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 |
|---|---|---|---|---|
| Adapter b 8 channel 10cm HCPCS C1883 | $747.93 | $1,359.88 | not published | 0 |
| Adding walker to prev cast CPT 29440 | not published | not published | $120.55 – $2,334.00 | 6 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | not published | not published | $0.34 – $0.87 | 5 |
| Adenovirus ag ia CPT 87301 | not published | not published | $8.98 – $23.12 | 7 |
| Adenovirus antibody,serum - quest CPT 86603 | $22.00 | $40.00 | $9.65 – $24.84 | 7 |
| Adenovirus assay w/optic CPT 87809 | not published | not published | $16.32 – $42.00 | 7 |
| Adhesiolysis tube ovary 58740 CPT 58740 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Adh-sendout CPT 84588 | $162.80 | $296.00 | $25.46 – $65.50 | 7 |
| Adj gastric band via subq port CPT 43999 | not published | not published | $672.83 – $4,761.00 | 6 |
| Adjmt/revj ext fixj sys anes CPT 20693 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Adj tis trans/see area/10.1-30sqcm 14041 CPT 14041 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | not published | not published | $1.52 – $1.52 | 1 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $213.40 | $388.00 | $53.41 – $137.45 | 4 |
| Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr CPT 96417 | $185.35 | $337.00 | $53.41 – $137.45 | 4 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $499.40 | $908.00 | $245.03 – $630.55 | 4 |
| Administration chemotherapy IV push single/initial substance/drug CPT 96409 | $309.65 | $563.00 | $245.03 – $630.55 | 4 |
| Administration chemotherapy subcutaneous/im anti neoplastic hormonal CPT 96402 | $141.35 | $257.00 | $53.41 – $137.45 | 4 |
| Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 | $139.70 | $254.00 | $53.41 – $137.45 | 4 |
| Administration immunization 1 vaccine CPT 90471 | $49.50 | $90.00 | $53.41 – $137.45 | 4 |
| Administration immunization each additional vaccine CPT 90472 | $43.45 | $79.00 | not published | 0 |
| Administration immunization intranasal/oral route 1 vaccine CPT 90473 | not published | not published | $53.41 – $137.45 | 4 |
| Administration rsv monoclonal ab seasonal dose im w/counseling CPT 96380 | $51.70 | $94.00 | not published | 0 |
| Administration vaccine hepatitis b HCPCS G0010 | $35.20 | $64.00 | $34.74 – $89.39 | 4 |
| Administration vaccine influenza virus HCPCS G0008 | $49.50 | $90.00 | $34.74 – $89.39 | 4 |
| Administration vaccine pneumococcal HCPCS G0009 | $49.50 | $90.00 | $34.74 – $89.39 | 4 |
| Administration vaccine rsv monoclonal ab seasonal dose im CPT 96381 | $48.95 | $89.00 | not published | 0 |
| Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 | not published | not published | $32.72 – $111.54 | 8 |
| Adrenal cortex & medulla img CPT 78075 | not published | not published | $960.41 – $2,471.46 | 4 |
| Adrenalectomy expl w/exc retro tumor 60545 CPT 60545 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Aep hearing status deter i&r CPT 92651 | not published | not published | $160.18 – $412.19 | 4 |
| Aep neurodiagnostic i&r CPT 92653 | not published | not published | $160.18 – $412.19 | 4 |
| Aep thrshld est mlt freq i&r CPT 92652 | not published | not published | $160.18 – $412.19 | 4 |
| Afamelanotide implant, 1 mg HCPCS J7352 | not published | not published | $2,207.57 – $7,822.63 | 5 |
| _afb id by dna probe rflx ast CPT 87149 | $96.80 | $176.00 | $15.04 – $38.70 | 7 |
| #afb mycobacteria suscep. #1 CPT 87190 | not published | not published | $5.48 – $14.11 | 7 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | $564.85 | $1,027.00 | $86.52 – $222.64 | 7 |
| Aflibercept injection HCPCS J0178 | not published | not published | $557.70 – $2,180.92 | 8 |
| Afo tib fx semi-rigid l2114 HCPCS L2114 | not published | not published | $582.44 – $1,498.82 | 4 |
| After cataract laser surgery CPT 66821 | not published | not published | $408.01 – $3,030.00 | 6 |
| Agalsidase beta 35 mg intravenous solution HCPCS J0180 | not published | not published | $174.54 – $608.54 | 8 |
| Air conduction bilat CPT 92552 | not published | not published | $98.70 – $253.99 | 4 |
| Air injection into abdomen 49400 CPT 49400 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Airway resistance by impulse oscillometry 94728 CPT 94728 | not published | not published | $95.45 – $245.63 | 4 |
| Albumin body fluid quantitative each specimen CPT 82042 | $33.00 | $60.00 | $5.84 – $15.02 | 7 |
| Albumin (human), 25%, 50ml HCPCS P9047 | not published | not published | $39.99 – $144.51 | 7 |
| Albumin, human 25 % intravenous solution HCPCS P9046 | not published | not published | $16.00 – $57.80 | 7 |
| Albumin (human), 5%, 250 ml HCPCS P9045 | not published | not published | $39.81 – $144.51 | 7 |
| Albumin, human 5 % intravenous solution HCPCS P9041 | not published | not published | $7.96 – $28.91 | 7 |
| Albumin ischemia modified CPT 82045 | not published | not published | $25.46 – $65.50 | 7 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $46.20 | $84.00 | $4.34 – $11.16 | 7 |
