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 |
|---|---|---|---|---|
| Ultrasound trgt dyn mbubb ea addl CPT 76979 | not published | not published | $42.89 – $104.14 | 6 |
| Ultraviolet therapy CPT 97028 | $54.15 | $95.00 | $9.67 – $15.10 | 7 |
| Umbilical artery cath newborn 36660 CPT 36660 | not published | not published | $71.63 – $255.04 | 7 |
| Umbilical cord occlud w/us CPT 59072 | not published | not published | $507.18 – $1,803.79 | 7 |
| Umbilicoplasty 15847 CPT 15847 | not published | not published | $1,200.75 – $1,200.75 | 2 |
| Unlisted CT procedure CPT 76497 | not published | not published | $182.03 – $182.03 | 2 |
| Unlisted cv px dx nuc med CPT 78499 | not published | not published | $848.52 – $848.52 | 2 |
| Unlisted cytogenetic study CPT 88299 | not published | not published | $15.07 – $63.73 | 3 |
| Unlisted cytopathology px CPT 88199 | not published | not published | $15.07 – $63.73 | 3 |
| Unlisted endocrine px dx nuc CPT 78099 | not published | not published | $848.52 – $848.52 | 2 |
| Unlisted fluoroscopic px CPT 76496 | not published | not published | $182.03 – $182.03 | 2 |
| Unlisted gi px dx nuc med CPT 78299 | not published | not published | $848.52 – $848.52 | 2 |
| Unlisted gu px dx nuc med CPT 78799 | not published | not published | $848.52 – $848.52 | 2 |
| Unlisted misc path test CPT 89240 | not published | not published | $15.07 – $63.73 | 3 |
| Unlisted mr procedure CPT 76498 | $1,457.49 | $2,557.00 | $182.03 – $182.03 | 2 |
| Unlisted muscskel px dx nuc CPT 78399 | not published | not published | $848.52 – $848.52 | 2 |
| Unlisted nrvs sys px dx nuc CPT 78699 | not published | not published | $848.52 – $848.52 | 2 |
| Unlisted procedure urinary 58750 CPT 58750 | not published | not published | $941.54 – $3,284.74 | 7 |
| Unlisted reprod med lab proc CPT 89398 | not published | not published | $15.07 – $63.73 | 3 |
| Unlisted resp px dx nuc med CPT 78599 | not published | not published | $848.52 – $848.52 | 2 |
| Unlisted surgical path px CPT 88399 | not published | not published | $15.07 – $63.73 | 3 |
| Unlisted transfusion med px CPT 86999 | not published | not published | $20.38 – $21.46 | 3 |
| Unlisted ultrasound procedure CPT 76999 | not published | not published | $182.03 – $182.03 | 2 |
| Unlstd hematop ret/endo lymp CPT 78199 | not published | not published | $848.52 – $848.52 | 2 |
| Upgrade pm system CPT 33214 | not published | not published | $476.63 – $26,705.00 | 8 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $2,474.94 | $4,342.00 | $115.76 – $293.52 | 7 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | not published | not published | $89.95 – $219.26 | 7 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $1,866.75 | $3,275.00 | $74.72 – $182.83 | 7 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | $234.27 | $411.00 | $126.80 – $673.55 | 7 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | $241.68 | $424.00 | $143.11 – $1,357.99 | 7 |
| Upper ext harvest for cabg1 seg 35600 CPT 35600 | not published | not published | $179.78 – $894.60 | 7 |
| Uppr gi scope w/submuc inj CPT 43236 | $242.25 | $425.00 | $143.11 – $1,361.40 | 7 |
| Urachal cyst/sinus excision 51500 CPT 51500 | not published | not published | $667.55 – $2,328.68 | 7 |
| Urea nitrogen CPT 84520 | $15.96 | $28.00 | $4.15 – $15.25 | 11 |
| Urea nitrogen 24 hour urine CPT 84540 | $18.24 | $32.00 | $5.84 – $21.46 | 11 |
| Urea nitrogen clearance CPT 84545 | not published | not published | $7.56 – $27.79 | 11 |
| Urea nitrogen semi-quant CPT 84525 | not published | not published | $5.39 – $19.80 | 11 |
| Ureteral embolization/occl CPT 50705 | not published | not published | $179.48 – $6,935.74 | 6 |
| Ureteral reflux study CPT 78740 | not published | not published | $28.28 – $66.89 | 7 |
| Ureter endoscopy CPT 50970 | not published | not published | $380.38 – $1,353.45 | 7 |
| Ureter endoscopy & biopsy CPT 50955 | not published | not published | $362.01 – $1,557.49 | 7 |
| Ureter endoscopy & biopsy CPT 50974 | not published | not published | $484.96 – $1,726.80 | 7 |
| Ureter endoscopy & catheter CPT 50972 | not published | not published | $367.36 – $1,308.45 | 7 |
| Ureter endoscopy & treatment CPT 50957 | not published | not published | $363.86 – $1,572.34 | 7 |
| Ureter endoscopy & treatment CPT 50961 | not published | not published | $326.01 – $1,417.31 | 7 |
| Ureter endoscopy & treatment CPT 50976 | not published | not published | $478.21 – $1,702.80 | 7 |
| Ureter endoscopy & treatment CPT 50980 | not published | not published | $365.51 – $1,301.78 | 7 |
| Ureteroneocystostomy 50780 CPT 50780 | not published | not published | $1,147.19 – $4,023.56 | 7 |
| Ureteroureterostomy 50760 CPT 50760 | not published | not published | $1,160.58 – $4,080.34 | 7 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | not published | not published | $16.71 – $40.03 | 7 |
| Urethrlys transvag with scope CPT 53500 | not published | not published | $776.65 – $2,726.93 | 7 |
