | not published | $677.01 – $2,863.80 | 7 |
| Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/< CPT 14000 | not published | not published | $525.92 – $2,254.24 | 7 |
| Trnsplj pd lvr&bwl cd154+cll CPT 81560 | not published | not published | $672.77 – $2,473.22 | 7 |
| Trnsxj/repos abrrnt rnl vsls CPT 50100 | not published | not published | $1,084.41 – $3,802.46 | 7 |
| Troponin quantitative CPT 84484 | $87.78 | $154.00 | $13.09 – $48.13 | 11 |
| Tr retinal les preterm inf CPT 67229 | not published | not published | $1,219.33 – $4,240.88 | 7 |
| Trurl dstrj prst8 tiss rf wv CPT 53854 | not published | not published | $402.06 – $6,559.01 | 6 |
| Tubal Ligation (Laparoscopic) CPT 58670 | not published | not published | $387.29 – $1,334.85 | 7 |
| Tumor cell deplete of harvst CPT 38211 | not published | not published | $74.41 – $267.60 | 6 |
| Tvh >250 gms 58290 CPT 58290 | not published | not published | $1,188.13 – $4,167.45 | 7 |
| Tvh w/mmk 58267 CPT 58267 | not published | not published | $1,106.78 – $3,853.91 | 7 |
| Tx atrial fib pulm vein isol CPT 93656 | not published | not published | $924.88 – $16,158.00 | 8 |
| Tx closed hip disl traumatic without anes CPT 27250 | $441.18 | $774.00 | $179.28 – $645.56 | 7 |
| Tx closed tib fx proximal w/w/o manip w/skel trac CPT 27532 | not published | not published | $610.30 – $2,208.38 | 7 |
| Tx closed tib shaft fx without manip CPT 27750 | $441.18 | $774.00 | $350.12 – $763.44 | 7 |
| Tx contour defects >10.0 cc CPT 11954 | not published | not published | $113.84 – $568.69 | 7 |
| Tx contour defects 1.1-5.0cc 11951 CPT 11951 | not published | not published | $74.20 – $383.85 | 7 |
| Tx ectopic pregnancy abdl pregnancy 59130 CPT 59130 | not published | not published | $941.64 – $3,267.60 | 7 |
| Tx ectopic pregnancy ntrstl prtl rescj uter 59136 CPT 59136 | not published | not published | $893.46 – $3,098.18 | 7 |
| Tx l/r atrial fib addl CPT 93657 | not published | not published | $299.33 – $16,158.00 | 8 |
| Tx open art fx mcp/iphlngl jnt incl int fixtn ea CPT 26746 | not published | not published | $778.75 – $2,664.23 | 7 |
| Tx open dstl phlngl fx f/t internal fixation ea CPT 26765 | $643.53 | $1,129.00 | $535.33 – $1,089.86 | 7 |
| Tx open iphlngl jt disl internal fixation sngl CPT 26785 | not published | not published | $580.22 – $1,960.58 | 7 |
| Tx open nsl fx uncomp CPT 21325 | not published | not published | $472.58 – $1,580.33 | 7 |
| Tx open nsl sptl fx CPT 21336 | not published | not published | $673.85 – $2,302.76 | 7 |
| Tx phalangeal shaft fx open prox/middle ea CPT 26735 | $830.49 | $1,457.00 | $628.59 – $1,292.23 | 7 |
| Tx septic abortion surgical 59830 CPT 59830 | not published | not published | $466.85 – $1,576.95 | 7 |
| Tx tarsal bone fx without manip 28450 CPT 28450 | not published | not published | $208.89 – $769.84 | 7 |
| Tympanic membrane repair CPT 69610 | not published | not published | $301.10 – $1,358.89 | 7 |
| Tympanolysis transcanal 69450 CPT 69450 | not published | not published | $581.20 – $1,953.98 | 7 |
| Tympanometry & reflex thresh CPT 92550 | not published | not published | $23.52 – $73.58 | 7 |
| Tympanostomy/ven tube/loc/top anes 69433 CPT 69433 | $462.84 | $812.00 | $140.58 – $713.96 | 7 |
| Tympp antrt/mastoidotomy prosthesis torp 69637 CPT 69637 | not published | not published | $1,478.52 – $4,947.15 | 7 |
| Tympp antrt/mastoid without ossic chain recnst 69635 CPT 69635 | not published | not published | $1,340.61 – $4,434.53 | 7 |
| Tyms gene com variants CPT 81346 | not published | not published | $183.55 – $674.77 | 7 |
| Typhoid vaccine oral CPT 90690 | not published | not published | $148.91 – $148.91 | 2 |
| U2af1 gene common variants CPT 81357 | not published | not published | $202.91 – $745.95 | 7 |
