Supplies, drugs & other prices at Ascension Calumet Hospital
Chilton, WI · every code in this section with a posted price and a Medicare benchmark.
24 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Admin hepatitis b vaccine (G0010) | $47.88 | $84 | 1.0× |
| Admin influenza virus vac (G0008) | $66.12 | $116 | 1.4× |
| Admin pneumococcal vaccine (G0009) | $66.12 | $116 | 1.4× |
| Behavior counsel obesity 15m (G0447) | $95.76 | $168 | 1.0× |
| Ca screen;pelvic/breast exam (G0101) | $67.83 | $119 | 0.7× |
| Catheterize for urine spec (P9612) range across 3 matching MRF lines |
$6.84–$101.46 | $12–$178 | varies |
| Chemo extend iv infus w/pump (G0498) | $656.07 | $1,151 | 2.0× |
| Colon ca scrn not hi rsk ind (G0121) | $372.21 | $653 | 0.4× |
| Colorectal scrn; hi risk ind (G0105) | $372.78 | $654 | 0.4× |
| Drug test def 1-7 classes (G0480) | $243.96 | $428 | 2.1× |
| Drug test def 8-14 classes (G0481) | $267.90 | $470 | 1.7× |
| Ekg tracing for initial prev (G0404) | $177.27 | $311 | 6.3× |
| Group behave couns 2-10 (G0473) | $30.78 | $54 | 0.8× |
| Hbot, full body chamber, 30m (G0277) | $292.98 | $514 | 2.2× |
| Initial preventive exam (G0402) | $91.77 | $161 | 0.7× |
| Mnt subs tx for change dx (G0270) | $51.87 | $91 | 1.6× |
| Njx platelet plasma (0232T) range across 2 matching MRF lines |
$469.11–$2,021.79 | $823–$3,547 | varies |
| Obtaining screen pap smear (Q0091) range across 2 matching MRF lines |
$14.25–$45.03 | $25–$79 | varies |
| Oth resp proc, group (G0239) | $318.63 | $559 | 8.7× |
| Oth resp proc, indiv (G0238) | $72.39 | $127 | 2.6× |
| Ppps, initial visit (G0438) | $273.60 | $480 | 1.6× |
| Ppps, subseq visit (G0439) | $220.02 | $386 | 1.6× |
| Psa screening (G0103) | $33.06 | $58 | 1.7× |
| Therapeutic procd strg endur (G0237) | $72.39 | $127 | 2.6× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.