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 |
|---|---|---|---|---|
| Clsd tx humeral fract without manip 24530 CPT 24530 | not published | not published | $182.99 – $2,334.00 | 6 |
| Clsd tx humerus fract without manip 24500 CPT 24500 | not published | not published | $182.99 – $2,334.00 | 6 |
| Clsd tx iphal jnt disl w/manip req anes CPT 26775 | $628.10 | $1,142.00 | $207.48 – $2,334.00 | 6 |
| Clsd tx mandibular fx without manip 21450 CPT 21450 | not published | not published | $400.09 – $2,334.00 | 6 |
| Clsd tx/metacar/interphal artic fx 26740 CPT 26740 | not published | not published | $182.99 – $2,334.00 | 6 |
| Clsd tx/metacarpal fx/sg without manip 26600 CPT 26600 | $498.85 | $907.00 | $182.99 – $2,334.00 | 6 |
| Clsd tx/metacarpal fx/sng/w manip 26605 CPT 26605 | $526.35 | $957.00 | $182.99 – $2,334.00 | 6 |
| Clsd tx metacarp fx w/manip&ext fix ea bone 26607 CPT 26607 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Clsd tx metatarsal fracture w/manip 28475 CPT 28475 | $374.00 | $680.00 | $182.99 – $2,334.00 | 6 |
| Clsd tx/metatarsal fx without manip 28470 CPT 28470 | not published | not published | $182.99 – $2,334.00 | 6 |
| Clsd tx/nasal bone fx/stabilize 21320 CPT 21320 | not published | not published | $2,459.51 – $6,329.15 | 6 |
| Clsd tx of ankle fracture w/manip 28435 CPT 28435 | $3,152.05 | $5,731.00 | $1,192.86 – $4,761.00 | 6 |
| Clsd tx patella disloc without anes 27560 CPT 27560 | $523.05 | $951.00 | $182.99 – $2,334.00 | 6 |
| Clsd tx/patellar fx without manip 27520 CPT 27520 | not published | not published | $182.99 – $2,334.00 | 6 |
| Clsd tx pelvic ring fx CPT 27197 | not published | not published | $182.99 – $2,334.00 | 6 |
| Clsd tx pelvic ring fx CPT 27198 | not published | not published | $182.99 – $2,334.00 | 6 |
| Clsd tx prox fib/shaft fx w/manip 27781 CPT 27781 | $3,372.60 | $6,132.00 | $1,192.86 – $3,069.63 | 6 |
| Clsd tx/prox/mid phalnx fx/no manp 26720 CPT 26720 | not published | not published | $182.99 – $2,334.00 | 6 |
| Clsd tx/radial head/neck fx/no manip 24650 CPT 24650 | not published | not published | $182.99 – $2,334.00 | 6 |
| Clsd tx radius fracture w/manip 24655 CPT 24655 | $3,152.05 | $5,731.00 | $1,192.86 – $3,069.63 | 6 |
| Clsd tx/scapular fx without manip 23570 CPT 23570 | not published | not published | $182.99 – $2,334.00 | 6 |
| Clsd tx shoulder dislc/fx 23665 CPT 23665 | $3,069.00 | $5,580.00 | $1,192.86 – $3,069.63 | 6 |
| Clsd tx shoulder disloc w/anatom neck fx w/manip 23675 CPT 23675 | $3,152.05 | $5,731.00 | $1,192.86 – $3,069.63 | 6 |
| Clsd tx/shoulder dislo/manip/anest 23655 CPT 23655 | $3,069.00 | $5,580.00 | $1,192.86 – $4,761.00 | 6 |
| Clsd tx/talotarsal dislocat/anes 28575 CPT 28575 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Clsd tx temporomandibular dislocat 21480 CPT 21480 | $579.15 | $1,053.00 | $182.99 – $2,334.00 | 6 |
| Clsd tx toe dislocation without anes28660 CPT 28660 | $507.10 | $922.00 | $182.99 – $2,334.00 | 6 |
| Clsd tx trimall ankle fx without manip 27816 CPT 27816 | not published | not published | $182.99 – $2,334.00 | 6 |
| Clsd tx trimall ankle fx w/manip 27818 CPT 27818 | $3,092.10 | $5,622.00 | $1,192.86 – $3,069.63 | 6 |
| Clsd tx/ulnar shaft fx without manip 25530 CPT 25530 | not published | not published | $182.99 – $2,334.00 | 6 |
| Clsd tx vert body fx without manip req &w/csting/bracing CPT 22310 | not published | not published | $182.99 – $2,334.00 | 6 |
