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 |
|---|---|---|---|---|
| Colonoscopy stoma w/snare 44394 CPT 44394 | not published | not published | $887.71 – $4,761.00 | 6 |
| Colonoscopy submucous njx CPT 45381 | not published | not published | $887.71 – $4,761.00 | 6 |
| Colonoscopy thru stoma spx CPT 44388 | not published | not published | $689.87 – $4,761.00 | 6 |
| Colonoscopy w/ablation CPT 45388 | not published | not published | $887.71 – $4,761.00 | 6 |
| Colonoscopy w/balloon dilat CPT 45386 | not published | not published | $887.71 – $4,761.00 | 6 |
| Colonoscopy w/band ligation CPT 45398 | not published | not published | $887.71 – $4,761.00 | 6 |
| Colonoscopy w/control bleed CPT 45382 | not published | not published | $887.71 – $4,761.00 | 6 |
| Colonoscopy w/decompression CPT 44408 | not published | not published | $689.87 – $4,761.00 | 6 |
| Colonoscopy w/dilation CPT 44405 | not published | not published | $887.71 – $4,761.00 | 6 |
| Colonoscopy w/endoscope Ultrasound CPT 45391 | not published | not published | $887.71 – $4,761.00 | 6 |
| Colonoscopy w/endoscopic fnb CPT 45392 | not published | not published | $887.71 – $4,761.00 | 6 |
| Colonoscopy/w endoscopic stent 45389 CPT 45389 | not published | not published | $3,579.00 – $11,589.23 | 6 |
| Colonoscopy w/fb removal CPT 45379 | not published | not published | $887.71 – $4,761.00 | 6 |
| Colonoscopy w/injection CPT 44404 | not published | not published | $887.71 – $4,761.00 | 6 |
| Colonoscopy with ablation CPT 44401 | not published | not published | $887.71 – $4,761.00 | 6 |
| Colonoscopy (with biopsy) CPT 45380 | not published | not published | $887.71 – $4,761.00 | 7 |
| Colonoscopy with biopsy CPT 44389 | not published | not published | $887.71 – $4,761.00 | 6 |
| Colonoscopy (with polyp removal) CPT 45385 | not published | not published | $887.71 – $4,761.00 | 7 |
| Colonoscopy w/ndl aspir/bx CPT 44407 | not published | not published | $887.71 – $4,761.00 | 6 |
| Colonoscopy w/resection CPT 45390 | not published | not published | $2,059.07 – $5,298.68 | 6 |
| Colonoscopy w/stent plcmt CPT 44402 | not published | not published | $3,579.00 – $11,589.23 | 6 |
| Colonoscopy w/ultrasound CPT 44406 | not published | not published | $887.71 – $4,761.00 | 6 |
| Colostomy skin level cecostomy 44320 CPT 44320 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Colotomy exploration/bx/foreign body removal 44025 CPT 44025 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Colpocentesis 57020 CPT 57020 | not published | not published | $3,388.00 – $9,549.58 | 6 |
| Colpocleisis (le forte type) 57120 CPT 57120 | not published | not published | $3,710.98 – $9,549.58 | 6 |
| Colpopexy abdominal approach 57280 CPT 57280 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Colpopexy extraperitoneal CPT 57282 | not published | not published | $5,501.01 – $16,106.00 | 6 |
| Colpopexy intraperitoneal CPT 57283 | not published | not published | $5,501.01 – $16,106.00 | 6 |
| Colpopexy, min/inv, ex-perit HCPCS C9778 | not published | not published | $3,710.98 – $9,549.58 | 6 |
| Colporrhapy/vag injury sut/non ob 57200 CPT 57200 | $4,804.25 | $8,735.00 | $2,401.40 – $7,791.00 | 6 |
| Colposcopy/cervix/bx vagina/cervix 57421 CPT 57421 | $371.80 | $676.00 | $683.26 – $3,030.00 | 6 |