| Ua w/micro/comp poc CPT 81000 | not published | not published | $4.22 – $15.52 | 11 |
| Ugt1a1 gene analy common variants CPT 81350 | not published | not published | $245.70 – $903.24 | 7 |
| Ultrasound abdomen aorta screening study aaa CPT 76706 | $271.89 | $477.00 | $27.65 – $67.08 | 6 |
| Ultrasound bone density measure CPT 76977 | not published | not published | $2.77 – $6.48 | 7 |
| Ultrasound breast complete CPT 76641 | $494.19 | $867.00 | $36.99 – $89.13 | 6 |
| Ultrasound breast unilateral limited (both sides) CPT 76642 | $371.07 | $651.00 | $34.41 – $82.96 | 6 |
| Ultrasound chest CPT 76604 | $314.64 | $552.00 | $28.79 – $70.66 | 7 |
| Ultrasound doppler velocimetry fetal umbilical artery CPT 76820 | not published | not published | $25.54 – $51.26 | 7 |
| Ultrasound dx ophth b-scan CPT 76512 | not published | not published | $32.78 – $98.07 | 7 |
| Ultrasound elastography ea l target les CPT 76983 | not published | not published | $26.50 – $61.46 | 6 |
| Ultrasound elastography parenchyma CPT 76981 | not published | not published | $30.22 – $72.37 | 6 |
| Ultrasound encephalogram CPT 76506 | not published | not published | $32.43 – $77.35 | 7 |
| Ultrasound exam follow-up CPT 76970 | not published | not published | $46.78 – $84.17 | 3 |
| Ultrasound exam k transpl w/doppler CPT 76776 | $493.05 | $865.00 | $38.10 – $93.25 | 7 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | not published | not published | $39.30 – $94.41 | 7 |
| Ultrasound guidance for vascular access CPT 76937 | $263.91 | $463.00 | $14.41 – $35.07 | 7 |
| Ultrasound guided needle placement supervision & interpretation CPT 76942 | $720.48 | $1,264.00 | $32.13 – $77.06 | 7 |
| Ultrasound guide intraoperative CPT 76998 | not published | not published | $46.96 – $144.29 | 7 |
| Ultrasound guide tissue ablation CPT 76940 | not published | not published | $102.51 – $236.41 | 7 |
| Ultrasound hips infant dynamic CPT 76885 | not published | not published | $37.36 – $90.87 | 7 |
| Ultrasound infant hips ltd without stress CPT 76886 | not published | not published | $31.33 – $75.89 | 7 |
| Ultrasound joint complete left CPT 76881 | not published | not published | $46.18 – $77.36 | 7 |
| Ultrasound joint/nonvascular extremity limited left CPT 76882 | $202.35 | $355.00 | $26.63 – $59.72 | 7 |
| Ultrasound nrv&acc strux 1xtr compre CPT 76883 | not published | not published | $36.80 – $61.55 | 6 |
| Ultrasound ob >=14wks ea addl gest CPT 76810 | $216.03 | $379.00 | $50.34 – $113.34 | 7 |
| Ultrasound pregnant uterus < 14 weeks each additional gestation CPT 76802 | $73.53 | $129.00 | $42.37 – $61.58 | 7 |
| Ultrasound pregnant uterus detailed fetal exam single/1st gestation CPT 76811 | not published | not published | $97.38 – $222.83 | 7 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | not published | not published | $43.71 – $104.11 | 7 |
| Ultrasound pregnant uterus limited >= 1 fetuses CPT 76815 | $343.71 | $603.00 | $32.81 – $79.43 | 7 |
| Ultrasound pregnant uterus transvaginal CPT 76817 | $285.57 | $501.00 | $38.32 – $91.79 | 7 |
| Ultrasound prostate/transrectal CPT 76872 | not published | not published | $34.89 – $82.71 | 7 |
| Ultrasound retroperitoneal limited CPT 76775 | $540.93 | $949.00 | $29.13 – $70.61 | 7 |
| Ultrasound scrotum and contents CPT 76870 | $558.03 | $979.00 | $32.08 – $77.67 | 7 |
| Ultrasound spinal canal and contents CPT 76800 | not published | not published | $63.03 – $138.86 | 7 |
| Ultrasound transabd ea addl gest CPT 76812 | not published | not published | $91.47 – $217.94 | 7 |
| Ultrasound transvaginal non obstetric CPT 76830 | $522.69 | $917.00 | $35.01 – $84.72 | 7 |
| Ultrasound trgt dyn mbubb 1st les CPT 76978 | not published | not published | $82.08 – $196.86 | 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.