Ascension Calumet Hospital

614 Memorial Drive, Chilton, WI 53014 · (920) 849-2386

Critical Access HospitalsVoluntary non-profit - PrivateAppleton, WI metro Website ↗Website taken from the domain of its price file

Price file

Prices published

File dated 2026-01-01

1,375 price rows for 68 procedures

Published prices

cash · negotiated range · list

Basic metabolic panel (blood test)

CPT 80048 · metro median $67

$98

cash

$9 to $33

20 negotiated rates

$172

list

CT scan of the abdomen and pelvis, with contrast

CPT 74177 · metro median $1,531

$1,553

cash

$92 to $818

13 negotiated rates

$2,725

list

CT scan of the head, no contrast

CPT 70450 · metro median $698

$641

cash

$43 to $392

13 negotiated rates

$1,124

list

CT scan of the pelvis, with contrast

CPT 72193 · metro median $823

$823

cash

$59 to $650

13 negotiated rates

$1,444

list

Cataract surgery with lens implant

CPT 66984

—

cash

$575 to $1,990

7 negotiated rates

—

list

Cesarean delivery with prenatal and postpartum care

CPT 59510

—

cash

$2,670 to $6,132

7 negotiated rates

—

list

Cesarean section hospital stay, no complications

MS-DRG 788

—

cash

$5,736 to $12,748

13 negotiated rates

—

list

Chlamydia test (DNA)

CPT 87491 · metro median $143

$157

cash

$37 to $135

20 negotiated rates

$275

list

Colonoscopy (diagnostic)

CPT 45378 · metro median $373

$373

cash

$190 to $1,198

13 negotiated rates

$654

list

Colonoscopy with biopsy

CPT 45380 · metro median $430

$430

cash

$207 to $1,548

13 negotiated rates

$755

list

Colonoscopy with polyp removal

CPT 45385 · metro median $600

$600

cash

$261 to $1,615

13 negotiated rates

$1,052

list

Complete blood count (CBC) with differential

CPT 85025 · metro median $32

$42

cash

$8 to $30

20 negotiated rates

$73

list

Comprehensive metabolic panel (blood test)

CPT 80053 · metro median $79

$116

cash

$11 to $41

20 negotiated rates

$203

list

Diagnostic mammogram (both breasts)

CPT 77066 · metro median $712

$726

cash

$50 to $406

12 negotiated rates

$1,273

list

Electrocardiogram (ECG) with interpretation

CPT 93000

—

cash

$15 to $55

7 negotiated rates

—

list

Established patient office visit (about 40 minutes)

CPT 99215 · lowest of 6 lines · metro median $243

$109

cash

$152 to $319

41 negotiated rates

$191

list

Family psychotherapy with the patient

CPT 90847

—

cash

$111 to $352

7 negotiated rates

—

list

Family psychotherapy without the patient

CPT 90846

—

cash

$107 to $340

7 negotiated rates

—

list

Gallbladder removal (laparoscopic)

CPT 47562 · metro median $1,354

$1,354

cash

$666 to $2,325

13 negotiated rates

$2,375

list

Gonorrhea test (DNA)

CPT 87591 · metro median $143

$157

cash

$37 to $135

20 negotiated rates

$275

list

Group psychotherapy

CPT 90853

—

cash

$26 to $92

7 negotiated rates

—

list

Hip or knee replacement, no major complications

MS-DRG 470

—

cash

$33,646 to $34,439

2 negotiated rates

—

list

Hospital stay for digestive disorders, no complications

MS-DRG 392

—

cash

$13,860 to $14,378

2 negotiated rates

—

list

Hysterectomy for non-cancer reasons, no complications

MS-DRG 743

—

cash

$20,600 to $21,267

2 negotiated rates

—

list

Inguinal hernia repair (age 5 and up)

CPT 49505 · metro median $901

$901

cash

$530 to $1,843

13 negotiated rates

$1,580

list

Knee arthroscopy with meniscus repair

CPT 29881 · metro median $1,080

$1,080

cash

$567 to $1,937

13 negotiated rates

$1,894

list

Laser treatment after cataract surgery (YAG)

CPT 66821

—

cash

$331 to $1,209

7 negotiated rates

—

list

Left heart catheterization

CPT 93452

—

cash

$233 to $2,963

7 negotiated rates

—

list

Lipid panel (cholesterol test)

CPT 80061 · metro median $55

$75

cash

$14 to $52

20 negotiated rates

$132

list

Liver function panel

CPT 80076 · metro median $65

$96

cash

$9 to $32

20 negotiated rates

$168

list

MRI of the brain, with and without contrast

CPT 70553 · metro median $1,818

$2,608

cash

$115 to $1,337

13 negotiated rates

$4,576

list

MRI of the knee or other lower joint, no contrast

CPT 73721 · metro median $1,015

$2,001

cash

$69 to $659

13 negotiated rates

$3,511

list

MRI of the lower back (lumbar spine), no contrast

CPT 72148 · metro median $1,472

$1,946

cash

$75 to $892

13 negotiated rates

$3,414

list

MRI of the neck (cervical spine), no contrast

CPT 72141 · metro median $1,701

$2,005

cash

$75 to $905

13 negotiated rates

$3,518

list

Neck (cervical) spinal fusion, no complications

MS-DRG 473

—

cash

$44,613 to $45,034

2 negotiated rates

—

list

Nerve block injection, lower back, with imaging guidance

CPT 64483 · metro median $1,253

$837

cash

$117 to $862

13 negotiated rates

$1,468

list

New patient office visit (about 30 minutes)