| Clsd tx wrist carpal fx without manip 25630 CPT 25630 | not published | not published | $182.99 – $2,334.00 | 6 |
| Clsd tx wrist scaphoid fx without manip 25622 CPT 25622 | not published | not published | $182.99 – $2,334.00 | 6 |
| Clsd tx wrist trans-scaph fx w/manip 25680 CPT 25680 | not published | not published | $182.99 – $2,334.00 | 6 |
| Clsd tx wrist ulnar styloid fx 25650 CPT 25650 | not published | not published | $182.99 – $2,334.00 | 6 |
| Clsd/ulnar fx/prox end without manip 24670 CPT 24670 | not published | not published | $182.99 – $2,334.00 | 6 |
| Cls tx of heel fracture w/manip 28405 CPT 28405 | not published | not published | $182.99 – $2,334.00 | 6 |
| Cltx carpl scphd fx w/mnpj CPT 25624 | not published | not published | $1,192.86 – $3,069.63 | 6 |
| Cltx gr hmrl tbrs fx w/mnpj CPT 23625 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Cltx hum epcndylr fx wo mnpj CPT 24560 | not published | not published | $182.99 – $2,334.00 | 6 |
| Cltx humrl cndylr fx w/mnpj CPT 24577 | not published | not published | $1,192.86 – $3,069.63 | 6 |
| Cltx humrl cndylr fx wo mnpj CPT 24576 | not published | not published | $182.99 – $2,334.00 | 6 |
| Cltx lunate dislc w/mnpj CPT 25690 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Cltx mndblr fx ntrdntl fixj CPT 21453 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Cltx mndblr fx w/mnpj CPT 21451 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Cltx mndblr/max alv ridge fx CPT 21440 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Cltx palatal/max fx wire fix CPT 21421 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Cltx post ankle fx CPT 27767 | not published | not published | $182.99 – $2,334.00 | 6 |
| Cltx post ankle fx w/mnpj CPT 27768 | $3,111.35 | $5,657.00 | $1,192.86 – $3,069.63 | 6 |
| Cltx scap fx w/mnpj +-tractj CPT 23575 | not published | not published | $1,192.86 – $3,069.63 | 6 |
| Cltx strnclav dislc w/mnpj CPT 23525 | not published | not published | $182.99 – $2,334.00 | 6 |
| Cltx thigh fx CPT 27267 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Cltx tmprmand dislc comp CPT 21485 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Cmbn ant pst colprhy CPT 57260 | not published | not published | $3,710.98 – $9,549.58 | 6 |
| C motor evoked lwr limbs CPT 95929 | not published | not published | $276.82 – $712.35 | 4 |
| C motor evoked uppr limbs CPT 95928 | $707.30 | $1,286.00 | $637.04 – $1,639.32 | 4 |
| C motor evoked upr&lwr limbs CPT 95939 | $1,419.00 | $2,580.00 | $637.04 – $1,639.32 | 4 |
| Cmptr ophth dx img ant segmt CPT 92132 | not published | not published | $43.76 – $112.62 | 4 |
| Cmptr ophth img optic nerve CPT 92133 | not published | not published | $43.76 – $112.62 | 4 |
| #cms hgb-carboxyhemoglobin CPT 82376 | not published | not published | $10.55 – $27.16 | 7 |
| #cms hgb-sulfhemoglobin CPT 83060 | not published | not published | $6.60 – $16.98 | 7 |
| #cmvcul-virus inoculation shell CPT 87254 | $122.10 | $222.00 | $14.67 – $37.75 | 7 |
| Cmv pcr-sendout CPT 87496 | $112.75 | $205.00 | $26.32 – $67.72 | 7 |
| Co2 monitor per day CPT 94681 | not published | not published | $276.82 – $712.35 | 4 |
| Coagulation factor viia 1,000 mcg/ml inj 1 ml HCPCS J7189 | not published | not published | $2.08 – $6.95 | 8 |
| Coagulation time activated teg CPT 85347 | $36.85 | $67.00 | $3.21 – $8.26 | 7 |
| Coagulation time otr method CPT 85348 | not published | not published | $3.37 – $8.67 | 7 |
| Cochlear implt f/up exam <7 CPT 92601 | not published | not published | $95.45 – $245.63 | 4 |
