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 |
|---|---|---|---|---|
| Warde virus isolation tissue culture innoculation presumptive id herpes simplex CPT 87252 | not published | not published | $27.37 – $100.63 | 11 |
| Warde viscosity CPT 85810 | $41.61 | $73.00 | $12.25 – $45.05 | 11 |
| Warde vitamin a CPT 84590 | $75.24 | $132.00 | $12.19 – $44.81 | 11 |
| Warde vitamin b-1 (thiamine) CPT 84425 | $70.11 | $123.00 | $22.29 – $81.95 | 11 |
| Warde vitamin b6 (pyridoxine) CPT 84207 | $177.84 | $312.00 | $29.51 – $108.47 | 11 |
| Warde vitamin c (ascorbic acid) CPT 82180 | $26.79 | $47.00 | $10.38 – $38.18 | 11 |
| Warde vitamin d (1 25 dihydroxy) CPT 82652 | $135.09 | $237.00 | $40.43 – $148.61 | 11 |
| Warde vitamin e (alpha-tocopherol) CPT 84446 | $52.44 | $92.00 | $14.89 – $54.73 | 11 |
| Warde zinc CPT 84630 | $38.19 | $67.00 | $11.96 – $43.97 | 11 |
| Wash harvest stem cells CPT 38209 | not published | not published | $12.41 – $44.93 | 6 |
| Wbc automated CPT 85048 | $17.10 | $30.00 | $2.67 – $9.80 | 11 |
| Wcd device interrogate CPT 93292 | not published | not published | $21.99 – $71.76 | 7 |
| Wedge biopsy of liver 47100 CPT 47100 | $1,459.20 | $2,560.00 | $859.04 – $1,812.62 | 7 |
| Wedge rescj/bisctj ovary uni/bi 58920 CPT 58920 | not published | not published | $741.25 – $2,569.13 | 7 |
| Wedge resect of lung add-on 32506 CPT 32506 | not published | not published | $151.18 – $545.21 | 7 |
| Wedge resect of lung diag 32507 CPT 32507 | not published | not published | $150.82 – $545.21 | 7 |
| Wedge resect of lung initial 32505 CPT 32505 | not published | not published | $920.96 – $3,259.80 | 7 |
| Wedging of cast CPT 29740 | not published | not published | $69.93 – $350.40 | 7 |
| Wedging of clubfoot cast CPT 29750 | not published | not published | $78.25 – $379.65 | 7 |
| Western blot test CPT 84181 | not published | not published | $17.88 – $65.74 | 11 |
| Whfo w/joint(s) custom fab HCPCS L3806 | $1,135.44 | $1,992.00 | $414.14 – $414.14 | 2 |
| Whole blood for transfusion HCPCS P9010 | $294.12 | $516.00 | $148.18 – $148.18 | 2 |
| Whole body photography CPT 96904 | not published | not published | $73.27 – $221.90 | 7 |
| Whole mitochondrial genome CPT 81460 | not published | not published | $1,351.35 – $4,967.82 | 7 |
| Whole mitochondrial genome CPT 81465 | not published | not published | $982.80 – $3,612.96 | 7 |
| Wnd prep f/n/hf/g addl cm CPT 15005 | not published | not published | $89.77 – $433.43 | 7 |
| Wound closure by adhesive HCPCS G0168 | $13.68 | $24.00 | $14.80 – $14.80 | 4 |
| Wound therapy negative pressure per session <= 50 sq cm CPT 97607 | $391.59 | $687.00 | $21.73 – $402.14 | 6 |
| Wound therapy negative pressure per session > 50 sq cm CPT 97608 | not published | not published | $25.04 – $403.25 | 6 |
| Wound therapy negative pressure per session <= 50 sq cm dme CPT 97605 | $155.61 | $273.00 | $51.52 – $85.41 | 7 |
| Wound therapy negative pressure per session > 50 sq cm dme CPT 97606 | $229.71 | $403.00 | $57.20 – $90.48 | 7 |
| Wrist arthroscopy CPT 29840 | not published | not published | $475.90 – $1,621.01 | 7 |
| Wrist arthroscopy/surgery CPT 29843 | not published | not published | $511.48 – $1,735.31 | 7 |