CPT 99203 · lowest of 2 lines · metro median $169

$100

cash

$86 to $234

19 negotiated rates

$176

list

New patient office visit (about 45 minutes)

CPT 99204 · lowest of 2 lines · metro median $176

$166

cash

$140 to $357

19 negotiated rates

$292

list

New patient office visit (about 60 minutes)

CPT 99205 · lowest of 2 lines · metro median $305

$211

cash

$191 to $452

19 negotiated rates

$370

list

PSA test (prostate)

CPT 84153 · lowest of 2 lines · metro median $31

$31

cash

$19 to $71

29 negotiated rates

$55

list

Partial thromboplastin time (blood clotting test)

CPT 85730 · metro median $24

$34

cash

$6 to $23

20 negotiated rates

$59

list

Physical therapy, therapeutic exercise (15 minutes)

CPT 97110 · lowest of 2 lines · metro median $99

$99

cash

$37 to $66

19 negotiated rates

$173

list

Pregnancy ultrasound (after first trimester)

CPT 76805 · metro median $431

$431

cash

$51 to $354

13 negotiated rates

$757

list

Preventive visit, new patient age 18 to 39

CPT 99385 · lowest of 3 lines · metro median $100

$100

cash

$99 to $291

22 negotiated rates

$176

list

Preventive visit, new patient age 40 to 64

CPT 99386 · lowest of 3 lines · metro median $107

$107

cash

$121 to $336

22 negotiated rates

$187

list

Prostate biopsy

CPT 55700

—

cash

$134 to $904

7 negotiated rates

—

list

Prostate removal (laparoscopic)

CPT 55866

—

cash

$1,240 to $5,277

7 negotiated rates

—

list

Prothrombin time (blood clotting test)

CPT 85610 · lowest of 2 lines · metro median $14

$20

cash

$5 to $17

29 negotiated rates

$35

list

Psychotherapy, 30 minutes

CPT 90832 · lowest of 2 lines · metro median $124

$124

cash

$75 to $233

19 negotiated rates

$217

list

Psychotherapy, 45 minutes

CPT 90834 · lowest of 2 lines · metro median $210

$166

cash

$99 to $310

19 negotiated rates

$291

list

Psychotherapy, 60 minutes

CPT 90837 · lowest of 2 lines · metro median $234

$234

cash

$146 to $464

19 negotiated rates

$411

list

Removal of a breast lump (biopsy by excision)

CPT 19120 · metro median $1,283

$541

cash

$427 to $1,788

13 negotiated rates

$949

list

Screening mammogram (both breasts)

CPT 77067 · metro median $310

$310

cash

$38 to $328

12 negotiated rates

$543

list

Shoulder arthroscopy with decompression

CPT 29826 · metro median $1,353

$1,353

cash

$173 to $621

13 negotiated rates

$2,374

list

Sleep study (overnight, attended)

CPT 95810 · metro median $3,551

$4,056

cash

$126 to $3,687

18 negotiated rates

$7,116

list

Spinal injection, lower back, no imaging guidance

CPT 62322 · lowest of 2 lines · metro median $669

$669

cash

$83 to $546

18 negotiated rates

$1,173

list

Spinal injection, lower back, with imaging guidance

CPT 62323 · lowest of 2 lines · metro median $1,147

$669

cash

$104 to $933

18 negotiated rates

$1,173

list

TSH test (thyroid)

CPT 84443 · metro median $68

$87

cash

$18 to $65

20 negotiated rates

$153

list

Tonsils and adenoids removal (under age 12)

CPT 42820

—

cash

$308 to $1,042

7 negotiated rates

—

list

Transvaginal ultrasound

CPT 76830 · metro median $342

$523

cash

$35 to $296

13 negotiated rates

$917

list

Ultrasound of the abdomen (complete)

CPT 76700 · metro median $552

$791

cash

$41 to $335

13 negotiated rates

$1,388

list

Upper endoscopy (EGD)

CPT 43235 · metro median $765

$234

cash

$127 to $1,017

13 negotiated rates

$411

list

Upper endoscopy with biopsy

CPT 43239 · metro median $242

$242

cash

$143 to $1,358

11 negotiated rates

$424

list

Urinalysis with microscope

CPT 81001 · metro median $18

$27

cash

$3 to $12

20 negotiated rates

$47

list

Vaginal delivery after a previous cesarean

CPT 59610

—

cash

$2,515 to $5,811

7 negotiated rates

—

list

Vaginal delivery hospital stay, no complications

MS-DRG 807

—

cash

$1,791 to $6,910

13 negotiated rates

—

list

Vaginal delivery with prenatal and postpartum care

CPT 59400

—

cash

$2,426 to $5,571

7 negotiated rates

—

list

X-ray of the lower spine (4 or more views)

CPT 72110 · metro median $227

$239

cash

$13 to $117

13 negotiated rates

$420

list

Source files

The machine-readable files this hospital lists in its cms-hpt.txt. Every price above comes from one of them.

https://healthcare.ascension.org/-/media/project/ascension/healthcare/price-transparency-files/wi-csv/390905385_ascension-calumet-hospital-inc_standardcharges.csv
Ascension Calumet Hospital, Inc. · parsed · tall v3.0.0 · file dated 2026-01-01 · 18.4 MB · 1375 price rows read · read Nov 2026