SSM Health St. Agnes Hospital - Fond du Lac
430 E Division St, Fond Du Lac, WI · SSM Health · · NPI 1346228541
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| 11-desoxycortisol - sendout CPT 82634 | not published | not published | $21.96 – $56.51 | 7 |
| 17-hydroxypregnenolone CPT 84143 | $46.75 | $85.00 | $17.11 – $44.02 | 7 |
| 17-ketosteroids CPT 83586 | not published | not published | $9.60 – $24.70 | 7 |
| 1st hosp/birthing center care per day nml nb 99460 CPT 99460 | not published | not published | $98.76 – $254.15 | 4 |
| 2019-ncov diagnostic p HCPCS U0001 | not published | not published | $26.94 – $69.33 | 7 |
| 24 hr ambulatory b/p monitor CPT 93786 | not published | not published | $98.70 – $253.99 | 4 |
| 2d tee w or without fol w/con,in HCPCS C8925 | $1,199.00 | $2,180.00 | $581.54 – $1,496.49 | 4 |
| 2d tte w or without fol w/con,co HCPCS C8923 | not published | not published | $581.54 – $1,496.49 | 4 |
| 2nd order venous cath CPT 36012 | $1,916.20 | $3,484.00 | $1,887.00 – $5,512.00 | 3 |
| 3d anat seg imaging preop HCPCS C8001 | not published | not published | $95.45 – $245.63 | 4 |
| 3d bn img algor drvd fr MRI HCPCS G0566 | not published | not published | $95.45 – $245.63 | 4 |
| 3d ech img cgen car anomal CPT 93319 | $360.25 | $655.00 | not published | 0 |
| 3-d radiotherapy plan CPT 77295 | $3,637.70 | $6,614.00 | $897.03 – $2,642.28 | 4 |
| 3d recon without postprocess indpndt CPT 76376 | $431.75 | $785.00 | $43.47 – $43.47 | 1 |
| 5' nucleotidase - sendout CPT 83915 | $19.80 | $36.00 | $8.36 – $21.52 | 7 |
| 88334 ap bill cytologic exam each additional site CPT 88334 | $100.10 | $182.00 | $18.04 – $30.80 | 2 |
| Aa graft w/bp/aortic root replace 33863 CPT 33863 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Abatacept (with maltose) 250 mg intravenous solution HCPCS J0129 | not published | not published | $34.39 – $119.25 | 8 |
| #a/b/c/c/h pnl-candida albicans ab CPT 86628 | $40.70 | $74.00 | $9.01 – $23.18 | 7 |
| Abciximab injection HCPCS J0130 | not published | not published | $1,520.84 – $1,520.84 | 1 |
| Abd aorta w/runoff s&i CPT 75630 | $2,954.60 | $5,372.00 | $273.99 – $6,027.57 | 4 |
| Abd exp/postop hem/throm/infec 35840 CPT 35840 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Abd/low ext cath 1st CPT 36245 | $1,469.05 | $2,671.00 | $1,887.00 – $5,512.00 | 3 |
| Abd/low ext cath 2nd CPT 36246 | $2,038.85 | $3,707.00 | $1,887.00 – $5,512.00 | 3 |
| Abd/low ext cath 3rd CPT 36247 | $2,318.80 | $4,216.00 | $1,887.00 – $5,512.00 | 3 |
| Abd/low ext cath addl CPT 36248 | $3,237.85 | $5,887.00 | $1,887.00 – $5,512.00 | 3 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $1,714.35 | $3,117.00 | $130.12 – $334.84 | 4 |
| Abdominal CT scan (with contrast) CPT 74160 | $1,632.95 | $2,969.00 | $130.12 – $334.84 | 4 |
| Abdominal CT scan (without contrast) CPT 74150 | $1,554.85 | $2,827.00 | $77.56 – $199.58 | 4 |
| Abdominal MRI (with and without contrast) CPT 74183 | $2,310.55 | $4,201.00 | $258.81 – $665.99 | 4 |
| Abdominal MRI (with contrast) CPT 74182 | $2,200.55 | $4,001.00 | $258.81 – $665.99 | 4 |
| Abdominal MRI (without contrast) CPT 74181 | $2,095.50 | $3,810.00 | $177.00 – $455.49 | 4 |
| Abdominal paracentesis w/image guidance CPT 49083 | $1,349.15 | $2,453.00 | $672.83 – $4,761.00 | 6 |
