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 |
|---|---|---|---|---|
| Warde hepatitis a antibody CPT 86708 | $20.90 | $38.00 | $9.29 – $23.91 | 7 |
| Warde hepatitis be antibody CPT 86707 | $94.05 | $171.00 | $8.68 – $22.33 | 7 |
| Warde hepatitis delta agent antibody CPT 86692 | not published | not published | $12.87 – $33.12 | 7 |
| Warde immunofixation electrophoresis urine CPT 86335 | $186.45 | $339.00 | $22.01 – $56.65 | 7 |
| Warde infectious agent antigen immunoassay ql/sq multi step hepatitis be agn CPT 87350 | $26.40 | $48.00 | $8.65 – $22.25 | 7 |
| Warde infectious agent nucleic acid genotype hepatitis c CPT 87902 | $2,859.45 | $5,199.00 | $193.09 – $496.88 | 7 |
| Warde islet cell antibody zinc transporter 8 CPT 86341 | $105.05 | $191.00 | $17.68 – $45.49 | 7 |
| Warde lipoprotein (a) CPT 83695 | $113.85 | $207.00 | $10.74 – $27.64 | 7 |
| Warde lipoprotein-associated phospholipase a2 CPT 83698 | not published | not published | $34.73 – $89.38 | 7 |
| Warde mitochondrial antibody each CPT 86381 | $41.80 | $76.00 | $19.09 – $49.12 | 7 |
| Warde neutralization rabies CPT 86382 | not published | not published | $12.68 – $32.64 | 7 |
| Warde oxcarbazepine therapeutic drug level CPT 80183 | $144.65 | $263.00 | $9.94 – $25.57 | 7 |
| Warde pancreatic elastase fecal quantitative CPT 82653 | $41.25 | $75.00 | $17.23 – $44.33 | 7 |
| Warde protein c antigen CPT 85302 | $103.95 | $189.00 | $9.01 – $23.18 | 7 |
| Warde sex hormone binding globulin CPT 84270 | $209.55 | $381.00 | $16.30 – $41.94 | 7 |
| Warde somatomedin CPT 84305 | $153.45 | $279.00 | $15.94 – $41.03 | 7 |
| Warde sugars single qualitative each specimen stool CPT 84376 | not published | not published | $4.12 – $10.62 | 7 |
| Warde t3 (triiodothyronine) reverse CPT 84482 | $28.05 | $51.00 | $11.82 – $30.42 | 7 |
| Warde thyroid stimulating immunoglobulins CPT 84445 | $192.50 | $350.00 | $38.14 – $98.16 | 7 |
| Warde topiramate therapeutic drug level CPT 80201 | $116.60 | $212.00 | $8.94 – $23.01 | 7 |
| Warde virus isolation tissue culture innoculation presumptive id herpes simplex CPT 87252 | $291.50 | $530.00 | $19.55 – $50.32 | 7 |
| Warde viscosity CPT 85810 | $103.95 | $189.00 | $8.75 – $22.52 | 7 |
| Warde vitamin a CPT 84590 | $102.85 | $187.00 | $8.71 – $22.41 | 7 |
| Warde vitamin b-1 (thiamine) CPT 84425 | $182.60 | $332.00 | $15.92 – $40.97 | 7 |
| Warde vitamin b6 (pyridoxine) CPT 84207 | $241.45 | $439.00 | $21.08 – $54.23 | 7 |
| Warde vitamin c (ascorbic acid) CPT 82180 | $18.15 | $33.00 | $7.42 – $19.09 | 7 |
| Warde vitamin d (1 25 dihydroxy) CPT 82652 | $307.45 | $559.00 | $28.88 – $74.30 | 7 |
| Warde vitamin e (alpha-tocopherol) CPT 84446 | $121.55 | $221.00 | $10.64 – $27.37 | 7 |
| Warde zinc CPT 84630 | $90.20 | $164.00 | $8.54 – $21.98 | 7 |
| Warfarin respon genetic test HCPCS G9143 | not published | not published | $120.72 – $244.27 | 4 |
| Wash harvest stem cells CPT 38209 | not published | not published | $327.28 – $2,334.00 | 6 |
| Wbc automated CPT 85048 | $48.40 | $88.00 | $1.90 – $4.90 | 7 |
| Wcd device interrogate CPT 93292 | not published | not published | $27.69 – $71.25 | 4 |