| Albumin serum plasma or whole blood CPT 82040 | $47.85 | $87.00 | $3.71 – $9.55 | 7 |
| Albuterol ipratrop non-comp HCPCS J7620 | not published | not published | $0.20 – $0.51 | 5 |
| Albuterol non-comp con HCPCS J7611 | not published | not published | $0.17 – $0.43 | 5 |
| Albuterol non-comp unit HCPCS J7613 | not published | not published | $0.08 – $0.20 | 5 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | $31.35 | $57.00 | $12.95 – $33.33 | 7 |
| Alcohol/sub misuse assess HCPCS G2011 | not published | not published | $21.46 – $55.21 | 4 |
| Alcohol/subs interv >30 min HCPCS G0397 | not published | not published | $131.67 – $338.84 | 4 |
| Aldesleukin injection HCPCS J9015 | not published | not published | $2,504.15 – $14,432.68 | 5 |
| Alemtuzumab 12 mg/1.2 ml intravenous solution HCPCS J0202 | not published | not published | $1,908.70 – $6,570.37 | 8 |
| Alkaline phosphatase CPT 84075 | $45.65 | $83.00 | $3.88 – $10.00 | 7 |
| Allergen alpha lactalbumin ige CPT 86008 | $29.70 | $54.00 | $13.45 – $34.60 | 7 |
| Allergen egg white ige CPT 86003 | $26.40 | $48.00 | $3.92 – $10.07 | 7 |
| Allergen specific ige qual multi scrn ea CPT 86005 | $64.35 | $117.00 | $5.98 – $15.38 | 7 |
| Allergy injections; 2 or more 95117 CPT 95117 | $30.25 | $55.00 | $34.74 – $89.39 | 4 |
| Allergy injection; single 95115 CPT 95115 | not published | not published | $34.74 – $89.39 | 4 |
| Allergy Skin Testing CPT 95004 | not published | not published | $637.04 – $1,639.32 | 4 |
| Allg patch or app # of tests 95044 CPT 95044 | not published | not published | $637.04 – $1,639.32 | 4 |
| Allgrft implnt knee w/scope CPT 29867 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Allograft allowrap 4x4cm dry 16sqcm HCPCS Q4150 | not published | not published | $91.04 – $237.56 | 7 |
| Allograft amnioexcel plus 17mm disk HCPCS Q4137 | not published | not published | $92.32 – $317.66 | 7 |
| Allograft dermis 20x25x1mm decell w/matracell arthroflex HCPCS Q4125 | $3,317.32 | $6,031.50 | not published | 0 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | not published | not published | $26.92 – $237.56 | 7 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | not published | not published | $92.32 – $431.05 | 7 |
| Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 | not published | not published | $92.32 – $371.55 | 5 |
| Allograft umbil cord+amniotic membrane-q4148-cost per sq cm HCPCS Q4148 | not published | not published | $92.32 – $347.14 | 7 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | not published | not published | $92.32 – $660.83 | 7 |
| Alloskin HCPCS Q4115 | not published | not published | $13.62 – $237.56 | 7 |
| All tstg perq&iq drugs/biol CPT 95018 | not published | not published | $27.71 – $71.30 | 4 |
| All tstg perq&iq w/venoms CPT 95017 | not published | not published | $21.46 – $55.21 | 4 |
| Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution HCPCS J0256 | not published | not published | $3.85 – $13.86 | 8 |
| Alpha-fetoprotein afp-l3 frac & total CPT 82107 | not published | not published | $48.31 – $124.31 | 7 |
| Alpha-fetoprotein amniotic CPT 82106 | not published | not published | $12.75 – $32.81 | 7 |
| Alpha-fetoprotein tumor marker CPT 82105 | $147.95 | $269.00 | $12.58 – $32.37 | 7 |
| Alprostadil for injection HCPCS J0270 | not published | not published | $1.29 – $1.29 | 1 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | not published | not published | $73.94 – $249.05 | 8 |
| Alt/sgpt CPT 84460 | $50.05 | $91.00 | $3.98 – $10.23 | 7 |
| Altuviiio per factor viii iu HCPCS J7214 | not published | not published | $3.47 – $12.64 | 8 |
| Aluminum - quest CPT 82108 | $386.65 | $703.00 | $19.11 – $49.18 | 7 |
| Alveoloplasty each quadrant CPT 41874 | not published | not published | $2,459.51 – $6,329.15 | 6 |
| Amantadine (symmetrel)-sendout CPT 80375 | $188.65 | $343.00 | $35.06 – $35.06 | 1 |
| Ambl bp mntr w/sw a/r CPT 93788 | not published | not published | $98.70 – $253.99 | 4 |
| Amikacin 4 mg/ml intravitreal injection - cnr HCPCS J0278 | not published | not published | $0.58 – $1.47 | 5 |
| Amino acid screen, urine CPT 82128 | not published | not published | $10.40 – $26.77 | 7 |
| Amino acid single qual CPT 82127 | not published | not published | $10.64 – $27.37 | 7 |
| Amino acids quant 2-5 CPT 82136 | not published | not published | $14.71 – $37.85 | 7 |
| Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr HCPCS J0281 | not published | not published | $1.43 – $2.84 | 2 |
| Aminolevulinic acid, 10% gel HCPCS J7345 | not published | not published | $1.39 – $4.69 | 8 |
| Aminolevulinic acid delta CPT 82135 | $145.20 | $264.00 | $12.34 – $31.75 | 7 |
| Aminolevulinic acid hcl top HCPCS J7308 | not published | not published | $291.96 – $1,076.10 | 8 |
| Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 | not published | not published | $5.60 – $15.77 | 5 |
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.