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 |
|---|---|---|---|---|
| Cerebrospinal fld flw imag CPT 78645 | $855.80 | $1,556.00 | $402.79 – $1,036.52 | 4 |
| Certolizumab pegol 400 mg (200 mg x 2 vials) subcutaneous kit HCPCS J0717 | not published | not published | $2.58 – $10.63 | 8 |
| Cervical lymphadenectomy 38720 CPT 38720 | not published | not published | $4,925.89 – $12,675.95 | 6 |
| Cervical or vaginal cancer screening g0101 HCPCS G0101 | $47.93 | $87.15 | $75.36 – $193.93 | 4 |
| Cesarean section delivery only 59514 CPT 59514 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Cetuximab 100 mg/50 ml intravenous solution HCPCS J9055 | not published | not published | $61.25 – $209.91 | 8 |
| #cf-97variants CPT 81220 | $1,322.75 | $2,405.00 | $417.45 – $1,074.24 | 7 |
| Cftr gene dup/delet variants CPT 81222 | not published | not published | $326.30 – $839.69 | 7 |
| Cftr gene intron poly t CPT 81224 | not published | not published | $126.56 – $325.69 | 7 |
| Cftr gene known fam variants CPT 81221 | not published | not published | $72.92 – $187.63 | 7 |
| Change cystostomy tube; complex 51710 CPT 51710 | not published | not published | $517.28 – $3,030.00 | 6 |
| Change cystostomy tube simple CPT 51705 | $738.65 | $1,343.00 | $185.35 – $2,334.00 | 6 |
| Change gastric port open CPT 43888 | not published | not published | $2,628.85 – $8,770.00 | 6 |
| Change g-tube to g-j perc CPT 49446 | $1,558.70 | $2,834.00 | $1,423.51 – $4,761.00 | 6 |
| Change nephroureteral cath CPT 50387 | $4,298.25 | $7,815.00 | $1,550.71 – $4,761.00 | 6 |
| Change of ureter tube/stent CPT 50688 | $1,591.70 | $2,894.00 | $1,550.71 – $4,761.00 | 6 |
| Change of windpipe airway 31502 CPT 31502 | $319.00 | $580.00 | $175.70 – $2,334.00 | 6 |
| Change stent via transureth CPT 50385 | not published | not published | $1,550.71 – $7,791.00 | 6 |
| Change ureter stent percut CPT 50382 | $2,682.90 | $4,878.00 | $1,550.71 – $7,791.00 | 6 |
| Chct for mal hyperthermia CPT 89049 | not published | not published | $96.64 – $325.23 | 5 |
| Chemical exfoliation acne 17360 CPT 17360 | not published | not published | $148.84 – $2,334.00 | 6 |
| Chemical peel face epiderm 15788 CPT 15788 | not published | not published | $301.57 – $2,334.00 | 6 |
| Chemical peel nonfacial 15793 CPT 15793 | not published | not published | $301.57 – $2,334.00 | 6 |
| Chemical peel nonfacial; epidermal CPT 15792 | not published | not published | $548.27 – $3,030.00 | 6 |
| Chemo adm cns w/lmbr punct CPT 96450 | $393.80 | $716.00 | $245.03 – $630.55 | 4 |
| Chemodener muscle larynx emg CPT 64617 | not published | not published | $523.65 – $3,030.00 | 6 |
| Chemodenerv 1 extrem 1-4 ea 64643 CPT 64643 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Chemodenerv 1 extrem 5/> ea 64645 CPT 64645 | $1,451.45 | $2,639.00 | $1,887.00 – $5,512.00 | 3 |
| Chemodenerv 1 extrem 5/> mus 64644 CPT 64644 | not published | not published | $523.65 – $3,030.00 | 6 |
| Chemodenerv 1 extremity 1-4 64642 CPT 64642 | $1,088.45 | $1,979.00 | $523.65 – $3,030.00 | 6 |
| Chemodenervation anal musc CPT 46505 | not published | not published | $887.71 – $4,761.00 | 6 |
| Chemodenervation/face muscl/unilat 64612 CPT 64612 | $805.75 | $1,465.00 | $227.71 – $2,334.00 | 6 |
