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 |
|---|---|---|---|---|
| Cyto/molecular report CPT 88291 | $79.20 | $144.00 | $34.65 – $46.56 | 2 |
| Cytopath c/v auto in fluid CPT 88174 | not published | not published | $19.03 – $48.96 | 7 |
| Cytopath c/v index add-on CPT 88155 | not published | not published | $10.99 – $28.27 | 7 |
| Cytopath fl nongyn filter CPT 88106 | not published | not published | $21.46 – $55.21 | 5 |
| Cytopathology cellular enhancement technique non-gyn CPT 88112 | $248.60 | $452.00 | $38.66 – $99.48 | 5 |
| Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review CPT 88175 | $212.30 | $386.00 | $19.96 – $51.36 | 7 |
| Cytopathology cervical/vaginal thin layer manual screening CPT 88142 | $172.15 | $313.00 | $15.20 – $39.10 | 7 |
| Cytopathology concentration technique smears & interpretation CPT 88108 | $177.10 | $322.00 | $27.71 – $71.30 | 5 |
| Cytopathology fluids/washings/brushings smears with interpretation CPT 88104 | $239.80 | $436.00 | $27.71 – $71.30 | 5 |
| Cytopathology fna adequacy evaluation each separate additional episode same site CPT 88177 | $61.60 | $112.00 | $7.22 – $10.68 | 2 |
| Cytopathology fna adequacy evaluation first episode each site CPT 88172 | $262.90 | $478.00 | $28.26 – $325.23 | 5 |
| Cytopathology fna adequacy evaluation first episode each site interp/rpt CPT 88173 | $262.90 | $478.00 | $38.66 – $99.48 | 5 |
| Cytopath smear other source CPT 88160 | not published | not published | $21.46 – $55.21 | 5 |
| Cytopath smear other source CPT 88162 | not published | not published | $38.66 – $99.48 | 5 |
| Cytopath smear oth prep screen & interp CPT 88161 | $56.65 | $103.00 | $21.46 – $55.21 | 5 |
| Cytopath tbs c/v manual CPT 88164 | not published | not published | $13.90 – $35.78 | 7 |
| Cytotoxic antibody screening CPT 86807 | $129.80 | $236.00 | $58.99 – $151.79 | 7 |
| Cytotoxic antibody screening CPT 86808 | not published | not published | $22.26 – $57.28 | 7 |
| Cytp urine 3-5 probes cmptr CPT 88121 | $736.45 | $1,339.00 | $126.39 – $325.23 | 5 |
| Dacarbazine 100 mg intravenous solution HCPCS J9130 | not published | not published | $4.52 – $11.35 | 5 |
| Dactinomycin 0.5 mg intravenous solution HCPCS J9120 | not published | not published | $230.56 – $884.27 | 8 |
| Dalbavancin 500 mg intravenous solution HCPCS J0875 | not published | not published | $8.47 – $42.47 | 8 |
| Dalteparin sodium HCPCS J1645 | not published | not published | $15.01 – $37.74 | 5 |
| Daptomycin 500 mg/10 ml intravenous solution HCPCS J0878 | not published | not published | $0.03 – $0.12 | 5 |
| Daptomycin (xellia) unrefrig HCPCS J0872 | not published | not published | $0.05 – $0.12 | 5 |
| Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln HCPCS J9144 | not published | not published | $42.79 – $139.90 | 8 |
| Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe HCPCS J0881 | not published | not published | $2.19 – $8.09 | 8 |
| Darbepoetin alfa, esrd use HCPCS J0882 | not published | not published | $2.19 – $8.09 | 8 |
| Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution HCPCS J9153 | not published | not published | $204.66 – $676.30 | 8 |
| Daunorubicin 5 mg/ml intravenous solution HCPCS J9150 | not published | not published | $25.46 – $64.04 | 5 |
| Dbrdmt prmlg les w/pdt CPT 96574 | not published | not published | $148.84 – $2,334.00 | 6 |
| D&c after delivery 59160 CPT 59160 | $4,616.15 | $8,393.00 | $2,401.40 – $7,791.00 | 6 |
| D&c/diagnostic/therapeutic/non ob 58120 CPT 58120 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Dch glucoscan CPT 82948 | not published | not published | $3.78 – $9.73 | 7 |
| Dch pulmonary stress test CPT 94621 | not published | not published | $276.82 – $712.35 | 4 |
| Dch validity tests CPT 81002 | not published | not published | $2.61 – $6.72 | 7 |
| Dcm pq ndl dsk sgl/mlt lv lmbr w/guide CPT 62287 | not published | not published | $1,448.59 – $8,770.00 | 6 |
| Dcmprn orbit only transcrnl CPT 61330 | not published | not published | $2,459.51 – $16,106.00 | 6 |
| Dcmprn plantar digital nerve CPT 64726 | not published | not published | $1,448.59 – $7,791.00 | 6 |
| D&c of cervical stump CPT 57558 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Deamidated gliadin antibody iga CPT 86258 | $70.40 | $128.00 | $9.04 – $23.26 | 7 |
| Debr g/per/abd wall 11006 CPT 11006 | not published | not published | $2,654.00 – $2,654.00 | 1 |
| Debrid ecz/inf skin up tp 10% body 11000 CPT 11000 | not published | not published | $301.57 – $2,334.00 | 6 |
| Debridement (>20 cm) charge pt CPT 97598 | $245.30 | $446.00 | $1,887.00 – $2,334.00 | 2 |
| Debridement bone <= 20 sq cm CPT 11044 | $2,257.20 | $4,104.00 | $1,225.21 – $3,152.87 | 6 |
| Debridement/bone/20 sq cm or less 11046 CPT 11046 | $759.55 | $1,381.00 | $1,887.00 – $5,512.00 | 3 |
| Debridement/bone/ea add 20 sq cm 11047 CPT 11047 | $1,197.90 | $2,178.00 | $1,887.00 – $5,512.00 | 3 |
| Debridement subcutaneous tissue <= 20 sq cm CPT 11042 | $950.40 | $1,728.00 | $301.57 – $2,334.00 | 6 |
| Debride nail1-5 11720 CPT 11720 | $215.60 | $392.00 | $43.76 – $2,334.00 | 6 |