| Urethrocystography void s&i CPT 74455 | not published | not published | $16.71 – $40.03 | 7 |
| Uric acid blood CPT 84550 | $25.08 | $44.00 | $4.75 – $17.45 | 11 |
| Uric acid urine CPT 84560 | $22.80 | $40.00 | $5.33 – $19.61 | 11 |
| Urinalysis glass test CPT 81020 | not published | not published | $4.94 – $18.14 | 11 |
| Urinalysis microscopic only CPT 81015 | $5.70 | $10.00 | $3.20 – $11.77 | 11 |
| Urinalysis qual/semiquant excpt ia CPT 81005 | not published | not published | $2.28 – $8.38 | 11 |
| Urinalysis (with microscopy) CPT 81001 | $26.79 | $47.00 | $3.33 – $12.24 | 11 |
| Urinalysis (without microscopy) CPT 81003 | $19.95 | $35.00 | $2.36 – $8.69 | 11 |
| Urinary bldr retent nuc study CPT 78730 | not published | not published | $8.09 – $19.37 | 7 |
| Urinary reflex study CPT 51792 | not published | not published | $57.01 – $202.88 | 7 |
| Urine Culture Test CPT 87086 | $63.84 | $112.00 | $8.47 – $31.15 | 11 |
| Urine flow measurement 51736 CPT 51736 | not published | not published | $8.60 – $18.41 | 7 |
| Urine pregnancy test CPT 81025 | $24.51 | $43.00 | $9.04 – $33.23 | 11 |
| Urine screen for bacteria CPT 81007 | not published | not published | $3.66 – $115.72 | 11 |
| Urine shunt to intestine CPT 50815 | not published | not published | $1,272.58 – $4,475.25 | 7 |
| Urography, antegrade CPT 74425 | not published | not published | $25.33 – $61.50 | 7 |
| Urography inf drip &/or bolus CPT 74410 | not published | not published | $24.58 – $58.88 | 7 |
| Use 1st target lesion CPT 76982 | not published | not published | $30.22 – $72.37 | 6 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | not published | not published | $204.29 – $226.18 | 2 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | not published | not published | $204.29 – $226.18 | 2 |
| Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im CPT 91320 | not published | not published | $183.54 – $203.21 | 2 |
| Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im CPT 91319 | not published | not published | $122.89 – $136.06 | 2 |
| Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im CPT 91318 | not published | not published | $91.50 – $101.60 | 2 |
| Vaccine dtap < 7 years im CPT 90700 | $28.50 | $50.00 | $38.27 – $38.27 | 2 |
| Vaccine dtap-hep b-ipv im CPT 90723 | $170.19 | $298.58 | $111.16 – $111.16 | 2 |
| Vaccine dtap-ipv 4-6 years im CPT 90696 | $57.57 | $101.00 | $72.66 – $72.66 | 2 |
| Vaccine dtap-ipv-hib-hepb im CPT 90697 | not published | not published | $564.12 – $564.12 | 2 |
| Vaccine dtap-ipv/hib im CPT 90698 | $125.97 | $221.00 | $214.07 – $214.07 | 2 |
| Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im CPT 90647 | $70.51 | $123.71 | $56.91 – $56.91 | 2 |
| Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 | $41.04 | $72.00 | $30.82 – $30.82 | 2 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | $166.44 | $292.00 | $98.11 – $1,400.00 | 7 |
| Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im CPT 90636 | $119.70 | $210.00 | $208.64 – $208.64 | 2 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im CPT 90633 | $34.20 | $60.00 | $44.10 – $44.10 | 2 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im CPT 90634 | not published | not published | $49.76 – $49.76 | 2 |
| Vaccine hepatitis b (hepb) adolescent 2 dose im CPT 90743 | not published | not published | $103.39 – $1,400.00 | 5 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | $59.28 | $104.00 | $43.68 – $1,400.00 | 7 |
| Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im CPT 90739 | $196.65 | $345.00 | $144.90 – $1,400.00 | 7 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | $30.78 | $54.00 | $22.68 – $1,400.00 | 7 |
| Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im CPT 90651 | $312.93 | $549.00 | $531.93 – $531.93 | 2 |
| Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im CPT 90649 | $220.02 | $386.00 | $180.05 – $180.05 | 2 |
| Vaccine influenza (iiv) preservative free antigen content im CPT 90662 | $111.67 | $195.91 | $82.28 – $1,400.00 | 7 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | $88.35 | $155.00 | $75.20 – $75.20 | 2 |
| Vaccine influenza nos 0.5ml dose im CPT 90658 | $22.23 | $39.00 | $21.81 – $21.81 | 2 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | $23.37 | $41.00 | $21.25 – $21.25 | 2 |
| Vaccine influenza quadrivalent (iiv4) 0.5ml dose im CPT 90688 | $19.95 | $35.00 | $14.70 – $1,400.00 | 7 |
| Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im CPT 90694 | not published | not published | $108.30 – $1,400.00 | 5 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im CPT 90685 | $27.36 | $48.00 | $27.34 – $27.34 | 2 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im CPT 90686 | $23.94 | $42.00 | $17.64 – $1,400.00 | 7 |
| Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im CPT 90687 | $17.10 | $30.00 | $12.60 – $1,400.00 | 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.