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 |
|---|---|---|---|---|
| Suction lipectomy lwr extrem CPT 15879 | not published | not published | $2,628.85 – $8,770.00 | 6 |
| Suction lipectomy trunk CPT 15877 | not published | not published | $2,628.85 – $8,770.00 | 6 |
| Suction lipectomy upr extrem CPT 15878 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Suction socket HCPCS L6686 | not published | not published | $633.22 – $1,629.48 | 4 |
| Suction susp ak/knee disart HCPCS L5652 | not published | not published | $400.31 – $1,030.14 | 4 |
| Sugars multiple quant CPT 84379 | not published | not published | $8.65 – $22.25 | 7 |
| Sugars single quant CPT 84378 | not published | not published | $8.65 – $22.25 | 7 |
| Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution HCPCS J2865 | not published | not published | $0.07 – $0.10 | 2 |
| Sulfonylurea screen qn-sendout CPT 80377 | $258.50 | $470.00 | $35.06 – $35.06 | 1 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | not published | not published | $440.85 – $440.85 | 1 |
| Sup of prep of antigen # of vials 95144 CPT 95144 | not published | not published | $34.74 – $89.39 | 4 |
| Supply of digital device HCPCS G0552 | not published | not published | $98.76 – $254.15 | 4 |
| Support clav 29.6-40.5in med HCPCS L3650 | not published | not published | $60.45 – $155.56 | 4 |
| Supprelin la implant HCPCS J9226 | not published | not published | $28,118.98 – $123,225.25 | 8 |
| Surg dx exam anorectal CPT 45990 | not published | not published | $2,059.07 – $5,298.68 | 6 |
| Surg ect salp-oophorectomy 59120 CPT 59120 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Surg ect without salp-oophorectomy 59121 CPT 59121 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Surgery for urethra pouch CPT 53240 | not published | not published | $2,614.94 – $8,770.00 | 6 |
| Surgery of pancreatic cyst CPT 48500 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Surgery to stop leg growth CPT 27475 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Surgery to stop leg growth CPT 27477 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Surgery to stop leg growth CPT 27479 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Surgery to stop leg growth CPT 27485 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Surgical exposure prostate 55860 CPT 55860 | not published | not published | $3,977.55 – $10,235.57 | 6 |
| Surgical opening esophagus CPT 43351 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Surgical opening esophagus CPT 43352 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Surgical opening of stomach CPT 43510 | not published | not published | $672.83 – $4,761.00 | 6 |
| Surgical opening of stomach 43500 CPT 43500 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Surgical opening of throat CPT 42955 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Surgical pathology level 1 gross examination only CPT 88300 | $125.40 | $228.00 | $15.05 – $55.21 | 5 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $131.45 | $239.00 | $22.99 – $71.30 | 5 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $274.45 | $499.00 | $38.66 – $99.48 | 5 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $271.70 | $494.00 | $38.66 – $99.48 | 5 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $384.45 | $699.00 | $265.91 – $684.27 | 5 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $372.35 | $677.00 | $451.73 – $1,538.03 | 5 |
| Surgical repair stomach bleedin ulcer 43501 CPT 43501 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Surgical repair stomach gastric lac 43502 CPT 43502 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Surgical revision intestine CPT 44680 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Surgigraft, 1 sq cm HCPCS Q4183 | not published | not published | $92.32 – $438.11 | 5 |
| Surg tx anal fistula 2nd stage 46285 CPT 46285 | not published | not published | $2,059.07 – $7,791.00 | 6 |
| Susceptibility agar dilution per agent CPT 87181 | $30.80 | $56.00 | $3.56 – $9.17 | 7 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $51.70 | $94.00 | $3.56 – $9.17 | 7 |
| Susceptibility mic per plate CPT 87186 | $118.80 | $216.00 | $6.49 – $16.69 | 7 |
| Suscept studies macrobroth dilution ea CPT 87188 | $210.65 | $383.00 | $4.98 – $12.82 | 7 |
| Suspend bowel w/prosthesis CPT 44700 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Suspension of testis CPT 54620 | not published | not published | $2,614.94 – $7,791.00 | 6 |
| Suspension of uterus CPT 58410 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Suspension of uterus 58400 CPT 58400 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Suspension sleeve lower ext HCPCS L2397 | not published | not published | $112.50 – $289.50 | 4 |
