Ascension Calumet Hospital, Inc.
Ascension Calumet Hospital, Inc. in Chilton, WI publishes cash prices for 57 common procedures listed here, from its own machine-readable price file updated —. Click a procedure to compare it with other hospitals nearby.
614 Memorial Dr Chilton WI 53014 Collected Sep 23, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN PELVIS W CONTRAST | $1,553.25 | $2,725.00 | 43% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD WO CONTRAST | $640.68 | $1,124.00 | 43% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST | $823.08 | $1,444.00 | 43% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC DX MAMMO INCL CAD BI | $725.61 | $1,273.00 | 43% |
| Diagnostic mammogram, one breast CPT 77065 HC DX MAMMO INCL CAD UNI | $581.40 | $1,020.00 | 43% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI JOINT LOWER EXTREMITY WO CONTRAST | $2,001.27 | $3,511.00 | 43% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI JOINT LOWER EXTREMITY W/WO CONTRAST | $2,253.21 | $3,953.00 | 43% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN WO CONTRAST | $1,943.70 | $3,410.00 | 43% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W/WO CONTRAST | $2,608.32 | $4,576.00 | 43% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE WO CONTRAST | $1,945.98 | $3,414.00 | 43% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB 14 WKS / > SINGLE FETUS | $431.49 | $757.00 | 43% |
| Screening mammogram, both breasts both sides CPT 77067 HC SCREEN MAMMO BI INCL CAD | $309.51 | $543.00 | 43% |
| Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMNOGRAM STUDY | $4,056.12 | $7,116.00 | 43% |
| Transvaginal pelvic ultrasound CPT 76830 HC US NON-OB TRANSVAGINAL | $522.69 | $917.00 | 43% |
| Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMINAL COMPLETE | $791.16 | $1,388.00 | 43% |
| X-ray of the lower back, 4 or more views CPT 72110 HC X-RAY EXAM L-2 SPINE 4/>VWS | $239.40 | $420.00 | 43% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL-CALCIUM, TOTAL | $98.04 | $172.00 | 43% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL | $75.24 | $132.00 | 43% |
| Complete blood count (CBC) with differential CPT 85025 HC COMPLETE CBC W/AUTO DIFFERENTIAL WBC | $41.61 | $73.00 | 43% |
| Complete blood count (CBC), no differential CPT 85027 HC COMPLETE CBC AUTOMATED | $34.20 | $60.00 | 43% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHENSIVE METABOLIC PANEL | $115.71 | $203.00 | 43% |
| Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL | $95.76 | $168.00 | 43% |
| Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL | $95.76 | $168.00 | 43% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE | $65.55 | $115.00 | 43% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL | $31.35 | $55.00 | 43% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA SCREENING | $96.33 | $169.00 | 43% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA OR WB | $33.63 | $59.00 | 43% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME | $19.95 | $35.00 | 43% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME - POC | $19.95 | $35.00 | 43% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC ASSAY THYROID STIM HORMONE | $87.21 | $153.00 | 43% |
| Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS AUTOMATED W/SCOPE | $26.79 | $47.00 | 43% |
| Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTOMATED W/O SCOPE | $19.95 | $35.00 | 43% |
| Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTOMATED W/O SCOPE - POC | $19.95 | $35.00 | 43% |
| Urinalysis without microscope exam, manual CPT 81002 HC URINALYSIS NONAUTOMATED W/O SCOPE-POC | $5.70 | $10.00 | 43% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Colonoscopy with polyp removal CPT 45385 HC PRO-S COLONOSCOPY W/LESION REMOVAL | $599.64 | $1,052.00 | 43% |
| Colonoscopy with tissue sample CPT 45380 HC PRO-S COLONOSCOPY AND BIOPSY | $430.35 | $755.00 | 43% |
| Colonoscopy, diagnostic CPT 45378 HC PRO-S DIAGNOSTIC COLONOSCOPY | $372.78 | $654.00 | 43% |
| Gallbladder removal, laparoscopic CPT 47562 HC PRO-S LAPAROSCOPIC CHOLECYSTECTOMY | $1,353.75 | $2,375.00 | 43% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC PRO-S PRP I/HERN INIT REDUC >5 YR | $900.60 | $1,580.00 | 43% |
