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 |
|---|---|---|---|---|
| Creatine kinase isoenzymes CPT 82552 | $100.10 | $182.00 | $10.04 – $25.84 | 7 |
| Creatine kinase mb CPT 82553 | $21.45 | $39.00 | $8.66 – $22.29 | 7 |
| Creatine - sendout CPT 82540 | not published | not published | $3.48 – $8.96 | 7 |
| Creatinine CPT 82565 | $45.10 | $82.00 | $3.84 – $9.88 | 7 |
| Creatinine 24 hour urine CPT 82570 | $45.65 | $83.00 | $3.88 – $10.00 | 7 |
| Creatinine clearance urine CPT 82575 | $85.80 | $156.00 | $7.10 – $18.26 | 7 |
| #creutz-prot.,western blot CPT 84182 | $54.45 | $99.00 | $21.91 – $56.38 | 7 |
| Cricopharyngeal myotomy 43030 CPT 43030 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Cricotracheal resection CPT 31592 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Crisis psychotherapy 90839 CPT 90839 | $130.90 | $238.00 | $131.67 – $338.84 | 4 |
| Crisis psychotherapy additional 30 mins 90840 CPT 90840 | $102.30 | $186.00 | not published | 0 |
| Critical care 30-74 minutes CPT 99291 | $1,657.15 | $3,013.00 | $612.77 – $1,576.87 | 4 |
| Critical care each additional 30 minutes CPT 99292 | $827.75 | $1,505.00 | not published | 0 |
| Crizanlizumab-tmca 10 mg/ml intravenous solution HCPCS J0791 | not published | not published | $97.45 – $350.33 | 8 |
| Crnec exc tum/bone les skull CPT 61500 | not published | not published | $6,779.00 – $18,364.00 | 3 |
| Crnop skull defect>5 cm diam CPT 62141 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Cromolyn sodium noncomp unit HCPCS J7631 | not published | not published | $0.24 – $0.58 | 5 |
| Cross-over vein graft CPT 34520 | not published | not published | $4,127.91 – $18,364.00 | 6 |
| Crotalidae poly immune fab HCPCS J0840 | not published | not published | $1,430.18 – $4,845.08 | 8 |
| Crtj pericardial window/prtl resecj w/drg/bx CPT 33025 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Cryoablate prostate CPT 55873 | not published | not published | $7,022.52 – $27,583.00 | 6 |
| Cryocautery of cervix 57511 CPT 57511 | not published | not published | $226.06 – $2,334.00 | 6 |
| Cryofibrinogen qualitative - sendout CPT 82585 | $25.30 | $46.00 | $10.60 – $27.29 | 7 |
| Cryoprecipitate each unit HCPCS P9012 | $205.15 | $373.00 | not published | 0 |
| Cryopreservation embryo(s) CPT 89258 | not published | not published | $597.68 – $1,538.03 | 5 |
| Cryopreservation oocyte(s) CPT 89337 | not published | not published | $126.39 – $325.23 | 5 |
| Cryopreservation sperm CPT 89259 | not published | not published | $126.39 – $325.23 | 5 |
| Cryopreserve stem cells CPT 38207 | not published | not published | $327.28 – $2,334.00 | 6 |
| Cryopreserve testicular tiss CPT 89335 | not published | not published | $38.66 – $99.48 | 5 |
| Cryosurg ablate fa each CPT 19105 | not published | not published | $2,904.59 – $8,770.00 | 6 |
| Cryosurgery penis lesion(s) 54056 CPT 54056 | not published | not published | $148.84 – $2,334.00 | 6 |
| Cryotherapy of acne 17340 CPT 17340 | not published | not published | $43.76 – $2,334.00 | 6 |
| Cryptococcus abs qn - sendout CPT 86641 | not published | not published | $10.81 – $27.81 | 7 |
| Cryptosporidium antigen CPT 87272 | not published | not published | $8.98 – $23.12 | 7 |
