Visits & medical services prices at Ascension Calumet Hospital
Chilton, WI · every code in this section with a posted price and a Medicare benchmark.
204 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Acupunct W/Stimul 15 Min (97813) range across 4 matching MRF lines |
$23.94–$54.15 | $42–$95 | varies |
| Acupuncture 1/> ndles w/o elec stimj init 15 min (97810) range across 4 matching MRF lines |
$20.52–$49.59 | $36–$87 | varies |
| Advncd Care Plan 30 Min (99497) range across 3 matching MRF lines |
$66.69–$168.72 | $117–$296 | varies |
| Aep Hearing Status Deter Broadband Stimuli I&R (92651) | $482.79 | $847 | 2.3× |
| Airway Inhalation Treatment (94640) range across 5 matching MRF lines |
$53.01–$144.21 | $93–$253 | varies |
| Airway resistance by oscillometry (94728) | $215.46 | $378 | 1.7× |
| Analyze neurostim complex (95972) range across 3 matching MRF lines |
$159.03–$336.87 | $279–$591 | varies |
| Analyze neurostim no prog (95970) range across 2 matching MRF lines |
$200.64–$357.39 | $352–$627 | varies |
| Analyze Neurostim Simple (95971) range across 2 matching MRF lines |
$141.93–$197.79 | $249–$347 | varies |
| Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) | $68.40 | $120 | 4.8× |
| Application on-body injector (96377) | $171 | $300 | 3.7× |
| Assessment of aphasia per hr (96105) | $246.81 | $433 | 2.5× |
| Audiometry Air & Bone (92553) | $70.68 | $124 | 0.6× |
| Behavral qualit analys voice (92524) | $178.41 | $313 | 1.6× |
| Bfb traing w/EMG &/manometry 1st 15 min cntct (90912) | $143.07 | $251 | 1.7× |
| Bfb training ea addl 15 min (90913) | $71.25 | $125 | 2.2× |
| Biofeedback training any modality (90901) | $132.24 | $232 | 3.2× |
| Bis Xtracell Fluid Analysis (93702) | $229.14 | $402 | 1.8× |
| Brief Emotional/Behav Assmt (96127) range across 2 matching MRF lines |
$24.51–$35.34 | $43–$62 | varies |
| Brncdilat rspse spmtry pre&post-brncdilat admn (94060) range across 2 matching MRF lines |
$40.47–$396.72 | $71–$696 | varies |
| Canalith repositioning proc (95992) | $48.45 | $85 | 1.2× |
| Cardiac Stress Tst,Tracing Only (93017) | $437.76 | $768 | 2.1× |
| Cardiopulmonary resuscitation (92950) range across 3 matching MRF lines |
$929.10–$1,397.64 | $1,630–$2,452 | varies |
| Cardioversion (92960) range across 3 matching MRF lines |
$1,047.66–$1,272.24 | $1,838–$2,232 | varies |
| Caregiver Training Strategies&Tq Ea Addl 15 Min (97551) | $42.75 | $75 | 1.6× |
| Cbt 1st hour (94644) | $255.36 | $448 | 2.0× |
| Chemo Anti-Neopl Sq/Im (96401) | $274.17 | $481 | 3.9× |
| Chemo Hormon Antineopl Sq/Im (96402) range across 2 matching MRF lines |
$80.37–$128.82 | $141–$226 | varies |
| Chemo IV infusion addl hr (96415) | $127.11 | $223 | 1.8× |
| Chemo IV push addl drug (96411) | $246.24 | $432 | 3.5× |
| Chemother Prolong Infuse W/Pump (96416) | $557.46 | $978 | 1.7× |
| Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) | $245.67 | $431 | 3.5× |
| Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) | $558.03 | $979 | 1.7× |
| Chemotx admn IV push tq 1/1st sbst/drug (96409) | $430.92 | $756 | 1.3× |
| Chest Wall Manipulation (94668) | $127.68 | $224 | 1.0× |
| Color/duplex Doppler, complete (93975) | $1,003.77 | $1,761 | 4.3× |
| Color/duplex Doppler, limited (93976) | $539.79 | $947 | 5.3× |