| Wrist arthroscopy/surgery CPT 29844 | not published | not published | $524.89 – $1,795.95 | 7 |
| Wrist arthroscopy/surgery CPT 29845 | not published | not published | $615.26 – $2,094.11 | 7 |
| Wrist arthroscopy/surgery CPT 29846 | not published | not published | $549.43 – $1,876.54 | 7 |
| Wrist arthroscopy/surgery CPT 29847 | not published | not published | $569.19 – $1,943.18 | 7 |
| Wrist endoscopy/surgery CPT 29848 | not published | not published | $540.98 – $1,832.36 | 7 |
| Wrist X-ray CPT 73110 | $153.33 | $269.00 | $8.96 – $21.45 | 7 |
| Xcapsl ctrc rmvl cplx w/ecp CPT 66987 | not published | not published | $3,014.36 – $3,014.36 | 2 |
| Xcapsl ctrc rmvl cplx wo ecp CPT 66982 | not published | not published | $786.85 – $2,729.06 | 7 |
| Xcapsl ctrc rmvl insj 1+ CPT 66991 | not published | not published | $722.03 – $2,542.58 | 6 |
| Xcapsl ctrc rmvl w/ecp CPT 66988 | not published | not published | $2,466.98 – $2,466.98 | 2 |
| Xcpsl ctrc rmvl cplx insj 1+ CPT 66989 | not published | not published | $902.45 – $3,183.56 | 6 |
| Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/< CPT 14040 | not published | not published | $655.91 – $2,742.68 | 7 |
| Xfer tis s/a/l 10 sq cm/< CPT 14020 | not published | not published | $595.75 – $2,513.93 | 7 |
| X-linked intellectual dblt CPT 81470 | not published | not published | $959.70 – $3,528.04 | 7 |
| X-linked intellectual dblt CPT 81471 | not published | not published | $959.70 – $3,528.04 | 7 |
| Xm archive tissue molec anal CPT 88363 | not published | not published | $15.07 – $132.75 | 8 |
| Xpos opn axillary/sbclvn art w/cndt crtn CPT 34716 | not published | not published | $359.21 – $1,298.40 | 6 |
| Xpos opn fmrl eprst aor uni add-on CPT 34812 | not published | not published | $197.01 – $729.31 | 7 |
| X-ray abdomen 1 view CPT 74018 | $143.64 | $252.00 | $9.33 – $22.34 | 6 |
| X-ray abdomen 2 views CPT 74019 | $229.71 | $403.00 | $11.55 – $28.52 | 6 |
| X-ray abdomen >=3 views CPT 74021 | not published | not published | $13.76 – $32.96 | 6 |
| X-ray abdomen complete acute series including spine erect and/or decubitus single view chest CPT 74022 | $218.31 | $383.00 | $16.10 – $39.11 | 7 |
| X-ray acromioclavicular joints without or w/weighted distraction bilateral CPT 73050 | $85.50 | $150.00 | $9.69 – $25.03 | 7 |
| X-ray ankle 2 views (both sides) CPT 73600 | $63.27 | $111.00 | $8.23 – $20.56 | 7 |
| X-ray arthrogram shoulder supervision & interpretation (both sides) CPT 73040 | $576.27 | $1,011.00 | $28.35 – $67.03 | 7 |
| X-ray assay calculus CPT 82370 | not published | not published | $13.15 – $48.33 | 11 |
| X-ray bone age studies CPT 77072 | $59.85 | $105.00 | $9.70 – $23.24 | 7 |
| X-ray bone length studies CPT 77073 | $74.67 | $131.00 | $13.86 – $33.66 | 7 |
| X-ray bone survey complete CPT 77075 | $232.56 | $408.00 | $28.01 – $67.93 | 7 |
| X-ray bone survey infant CPT 77076 | $181.83 | $319.00 | $35.51 – $85.61 | 7 |
| X-ray cervical spine 2-3 views CPT 72040 | $195.51 | $343.00 | $11.54 – $27.63 | 7 |
| X-ray cervical spine 4-5 views CPT 72050 | $204.06 | $358.00 | $13.76 – $36.50 | 7 |
| X-ray cervical spine >= 6 views CPT 72052 | $287.85 | $505.00 | $15.36 – $42.23 | 7 |