| Abdominal Ultrasound (complete) CPT 76700 | $674.30 | $1,226.00 | $77.56 – $199.58 | 4 |
| Abdominal Ultrasound (limited) CPT 76705 | $616.00 | $1,120.00 | $77.56 – $199.58 | 4 |
| Abdominoplasty 15830 CPT 15830 | not published | not published | $4,925.89 – $16,106.00 | 6 |
| Abd paracentesis/w/o image guide 49082 CPT 49082 | $1,051.05 | $1,911.00 | $672.83 – $4,761.00 | 6 |
| Abl1 gene CPT 81170 | not published | not published | $225.00 – $579.00 | 7 |
| Ablate arrhythmia add on CPT 93655 | $324.50 | $590.00 | $1,887.00 – $2,334.00 | 2 |
| Ablate atria lmtd endo 33265 CPT 33265 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Ablate atria w/bypass exten 33256 CPT 33256 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Ablate atria x10sv add-on 33258 CPT 33258 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Ablate atria x10sv endo 33266 CPT 33266 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Ablate bone tumor(s) cryo perq 20983 CPT 20983 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Ablate bone tumor(s) perq CPT 20982 | $8,878.10 | $16,142.00 | $6,779.00 – $33,471.73 | 6 |
| Ablate heart dysrhythm focus CPT 93650 | $7,418.95 | $13,489.00 | $5,786.04 – $18,364.00 | 6 |
| Ablate inf turbinate submuc 30802 CPT 30802 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Ablate inf turbinate superf 30801 CPT 30801 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Ablate pulm tumor perq crybl CPT 32994 | $6,283.75 | $11,425.00 | $5,257.00 – $20,292.15 | 6 |
| Ablate pulm tumor perq rf CPT 32998 | $9,006.80 | $16,376.00 | $4,484.77 – $18,364.00 | 6 |
| Ablation cardiac vagal inputs atrium CPT 93799 | $3,587.65 | $6,523.00 | $95.45 – $2,334.00 | 6 |
| Ablation cryo abd perit om CPT 49999 | $2,335.30 | $4,246.00 | $672.83 – $4,761.00 | 6 |
| Ablation cryo adrenal tumor CPT 60699 | not published | not published | $4,484.77 – $18,364.00 | 6 |
| Ablation cryo pq chest wall tumor(s) w/guid CPT 23929 | not published | not published | $182.99 – $2,334.00 | 6 |
| Ablation cryo pq liver tumor(s) CPT 47383 | $9,528.75 | $17,325.00 | $5,257.00 – $20,292.15 | 6 |
| Ablation cryo retro lymph node CPT 38999 | not published | not published | $327.28 – $2,334.00 | 6 |
| Ablation cryo thigh/knee CPT 27599 | not published | not published | $182.99 – $2,334.00 | 6 |
| Ablation ire liver 1+ tumor(s) w/image pq CPT 47384 | not published | not published | $7,885.55 – $20,292.15 | 4 |
| Ablation of upper extremity nerves rf CPT 64999 | $1,692.90 | $3,078.00 | $227.71 – $2,334.00 | 6 |
| Abltj 1/+thyr ndul 1lobe prq CPT 60660 | not published | not published | $1,225.21 – $3,152.87 | 4 |
| Abltj mal prst8 tiss hifu CPT 55880 | not published | not published | $7,022.52 – $18,071.30 | 6 |
| Ablt trurl prst8 tis trnsdcr CPT 55882 | not published | not published | $8,923.00 – $25,186.06 | 4 |
| Abobotulinumtoxina HCPCS J0586 | not published | not published | $6.71 – $23.22 | 8 |
| Abortion CPT 59850 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Abortion (mpr) CPT 59866 | not published | not published | $226.06 – $2,334.00 | 6 |
| Abrasion lesions add-on CPT 15787 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Abrasion lesion single CPT 15786 | not published | not published | $148.84 – $2,334.00 | 6 |