| Community/Work Reintegration Trainj Ea 15 Min (97537) | $92.91 | $163 | 2.9× |
| Comprehensive Hearing Test (92557) | $37.05 | $65 | 0.3× |
| Continuous Pulse Ox (94762) | $255.36 | $448 | 2.0× |
| Cpap Ventilation Cpap Initiation&Mgmt (94660) | $547.77 | $961 | 2.6× |
| Cpt initial (94667) | $127.68 | $224 | 1.0× |
| Critical care first hour (99291) range across 3 matching MRF lines |
$493.05–$2,368.35 | $865–$4,155 | varies |
| Debridement Open Wound 20 Sq Cm< (97597) range across 8 matching MRF lines |
$46.74–$305.52 | $82–$536 | varies |
| Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) | $574.56 | $1,008 | 5.6× |
| Dup-scan lxtr art/artl bpgs compl bi study (93925) | $1,584.60 | $2,780 | 6.8× |
| Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) | $792.30 | $1,390 | 7.8× |
| Dup-Scan Xtr Veins Complete Bilateral Study (93970) | $992.37 | $1,741 | 4.3× |
| Dup-scan xtr veins unilateral/limited study (93971) range across 2 matching MRF lines |
$74.10–$661.77 | $130–$1,161 | varies |
| Duplex up extrem art bilat (93930) | $1,584.60 | $2,780 | 6.8× |
| Duplex up extrem art unilat/ltd (93931) | $792.30 | $1,390 | 7.8× |
| Echo Heart Xthoracic,Limited (93308) | $844.17 | $1,481 | 3.6× |
| Eeg 41-60 Minutes (95812) | $747.84 | $1,312 | 3.5× |
| EEG awake and asleep (95819) range across 2 matching MRF lines |
$450.87–$1,035.69 | $791–$1,817 | varies |
| EEG awake drowsy (95816) range across 2 matching MRF lines |
$375.63–$872.10 | $659–$1,530 | varies |
| EEG extended monitoring 61-119 minutes (95813) | $889.20 | $1,560 | 4.2× |
| Elec Alys Implt Smpl Cn Npgt Prgrmg (95976) | $82.65 | $145 | 2.3× |
| Electrical Stimulation Ea 15 Min (97032) | $68.40 | $120 | 4.7× |
| Electrocardiogram Tracing (93005) | $177.27 | $311 | 3.1× |
| Emergency Dept Visit Level 2 (99282) range across 2 matching MRF lines |
$233.70–$262.77 | $410–$461 | varies |
| Emergency Dept Visit Level 3 (99283) range across 2 matching MRF lines |
$349.98–$411.54 | $614–$722 | varies |
| Emergency Dept Visit Level 4 (99284) range across 2 matching MRF lines |
$656.07–$675.45 | $1,151–$1,185 | varies |
| Emg 3 Extremities (95863) | $424.08 | $744 | 3.4× |
| Emg 4 Extremities (95864) | $465.69 | $817 | 3.7× |
| Er level 1 (99281) range across 2 matching MRF lines |
$111.15–$117.42 | $195–$206 | varies |
| Er level v (99285) range across 3 matching MRF lines |
$963.87–$1,957.38 | $1,691–$3,434 | varies |
| Evaluate pt use of inhaler (94664) | $182.40 | $320 | 0.9× |
| Evaluate Speech Production (92522) | $168.15 | $295 | 1.5× |
| Evaluate Swallowing Function (92610) | $410.97 | $721 | 4.8× |
| Evaluation of speech fluency (92521) | $210.90 | $370 | 1.6× |
| External Ecg Scanning Analysis Report (93226) | $507.30 | $890 | 8.8× |
| Extracranial Bilat Study (93880) | $954.75 | $1,675 | 4.1× |
| Extracranial Uni/Ltd Study (93882) | $654.36 | $1,148 | 6.4× |
| Gastroesophag Reflx Test W/Cath Ph Eltrd Plcmt (91034) | $498.18 | $874 | 1.4× |
| Gastroesophag reflx test w/telemtry ph eltrd (91035) range across 2 matching MRF lines |
$185.82–$865.26 | $326–$1,518 | varies |
| Group Therapeutic Procedures (97150) | $46.74 | $82 | 2.6× |
| High altitude simulation test (94452) | $147.63 | $259 | 1.1× |
| High Altitude Simulatj W/Phys I&R W/O2 Titration (94453) | $147.63 | $259 | 1.1× |