| Crystal identification light microscopy CPT 89060 | $66.55 | $121.00 | $5.50 – $14.15 | 7 |
| C-Section Delivery (full care) CPT 59510 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| C-section delivery incl p/p care 59515 CPT 59515 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Csf leakage imaging CPT 78650 | $1,936.00 | $3,520.00 | $960.41 – $2,471.46 | 4 |
| Csf shunt reprogram 62252 CPT 62252 | not published | not published | $227.84 – $2,334.00 | 6 |
| Csf ventriculography CPT 78635 | not published | not published | $402.79 – $1,036.52 | 4 |
| CT 3d report other modality w/workstation CPT 76377 | $574.20 | $1,044.00 | $81.49 – $81.49 | 1 |
| Cta abdomen without & /or w/contrast CPT 74175 | $1,693.45 | $3,079.00 | $130.12 – $334.84 | 4 |
| Cta abdominal aorta & (both sides) ileofemoral lower extremity w runoff without & w/contrast CPT 75635 | $1,693.45 | $3,079.00 | $130.12 – $334.84 | 4 |
| Cta lower extremity without & w/contrast (both sides) CPT 73706 | $1,498.20 | $2,724.00 | $130.12 – $334.84 | 4 |
| Cta neck without &/or w/contrast CPT 70498 | $1,375.00 | $2,500.00 | $130.12 – $334.84 | 4 |
| CT Angiogram of Abdomen and Pelvis CPT 74174 | $1,693.45 | $3,079.00 | $258.81 – $665.99 | 4 |
| CT Angiogram of the Chest (for blood clot) CPT 71275 | $1,693.45 | $3,079.00 | $130.12 – $334.84 | 4 |
| CT Angiogram of the Head CPT 70496 | $1,375.00 | $2,500.00 | $130.12 – $334.84 | 4 |
| CT angio hrt w/3d image CPT 75574 | $1,543.85 | $2,807.00 | $258.81 – $665.99 | 4 |
| CT angio pelvis CPT 72191 | $1,498.20 | $2,724.00 | $130.12 – $334.84 | 4 |
| Cta upper extremity w &/or without contrast left CPT 73206 | $1,498.20 | $2,724.00 | $130.12 – $334.84 | 4 |
| CT bone density axial CPT 77078 | not published | not published | $64.56 – $166.13 | 4 |
| CT cerebral perf w cont & prcssng CPT 70473 | not published | not published | $130.12 – $334.84 | 4 |
| CT colonography dx CPT 74261 | $1,498.20 | $2,724.00 | $77.56 – $199.58 | 4 |
| CT colonography dx w/dye CPT 74262 | $1,648.35 | $2,997.00 | $130.12 – $334.84 | 4 |
| CT colonography screening CPT 74263 | $1,543.85 | $2,807.00 | $177.00 – $455.49 | 4 |
| CT guidance for needle placement CPT 77012 | $1,498.20 | $2,724.00 | $221.70 – $221.70 | 1 |
| CT guidance for percutaneous drain w/catheter placement supervision & interpretation CPT 75989 | $533.50 | $970.00 | $206.25 – $206.25 | 1 |
| CT guid cryo ablat intramuscular CPT 20999 | not published | not published | $182.99 – $2,334.00 | 6 |
| CT guid parench tis ablat CPT 77013 | $1,498.20 | $2,724.00 | $1,150.22 – $1,150.22 | 1 |
| CT heart w/evaluation of calcium without contrast CPT 75571 | $13.75 | $25.00 | $64.56 – $166.13 | 4 |
| CT hrt c+ strux cgen hrt ds CPT 75573 | $1,543.85 | $2,807.00 | $258.81 – $665.99 | 4 |
| CT hrt w/3d image CPT 75572 | $1,543.85 | $2,807.00 | $258.81 – $665.99 | 4 |
| CT limited or localized follow-up study CPT 76380 | $536.25 | $975.00 | $64.56 – $166.13 | 4 |
| CT lower extremity w/contrast (both sides) CPT 73701 | $1,558.15 | $2,833.00 | $130.12 – $334.84 | 4 |
| CT lower extremity without contrast (both sides) CPT 73700 | $1,484.45 | $2,699.00 | $77.56 – $199.58 | 4 |
| CT lwr extremity w/o&w/dye CPT 73702 | $1,636.25 | $2,975.00 | $130.12 – $334.84 | 4 |