| Abscess drain retroperitoneal surg code CPT 49406 | $3,294.50 | $5,990.00 | $1,225.21 – $4,761.00 | 6 |
| Access & clsr pq fem art endogft dlvry w/img uni CPT 34713 | $877.25 | $1,595.00 | $1,887.00 – $5,512.00 | 3 |
| Access thoracic lymph duct CPT 38794 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Acetaminophen 10 mg/ml soln 100 ml glass cont HCPCS J0131 | not published | not published | $0.06 – $0.13 | 5 |
| Acetaminophen level CPT 80143 | $30.80 | $56.00 | $13.98 – $35.98 | 7 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | not published | not published | $20.97 – $58.86 | 5 |
| Acetone qualitative CPT 82009 | not published | not published | $3.39 – $8.72 | 7 |
| Acetylcholine receptor modulating antibody CPT 86043 | $49.50 | $90.00 | $9.04 – $23.26 | 7 |
| Acetylcholinesterase assay CPT 82013 | not published | not published | $9.22 – $23.72 | 7 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | not published | not published | $0.50 – $1.50 | 5 |
| Acetylcysteine non-comp unit HCPCS J7608 | not published | not published | $8.82 – $22.19 | 5 |
| Acid perfusion of esophagus CPT 91030 | not published | not published | $276.82 – $2,334.00 | 6 |
| Acne surgery 10040 CPT 10040 | $413.05 | $751.00 | $148.84 – $2,334.00 | 6 |
| Aco annual medicare visit (awv), initial g0438aco HCPCS G0438 | not published | not published | $125.24 – $322.29 | 4 |
| Aco annual medicare visit (awv), subsq g0439aco HCPCS G0439 | not published | not published | $98.78 – $254.18 | 4 |
| Aco ccm; at least 20 min 99490aco CPT 99490 | not published | not published | $75.36 – $193.93 | 4 |
| Aco cmplx chron care without pt visit, 60 min 99487aco CPT 99487 | not published | not published | $131.67 – $338.84 | 4 |
| Aco cont gluc mnt phys/qhp eqp 95250aco CPT 95250 | $435.05 | $791.00 | $98.76 – $254.15 | 4 |
| Aco depression screen annual medicare g0444aco HCPCS G0444 | not published | not published | $27.80 – $71.53 | 4 |
| Aco med nutria tx/group, ea 30 min 97804aco CPT 97804 | not published | not published | $8.98 – $23.10 | 4 |
| Acoustic immitance testing CPT 92570 | not published | not published | $95.45 – $245.63 | 4 |
| Acoustic refl threshold tst CPT 92568 | not published | not published | $27.71 – $71.30 | 4 |
| Acromp/acromionectomy prtl CPT 23130 | not published | not published | $2,427.27 – $16,106.00 | 6 |
| Actigraphy testing CPT 95803 | $205.70 | $374.00 | $43.76 – $112.62 | 4 |
| Actinotherapy uv light CPT 96900 | not published | not published | $27.71 – $71.30 | 4 |
| Acup 1/> w/estim 1st 15 min CPT 97813 | not published | not published | $21.46 – $55.21 | 4 |
| Acup 1/> wo estim 1st 15 min CPT 97810 | not published | not published | $21.46 – $55.21 | 4 |
| Acute hepatitis panel CPT 80074 | $314.05 | $571.00 | $35.72 – $91.93 | 7 |
| Acute venous thrombus image CPT 78456 | not published | not published | $924.84 – $2,471.46 | 4 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | not published | not published | $0.04 – $0.13 | 5 |
| #acylcarnitineprfl CPT 82017 | $129.25 | $235.00 | $12.65 – $32.56 | 7 |
| Acylcarnitines qual CPT 82016 | not published | not published | $12.37 – $31.83 | 7 |
| Adapt behavior tx phys/qhp CPT 97155 | not published | not published | $131.67 – $338.84 | 4 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.