| Sutr lg intestine 1/mult perf without colostomy 44604 CPT 44604 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Suture bile duct injury 47900 CPT 47900 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Svc venogram s&i CPT 75827 | $1,815.00 | $3,300.00 | $273.99 – $3,005.03 | 4 |
| Sweat collection by iontophoresis CPT 89230 | not published | not published | $7.42 – $99.48 | 5 |
| Symes ankle without (sach) foot HCPCS L5703 | not published | not published | $2,329.89 – $5,995.58 | 4 |
| Symes met fr leath socket ar HCPCS L5060 | not published | not published | $3,119.37 – $8,027.18 | 4 |
| Symes type medial opening so HCPCS L5636 | not published | not published | $237.68 – $611.64 | 4 |
| Symes type poster opening so HCPCS L5634 | not published | not published | $310.96 – $800.22 | 4 |
| Symes type ptb brim design s HCPCS L5632 | not published | not published | $248.66 – $639.87 | 4 |
| Syme typ expandabl wall sckt HCPCS L5630 | not published | not published | $507.01 – $1,304.70 | 4 |
| Sympathectomy cervical CPT 64802 | not published | not published | $1,448.59 – $4,761.00 | 6 |
| Sympathectomy digital artery CPT 64820 | not published | not published | $1,448.59 – $7,791.00 | 6 |
| Sympathectomy lumbar CPT 64818 | $1,147.85 | $2,087.00 | $4,428.00 – $4,428.00 | 1 |
| Sympathectomy supfc palmar CPT 64823 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Sympathectomy thoracolumbar CPT 64809 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Synojoynt, inj., 1 mg HCPCS J7331 | not published | not published | $9.27 – $24.24 | 5 |
| Synthetic sentence id test CPT 92576 | not published | not published | $27.71 – $71.30 | 4 |
| Synvisc or synvisc-one HCPCS J7325 | not published | not published | $4.51 – $24.93 | 8 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $35.20 | $64.00 | $3.30 – $8.49 | 7 |
| System cardiomems hosp electronics HCPCS C2624 | $31,779.69 | $57,781.25 | not published | 0 |
| System pacing micra av HCPCS C1786 | $6,863.20 | $12,478.55 | not published | 0 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $4,180.35 | $7,600.64 | not published | 0 |
| T3 (triiodothyronine) free CPT 84481 | $106.70 | $194.00 | $12.70 – $32.69 | 7 |
| T3 (triiodothyronine) total CPT 84480 | $122.10 | $222.00 | $10.64 – $27.37 | 7 |
| T4 (thyroxine) free CPT 84439 | $81.40 | $148.00 | $6.76 – $17.41 | 7 |
| T4 (thyroxine) total CPT 84436 | $67.10 | $122.00 | $5.15 – $13.26 | 7 |
| Tacrol astagraf ex rel oral HCPCS J7508 | not published | not published | $0.61 – $1.55 | 5 |
| Tacrol envarsus ex rel oral HCPCS J7503 | not published | not published | $1.95 – $4.90 | 5 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | not published | not published | $0.19 – $0.50 | 5 |
| Tacrolimus 5 mg/ml intravenous solution HCPCS J7525 | not published | not published | $201.13 – $693.35 | 8 |
| Tacrolimus therapeutic drug level CPT 80197 | $122.65 | $223.00 | $10.30 – $26.50 | 7 |
| Tafasitamab-cxix 200 mg intravenous solution HCPCS J9349 | not published | not published | $10.82 – $38.03 | 8 |
| Tah rad debulk/lymph remove 58954 CPT 58954 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Tah rad dissect for debulk 58953 CPT 58953 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Tah w/mmk 58152 CPT 58152 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Talimogene laherparepvec 10exp6 (1 million) pfu/ml susp for injection HCPCS J9325 | not published | not published | $58.00 – $191.58 | 8 |
| Talquetamab-tgvs 2 mg/ml subcutaneous solution HCPCS J3055 | not published | not published | $57.54 – $190.49 | 8 |
| Talymed HCPCS Q4127 | not published | not published | $75.34 – $237.56 | 7 |
| Tap block bilat cont infusion 64489 CPT 64489 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Tap block uni by cont infusion 64487 CPT 64487 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Target gsa panel hmtlmph neop CPT 81450 | $2,020.70 | $3,674.00 | $569.65 – $1,465.89 | 7 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | $6,937.15 | $12,613.00 | $2,189.70 – $5,634.83 | 7 |
| Target gsa panel organ neop CPT 81445 | $1,037.30 | $1,886.00 | $448.43 – $1,153.97 | 7 |
| Tarlatamab-dlle 10 mg intravenous solution HCPCS J9026 | not published | not published | $1,209.32 – $4,289.08 | 6 |
| Tattooing/intraderm 6.1-20.0 sq cm 11921 CPT 11921 | not published | not published | $548.27 – $2,334.00 | 6 |
| Tavr perq femoral CPT 33361 | $16,500.00 | $30,000.00 | $7,609.00 – $7,609.00 | 1 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | not published | not published | $0.18 – $1.09 | 8 |
| Tbp gene detc abnor alleles CPT 81344 | not published | not published | $102.75 – $264.41 | 7 |
| Tbs dxa cal w/i&r fx risk CPT 77089 | not published | not published | $145.31 – $145.31 | 1 |
| Tbs i&r fx rsk qhp CPT 77092 | not published | not published | $37.25 – $37.25 | 1 |
| Tbs techl calculation only CPT 77091 | $144.65 | $263.00 | $64.56 – $166.13 | 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.