| Debride nail6 or more 11721 CPT 11721 | $215.60 | $392.00 | $43.76 – $2,334.00 | 6 |
| Debride/rmv fb/open fx/skin/sq/musc11011 CPT 11011 | not published | not published | $525.32 – $3,030.00 | 6 |
| Debride skin bone at fx site CPT 11012 | not published | not published | $2,154.81 – $5,545.05 | 6 |
| Debride skn/sq/musc/abd wall 11004 CPT 11004 | not published | not published | $2,654.00 – $2,654.00 | 1 |
| Debride skn/sq t/m/f necro infctj abdl wall 11005 CPT 11005 | not published | not published | $2,654.00 – $2,654.00 | 1 |
| Debride/subq tissue/ea add 20sq cm 11045 CPT 11045 | $759.55 | $1,381.00 | $1,887.00 – $5,512.00 | 3 |
| Debrid mastoidectomy cavity simple 69220 CPT 69220 | not published | not published | $148.84 – $2,334.00 | 6 |
| Debrid/rmv fgn bdy/open fx/skin/sq 11010 CPT 11010 | $1,494.35 | $2,717.00 | $525.32 – $3,030.00 | 6 |
| Debr inf skin add-on 11001 CPT 11001 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Debr musc/fascia 20sq cm/< 11043 CPT 11043 | $827.75 | $1,505.00 | $548.27 – $2,334.00 | 6 |
| Decalcification CPT 88311 | $113.85 | $207.00 | $9.02 – $11.99 | 2 |
| Decitabine 50 mg intravenous solution HCPCS J0894 | not published | not published | $1.95 – $6.34 | 5 |
| Declotting thrombolytic agent implanted vas access device 36 CPT 36593 | $510.95 | $929.00 | $245.03 – $2,334.00 | 6 |
| Decomp fasct leg ant+/lat+pst cmprt 27602 CPT 27602 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Decomp forearm 1 space 25020 CPT 25020 | not published | not published | $1,192.86 – $8,770.00 | 6 |
| Decomp forearm 2 spaces w/debrid 25025 CPT 25025 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Decompress fasciotomyhand 26037 CPT 26037 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Decompress fingers/hand CPT 26035 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Decompress forearm 1 space CPT 25023 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Decompress forearm 2 spaces CPT 25024 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Decompression fasct forearm CPT 24495 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Decompression of leg CPT 27892 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Decompression of leg CPT 27893 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Decompression of leg CPT 27894 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Decompression of lower leg CPT 27600 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Decompression of lower leg CPT 27601 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Decompression of thigh/knee CPT 27496 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Decompression of thigh/knee CPT 27497 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Decompression of thigh/knee CPT 27498 | not published | not published | $1,192.86 – $8,770.00 | 6 |
| Decompression of thigh/knee CPT 27499 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Decompression of tibia nerve CPT 28035 | not published | not published | $1,448.59 – $7,791.00 | 6 |
| Decompression unspecified nerve 64722 CPT 64722 | not published | not published | $1,448.59 – $7,791.00 | 6 |
| Decompressive craniotomy CPT 61322 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Decompress optic nerve CPT 67570 | not published | not published | $2,916.44 – $8,770.00 | 6 |
| Decompres spinal cord;thoracic 63055 CPT 63055 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Decompress small bowel CPT 44021 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Decompress spinal cord lmbr CPT 63056 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Decompress spinal cord thrc CPT 63064 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Decomp spinal cord/transped/ad seg 63057 CPT 63057 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Deep muscle biopsy 20205 CPT 20205 | not published | not published | $2,154.81 – $5,545.05 | 6 |
| Deferoxamine 500 mg solution for injection HCPCS J0895 | not published | not published | $9.03 – $24.34 | 5 |
| Degarelix 120 mg subcutaneous solution HCPCS J9155 | not published | not published | $3.36 – $11.65 | 8 |
| Delayed breast prosthesis 19342 CPT 19342 | not published | not published | $6,063.28 – $18,364.00 | 6 |
| Delay flap arms/legs CPT 15610 | not published | not published | $1,530.61 – $7,791.00 | 6 |
| Delay flap eye/nos/ear/lip CPT 15630 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Delay flap fccnaxghf 15620 CPT 15620 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Delay flap trunk 15600 CPT 15600 | not published | not published | $2,628.85 – $8,770.00 | 6 |
| Delivery of placenta 59414 CPT 59414 | $3,807.65 | $6,923.00 | $2,401.40 – $7,791.00 | 6 |
| Delivery only failed vbac 59620 CPT 59620 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Delivery only/pp care/failed vbac 59622 CPT 59622 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Delivery transcath fxtn dvc to endogrft w/s&i CPT 34712 | $7,233.60 | $13,152.00 | $3,735.00 – $3,735.00 | 1 |
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.