| Wedge biopsy of liver 47100 CPT 47100 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Wedge rescj/bisctj ovary uni/bi 58920 CPT 58920 | not published | not published | $5,501.01 – $14,155.93 | 6 |
| Wedge resect of lung add-on 32506 CPT 32506 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Wedge resect of lung diag 32507 CPT 32507 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Wedge resect of lung initial 32505 CPT 32505 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Wedging of cast CPT 29740 | not published | not published | $207.48 – $2,334.00 | 6 |
| Wedging of clubfoot cast CPT 29750 | not published | not published | $207.48 – $2,334.00 | 6 |
| Western blot test CPT 84181 | not published | not published | $12.77 – $32.87 | 7 |
| Wet mounts/ w preparations HCPCS Q0111 | not published | not published | $8.64 – $35.78 | 7 |
| Whfo electric custom fitted HCPCS L3904 | not published | not published | $2,831.42 – $7,286.19 | 4 |
| Whfo nontorsion joint prefab HCPCS L3931 | not published | not published | $174.90 – $450.08 | 4 |
| Whfo w/joint(s) custom fab HCPCS L3806 | $436.49 | $793.62 | $381.02 – $980.50 | 4 |
| Whole blood or red blood cells frozen/deglycerolized/washed leukocytes reduced each unit HCPCS P9054 | $249.15 | $453.00 | not published | 0 |
| Whole mitochondrial genome CPT 81460 | not published | not published | $965.25 – $2,483.91 | 7 |
| Whole mitochondrial genome CPT 81465 | not published | not published | $702.00 – $1,806.48 | 7 |
| Who nontorsion jnts pre cst HCPCS L3915 | not published | not published | $445.90 – $1,147.46 | 4 |
| Who nontorsion jnts pre ots HCPCS L3916 | not published | not published | $445.90 – $1,147.46 | 4 |
| Wilate injection HCPCS J7183 | not published | not published | $0.99 – $3.48 | 8 |
| Wnd prep f/n/hf/g addl cm CPT 15005 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Woman's shoe oxford brace HCPCS L3224 | not published | not published | $62.28 – $160.27 | 4 |
| Wound closure by adhesive HCPCS G0168 | $410.30 | $746.00 | $1,887.00 – $2,334.00 | 2 |
| Woundfix biowound plus xplus HCPCS Q4217 | not published | not published | $92.32 – $1,009.67 | 7 |
| Wound therapy negative pressure per session <= 50 sq cm CPT 97607 | $298.10 | $542.00 | $301.57 – $776.03 | 4 |
| Wound therapy negative pressure per session > 50 sq cm CPT 97608 | $298.10 | $542.00 | $301.57 – $776.03 | 4 |
| Wound therapy negative pressure per session <= 50 sq cm dme CPT 97605 | $269.50 | $490.00 | $148.84 – $383.01 | 4 |
| Wound therapy negative pressure per session > 50 sq cm dme CPT 97606 | $301.40 | $548.00 | $301.57 – $776.03 | 4 |
| Wrist arthroscopy CPT 29840 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Wrist arthroscopy/surgery CPT 29843 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Wrist arthroscopy/surgery CPT 29844 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Wrist arthroscopy/surgery CPT 29845 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Wrist arthroscopy/surgery CPT 29846 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Wrist arthroscopy/surgery CPT 29847 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Wrist/elbow bowden cable mol HCPCS L6580 | not published | not published | $1,864.53 – $4,798.06 | 4 |
| Wrist/elbow bowden cbl dir f HCPCS L6582 | not published | not published | $1,565.96 – $4,029.72 | 4 |