| Holter monitor recording (93225) | $204.06 | $358 | 1.6× |
| Icd Device Interrogate (93289) | $80.94 | $142 | 2.2× |
| Icd device progr eval dual (93283) | $122.55 | $215 | 3.4× |
| Icd Device Progr Eval Mult (93284) | $135.66 | $238 | 3.7× |
| Ilr Device Interrogate (93291) | $33.06 | $58 | 1.2× |
| Im Adm Intransl/Oral 1 Vaccine (90473) | $17.10 | $30 | 0.2× |
| Immunization administration (90471) range across 2 matching MRF lines |
$30.78–$66.12 | $54–$116 | varies |
| Iontophoresis 15 min (97033) | $100.89 | $177 | 5.3× |
| Irrig Drug Delivery Device (96523) | $123.12 | $216 | 2.1× |
| IV infusion hydration each additional hour (96361) | $122.55 | $215 | 2.7× |
| IV infusion hydration initial 31 min-1 hour (96360) | $439.47 | $771 | 2.1× |
| IV infusion ther proph addl sequential to 1 hr (96367) | $193.23 | $339 | 2.7× |
| IV infusion therapy prophylaxis/dx ea hour (96366) | $133.38 | $234 | 2.9× |
| IV push initial (96374) | $189.24 | $332 | 0.9× |
| Lung Function Test (Mbc/Mvv) (94200) | $179.55 | $315 | 3.1× |
| Lwr Xtr Vasc Stdy Bilat (93924) | $799.71 | $1,403 | 3.8× |
| Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) | $55.29 | $97 | 1.7× |
| Medical nutrition assmt&ivntj indiv each 15 mi (97802) | $63.84 | $112 | 1.7× |
| Medical nutrition therapy grp2/ indiv ea 30 mi (97804) | $42.75 | $75 | 2.5× |
| Methacholine challenge (94070) | $511.29 | $897 | 1.4× |
| Motion Fluoroscopy/Swallow (92611) | $271.32 | $476 | 3.0× |
| Muscle Test 2 Limbs (95861) range across 2 matching MRF lines |
$292.41–$362.52 | $513–$636 | varies |
| Muscle Test Nonparaspinal (95870) range across 2 matching MRF lines |
$153.90–$182.97 | $270–$321 | varies |
| Muscle Test One Limb (95860) range across 2 matching MRF lines |
$229.71–$242.25 | $403–$425 | varies |
| Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) | $391.59 | $687 | 1.0× |
| Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) range across 4 matching MRF lines |
$45.03–$155.61 | $79–$273 | varies |
| Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) range across 4 matching MRF lines |
$43.32–$229.71 | $76–$403 | varies |
| Nerve Conduction Studies 1-2 Studies (95907) range across 2 matching MRF lines |
$243.96–$271.32 | $428–$476 | varies |
| Nerve Conduction Studies 3-4 Studies (95908) range across 2 matching MRF lines |
$302.10–$555.75 | $530–$975 | varies |
| Nerve conduction studies 5-6 studies (95909) range across 2 matching MRF lines |
$372.78–$872.10 | $654–$1,530 | varies |
| Nerve conduction studies 7-8 studies (95910) range across 2 matching MRF lines |
$477.09–$1,189.59 | $837–$2,087 | varies |
| Nerve Conduction Studies 9-10 Studies (95911) range across 2 matching MRF lines |
$577.41–$1,503.66 | $1,013–$2,638 | varies |
| Neuromuscular Reeducation (97112) | $113.43 | $199 | 3.5× |
| Nonphysician Telephone Assessment 11-20 Min (98967) range across 2 matching MRF lines |
$14.82–$44.46 | $26–$78 | varies |
| Nonphysician Telephone Assessment 21-30 Min (98968) range across 2 matching MRF lines |
$27.36–$53.01 | $48–$93 | varies |
| Nonphysician Telephone Assessment 5-10 Min (98966) range across 2 matching MRF lines |
$9.69–$25.08 | $17–$44 | varies |
| Oral Function Therapy (92526) | $226.29 | $397 | 2.7× |
| Oral Speech Device Eval (92597) | $80.37 | $141 | 1.1× |
