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 |
|---|---|---|---|---|
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | $409.20 | $744.00 | $77.56 – $199.58 | 4 |
| Ultrasound guidance for vascular access CPT 76937 | $293.70 | $534.00 | $57.02 – $57.02 | 1 |
| Ultrasound guided needle placement supervision & interpretation CPT 76942 | $470.80 | $856.00 | $92.20 – $92.20 | 1 |
| Ultrasound guide intraoperative CPT 76998 | $409.20 | $744.00 | $211.13 – $211.13 | 1 |
| Ultrasound guide tissue ablation CPT 76940 | not published | not published | $209.52 – $209.52 | 1 |
| Ultrasound hips infant dynamic CPT 76885 | $400.95 | $729.00 | $64.56 – $166.13 | 4 |
| Ultrasound infant hips ltd without stress CPT 76886 | not published | not published | $64.56 – $166.13 | 4 |
| Ultrasound joint complete left CPT 76881 | $470.80 | $856.00 | $77.56 – $199.58 | 4 |
| Ultrasound joint/nonvascular extremity limited left CPT 76882 | $470.80 | $856.00 | $37.54 – $199.58 | 4 |
| Ultrasound nrv&acc strux 1xtr compre CPT 76883 | not published | not published | $52.32 – $199.58 | 4 |
| Ultrasound ob >=14wks ea addl gest CPT 76810 | $409.20 | $744.00 | $146.14 – $146.14 | 1 |
| Ultrasound pregnant uterus < 14 weeks each additional gestation CPT 76802 | $409.20 | $744.00 | $74.86 – $74.86 | 1 |
| Ultrasound pregnant uterus detailed fetal exam single/1st gestation CPT 76811 | $400.95 | $729.00 | $177.00 – $455.49 | 4 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | $409.20 | $744.00 | $77.56 – $199.58 | 4 |
| Ultrasound pregnant uterus limited >= 1 fetuses CPT 76815 | $470.80 | $856.00 | $77.56 – $199.58 | 4 |
| Ultrasound pregnant uterus transvaginal CPT 76817 | $409.20 | $744.00 | $77.56 – $199.58 | 4 |
| Ultrasound prostate/transrectal CPT 76872 | $443.27 | $805.95 | $77.56 – $199.58 | 4 |
| Ultrasound retroperitoneal limited CPT 76775 | $460.90 | $838.00 | $77.56 – $199.58 | 4 |
| Ultrasound scrotum and contents CPT 76870 | $460.90 | $838.00 | $77.56 – $199.58 | 4 |
| Ultrasound spinal canal and contents CPT 76800 | $409.20 | $744.00 | $77.56 – $199.58 | 4 |
| Ultrasound transabd ea addl gest CPT 76812 | $409.20 | $744.00 | $384.48 – $384.48 | 1 |
| Ultrasound transvaginal non obstetric CPT 76830 | $409.20 | $744.00 | $77.56 – $199.58 | 4 |
| Ultrasound trgt dyn mbubb 1st les CPT 76978 | not published | not published | $258.81 – $665.99 | 4 |
| Ultrasound trgt dyn mbubb ea addl CPT 76979 | not published | not published | $603.69 – $603.69 | 1 |
| Ultraviolet therapy CPT 97028 | not published | not published | $5.92 – $15.23 | 4 |
| Umbilical artery cath newborn 36660 CPT 36660 | $53.35 | $97.00 | $3,388.00 – $3,388.00 | 1 |
| Umbilical cord occlud w/us CPT 59072 | not published | not published | $226.06 – $2,334.00 | 6 |
| Umbilicoplasty 15847 CPT 15847 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Unit mobile power mpu HCPCS Q0479 | not published | not published | $11,085.67 – $28,527.12 | 4 |
| Unlistd noninvas vasc dx std CPT 93998 | not published | not published | $21.46 – $55.21 | 4 |
| Unlisted all/immlg svc/px CPT 95199 | not published | not published | $21.46 – $55.21 | 4 |
| Unlisted chemotherapy px CPT 96549 | not published | not published | $34.74 – $89.39 | 4 |
| Unlisted cranfcl&maxlfcl px CPT 21299 | not published | not published | $175.70 – $2,334.00 | 6 |
| Unlisted CT procedure CPT 76497 | $136.95 | $249.00 | $64.56 – $166.13 | 4 |
| Unlisted cv px dx nuc med CPT 78499 | not published | not published | $296.56 – $763.16 | 4 |
| Unlisted cytogenetic study CPT 88299 | not published | not published | $38.66 – $99.48 | 5 |
| Unlisted cytopathology px CPT 88199 | not published | not published | $38.66 – $99.48 | 5 |
| Unlisted dialysis procedure CPT 90999 | $746.90 | $1,358.00 | not published | 0 |
| Unlisted dx gi procedure CPT 91299 | not published | not published | $95.45 – $2,334.00 | 6 |
| Unlisted endocrine px dx nuc CPT 78099 | not published | not published | $296.56 – $763.16 | 4 |
| Unlisted fetal invas px w/us CPT 59897 | not published | not published | $149.98 – $2,334.00 | 6 |
| Unlisted fluoroscopic px CPT 76496 | $502.15 | $913.00 | $64.56 – $166.13 | 4 |
| Unlisted gi px dx nuc med CPT 78299 | not published | not published | $296.56 – $763.16 | 4 |
| Unlisted gu px dx nuc med CPT 78799 | not published | not published | $296.56 – $763.16 | 4 |
| Unlisted hystsc px uterus CPT 58579 | not published | not published | $149.98 – $2,334.00 | 6 |