| Knee arthroscopy with meniscus trim CPT 29881 HC PRO-S KNEE SURGERY; MENISCECTOMY | $1,079.58 | $1,894.00 | 43% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC PRO INJ EPI LUM/SAC W/IMG | $668.61 | $1,173.00 | 43% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC NJX INTERLAMINAR LMBR/SAC W IMG | $1,946.55 | $3,415.00 | 43% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC PRO INJ EPI LUM/SAC W/O IMG | $668.61 | $1,173.00 | 43% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC NJX INTERLAMINAR LMBR/SAC W/O IMG | $1,268.82 | $2,226.00 | 43% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC PRO INJ TRANSEPI LUM/SAC SGL | $836.76 | $1,468.00 | 43% |
| Removal of a breast lump, open surgery CPT 19120 HC PRO-S EXC BRST CYST TUMR/LES OPN M/F | $540.93 | $949.00 | 43% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 HC PRO-S SHO ARTHRS SRG DECOMPRESSION | $1,353.18 | $2,374.00 | 43% |
| Total hip replacement CPT 27130 HC PRO-S TOTAL HIP ARTHROPLASTY | $2,561.01 | $4,493.00 | 43% |
| Total knee replacement CPT 27447 HC PRO-S TOTAL KNEE ARTHROPLASTY | $2,739.99 | $4,807.00 | 43% |
| Total knee replacement CPT 27447 HC PRO TOTAL KNEE ARTHROPLASTY | $4,798.83 | $8,419.00 | 43% |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC PRO-S EGD BIOPSY SINGLE/MULTIPLE | $241.68 | $424.00 | 43% |
| Upper endoscopy (EGD), diagnostic CPT 43235 HC PRO-S EGD DIAGNOSTIC BRUSH WASH | $234.27 | $411.00 | 43% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| New patient office visit, about 30 minutes CPT 99203 HC PRO-S OFFICE O/P NEW LOW 30 MIN OR > | $100.32 | $176.00 | 43% |
| New patient office visit, about 30 minutes CPT 99203 HC PRO OFFICE O/P NEW LOW 30 MIN OR > | $200.07 | $351.00 | 43% |
| New patient office visit, about 45 minutes CPT 99204 HC PRO-S OFFICE O/P NEW MOD 45 MIN OR > | $166.44 | $292.00 | 43% |
| New patient office visit, about 45 minutes CPT 99204 HC PRO OFFICE O/P NEW MOD 45 MIN OR > | $294.69 | $517.00 | 43% |
| New patient office visit, about 60 minutes CPT 99205 HC PRO-S OFFICE O/P NEW HI 60 MIN OR > | $210.90 | $370.00 | 43% |
| New patient office visit, about 60 minutes CPT 99205 HC PRO OFFICE O/P NEW HI 60 MIN OR > | $380.76 | $668.00 | 43% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC OT THERAPEUTIC EXERCISES / 15 MIN | $98.61 | $173.00 | 43% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC PT THERAPEUTIC EXERCISES / 15 MIN | $98.61 | $173.00 | 43% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC FAC INIT PREV MED E&M NEW PT; 18-3 | $100.32 | $176.00 | 43% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC PRO-S PREV VISIT NEW AGE 18-39 | $112.29 | $197.00 | 43% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC PRO PREV VISIT NEW AGE 18-39 | $212.61 | $373.00 | 43% |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC FAC INIT PREV MED E&M NEW PT; 40-6 | $106.59 | $187.00 | 43% |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC PRO-S PREV VISIT NEW AGE 40-64 | $133.95 | $235.00 | 43% |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC PRO PREV VISIT NEW AGE 40-64 | $240.54 | $422.00 | 43% |
| Psychotherapy session, 30 minutes CPT 90832 HC PRO-S PSYCHOTHERAPY 30 MIN | $123.69 | $217.00 | 43% |
| Psychotherapy session, 30 minutes CPT 90832 HC PRO PSYCHOTHERAPY 30 MIN | $158.46 | $278.00 | 43% |
| Psychotherapy session, 45 minutes CPT 90834 HC PRO-S PSYCHOTHERAPY 45 MIN | $165.87 | $291.00 | 43% |
| Psychotherapy session, 45 minutes CPT 90834 HC PRO PSYCHOTHERAPY 45 MIN | $212.04 | $372.00 | 43% |
| Psychotherapy session, 60 minutes CPT 90837 HC PRO-S PSYCHOTHERAPY 60 MIN | $234.27 | $411.00 | 43% |
| Psychotherapy session, 60 minutes CPT 90837 HC PRO PSYCHOTHERAPY 60 MIN | $298.68 | $524.00 | 43% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 HC FAC OFFICE CNSLT NEW/ESTAB PT | $104.88 | $184.00 | 43% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 HC PRO-S OFFICE CONSULT NEW/EST LOW | $138.51 | $243.00 | 43% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 HC PRO OFFICE CONSULT NEW/EST LOW | $243.39 | $427.00 | 43% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC FAC OFC CNSLT NEW/ESTAB PT | $140.22 | $246.00 | 43% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC PRO-S OFFICE CONSULT NEW/EST MOD | $220.02 | $386.00 | 43% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC PRO OFFICE CONSULT NEW/EST MOD | $360.24 | $632.00 | 43% |