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 |
|---|---|---|---|---|
| Bx breast add lesion Ultrasound imag CPT 19084 | $237.05 | $431.00 | $1,887.00 – $5,512.00 | 3 |
| Bx breast perq without image 19100 CPT 19100 | not published | not published | $1,225.21 – $4,761.00 | 6 |
| Bx breast pq tomo guide CPT 19499 | not published | not published | $2,904.59 – $7,791.00 | 6 |
| Bx/curett of cervix w/scope 57454 CPT 57454 | $610.50 | $1,110.00 | $226.06 – $2,334.00 | 6 |
| Bx/exc idrl spine lesn crvl CPT 63280 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Bx/exc lymph node/open/deep cervic 38510 CPT 38510 | not published | not published | $2,904.59 – $7,791.00 | 6 |
| Bx/exc lymph node/open/superfic 38500 CPT 38500 | not published | not published | $2,904.59 – $7,791.00 | 6 |
| Bx/exc xdrl spine lesn lmbr CPT 63277 | not published | not published | $6,779.00 – $27,583.00 | 3 |
| Bx leg/ankle soft tissue deep 27614 CPT 27614 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Bx liver with other CPT 47001 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Bx muscle CPT 20200 | not published | not published | $1,225.21 – $4,761.00 | 6 |
| Bx nasopharynx/unknown pri lesion 42806 CPT 42806 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Bx of breast open 19101 CPT 19101 | not published | not published | $2,904.59 – $7,791.00 | 6 |
| Bx of cervix w/scope leep 57460 CPT 57460 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Bx pancreas pq ndl CPT 48102 | $1,045.55 | $1,901.00 | $1,225.21 – $4,761.00 | 6 |
| Bx perianal mass CPT 46999 | not published | not published | $689.87 – $3,030.00 | 6 |
| Bx pleura pq ndl CPT 32400 | $378.40 | $688.00 | $1,225.21 – $4,761.00 | 6 |
| Bx prostate trnsrctl u/s guid CPT 55707 | not published | not published | $2,614.94 – $6,729.12 | 4 |
| Bx prst8 ndl sat sampling CPT 55706 | not published | not published | $2,614.94 – $6,729.12 | 6 |
| Bx shoulder tissues deep 23066 CPT 23066 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Bx shoulder tissues supf 23065 CPT 23065 | $3,244.45 | $5,899.00 | $1,225.21 – $3,152.87 | 6 |
| Bx skin incisnl ea sep/add l les CPT 11107 | $624.80 | $1,136.00 | $1,887.00 – $5,512.00 | 3 |
| Bx skin punch ea sep/ addl les CPT 11105 | $394.35 | $717.00 | $1,887.00 – $5,512.00 | 3 |
| Bx skin tangential ea sep/ addl les CPT 11103 | $394.35 | $717.00 | $1,887.00 – $5,512.00 | 3 |
| Bx/soft tis/forearm/wrist/superfic 25065 CPT 25065 | not published | not published | $1,225.21 – $3,152.87 | 6 |
| Bx soft tiss pelvis+hip area supf 27040 CPT 27040 | not published | not published | $1,225.21 – $3,152.87 | 6 |
| Bx soft tiss pelvis/hip deep 27041 CPT 27041 | not published | not published | $1,225.21 – $3,152.87 | 6 |
| Bx soft tissue back/flank deep 21925 CPT 21925 | not published | not published | $1,225.21 – $7,791.00 | 6 |
| Bx soft tissue back/flank supf 21920 CPT 21920 | not published | not published | $1,225.21 – $3,152.87 | 6 |
| Bx spinal cord pq ndl CPT 62269 | not published | not published | $1,225.21 – $4,761.00 | 6 |
| Bx thigh/knee soft tiss supf 27323 CPT 27323 | not published | not published | $1,225.21 – $3,152.87 | 6 |
| Bx thyroid/percutan core needle 60100 CPT 60100 | $1,092.30 | $1,986.00 | $525.32 – $3,030.00 | 6 |
| Bx vag mucos smpl (sep proc) CPT 57100 | not published | not published | $683.26 – $3,030.00 | 6 |
| Bx vulva or perineum/1 lesion 56605 CPT 56605 | $227.15 | $413.00 | $683.26 – $3,030.00 | 6 |
| Bx vulva or perineum/ea add lesion 56606 CPT 56606 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Bypass temp external fem-fem CPT 37799 | $1,780.35 | $3,237.00 | $465.35 – $3,030.00 | 6 |
| C-1 esterase, berinert HCPCS J0597 | not published | not published | $59.45 – $197.27 | 8 |
| C-1 esterase, cinryze HCPCS J0598 | not published | not published | $50.06 – $174.44 | 8 |
| C1 esterase inhibitor func - sendout CPT 86161 | $87.45 | $159.00 | $9.00 – $23.16 | 7 |
| Cabazitaxel 10 mg/ml (first dilution) intravenous solution HCPCS J9043 | not published | not published | $175.30 – $610.09 | 8 |
| Cabergoline, oral 0.25mg HCPCS J8515 | not published | not published | $49.90 – $49.90 | 1 |
| Cabg 2 arterial grafts 33534 CPT 33534 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Cabg 3 arterial grafts 33535 CPT 33535 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Cabg arterial four or more 33536 CPT 33536 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Cabgsingle artery graft 33533 CPT 33533 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Cabgsingle coronary venous graft 33510 CPT 33510 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Cabg/valve reop >1 mo p org proced 33530 CPT 33530 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Cabg/vein only/2 cor venous gfts 33511 CPT 33511 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Cabg/vein only/3 cor venous gfts 33512 CPT 33512 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Cabg/vein