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 |
|---|---|---|---|---|
| Contrast x-ray of hip CPT 73525 | $1,229.80 | $2,236.00 | $241.91 – $665.99 | 4 |
| Contrast x-ray of knee joint CPT 73580 | $1,024.65 | $1,863.00 | $258.81 – $665.99 | 4 |
| Contrast x-ray of wrist CPT 73115 | $1,024.65 | $1,863.00 | $258.81 – $665.99 | 4 |
| Controler lvad heartmate 3 includes ebb HCPCS Q0481 | not published | not published | $13,419.56 – $34,533.01 | 4 |
| Controller infinity pt dbs HCPCS C1787 | $7,015.04 | $12,754.61 | not published | 0 |
| Control nosebleed pack+caut 30905 CPT 30905 | $702.35 | $1,277.00 | $98.70 – $2,334.00 | 6 |
| Control nose/throat bleeding comp req hospital 42971 CPT 42971 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Control nose/throat bleeding with surg ivntj 42972 CPT 42972 | not published | not published | $2,459.51 – $6,329.15 | 6 |
| Control nose/throat bleeding w/pst nsl packs 42970 CPT 42970 | not published | not published | $175.70 – $2,334.00 | 6 |
| Control of nosebleed ant comp 30903 CPT 30903 | $555.50 | $1,010.00 | $98.70 – $2,334.00 | 6 |
| Control of nosebleedantersmpl 30901 CPT 30901 | $386.10 | $702.00 | $98.70 – $2,334.00 | 6 |
| Control oropharyngeal hemorr/simp 42960 CPT 42960 | not published | not published | $400.09 – $2,334.00 | 6 |
| Control throat bleeding CPT 42961 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Control throat bleeding CPT 42962 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Conversion ext bil drg cath CPT 47535 | not published | not published | $2,656.06 – $8,770.00 | 6 |
| Convert nephrostomy catheter CPT 50434 | $1,802.90 | $3,278.00 | $1,550.71 – $3,990.50 | 6 |
| Conv gtube to jtube CPT 44373 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Coombs direct CPT 86880 | $66.00 | $120.00 | $5.39 – $112.62 | 7 |
| Coombs indirect qualitative each reagent red cell reference CPT 86885 | not published | not published | $5.72 – $325.23 | 7 |
| Coombs indirect titer reference CPT 86886 | $226.05 | $411.00 | $5.18 – $325.23 | 7 |
| Copper cu 64 dotatate diag HCPCS A9592 | not published | not published | $445.71 – $1,620.17 | 5 |
| Copper intrauterine device HCPCS J7300 | not published | not published | $3,718.94 – $3,718.94 | 1 |
| Cor artery disease mrna CPT 81493 | not published | not published | $787.50 – $2,026.50 | 7 |
| Core ndl bx lng/med perq CPT 32408 | $5,041.30 | $9,166.00 | $1,225.21 – $4,761.00 | 6 |
| Cor hlx vlgs double osteot CPT 28299 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Cor hlx vlgs dstl mtar osteo CPT 28296 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Cor hlx vlgs prx phlx osteot CPT 28298 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Corneal hysteresis deter CPT 92145 | not published | not published | $43.76 – $112.62 | 4 |
| Corneal smear CPT 65430 | not published | not published | $331.39 – $2,334.00 | 6 |
| Corneal transplant CPT 65710 | not published | not published | $3,947.51 – $16,106.00 | 6 |
| Corneal transplant CPT 65730 | not published | not published | $3,066.31 – $16,106.00 | 6 |
| Corneal transplant CPT 65750 | not published | not published | $3,947.51 – $16,106.00 | 6 |
| Corneal transplant CPT 65755 | not published | not published | $3,066.31 – $16,106.00 | 6 |
| Corneal trnspl endothelial CPT 65756 | not published | not published | $3,066.31 – $16,106.00 | 6 |
| Coronary angio/cath placement bypass graft/lv gram/lt heart CPT 93459 | $8,731.80 | $15,876.00 | $2,404.97 – $16,106.00 | 6 |
| Coronary angio/lv gram/lt heart CPT 93458 | $7,956.30 | $14,466.00 | $2,404.97 – $16,106.00 | 6 |
| Coronary angio/lv gram/rt< heart CPT 93460 | $8,092.15 | $14,713.00 | $2,404.97 – $16,106.00 | 6 |
| Coronary art/grft angio s&i CPT 93455 | $6,017.55 | $10,941.00 | $2,404.97 – $16,106.00 | 6 |
| Coronary catheterization w/angiography supervision & interpretation CPT 93454 | $6,475.15 | $11,773.00 | $2,404.97 – $16,106.00 | 6 |
| Coronary thrombolysis/iv infusion 92977 CPT 92977 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Correct bunion/keller/mcbride/mayo 28292 CPT 28292 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Correct cock-up 5th toe/plast clos 28286 CPT 28286 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Correct finger deformity CPT 26567 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Correct inverted nipple(s) CPT 19355 | not published | not published | $2,904.59 – $8,770.00 | 6 |
| Correction claw finger other CPT 26499 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Correction eyelid w/implant CPT 67912 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Correction hallux valgus sesamoidectomy;prox meta osteotomy CPT 28295 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Correction of astigmatism CPT 65772 | not published | not published | $739.52 – $4,761.00 | 6 |
| Correction of astigmatism CPT 65775 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Correction of everted punctum 68705 CPT 68705 | not published | not published | $235.46 – $2,334.00 | 6 |