| Wrist endoscopy/surgery CPT 29848 | not published | not published | $1,192.86 – $8,770.00 | 7 |
| Wrist X-ray CPT 73110 | $304.15 | $553.00 | $64.56 – $166.13 | 4 |
| Wrst mld sck flx hng tri pad HCPCS L6050 | not published | not published | $2,295.63 – $5,907.42 | 4 |
| Xcapsl ctrc rmvl cplx w/ecp CPT 66987 | not published | not published | $3,066.31 – $16,106.00 | 6 |
| Xcapsl ctrc rmvl cplx wo ecp CPT 66982 | not published | not published | $1,712.02 – $7,791.00 | 7 |
| Xcapsl ctrc rmvl insj 1+ CPT 66991 | not published | not published | $3,947.51 – $16,106.00 | 6 |
| Xcapsl ctrc rmvl w/ecp CPT 66988 | not published | not published | $3,066.31 – $16,106.00 | 6 |
| Xcellistem, 1 mg HCPCS A2004 | not published | not published | $42.47 – $42.47 | 1 |
| Xcpsl ctrc rmvl cplx insj 1+ CPT 66989 | not published | not published | $3,947.51 – $16,106.00 | 6 |
| Xe133 xenon 10mci HCPCS A9558 | $46.20 | $84.00 | $706.27 – $706.27 | 1 |
| Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/< CPT 14040 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Xfer tis s/a/l 10 sq cm/< CPT 14020 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| X-linked intellectual dblt CPT 81470 | not published | not published | $685.50 – $1,764.02 | 7 |
| X-linked intellectual dblt CPT 81471 | not published | not published | $685.50 – $1,764.02 | 7 |
| Xm archive tissue molec anal CPT 88363 | $56.65 | $103.00 | $21.46 – $55.21 | 5 |
| Xpos opn axillary/sbclvn art w/cndt crtn CPT 34716 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Xpos opn fmrl eprst aor uni add-on CPT 34812 | $2,789.60 | $5,072.00 | $3,388.00 – $3,388.00 | 1 |
| X-ray abdomen 1 view CPT 74018 | $276.65 | $503.00 | $59.99 – $166.13 | 4 |
| X-ray abdomen 2 views CPT 74019 | $276.65 | $503.00 | $71.86 – $199.58 | 4 |
| X-ray abdomen >=3 views CPT 74021 | $276.65 | $503.00 | $77.56 – $199.58 | 4 |
| X-ray abdomen complete acute series including spine erect and/or decubitus single view chest CPT 74022 | $276.65 | $503.00 | $77.56 – $199.58 | 4 |
| X-ray acromioclavicular joints without or w/weighted distraction bilateral CPT 73050 | $304.15 | $553.00 | $64.56 – $166.13 | 4 |
| X-ray ankle 2 views (both sides) CPT 73600 | $304.15 | $553.00 | $64.56 – $166.13 | 4 |
| X-ray arthrogram shoulder supervision & interpretation (both sides) CPT 73040 | $619.30 | $1,126.00 | $240.73 – $665.99 | 4 |
| X-ray assay calculus CPT 82370 | not published | not published | $9.39 – $24.16 | 7 |
| X-ray bone age studies CPT 77072 | $304.15 | $553.00 | $44.67 – $199.58 | 4 |
| X-ray bone length studies CPT 77073 | $304.15 | $553.00 | $72.00 – $199.58 | 4 |
| X-ray bone survey complete CPT 77075 | $304.15 | $553.00 | $77.56 – $199.58 | 4 |
| X-ray bone survey infant CPT 77076 | $304.15 | $553.00 | $77.56 – $199.58 | 4 |
| X-ray cervical spine 2-3 views CPT 72040 | $304.15 | $553.00 | $64.56 – $166.13 | 4 |
| X-ray cervical spine 4-5 views CPT 72050 | $304.15 | $553.00 | $77.56 – $199.58 | 4 |
| X-ray cervical spine >= 6 views CPT 72052 | $304.15 | $553.00 | $77.56 – $199.58 | 4 |
| X-ray clavicle complete (both sides) CPT 73000 | $304.15 | $553.00 | $62.49 – $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.