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 |
|---|---|---|---|---|
| Trastuzumab-qyyp 150 mg intravenous solution HCPCS Q5116 | not published | not published | $9.77 – $54.37 | 7 |
| Trauma partial team response w/critical care services level 4 HCPCS G0390 | $5,503.85 | $10,007.00 | $988.80 – $2,544.50 | 4 |
| Trb@ gene rearrange dirprobe CPT 81341 | not published | not published | $37.19 – $95.71 | 7 |
| Treat ankle dislocation CPT 27842 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Treat ankle dislocation CPT 27846 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Treat ankle dislocation CPT 27848 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Treat ankle fracture CPT 28445 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Treat big toe fracture CPT 28505 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Treat cheek bone fracturemalar 21360 CPT 21360 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Treat chest lining CPT 32215 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Treat clavicle dislocation 23545 CPT 23545 | $541.20 | $984.00 | $182.99 – $2,334.00 | 6 |
| Treat each add spine fx CPT 22328 | not published | not published | $1,887.00 – $3,735.00 | 3 |
| Treat ectopic pregnancy CPT 59150 | not published | not published | $4,484.77 – $18,364.00 | 6 |
| Treat ectopic pregnancy CPT 59151 | not published | not published | $4,484.77 – $18,364.00 | 6 |
| Treat ectopic pregnancy CPT 59140 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Treat elbow dislocation CPT 24605 | $2,987.60 | $5,432.00 | $1,192.86 – $4,761.00 | 6 |
| Treat elbow dislocation CPT 24615 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Treat elbow fracture CPT 24586 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Treat elbow fracture CPT 24620 | $3,394.60 | $6,172.00 | $1,192.86 – $4,761.00 | 6 |
| Treat elbow fracture CPT 24635 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Treat eyelid by injection CPT 68200 | not published | not published | $331.39 – $2,334.00 | 6 |
| Treat eyelid lesion 67850 CPT 67850 | not published | not published | $739.52 – $4,761.00 | 6 |
| Treat finger fracture each CPT 26727 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Treat finger fracture each CPT 26742 | $3,092.10 | $5,622.00 | $1,192.86 – $3,069.63 | 6 |
| Treat foot bone lesion CPT 28005 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Treat foot dislocation CPT 28540 | not published | not published | $182.99 – $2,334.00 | 6 |
| Treat foot dislocation CPT 28545 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Treat foot dislocation CPT 28546 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Treat foot dislocation CPT 28570 | $708.40 | $1,288.00 | $182.99 – $2,334.00 | 6 |
| Treat foot dislocation CPT 28576 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Treat foot dislocation CPT 28600 | not published | not published | $182.99 – $2,334.00 | 6 |
| Treat foot dislocation CPT 28605 | not published | not published | $182.99 – $2,334.00 | 6 |
| Treat foot dislocation CPT 28606 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Treat fracture of radius CPT 25505 | $2,987.60 | $5,432.00 | $1,192.86 – $3,069.63 | 6 |
| Treat fracture of radius CPT 25520 | $2,416.70 | $4,394.00 | $1,192.86 – $3,069.63 | 6 |
| Treat fracture of ulna CPT 25535 | not published | not published | $182.99 – $2,334.00 | 6 |
| Treat/graft heel fracture CPT 28420 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Treat hand bone lesion CPT 26034 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Treat hand dislocation CPT 26675 | not published | not published | $1,192.86 – $3,069.63 | 6 |
| Treat hand dislocation CPT 26685 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Treat hand dislocation CPT 26686 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Treat heel fracture CPT 28415 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Treat hip dislocation CPT 27252 | $2,561.90 | $4,658.00 | $1,192.86 – $3,069.63 | 6 |
| Treat hip dislocation CPT 27257 | $3,152.05 | $5,731.00 | $1,192.86 – $3,069.63 | 6 |
| Treat hip dislocation CPT 27258 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Treat hip dislocation CPT 27253 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Treat hip dislocation CPT 27254 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Treat hip dislocation CPT 27259 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Treat hip fracture(s) CPT 27227 | not published | not published | $3,735.00 – $16,106.00 | 6 |
| Treat hip fracture(s) CPT 27228 | not published | not published | $3,735.00 – $16,106.00 | 6 |
| Treat hip socket fracture CPT 27222 | $377.30 | $686.00 | $182.99 – $2,334.00 | 6 |
| Treat hip wall fracture CPT 27226 | not published | not published | $3,735.00 – $16,106.00 | 6 |