| CT neck soft tissue w/contrast CPT 70491 | $1,380.50 | $2,510.00 | $130.12 – $334.84 | 4 |
| CT neck soft tissue without contrast CPT 70490 | $1,314.50 | $2,390.00 | $77.56 – $199.58 | 4 |
| CT neck soft tissue without & w/contrast CPT 70492 | $1,449.80 | $2,636.00 | $130.12 – $334.84 | 4 |
| CT orbit/sella/fossa w/wo contrast CPT 70482 | $1,455.30 | $2,646.00 | $130.12 – $334.84 | 4 |
| CT orbit/sella/ or posterior outer inner or middle ear w/contrast CPT 70481 | $1,386.00 | $2,520.00 | $130.12 – $334.84 | 4 |
| CT orbit/sella/ or posterior outer inner or middle ear without contrast CPT 70480 | $1,320.00 | $2,400.00 | $77.56 – $199.58 | 4 |
| Ctrl nosebld postir subsq 30906 CPT 30906 | not published | not published | $175.70 – $2,334.00 | 6 |
| CT scan for therapy guide CPT 77014 | $596.75 | $1,085.00 | $246.65 – $246.65 | 1 |
| CT Scan of Abdomen and Pelvis (with and without contrast) CPT 74178 | $1,799.05 | $3,271.00 | $258.81 – $665.99 | 4 |
| CT Scan of Abdomen and Pelvis (with contrast) CPT 74177 | $1,713.25 | $3,115.00 | $258.81 – $665.99 | 4 |
| CT Scan of Abdomen and Pelvis (without contrast) CPT 74176 | $1,631.85 | $2,967.00 | $177.00 – $455.49 | 4 |
| CT thoracic spine w/contrast CPT 72129 | $1,570.25 | $2,855.00 | $130.12 – $334.84 | 4 |
| CT thoracic spine without contrast CPT 72128 | $1,495.45 | $2,719.00 | $77.56 – $199.58 | 4 |
| CT thorax low dose for lung screening without contrast CPT 71271 | $113.30 | $206.00 | $77.56 – $199.58 | 4 |
| CT t-spine w /wo contrast CPT 72130 | $1,648.90 | $2,998.00 | $130.12 – $334.84 | 4 |
| CT upper extremity w/contrast (both sides) CPT 73201 | $1,558.15 | $2,833.00 | $258.81 – $665.99 | 4 |
| CT upper extremity without contrast (both sides) CPT 73200 | $1,484.45 | $2,699.00 | $77.56 – $199.58 | 4 |
| CT uppr extremity w/o&w/dye CPT 73202 | $1,636.25 | $2,975.00 | $130.12 – $334.84 | 4 |
| Cultr oocyte/embryo <4 days CPT 89250 | not published | not published | $126.39 – $325.23 | 5 |
| Cultr oocyte/embryo <4 days CPT 89251 | not published | not published | $126.39 – $325.23 | 5 |
| Cult skin graft fnhfg 15155 CPT 15155 | not published | not published | $2,628.85 – $8,770.00 | 6 |
| Cult skin grft t/arm/leg CPT 15150 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Culture aerobic additional method definitive id each CPT 87077 | $27.50 | $50.00 | $6.06 – $15.59 | 7 |
| Culture afb any source CPT 87116 | $123.75 | $225.00 | $8.10 – $20.84 | 7 |
| Culture anaerobic additional method definitive id each CPT 87076 | $107.25 | $195.00 | $6.06 – $15.59 | 7 |
| Culture anaerobic except blood CPT 87075 | $123.20 | $224.00 | $7.10 – $18.28 | 7 |
| Culture bact stool aero addl path ea CPT 87046 | $85.80 | $156.00 | $7.08 – $18.22 | 7 |
| Culture body fluid CPT 87070 | $103.40 | $188.00 | $6.46 – $16.64 | 7 |
| Culture fungi definitive id mold CPT 87107 | $110.55 | $201.00 | $7.74 – $19.92 | 7 |
| Culture fungi definitive id yeast CPT 87106 | $112.20 | $204.00 | $7.74 – $19.92 | 7 |
| Culture fungi other (except blood) CPT 87102 | $111.10 | $202.00 | $6.31 – $16.23 | 7 |
| Culture fungi skin/hair/nail CPT 87101 | $125.95 | $229.00 | $5.78 – $14.88 | 7 |
| Culture mycobacteria definitive id each isolate CPT 87118 | $159.50 | $290.00 | $10.96 – $28.20 | 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.