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 |
|---|---|---|---|---|
| Spine device implant surgery HCPCS C9757 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Spirmtry w/brnchdil inf-2 yr CPT 94012 | not published | not published | $160.18 – $412.19 | 4 |
| Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 | $303.05 | $551.00 | $276.82 – $712.35 | 4 |
| Spirometry up to 2 yrs old CPT 94011 | not published | not published | $95.45 – $245.63 | 4 |
| Spleen imaging CPT 78185 | not published | not published | $296.56 – $763.16 | 4 |
| Splenectomy total open 38100 CPT 38100 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Splice spleen/kidney veins CPT 37181 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Splicing of ureters CPT 50770 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Splint dorsal bloc wh med perf 3.2mm lf polyflex ii HCPCS L3906 | $345.94 | $628.98 | $425.09 – $1,093.90 | 4 |
| Splint extn xsm w sof-stretch rolyan HCPCS L3925 | not published | not published | $55.10 – $141.80 | 4 |
| Splint finger fold over sm HCPCS L3924 | not published | not published | $81.03 – $208.52 | 4 |
| Splint finger frog med HCPCS L3927 | not published | not published | $29.36 – $75.56 | 4 |
| Splint rstrc wrst/cmc right med HCPCS L3923 | $73.06 | $132.84 | $81.03 – $208.52 | 4 |
| Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 % CPT 15120 | not published | not published | $2,628.85 – $8,770.00 | 6 |
| Split blood or products CPT 86985 | not published | not published | $35.06 – $325.23 | 5 |
| Split flat caliper stirr & p HCPCS L2230 | not published | not published | $88.17 – $226.89 | 4 |
| Splt agrft f/s/n/h/f/g/m ea CPT 15121 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Sprchoroidal spc njx rx agt CPT 67516 | not published | not published | $245.03 – $2,334.00 | 5 |
| Spring-ass rot wrst with latch HCPCS L6623 | not published | not published | $658.90 – $1,695.56 | 4 |
| Sputum specimen collection CPT 89220 | $246.95 | $449.00 | $23.16 – $325.23 | 5 |
| Sr-89 stront chlor ther / mci HCPCS A9600 | not published | not published | $3,109.75 – $11,288.41 | 5 |
| Srs cranial lesion complex CPT 61798 | not published | not published | $3,388.00 – $18,364.00 | 3 |
| Srs cranial lesion simple CPT 61796 | not published | not published | $3,388.00 – $18,364.00 | 3 |
| Srs cran les complex addl CPT 61799 | not published | not published | $3,579.00 – $10,779.00 | 3 |
| Srs cran les simple addl CPT 61797 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Srsf2 gene common variants CPT 81348 | not published | not published | $131.55 – $338.52 | 7 |
| Srs linear based CPT 77372 | $8,030.00 | $14,600.00 | $3,586.50 – $14,060.20 | 4 |
| Srs multisource CPT 77371 | not published | not published | $4,103.08 – $14,060.20 | 4 |
| Srs spinal lesion CPT 63620 | not published | not published | $3,388.00 – $18,364.00 | 3 |
| Srs spinal lesion addl CPT 63621 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Staggered spondaic word test CPT 92572 | not published | not published | $95.45 – $245.63 | 4 |
| Stainless steel any wrist HCPCS L6630 | not published | not published | $263.85 – $678.97 | 4 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $284.90 | $518.00 | $80.25 – $206.51 | 4 |
| Stance phase only HCPCS L5858 | not published | not published | $17,163.79 – $44,168.15 | 4 |
| Standard control cable extra HCPCS L6655 | not published | not published | $70.76 – $182.08 | 4 |
| Staph a dna amp probe CPT 87640 | $151.25 | $275.00 | $26.32 – $67.72 | 7 |
| Static or dynami afo pre ots HCPCS L4397 | not published | not published | $154.67 – $398.02 | 4 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $494.45 | $899.00 | $75.05 – $193.14 | 4 |
| Stem cells total count CPT 86367 | not published | not published | $58.34 – $150.12 | 7 |
| Stenger test pure tone CPT 92565 | not published | not published | $43.76 – $112.62 | 4 |
| Stenger test speech CPT 92577 | not published | not published | $276.82 – $712.35 | 4 |
| Stent/athrectomy/fem/pop/unilat 37227 CPT 37227 | $20,641.50 | $37,530.00 | $8,923.00 – $44,873.00 | 3 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $3,982.32 | $7,240.59 | not published | 0 |
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $401.95 | $730.82 | not published | 0 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $1,367.47 | $2,486.31 | not published | 0 |
| Stent iliac/open or perc/uni/init 37221 CPT 37221 | $10,552.30 | $19,186.00 | $7,609.00 – $27,583.00 | 3 |
| Stent iliac/open/perc/ea ad/ipsila 37223 CPT 37223 | $9,784.50 | $17,790.00 | $5,512.00 – $18,364.00 | 3 |
| Stent placemt retro carotid CPT 37217 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Stent/tib/peroneal/unilat/initial 37230 CPT 37230 | $11,025.85 | $20,047.00 | $8,923.00 – $27,583.00 | 3 |