| Treat humerus fracture CPT 24515 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Treat humerus fracture CPT 24516 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Treat humerus fracture CPT 24535 | $3,394.60 | $6,172.00 | $1,192.86 – $3,069.63 | 6 |
| Treat humerus fracture CPT 24545 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Treat humerus fracture CPT 24546 | not published | not published | $8,923.00 – $24,508.80 | 6 |
| Treat humerus fracture CPT 24565 | not published | not published | $1,192.86 – $3,069.63 | 6 |
| Treat humerus fracture CPT 24575 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Treat humerus fracture CPT 24579 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Treat humerus fracture CPT 24582 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Treat kneecap dislocation CPT 27562 | $579.15 | $1,053.00 | $182.99 – $2,334.00 | 6 |
| Treat kneecap dislocation CPT 27566 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Treat kneecap fracture CPT 27524 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Treat knee dislocation CPT 27552 | $2,501.95 | $4,549.00 | $1,192.86 – $4,761.00 | 6 |
| Treat knee dislocation CPT 27556 | not published | not published | $3,735.00 – $16,106.00 | 6 |
| Treat knee dislocation CPT 27557 | not published | not published | $3,735.00 – $16,106.00 | 6 |
| Treat knee dislocation CPT 27558 | not published | not published | $3,735.00 – $16,106.00 | 6 |
| Treat knee fracture CPT 27535 | not published | not published | $3,735.00 – $16,106.00 | 6 |
| Treat knee fracture CPT 27536 | not published | not published | $3,735.00 – $16,106.00 | 6 |
| Treat knee fracture CPT 27540 | not published | not published | $3,735.00 – $16,106.00 | 6 |
| Treat knee fracture 27530 CPT 27530 | not published | not published | $182.99 – $2,334.00 | 6 |
| Treat knee fracture(s) CPT 27538 | not published | not published | $182.99 – $2,334.00 | 6 |
| Treat knuckle dislocation CPT 26705 | $3,372.60 | $6,132.00 | $1,192.86 – $3,069.63 | 6 |
| Treat knuckle dislocation CPT 26715 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Treat lower jaw fracture 21462 CPT 21462 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Treat lower leg bone lesion CPT 27607 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Treat lower leg dislocation CPT 27830 | not published | not published | $182.99 – $2,334.00 | 6 |
| Treat lower leg dislocation CPT 27831 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Treat lower leg dislocation CPT 27832 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Treat lower leg fracture CPT 27826 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Treat lower leg fracture CPT 27827 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Treat lower leg fracture CPT 27828 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Treat lower leg joint CPT 27829 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Treatment fx radial distal open w/internal fixation 2 frag left (restricted method ii cah) CPT 25608 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Treatment fx radial distal open w/internal fixation 3+ frag left (restricted method ii cah) CPT 25609 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Treatment fx radial distal open w/internal fixation left (restricted method ii cah) CPT 25607 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Treatment incomplete abortion completed surgically any trimester CPT 59812 | $5,938.35 | $10,797.00 | $2,401.40 – $7,791.00 | 6 |
| Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour CPT 94644 | $312.40 | $568.00 | $98.70 – $253.99 | 4 |
| Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour CPT 94645 | $298.10 | $542.00 | not published | 0 |
| Treatment inhalation pressurized/nonpressurized acute airway obstruction CPT 94640 | $129.80 | $236.00 | $162.44 – $418.02 | 4 |
| Treatment missed abortion completed surgically 1st trimester CPT 59820 | $6,133.60 | $11,152.00 | $2,401.40 – $7,791.00 | 6 |
| Treatment mouth roof lesion CPT 42160 | not published | not published | $2,459.51 – $6,329.15 | 6 |
| Treatment of anal fissure CPT 46942 | not published | not published | $689.87 – $3,030.00 | 6 |
| Treatment of anal fissure w/dilat 46940 CPT 46940 | not published | not published | $2,059.07 – $5,298.68 | 6 |
| Treatment of ankle fracture CPT 27792 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Treatment of ankle fracture CPT 27814 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Treatment of ankle fracture CPT 27822 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Treatment of ankle fracture CPT 27823 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Treatment of ankle fracture 27786 CPT 27786 | $574.20 | $1,044.00 | $182.99 – $2,334.00 | 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.