| Cochlear implt f/up exam 7/> CPT 92603 | not published | not published | $95.45 – $245.63 | 4 |
| Codeine 15 mg/ml inj 2 ml HCPCS J0745 | not published | not published | $2.64 – $2.64 | 1 |
| Cold agglutinin screen (arc) CPT 86156 | not published | not published | $6.05 – $15.58 | 7 |
| Cold agglutinin titer CPT 86157 | $46.20 | $84.00 | $6.04 – $15.56 | 7 |
| Colectomy/end colost/close dis seg 44143 CPT 44143 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Colectomy/ ileostomy without prctect 44150 CPT 44150 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Colectomy/ ileostomy w/prctect 44155 CPT 44155 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Colectomy partial w/anastomosis 44140 CPT 44140 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Colectomy prtl abdominal + transanal appr 44147 CPT 44147 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Colectomy prtl w/coloproctostomy 44145 CPT 44145 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Colectomy prtl w/coloproctostomy + colostomy 44146 CPT 44146 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Colectomy prtl w/remove terminal ileum+ileocolos 44160 CPT 44160 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Colectomy prtl w/skin level cecost/colostomy 44141 CPT 44141 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Colectomy/w colostomy or ileostomy 44144 CPT 44144 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Colistimethate sodium inj HCPCS J0770 | not published | not published | $13.13 – $33.10 | 5 |
| Collagenase, clost hist inj HCPCS J0775 | not published | not published | $58.72 – $193.00 | 8 |
| Collar cerv 18.25x3.5in serp firm density sm HCPCS L0120 | not published | not published | $24.38 – $62.74 | 4 |
| Collar cerv adlt perfit ace extric HCPCS L0140 | not published | not published | $55.17 – $141.97 | 4 |
| Collar cerv ascend 172 reg HCPCS L0172 | $86.17 | $156.68 | $130.54 – $335.92 | 4 |
| Collar cerv patriot adlt HCPCS L0150 | not published | not published | $98.66 – $253.87 | 4 |
| Collar extrication adult univ HCPCS L0200 | not published | not published | $568.87 – $1,463.89 | 4 |
| Collection blood specimen from completely implantable venous access device CPT 36591 | $110.00 | $200.00 | $98.70 – $2,334.00 | 6 |
| Collection blood specimen using established central/peripheral catheter venous nos CPT 36592 | $110.00 | $200.00 | $98.70 – $2,334.00 | 6 |
| Collection of venous blood by venipuncture CPT 36415 | $20.90 | $38.00 | $3.00 – $18.03 | 7 |
| Colon motility 6 hr study CPT 91117 | not published | not published | $160.18 – $2,334.00 | 6 |
| Colonoscopy (diagnostic) CPT 45378 | not published | not published | $689.87 – $4,761.00 | 7 |
| Colonoscopy flex with decompression 45393 CPT 45393 | not published | not published | $887.71 – $4,761.00 | 6 |
| Colonoscopy flex w/rem of tumor(s)/polyp(s)/lesion(s) by hot biopsy(s) forceps (rest meth ii cah) CPT 45384 | not published | not published | $887.71 – $4,761.00 | 7 |
| Colonoscopy for bleeding 44391 CPT 44391 | not published | not published | $887.71 – $4,761.00 | 6 |
| Colonoscopy for foreign body CPT 44390 | not published | not published | $689.87 – $4,761.00 | 6 |
| Colonoscopy & polypectomy 44392 CPT 44392 | not published | not published | $887.71 – $4,761.00 | 6 |
| Colonoscopy stoma w/endo mucosal rescj 44403 CPT 44403 | not published | not published | $887.71 – $4,761.00 | 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.