| Stereoscopic x-ray guidance HCPCS G6002 | not published | not published | $183.68 – $183.68 | 1 |
| Stereotactic bx aspir/exc burr intracranial les 61750 CPT 61750 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Stereotactic radiation trmt CPT 77432 | not published | not published | $1,417.12 – $1,417.12 | 1 |
| Sternal debridement CPT 21627 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Sternal pad HCPCS L1050 | not published | not published | $92.48 – $237.99 | 4 |
| St evaluate speech sound production CPT 92522 | $492.25 | $895.00 | $81.76 – $210.41 | 4 |
| St evaluate speech sound production comprehensive/expressive CPT 92523 | $569.80 | $1,036.00 | $166.59 – $428.69 | 4 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $506.00 | $920.00 | $66.32 – $170.67 | 4 |
| St evaluation swallow function CPT 92610 | $246.95 | $449.00 | $42.72 – $109.93 | 4 |
| Stimulants synthetic CPT 80371 | not published | not published | $35.06 – $35.06 | 1 |
| Stimulation of spinal cord CPT 63610 | not published | not published | $1,448.59 – $4,761.00 | 6 |
| Stocking sup grips 4 pre ots HCPCS L0982 | not published | not published | $14.42 – $37.11 | 4 |
| Storage/year embryo(s) CPT 89342 | not published | not published | $126.39 – $325.23 | 5 |
| Storage/year oocyte(s) CPT 89346 | not published | not published | $126.39 – $325.23 | 5 |
| Storage/year reprod tissue CPT 89344 | not published | not published | $126.39 – $325.23 | 5 |
| Storage/year sperm/semen CPT 89343 | not published | not published | $126.39 – $325.23 | 5 |
| Stot/tot hysterectomy after cesaren delivery 59525 CPT 59525 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Straight knee joint heavy du HCPCS L2385 | not published | not published | $135.44 – $348.52 | 4 |
| Strapping of ankle and/or ft 29540 CPT 29540 | not published | not published | $120.55 – $2,334.00 | 6 |
| Strapping of chest CPT 29200 | not published | not published | $120.55 – $2,334.00 | 6 |
| Strapping of elbow or wrist 29260 CPT 29260 | not published | not published | $43.76 – $2,334.00 | 6 |
| Strapping of hand or finger CPT 29280 | not published | not published | $43.76 – $2,334.00 | 6 |
| Strapping of hip CPT 29520 | $138.60 | $252.00 | $98.70 – $2,334.00 | 6 |
| Strapping of knee CPT 29530 | $307.45 | $559.00 | $98.70 – $2,334.00 | 6 |
| Strapping of toes 29550 CPT 29550 | not published | not published | $43.76 – $2,334.00 | 6 |
| Strep a ag ia CPT 87430 | $123.75 | $225.00 | $12.61 – $32.44 | 7 |
| Strep a dna dir probe CPT 87650 | not published | not published | $15.04 – $38.70 | 7 |
| Strep a dna quant CPT 87652 | not published | not published | $31.32 – $80.60 | 7 |
| Strep b assay w/optic CPT 87802 | not published | not published | $9.55 – $24.57 | 7 |
| Strep b dna amp probe CPT 87653 | $201.85 | $367.00 | $26.32 – $67.72 | 7 |
| Streptokinase 1.5 m-units inj HCPCS J2995 | not published | not published | $193.73 – $193.73 | 1 |
| Streptokinase antibody CPT 86590 | not published | not published | $9.50 – $24.43 | 7 |
| Streptomycin injection HCPCS J3000 | not published | not published | $28.15 – $76.94 | 5 |
| Streptozocin injection HCPCS J9320 | not published | not published | $1,140.94 – $1,140.94 | 1 |
| Stress test pulmonary CPT 94618 | $522.50 | $950.00 | $98.70 – $253.99 | 4 |
| Stress tte complete CPT 93351 | not published | not published | $405.35 – $1,043.10 | 4 |
| Str markers spec anal addl CPT 81266 | not published | not published | $228.61 – $588.28 | 7 |
| Str markers specimen anal CPT 81265 | not published | not published | $174.80 – $449.83 | 7 |
| St treatment speech individual CPT 92507 | $163.90 | $298.00 | $55.92 – $143.90 | 4 |
| St treatment swallow dysfunction/oral CPT 92526 | $363.00 | $660.00 | $61.72 – $158.84 | 4 |
| Subdural tap fontanelle/sutur infant init 61000 CPT 61000 | not published | not published | $523.65 – $3,030.00 | 6 |
| Subq njx filling matrl 1cc/< CPT 11950 | not published | not published | $148.84 – $2,334.00 | 6 |
| Subq njx fil matrl 5.1-10cc CPT 11952 | not published | not published | $548.27 – $2,334.00 | 6 |
| Subsequent repair of nerve CPT 64872 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Subtalar arthro w/deb CPT 29906 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Subtalar arthro w/exc CPT 29905 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Subtalar arthro w/fb rmvl CPT 29904 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Subtalar arthro w/fusion CPT 29907 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Subtemporal cranial dcmprn CPT 61340 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | not published | not published | $4.31 – $4.31 | 1 |
| Suction lipectomy head&neck CPT 15876 | not published | not published | $2,628.85 – $8,770.00 | 6 |
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.