| Orthc/Prostc Mgmt Sbsq Enc (97763) | $135.09 | $237 | 2.7× |
| Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) | $123.69 | $217 | 2.7× |
| Osteopathic Manipulative Tx 1-2 Body Regions (98925) range across 3 matching MRF lines |
$34.20–$74.10 | $60–$130 | varies |
| Ot eval high complexity (97167) | $312.93 | $549 | 3.1× |
| Ot Eval Low Complex (97165) | $222.30 | $390 | 2.2× |
| Ot Eval Moderate Complexity (97166) | $268.47 | $471 | 2.7× |
| Ot manual therapy 15 min (97140) | $86.64 | $152 | 3.1× |
| Ot paraffin bath (97018) | $45.03 | $79 | 7.5× |
| Ot Prosthetic Training, Each 15 Min (97761) | $107.16 | $188 | 2.7× |
| Ot Re-Eval Est Plan Care (97168) | $114 | $200 | 1.7× |
| Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) | $281.58 | $494 | 2.2× |
| Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) | $258.78 | $454 | 2.1× |
| Peripheral arterial disease rehab per session (93668) | $93.48 | $164 | 1.6× |
| Phlebotomy therapeutic (99195) | $345.99 | $607 | 2.7× |
| Phys/qhp svcs op pulm rehab w/cont oximtry mntr (94626) | $361.95 | $635 | 6.3× |
| Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) | $304.95 | $535 | 5.3× |
| Physical Performance Test (97750) | $76.38 | $134 | 2.3× |
| Plethysmography (94726) | $171 | $300 | 0.5× |
| Pm device eval in person (93288) | $35.91 | $63 | 1.0× |
| Pm device progr eval dual (93280) | $70.11 | $123 | 1.9× |
| Pm device progr eval multi (93281) | $83.79 | $147 | 2.3× |
| Pm Device Progr Eval Sngl (93279) | $58.71 | $103 | 1.6× |
| Pm/Icd Remote Tech Serv (93296) | $107.73 | $189 | 3.0× |
| Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) | $4,268.16 | $7,488 | 5.1× |
| Polysom <6 yrs 4/> paramtrs (95782) | $1,874.73 | $3,289 | 2.2× |
| Polysom <6 Yrs Sleep W/Cpap/Bilvl Vent 4/> Param (95783) | $1,874.73 | $3,289 | 2.2× |
| Prgrmng Dev Eval Implantable in Persn 1 Ld Dfb (93282) | $80.37 | $141 | 2.2× |
| Principal care management services, for a single high-risk disease, with the following required elements: one complex… (99426) | $186.96 | $328 | 1.9× |
| Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) | $23.37 | $41 | 0.5× |
| Prof svcs allg immntx x w/prv allgic xtrcs njxs (95117) | $30.78 | $54 | 0.7× |
| Psych diag eval w/med srvcs (90792) | $377.34 | $662 | 2.2× |
| Psychiatric diagnostic evaluation (90791) range across 2 matching MRF lines |
$277.02–$371.64 | $486–$652 | varies |
| Pt Asstv Technol Assmt Dir Cntct W/Reprt Ea 15 Min (97755) | $132.24 | $232 | 3.5× |
| Pt Eval High Complex (97163) | $323.19 | $567 | 3.3× |
| Pt eval low complex 20 min (97161) | $223.44 | $392 | 2.3× |
| Pt Eval Mod Complex (97162) | $269.04 | $472 | 2.7× |
| Pt gait training 15 min (97116) | $101.46 | $178 | 3.5× |
| Pt group caregiver training (97552) | $35.91 | $63 | 1.6× |
| Pt mechanical traction (97012) | $67.26 | $118 | 4.7× |
| Pt Re-Eval Est Plan Care (97164) | $141.93 | $249 | 2.1× |
| Pt ultraviolet (97028) | $54.15 | $95 | 6.5× |
| Pulm function test by gas (94727) | $182.40 | $320 | 0.9× |
| Pulmonary Stress Testing (94618) | $164.16 | $288 | 1.3× |
| Pure Tone Audiometry Air (92552) | $56.43 | $99 | 0.4× |
| Quan puplmtry phy/qhp uni/bi (95919) range across 2 matching MRF lines |
$34.20–$494.76 | $60–$868 | varies |
| Remote 30 Day Ecg Rev/Report (93270) | $221.16 | $388 | 6.1× |