| Colposcopy/cervix/ conization 57461 CPT 57461 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Colposcopy/cervix/inc up/adjacent vag 57452 CPT 57452 | not published | not published | $149.98 – $2,334.00 | 6 |
| Colposcopy vulva 56820 CPT 56820 | not published | not published | $149.98 – $2,334.00 | 6 |
| Colposcopy vulva w/biopsy 56821 CPT 56821 | not published | not published | $226.06 – $2,334.00 | 6 |
| Colposcopy w/biopsy of cervix 57455 CPT 57455 | not published | not published | $226.06 – $2,334.00 | 6 |
| Colpotomy drng of abscess 57010 CPT 57010 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Colpotomy w/exploration 57000 CPT 57000 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Compatibility test each unit antiglobulin technique CPT 86922 | $158.95 | $289.00 | $51.34 – $325.23 | 5 |
| Compatibility test each unit electronic CPT 86923 | $88.55 | $161.00 | $38.62 – $325.23 | 5 |
| Compatibility test each unit immediate spin technique CPT 86920 | $99.00 | $180.00 | $48.28 – $325.23 | 5 |
| Compatibility test incubate CPT 86921 | $219.45 | $399.00 | $43.19 – $325.23 | 5 |
| Comp cystometrogram/void presssure 51728 CPT 51728 | $747.78 | $1,359.60 | $517.28 – $3,030.00 | 6 |
| Comp cystometrogram/void/uret pres 51729 CPT 51729 | not published | not published | $517.28 – $3,030.00 | 6 |
| Complement antigen each component c3 CPT 86160 | $99.55 | $181.00 | $9.00 – $23.16 | 7 |
| Complement fixation each CPT 86171 | not published | not published | $7.51 – $19.32 | 7 |
| Complete removal of vulva CPT 56625 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Completion pneumonectomy 32488 CPT 32488 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Complex cystometrogram 51726 CPT 51726 | not published | not published | $185.35 – $2,334.00 | 6 |
| Complex repair trunk 1.1-2.5cm 13120 CPT 13120 | $1,247.95 | $2,269.00 | $301.57 – $2,334.00 | 6 |
| Complex repair trunk 2.6-7.5cm 13101 CPT 13101 | not published | not published | $548.27 – $2,334.00 | 6 |
| Complex uroflowmetry (electronic) 51741 CPT 51741 | $226.86 | $412.48 | $160.18 – $2,334.00 | 6 |
| Compl oph exam general anes CPT 92018 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Complx repair enel 1.1-2.5 cm 13151 CPT 13151 | $1,247.95 | $2,269.00 | $548.27 – $2,334.00 | 6 |
| Complx repair enel 2.6-7.5 cm 13152 CPT 13152 | $1,252.90 | $2,278.00 | $548.27 – $2,334.00 | 6 |
| Complx repair enel addl 5cm/< 13153 CPT 13153 | $379.50 | $690.00 | $1,887.00 – $5,512.00 | 3 |
| Complx repair fccmnaxghf 13131 CPT 13131 | $805.20 | $1,464.00 | $301.57 – $2,334.00 | 6 |
| Complx repair fccmnaxghf 13132 CPT 13132 | $1,247.95 | $2,269.00 | $301.57 – $2,334.00 | 6 |
| Complx repair fccmnaxghf 13133 CPT 13133 | $589.60 | $1,072.00 | $1,887.00 – $5,512.00 | 3 |
| Complx repair sal addl 5 cm/> 13122 CPT 13122 | $1,144.55 | $2,081.00 | $1,887.00 – $5,512.00 | 3 |
| Complx repair trunk 1.1-2.5 cm 13100 CPT 13100 | not published | not published | $548.27 – $2,334.00 | 6 |
| Complx repair trunk addl 5cm/< 13102 CPT 13102 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Component ankle afo plastic jt mold to pt mdl foot cup HCPCS L1970 | not published | not published | $637.96 – $1,641.68 | 4 |
| Composite graft/pri close/don area 15760 CPT 15760 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Comprehensive hearing test CPT 92557 | not published | not published | $95.45 – $245.63 | 4 |
| Compre oph exam est pt 1/> CPT 92014 | not published | not published | $98.76 – $254.15 | 4 |