| Correction trichiasis epilation forcep 67820 CPT 67820 | not published | not published | $98.70 – $2,334.00 | 6 |
| Correction trichiasis inccision lid margin 67830 CPT 67830 | not published | not published | $739.52 – $4,761.00 | 6 |
| Correct malrotation of bowel 44055 CPT 44055 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Correct metacarpal flaw CPT 26565 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Correct rectal prolapse CPT 45541 | not published | not published | $2,059.07 – $8,770.00 | 6 |
| Correct rectal prolapse; abdominal approach 45540 CPT 45540 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Correct skin color 6.0 cm/< CPT 11920 | not published | not published | $548.27 – $2,334.00 | 6 |
| Corrj halux rigdus w/implt CPT 28291 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Corrj halux rigdus without implt CPT 28289 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Cortisol acth stimulation test - sendout CPT 80400 | not published | not published | $24.46 – $62.96 | 7 |
| Cortisol total am CPT 82533 | $143.00 | $260.00 | $12.22 – $31.46 | 7 |
| Costotransversectomy CPT 21610 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Cosyntropin 0.25 mg solution for injection HCPCS J0834 | not published | not published | $36.20 – $91.01 | 5 |
| Co-treatment - group 15 mins, st CPT 92508 | $15.95 | $29.00 | $17.46 – $44.93 | 4 |
| Counseling smoke cess interm >10mins CPT 99407 | $46.20 | $84.00 | $27.80 – $71.53 | 4 |
| Counseling visit to discuss need for ldct g0296 HCPCS G0296 | not published | not published | $75.36 – $193.93 | 4 |
| Coveredge 32 lead kit 40cm 48 HCPCS C1897 | $1,073.12 | $1,951.12 | not published | 0 |
| Cover eye w/membrane CPT 65778 | not published | not published | $739.52 – $4,761.00 | 6 |
| Cover eye w/membrane suture CPT 65779 | not published | not published | $2,916.44 – $8,770.00 | 6 |
| Cover wrist HCPCS L3984 | not published | not published | $290.27 – $746.97 | 4 |
| Covid-19 administration immunization im inj 1st/only component CPT 90480 | $66.55 | $121.00 | $30.15 – $77.58 | 4 |
| Covid-19 lab test non-cdc HCPCS U0002 | not published | not published | $38.48 – $99.03 | 7 |
| #covid19rsv-rsv CPT 87634 | $156.75 | $285.00 | $52.65 – $135.49 | 7 |
| #coxa-coxsackie a serotype a16 CPT 86658 | $22.00 | $40.00 | $9.77 – $25.15 | 7 |
| C-peptide CPT 84681 | $44.00 | $80.00 | $10.56 – $40.16 | 7 |
| Cptrized corneal topography CPT 92025 | not published | not published | $43.76 – $112.62 | 4 |
| Cptr ophth dx img post segmt CPT 92134 | not published | not published | $43.76 – $112.62 | 4 |
| Cptrz oph img pst sg rta oct CPT 92137 | not published | not published | $160.18 – $412.19 | 4 |
| Cr-51 sodium chromate HCPCS A9553 | not published | not published | $885.03 – $3,701.66 | 5 |
| Craniect/craniot w/wo duraplasty w/lobectomy 61323 CPT 61323 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Craniectomy/craniotomy expl 61304 CPT 61304 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Craniectomy/craniotomy tx penet wound brain 61571 CPT 61571 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Craniectomy exc brain tumor fossa 61518 CPT 61518 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Craniectomy exc brain tumor meningioma 61519 CPT 61519 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Craniectomy or craniotomy for drng abscess 61320 CPT 61320 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Craniectomy or craniotomy for drng inf 61315 CPT 61315 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Craniectomy or craniotomy for drng supr 61313 CPT 61313 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Craniectomy subocc w/cerv lam (press relief) 61343 CPT 61343 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Crbrospnl fld flw imag cistern CPT 78630 | $1,936.00 | $3,520.00 | $402.79 – $1,036.52 | 4 |
| C-reactive protein CPT 86140 | $44.55 | $81.00 | $3.88 – $10.00 | 7 |
| C-reactive protein high sensitivity CPT 86141 | $77.55 | $141.00 | $9.71 – $24.99 | 7 |
| C-reactive protein, quantitative CPT 86406 | not published | not published | $7.98 – $20.54 | 7 |
| Creat artery-vein fistula autograft 36825 CPT 36825 | not published | not published | $4,127.91 – $18,364.00 | 6 |
| Create eardrum opening CPT 69436 | not published | not published | $1,151.01 – $4,761.00 | 7 |
| Create passage to kidney CPT 52334 | not published | not published | $2,614.94 – $7,791.00 | 6 |
| Create tear duct drain CPT 68745 | not published | not published | $2,916.44 – $8,770.00 | 6 |
| Create tear duct drain CPT 68750 | not published | not published | $2,916.44 – $8,770.00 | 6 |
| Create tear sac drain CPT 68720 | not published | not published | $2,916.44 – $8,770.00 | 6 |
| Creatine isoforms CPT 82554 | not published | not published | $8.90 – $22.91 | 7 |
| Creatine kinase CPT 82550 | $58.30 | $106.00 | $4.88 – $12.56 | 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.