| Unlisted laparoscopic liver biopy 47379 CPT 47379 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Unlisted laparoscopic procedure 49659 CPT 49659 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Unlisted laparoscopic reduction intestine 44238 CPT 44238 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Unlisted laparoscopy procedure biliary tract 47579 CPT 47579 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Unlisted laps px appendix CPT 44979 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Unlisted laps px bladder CPT 51999 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Unlisted laps px endoc sys CPT 60659 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Unlisted laps px esoph CPT 43289 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Unlisted laps px lymphtc sys CPT 38589 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Unlisted laps px ovidct ovry CPT 58679 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Unlisted laps px renal CPT 50549 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Unlisted laps px spleen CPT 38129 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Unlisted laps px testis CPT 54699 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Unlisted laps px ureter CPT 50949 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Unlisted laps px uterus CPT 58578 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Unlisted maxlfcl prosth px CPT 21089 | not published | not published | $175.70 – $2,334.00 | 6 |
| Unlisted misc path test CPT 89240 | not published | not published | $38.66 – $99.48 | 5 |
| Unlisted mr procedure CPT 76498 | $2,305.60 | $4,192.00 | $64.56 – $166.13 | 4 |
| Unlisted muscskel px dx nuc CPT 78399 | not published | not published | $296.56 – $763.16 | 4 |
| Unlisted muscskel px head CPT 21499 | not published | not published | $175.70 – $2,334.00 | 6 |
| Unlisted neurological dx px CPT 95999 | not published | not published | $95.45 – $245.63 | 4 |
| Unlisted nrvs sys px dx nuc CPT 78699 | not published | not published | $296.56 – $763.16 | 4 |
| Unlisted oph svc/procedure CPT 92499 | not published | not published | $21.46 – $55.21 | 4 |
| Unlisted orl service/px CPT 92700 | not published | not published | $21.46 – $55.21 | 4 |
| Unlisted procedure colon CPT 45399 | not published | not published | $689.87 – $4,761.00 | 6 |
| Unlisted procedure esophagus CPT 43499 | not published | not published | $672.83 – $4,761.00 | 6 |
| Unlisted procedure eyelids CPT 67999 | not published | not published | $235.46 – $2,334.00 | 6 |
| Unlisted procedure larynx CPT 31599 | not published | not published | $175.70 – $2,334.00 | 6 |
| Unlisted procedure liver CPT 47399 | not published | not published | $525.32 – $3,030.00 | 6 |
| Unlisted procedure orbit CPT 67599 | not published | not published | $235.46 – $2,334.00 | 6 |
| Unlisted procedure pancreas CPT 48999 | not published | not published | $525.32 – $3,030.00 | 6 |
| Unlisted procedure rectum CPT 45999 | not published | not published | $689.87 – $3,030.00 | 6 |
| Unlisted procedure spine CPT 22899 | not published | not published | $182.99 – $2,334.00 | 6 |
| Unlisted procedure urinary 58750 CPT 58750 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Unlisted psychiatric service/proc 90899 CPT 90899 | not published | not published | $27.80 – $71.53 | 4 |
| Unlisted px abdomen muscskel CPT 22999 | not published | not published | $182.99 – $2,334.00 | 6 |
| Unlisted px accessory sinus CPT 31299 | not published | not published | $175.70 – $2,334.00 | 6 |
| Unlisted px ant segment eye CPT 66999 | not published | not published | $1,712.02 – $4,761.00 | 6 |
| Unlisted px arthroscopy CPT 29999 | not published | not published | $182.99 – $2,334.00 | 6 |
| Unlisted px biliary tract CPT 47999 | not published | not published | $672.83 – $4,761.00 | 6 |
| Unlisted px casting/strpg CPT 29799 | not published | not published | $120.55 – $2,334.00 | 6 |
| Unlisted px conjunctiva CPT 68399 | not published | not published | $235.46 – $2,334.00 | 6 |
| Unlisted px diaphragm CPT 39599 | not published | not published | $10,779.00 – $10,779.00 | 1 |
| Unlisted px exc pressure ulc CPT 15999 | not published | not published | $525.32 – $3,030.00 | 6 |
| Unlisted px external ear CPT 69399 | not published | not published | $175.70 – $2,334.00 | 6 |
| Unlisted px extraocular musc CPT 67399 | not published | not published | $235.46 – $2,334.00 | 6 |
| Unlisted px foot/toes CPT 28899 | not published | not published | $182.99 – $2,334.00 | 6 |
| Unlisted px forearm/wrist CPT 25999 | not published | not published | $182.99 – $2,334.00 | 6 |
| Unlisted px hands/fingers CPT 26989 | not published | not published | $182.99 – $2,334.00 | 6 |
| Unlisted px inner ear CPT 69949 | not published | not published | $175.70 – $2,334.00 | 6 |
| Unlisted px lacrimal system CPT 68899 | not published | not published | $235.46 – $2,334.00 | 6 |
| Unlisted px leg/ankle CPT 27899 | not published | not published | $182.99 – $2,334.00 | 6 |
| Unlisted px male genital sys CPT 55899 | not published | not published | $185.35 – $2,334.00 | 6 |
| Unlisted px mediastinum CPT 39499 | not published | not published | $10,779.00 – $10,779.00 | 1 |
| Unlisted px med radj physics CPT 77399 | not published | not published | $99.71 – $256.58 | 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.