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ASCENSION CALUMET HOSPITAL

Hospital

614 MEMORIAL DRIVE

CHILTON, WI, 53014

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Procedure Prices at ASCENSION CALUMET HOSPITAL

COLLECTION VENOUS BLOOD VENIPUNCTURE

CPT 36415

$3.95

BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC

CPT 85025

$12.61

Mechanical Traction

CPT 97012

$15.55

EKG Interpretation

CPT 93010

$16.74

COMPREHENSIVE METABOLIC PANEL

CPT 80053

$17.15

Therapeutic Exercises

CPT 97110

$18.9

EKG Tracing

CPT 93005

$20.4

Therapeutic Activities

CPT 97530

$34.1

EKG

CPT 93000

$37.14

Chest X-Ray (1 view)

CPT 71045

$48.84

PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES

CPT 90837

$60.48

OFFICE OUTPATIENT VISIT 15 MINUTES

CPT 99213

$60.48

Chest X-Ray (2 views)

CPT 71046

$68.03

Thoracic Spine X-Ray

CPT 72072

$77.55

ER Visit — Low-Moderate Complexity

CPT 99283

$112.12

Diagnostic Mammogram (unilateral)

CPT 77065

$164

Diagnostic Mammogram (bilateral)

CPT 77066

$164

Screening Mammogram (bilateral)

CPT 77067

$164

Abdominal Ultrasound — Limited

CPT 76705

$207.24

ER Visit — Moderate Complexity

CPT 99284

$213.89

Upper GI Endoscopy w/ Biopsy

CPT 43239

$233.1

Echocardiogram

CPT 93307

$233.17

Retroperitoneal Ultrasound

CPT 76770

$256.49

Abdominal Ultrasound

CPT 76700

$277.37

ER Visit — High Complexity

CPT 99285

$313.66

OB Ultrasound

CPT 76805

$321.74

CT Chest

CPT 71250

$366

NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL

CPT 64483

$373.05

Echocardiogram w/ Doppler

CPT 93306

$386.38

Colonoscopy w/ Biopsy

CPT 45380

$414.54

Colonoscopy

CPT 45378

$466.83

MRI Brain w/o Contrast

CPT 70551

$520.11

MRI Joint of Lower Extremity

CPT 73721

$533.93

Tonsillectomy & Adenoidectomy (under 12)

CPT 42820

$628.35

Tonsillectomy & Adenoidectomy (12+)

CPT 42821

$653.04

Laparoscopic Hernia Repair

CPT 49650

$686.7

CT Abdomen & Pelvis

CPT 74177

$701.01

MRI Brain w/ Contrast

CPT 70553

$836

Inguinal Hernia Repair

CPT 49505

$867.51

Knee Arthroscopy

CPT 29881

$1,145.68

Laparoscopic Cholecystectomy

CPT 47562

$1,304.73

Recurrent Inguinal Hernia Repair

CPT 49520

$1,311.92

Appendectomy

CPT 44950

$1,329.18

Cataract Surgery

CPT 66984

$1,397.29

Cataract Surgery — Complex

CPT 66982

$1,733.01

ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR

CPT 29827

$2,250.14

TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW

CPT 27245

$2,573.18

Hip Replacement

CPT 27130

$3,010.23

Knee Replacement

CPT 27447

$3,213.99

Vaginal Delivery

CPT 59400

$4,206.34

VBAC Delivery

CPT 59610

$4,398.41

C-Section

CPT 59510

$4,822.75

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Prices sourced from federally mandated hospital price transparency files. Cash prices reflect self-pay discounted rates. Negotiated rates vary by insurance plan. Data may not reflect current pricing — always confirm with the hospital before scheduling.