| Compre oph exam new pt 1/> CPT 92004 | not published | not published | $98.76 – $254.15 | 4 |
| Computed tomographic angiography head and neck with contrast CPT 70471 | not published | not published | $258.81 – $665.99 | 4 |
| Concentration infection agents any type CPT 87015 | $34.10 | $62.00 | $5.01 – $12.89 | 7 |
| Conditioning play audiometry 92582 CPT 92582 | not published | not published | $95.45 – $245.63 | 4 |
| Condylomata destruction 56420 CPT 56420 | $512.05 | $931.00 | $149.98 – $2,334.00 | 6 |
| Conization/cerv/loop electrode exc 57522 CPT 57522 | not published | not published | $2,401.40 – $7,791.00 | 7 |
| Conization of cervix CPT 57520 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Conjugated estrogens 25 mg solution for injection HCPCS J1410 | not published | not published | $301.13 – $1,042.47 | 8 |
| Constj trachesophgl fstl CPT 31611 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Construction of vagina CPT 57291 | not published | not published | $3,388.00 – $9,549.58 | 6 |
| Construct thumb replacement CPT 26550 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Construct vagina with graft CPT 57292 | not published | not published | $3,710.98 – $9,549.58 | 6 |
| Consultation pathology during surgery CPT 88329 | not published | not published | $33.43 – $112.62 | 5 |
| Consultation pathology during surgery cytological exam initial site CPT 88333 | $154.00 | $280.00 | $50.62 – $1,538.03 | 5 |
| Consultation pathology during surgery frozen section each additional block CPT 88332 | $100.10 | $182.00 | $23.10 – $26.72 | 2 |
| Consultation pathology during surgery frozen section first tissue block CPT 88331 | $258.50 | $470.00 | $44.53 – $325.23 | 5 |
| Consultation/report referred material w/preparation of slides CPT 88323 | not published | not published | $38.66 – $99.48 | 5 |
| Consultation/report referred slides prepared elsewhere CPT 88321 | not published | not published | $27.71 – $71.30 | 5 |
| Consult comp w/report rfrd material CPT 88325 | $260.15 | $473.00 | $49.47 – $325.23 | 5 |
| Contact lens fitg aphakia 1 CPT 92311 | not published | not published | $331.39 – $852.79 | 4 |
| Contact lens fitg aphakia ou CPT 92312 | not published | not published | $98.70 – $253.99 | 4 |
| Cont intraop neuro monitor HCPCS G0453 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Contour cranial bone lesion CPT 21181 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Contour of face bone lesion CPT 21029 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Contrast baths charges CPT 97034 | not published | not published | $10.14 – $26.09 | 4 |
| Contrast exam abdominl aorta 75625-26 CPT 75625 | $2,526.70 | $4,594.00 | $273.99 – $6,027.57 | 4 |
| Contrast exam thoracic aorta CPT 75600 | not published | not published | $578.16 – $6,027.57 | 4 |
| Contrast exam thoracic aorta 75605-26 CPT 75605 | $3,418.80 | $6,216.00 | $276.36 – $10,622.50 | 4 |
| Contrast x-ray gallbladder CPT 74290 | $276.65 | $503.00 | $130.12 – $334.84 | 4 |
| Contrast x-ray of ankle CPT 73615 | $1,024.65 | $1,863.00 | $253.79 – $665.99 | 4 |
| Contrast x-ray of brain CPT 70010 | not published | not published | $209.76 – $665.99 | 4 |
| Contrast x-ray of brain CPT 70015 | $880.00 | $1,600.00 | $301.32 – $1,496.49 | 4 |
| Contrast x-ray of elbow CPT 73085 | $1,229.80 | $2,236.00 | $227.65 – $665.99 | 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.