| Chemodenervation nerve of eye muscle 67345 CPT 67345 | not published | not published | $235.46 – $2,334.00 | 6 |
| Chemodenerv eccrine glands CPT 64653 | not published | not published | $227.71 – $2,334.00 | 6 |
| Chemodenerv eccrine glands 64650 CPT 64650 | not published | not published | $227.71 – $2,334.00 | 6 |
| Chemodenerv musc migraine 64615 CPT 64615 | $832.15 | $1,513.00 | $227.71 – $2,334.00 | 6 |
| Chemodenerv musc neck dyston 64616 CPT 64616 | $1,915.65 | $3,483.00 | $227.71 – $2,334.00 | 6 |
| Chemodenerv saliv glands bilat 64611 CPT 64611 | not published | not published | $227.71 – $2,334.00 | 6 |
| Chemodenerv trunk musc 1-5 64646 CPT 64646 | $1,088.45 | $1,979.00 | $523.65 – $3,030.00 | 6 |
| Chemodenerv trunk musc 6/] 64647 CPT 64647 | $1,377.75 | $2,505.00 | $523.65 – $3,030.00 | 6 |
| Chemo extend IV infus w/pump HCPCS G0498 | $382.25 | $695.00 | $245.03 – $630.55 | 4 |
| Chemo ia infuse each addl hr CPT 96423 | not published | not published | $34.74 – $89.39 | 4 |
| Chemo ia infusion up to 1 hr CPT 96422 | $212.30 | $386.00 | $245.03 – $630.55 | 4 |
| Chemo ia push tecnique CPT 96420 | $611.60 | $1,112.00 | $245.03 – $630.55 | 4 |
| Chemo intralesional over 7 CPT 96406 | not published | not published | $157.79 – $406.05 | 4 |
| Chemo intralesional up to 7 96405 CPT 96405 | not published | not published | $53.41 – $137.45 | 4 |
| Chemotaxis assay CPT 86155 | not published | not published | $11.99 – $30.86 | 7 |
| Chemotherapy injection 96542 CPT 96542 | $388.85 | $707.00 | $245.03 – $630.55 | 4 |
| Chemotx admn pertl cav impl CPT 96446 | not published | not published | $245.03 – $630.55 | 4 |
| Chest 2 vws w oblique CPT 71048 | $261.25 | $475.00 | $77.56 – $199.58 | 4 |
| Chest apical lordotic proj CPT 71047 | $261.25 | $475.00 | $64.56 – $166.13 | 4 |
| Chest CT scan (with and without contrast) CPT 71270 | $1,714.35 | $3,117.00 | $130.12 – $334.84 | 4 |
| Chest CT scan (with contrast) CPT 71260 | $1,632.95 | $2,969.00 | $130.12 – $334.84 | 4 |
| Chest CT scan (without contrast) CPT 71250 | $1,554.85 | $2,827.00 | $77.56 – $199.58 | 4 |
| Chest X-ray CPT 71046 | $261.25 | $475.00 | $64.56 – $166.13 | 4 |
| Chest X-ray (single view) CPT 71045 | $261.25 | $475.00 | $34.96 – $166.13 | 4 |
| Chg pr pul rehab for copd patients CPT 94626 | $147.95 | $269.00 | $43.76 – $112.62 | 4 |
| Chg radiologic exam esophagus double contrast CPT 74221 | $276.65 | $503.00 | $130.12 – $334.84 | 4 |
| Chimerism anal no cell selec CPT 81267 | not published | not published | $155.60 – $400.40 | 7 |
| Chimerism anal w/cell select CPT 81268 | not published | not published | $195.59 – $503.32 | 7 |
| Chlamydia culture CPT 87110 | not published | not published | $14.70 – $37.83 | 7 |
| Chlamydia trachomatis ag if CPT 87270 | not published | not published | $8.98 – $23.12 | 7 |
| Chlamydia type CPT 87140 | $36.30 | $66.00 | $4.18 – $10.75 | 7 |
| Chlnggrphy intraop addl s&i CPT 74301 | not published | not published | $65.08 – $65.08 | 1 |
| Chloramphenicol sodium injec HCPCS J0720 | not published | not published | $158.94 – $158.94 | 1 |
| Chloride CPT 82435 | $38.50 | $70.00 | $3.45 – $8.88 | 7 |
| Chloride 24 hour urine CPT 82436 | $46.75 | $85.00 | $4.31 – $11.10 | 7 |