only/4 cor venous gfts 33513 CPT 33513 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Cabg venous & art 1 vein graft 33517 CPT 33517 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Cabg venous & art 2 vein graft 33518 CPT 33518 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Cabg venous & art 3 vein graft 33519 CPT 33519 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Cabg venous & art 4 vein graft 33521 CPT 33521 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Cabg venous & art 5 vein graft 33522 CPT 33522 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Cabg venous & art 6 vein graft 33523 CPT 33523 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Cable cath 22-pin diag HCPCS C1730 | $1,101.74 | $2,003.16 | not published | 0 |
| Cabotegravir ER 400 mg/2 ml-rilpivirine ER 600 mg/2ml im suspension,er HCPCS J0741 | not published | not published | $18.50 – $63.08 | 8 |
| Cacna1a gene full gene seq CPT 81185 | not published | not published | $634.70 – $1,633.30 | 7 |
| Cadd pump refill CPT 96521 | $380.60 | $692.00 | $157.79 – $406.05 | 4 |
| Caffeine citrate 20 mg/ml inj for po HCPCS J0706 | not published | not published | $5.48 – $5.48 | 1 |
| Calaspargase pegol-mknl 750 unit/ml intravenous solution HCPCS J9118 | not published | not published | $64.34 – $208.35 | 8 |
| Calcitonin (salmon) 200 unit/ml injection solution HCPCS J0630 | not published | not published | $1,236.91 – $3,110.22 | 3 |
| Calcium 24 hour urine CPT 82340 | $57.75 | $105.00 | $4.52 – $11.64 | 7 |
| Calcium acetate(phosphate binders) 667 mg tablet HCPCS J0615 | not published | not published | $0.08 – $0.08 | 1 |
| Calcium gluconate 100 mg/ml (10 %) intravenous solution HCPCS J0612 | not published | not published | $0.04 – $0.12 | 5 |
| Calcium gluconate 2 gram/100 ml in sodium chloride,iso-osm IV solution HCPCS J0613 | not published | not published | $0.09 – $0.30 | 5 |
| Calcium ionized CPT 82330 | $95.15 | $173.00 | $10.26 – $26.40 | 7 |
| Calcium total CPT 82310 | $43.45 | $79.00 | $3.87 – $9.96 | 7 |
| Calculi urinary-sendout CPT 82360 | not published | not published | $9.65 – $24.84 | 7 |
| Calculus analysis qual CPT 82355 | not published | not published | $8.68 – $22.35 | 7 |
| Caloric vstblr test w/rec CPT 92538 | not published | not published | $160.18 – $412.19 | 4 |
| Calprotectin fecal CPT 83993 | $36.85 | $67.00 | $14.72 – $37.89 | 7 |
| Camisole mastectomy wht/l post-surg gental touch HCPCS L8015 | not published | not published | $55.36 – $142.45 | 4 |
| Campylobacter antibody CPT 86625 | not published | not published | $9.84 – $25.32 | 7 |
| Canakinumab injection HCPCS J0638 | not published | not published | $117.41 – $369.93 | 8 |
| Candida dna CPT 87480 | not published | not published | $15.04 – $38.70 | 7 |
| Candida skin test CPT 86485 | not published | not published | $21.46 – $55.21 | 5 |
| Cannula declotting 36861 CPT 36861 | not published | not published | $4,127.91 – $18,364.00 | 6 |
| Cannula ercp contour 5-4-3 tip HCPCS C1889 | $13,352.53 | $24,277.32 | not published | 0 |
| Cantharidin top, applicator HCPCS J7354 | not published | not published | $521.41 – $1,937.74 | 8 |
| Canthotomy 67715 CPT 67715 | $3,741.65 | $6,803.00 | $1,763.69 – $7,791.00 | 6 |
| Capecitabine, oral, 50 mg HCPCS J8522 | not published | not published | $0.05 – $0.15 | 8 |
| Cap nerve 2x15mm HCPCS C1763 | $1,157.82 | $2,105.12 | not published | 0 |
| Capsaicin 8% patch HCPCS J7336 | not published | not published | $2.63 – $9.06 | 8 |
| Capsular contracture release CPT 23020 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Capsulotomy; interphalangeal joint, each joint (separate proc) CPT 28272 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Capsulotomy mpj ea joint (sep proc) CPT 28270 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Cap trach decann 15mm HCPCS C1750 | $716.59 | $1,302.89 | not published | 0 |
| Carbamazepine free CPT 80157 | not published | not published | $9.94 – $25.57 | 7 |
| Carbamazepine free -sendout CPT 80161 | $30.80 | $56.00 | $13.98 – $35.98 | 7 |
| Carbamazepine total therapeutic drug level CPT 80156 | $135.85 | $247.00 | $10.93 – $28.12 | 7 |
| Carbidopa levodopa ent 100ml HCPCS J7340 | not published | not published | $183.37 – $642.38 | 8 |
| Carbohydrate deficient transf - sendout CPT 82373 | not published | not published | $13.54 – $34.86 | 7 |
| Carbohydrate urine - sendout CPT 84377 | not published | not published | $4.12 – $10.62 | 7 |
| Carbon dioxide CPT 82374 | $45.65 | $83.00 | $3.66 – $9.42 | 7 |
| Carboplatin 10 mg/ml desensitization HCPCS J9045 | not published | not published | $3.22 – $9.88 | 5 |
| Carboxyhemoglobin quantitative CPT 82375 | $116.05 | $211.00 | $9.24 – $23.78 | 7 |
| Carcinoembryonic ag (cea) CPT 82378 | $158.40 | $288.00 | $14.22 – $36.59 | 7 |
| Cardiac drug stress test CPT 93024 | not published | not published | $331.39 – $852.79 | 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.