| Respiratory flow volume loop (94375) | $345.42 | $606 | 1.6× |
| Rhythm Ecg 1-3 Leads Tracing Only W/O I&R (93041) | $117.99 | $207 | 2.0× |
| Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) | $209.19 | $367 | 1.1× |
| Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) | $153.33 | $269 | 1.3× |
| Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) | $76.95 | $135 | 1.6× |
| Self Care Mngment Training (97535) | $97.47 | $171 | 3.0× |
| Sensory Integration Ea 15 Min (97533) | $83.79 | $147 | 1.4× |
| Sleep study unattended (95806) | $726.18 | $1,274 | 3.4× |
| Slp caregiver training 1st 30 min (97550) | $85.50 | $150 | 1.6× |
| Speech Audiometry Complete (92556) | $62.13 | $109 | 1.1× |
| Speech audiometry threshold (92555) | $41.04 | $72 | 0.7× |
| Speech sound lang comprehen (92523) | $310.08 | $544 | 1.4× |
| Spirometry (94010) range across 3 matching MRF lines |
$30.21–$119.70 | $53–$210 | varies |
| Standardized Cognitive Performance Testing (96125) | $212.61 | $373 | 2.1× |
| Surfactant Admin Thru Tube (94610) | $245.10 | $430 | 1.1× |
| Temp transcutaneous pacing (92953) | $207.48 | $364 | 0.3× |
| Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) | $60.42 | $106 | 2.7× |
| Ther Ivntj Ea Addl 15 Min (97130) | $30.21 | $53 | 1.4× |
| Ther Px 1/> Areas Each 15 Min Aqua Ther W/Xerss (97113) | $90.06 | $158 | 2.4× |
| Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) | $214.89 | $377 | 2.1× |
| Ther/Proph/Diag Inj Sc/Im (96372) range across 2 matching MRF lines |
$64.41–$129.39 | $113–$227 | varies |
| Ther/Proph/Diag Iv Inf Init (96365) | $433.77 | $761 | 2.1× |
| Therapeutic Activities (97530) | $102.60 | $180 | 2.9× |
| Tobacco Use Cessation Intensive >10 Minutes (99407) range across 4 matching MRF lines |
$18.81–$86.64 | $33–$152 | varies |
| Tobacco Use Cessation Intermediate 3-10 Minutes (99406) range across 4 matching MRF lines |
$13.11–$58.14 | $23–$102 | varies |
| Trans Care Mgmt 14 Day Disch (99495) range across 4 matching MRF lines |
$162.45–$334.02 | $285–$586 | varies |
| Trans Care Mgmt 7 Day Disch (99496) range across 4 matching MRF lines |
$184.11–$477.09 | $323–$837 | varies |
| Tte w/doppler, complete (93306) range across 3 matching MRF lines |
$501.60–$1,877.01 | $880–$3,293 | varies |
| Tte W/O Doppler Complete (93307) | $1,594.86 | $2,798 | 6.8× |
| Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) | $165.87 | $291 | 2.2× |
| Tx Speech Language Voice Commj Auditry 2/>Indiv (92508) | $58.71 | $103 | 2.4× |
| Tx/Pro/Dx Inj New Drug Addon (96375) | $189.24 | $332 | 4.1× |
| Tympanometry (92567) | $19.38 | $34 | 0.5× |
| Upr/L Xtremity Art 2 Levels (93922) | $420.09 | $737 | 3.2× |
| Upr/Lxtr Art Stdy 3+ Lvls (93923) range across 2 matching MRF lines |
$46.74–$776.34 | $82–$1,362 | varies |
| Vasopneumatic device (97016) | $42.75 | $75 | 3.6× |
| Vent Mgmt Inpat Init Day (94002) | $868.68 | $1,524 | 1.4× |
| Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) | $868.68 | $1,524 | 1.4× |
| Visual reinforcement audiometry (vra) (92579) | $41.61 | $73 | 0.2× |
| Vital capacity, total (94150) | $232.56 | $408 | 1.9× |
| Wheelchair Mgmt Ea 15 Min (97542) | $71.82 | $126 | 2.3× |
| Whirlpool Therapy (97022) | $64.98 | $114 | 4.1× |
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.