| Chloroprocaine hcl injection HCPCS J2401 | not published | not published | $0.04 – $0.08 | 5 |
| Chloroprocaine opht gel, 1mg HCPCS J2403 | not published | not published | $0.66 – $1.67 | 5 |
| Chlorothiazide sodium 500 mg intravenous solution HCPCS J1205 | not published | not published | $35.73 – $164.60 | 5 |
| Chlorpromazine 0.125 mg/ml IV syringe - cnr HCPCS J3230 | not published | not published | $31.94 – $82.98 | 5 |
| Chmotx admn plrl cav thrcnts CPT 96440 | not published | not published | $245.03 – $630.55 | 4 |
| Cholangiogram percutaneous compl CPT 47532 | not published | not published | $2,656.06 – $8,770.00 | 6 |
| Cholangiography and/or pancreatography intraoperative supervision & interpretation CPT 74300 | $276.65 | $503.00 | $112.83 – $112.83 | 1 |
| Cholecystectomy expl duct 47612 CPT 47612 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Cholecystectomy w/cholangiography 47605 CPT 47605 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Cholecystoenterostomy direct 47720 CPT 47720 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Cholecystostomy complete w/supervision & interpretation CPT 47490 | $2,391.95 | $4,349.00 | $2,656.06 – $8,770.00 | 6 |
| Cholesterol CPT 82465 | $44.55 | $81.00 | $3.26 – $8.40 | 7 |
| Cholesterol body fluid CPT 84999 | $132.55 | $241.00 | not published | 0 |
| Cholesterol (Lipid) Test CPT 80061 | $118.80 | $216.00 | $10.04 – $25.84 | 7 |
| Choline c-11 HCPCS A9515 | not published | not published | $1,887.32 – $5,616.35 | 5 |
| Cholinesterase CPT 82480 | not published | not published | $5.90 – $15.19 | 7 |
| Cholinesterase challenge CPT 95857 | not published | not published | $160.18 – $412.19 | 4 |
| Chorion biopsy CPT 59015 | $1,525.70 | $2,774.00 | $683.26 – $3,030.00 | 6 |
| Chorionic gonadotropin/1000u HCPCS J0725 | not published | not published | $20.08 – $53.56 | 5 |
| Chrom analysis CPT 88273 | not published | not published | $26.11 – $67.18 | 7 |
| Chromatogram assay sugars CPT 84375 | not published | not published | $11.77 – $75.27 | 7 |
| Chromatography CPT 83021 | $156.75 | $285.00 | $13.54 – $34.86 | 7 |
| Chromogenic substrate assay CPT 85130 | not published | not published | $8.92 – $22.95 | 7 |
| Chromo high res and frag x - sendout CPT 81243 | not published | not published | $42.78 – $110.09 | 7 |
| Chromosome analys amniotic CPT 88269 | not published | not published | $130.24 – $335.16 | 7 |
| Chromosome analysis 100 CPT 88249 | not published | not published | $129.88 – $334.22 | 7 |
| Chromosome analysis 15-20 cell count CPT 88262 | $770.00 | $1,400.00 | $94.12 – $242.20 | 7 |
| Chromosome analysis 20-25 CPT 88245 | not published | not published | $129.88 – $334.22 | 7 |
| Chromosome analysis 45 CPT 88263 | not published | not published | $112.72 – $290.06 | 7 |
| Chromosome analysis 5 CPT 88261 | not published | not published | $198.26 – $510.18 | 7 |
| Chromosome analysis 50-100 CPT 88248 | not published | not published | $129.88 – $334.22 | 7 |
| Chromosome analys placenta CPT 88267 | not published | not published | $141.43 – $363.94 | 7 |
| Chromosome banding study CPT 88283 | not published | not published | $51.45 – $132.40 | 7 |
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.