| X-ray clavicle complete (both sides) CPT 73000 | $63.84 | $112.00 | $8.59 – $20.56 | 7 |
| X-ray colon abdominal radiograph(s) & delayed images single contrast study CPT 74270 | not published | not published | $52.23 – $126.81 | 7 |
| X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study CPT 74280 | not published | not published | $63.54 – $153.57 | 7 |
| X-ray elbow 2 views (both sides) CPT 73070 | $63.84 | $112.00 | $8.59 – $20.56 | 7 |
| X-ray elbow >= 3 views (both sides) CPT 73080 | $179.55 | $315.00 | $8.96 – $21.46 | 7 |
| Xray endovasc thor ao repr CPT 75956 | not published | not published | $0.02 – $805.76 | 7 |
| Xray endovasc thor ao repr CPT 75957 | not published | not published | $0.02 – $688.08 | 7 |
| X-ray esophogram chest radiograph(s) & delayed images single contrast study CPT 74220 | not published | not published | $30.23 – $73.26 | 7 |
| X-ray exam entire spi 4/5 vw CPT 72083 | $340.86 | $598.00 | $18.52 – $44.64 | 6 |
| X-ray exam entire spi 6/> vw CPT 72084 | $648.66 | $1,138.00 | $21.24 – $50.87 | 6 |
| X-ray exam of arm infant CPT 73092 | $148.77 | $261.00 | $8.23 – $19.72 | 7 |
| X-ray exam of eye sockets CPT 70200 | $93.48 | $164.00 | $14.49 – $34.70 | 7 |
| X-ray exam of femur 1 CPT 73551 | $192.66 | $338.00 | $8.59 – $20.56 | 6 |
| X-ray exam of jaw joint CPT 70328 | not published | not published | $9.33 – $22.34 | 7 |
| X-ray exam of jaw joint CPT 70332 | not published | not published | $27.28 – $66.19 | 7 |
| X-ray exam of mastoids CPT 70120 | not published | not published | $9.33 – $22.35 | 7 |
| X-ray exam of middle ear CPT 70134 | not published | not published | $18.51 – $43.45 | 7 |
| X-ray exam of penis CPT 74445 | not published | not published | $57.27 – $136.03 | 7 |
| X-ray exam of perineum CPT 74775 | not published | not published | $31.33 – $75.89 | 7 |
| X-ray exam of salivary gland CPT 70380 | not published | not published | $8.60 – $21.65 | 7 |
| X-ray exam of sinuses CPT 70210 | $67.83 | $119.00 | $8.96 – $21.46 | 7 |
| X-ray exam of tear duct CPT 70170 | not published | not published | $15.36 – $36.48 | 7 |
| X-ray exam of teeth CPT 70300 | not published | not published | $5.28 – $13.49 | 7 |
| X-ray exam of teeth CPT 70310 | not published | not published | $8.59 – $18.85 | 7 |
| X-ray exam si joints CPT 72200 | not published | not published | $8.60 – $21.46 | 7 |
| X-ray exam thorac spine4/>vw CPT 72074 | $239.40 | $420.00 | $12.65 – $30.31 | 7 |
| X-ray eye detection foreign body (both sides) CPT 70030 | $63.27 | $111.00 | $8.97 – $20.61 | 7 |
| X-ray facial bones complete > 3 views CPT 70150 | $106.02 | $186.00 | $13.38 – $32.91 | 7 |
| X-ray fallopian tube CPT 74742 | not published | not published | $30.96 – $75.00 | 7 |
| X-ray femur >=2 views (both sides) CPT 73552 | $222.87 | $391.00 | $9.33 – $22.35 | 6 |
| X-ray finger(s) >= 2 views (both sides) CPT 73140 | $106.02 | $186.00 | $7.11 – $17.01 | 7 |
| X-ray foot 2 views (both sides) CPT 73620 | $136.80 | $240.00 | $7.87 – $18.85 | 7 |
| X-ray forearm 2 views (both sides) CPT 73090 | $153.90 | $270.00 | $8.23 – $20.56 | 7 |
| X-ray hand 2 views (both sides) CPT 73120 | $106.02 | $186.00 | $8.59 – $20.56 | 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.