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 |
|---|---|---|---|---|
| Dest mal lesion feenlm <0.5cm 17280 CPT 17280 | not published | not published | $148.84 – $2,334.00 | 6 |
| Dest mal lesion feenlm 0.6-1cm 17281 CPT 17281 | not published | not published | $148.84 – $2,334.00 | 6 |
| Dest mal lesion feenlm 1.1 - 2.0 cm 17282 CPT 17282 | not published | not published | $148.84 – $2,334.00 | 6 |
| Dest mal lesion snhfg <0.5cm 17270 CPT 17270 | not published | not published | $148.84 – $2,334.00 | 6 |
| Dest mal lesion snhfg 0.6-1cm 17271 CPT 17271 | not published | not published | $148.84 – $2,334.00 | 6 |
| Dest mal lesion snhfg 1.1-2cm 17272 CPT 17272 | not published | not published | $148.84 – $2,334.00 | 6 |
| Dest mal lesion tal <0.5 17260 CPT 17260 | not published | not published | $148.84 – $2,334.00 | 6 |
| Dest mal lesion tal 0.6-1.0cm 17261 CPT 17261 | $473.55 | $861.00 | $148.84 – $2,334.00 | 6 |
| Dest mal lesion tal 1.1-2.0cm 17262 CPT 17262 | not published | not published | $148.84 – $2,334.00 | 6 |
| Dest mal lesion tal 2.1-3.0cm 17263 CPT 17263 | not published | not published | $148.84 – $2,334.00 | 6 |
| Destroy cervthor facet jnt 64633 CPT 64633 | $5,696.90 | $10,358.00 | $1,448.59 – $7,791.00 | 6 |
| Destroy cth facet jnt addl 64634 CPT 64634 | $3,483.70 | $6,334.00 | $1,887.00 – $5,512.00 | 3 |
| Destroy internal hemorrhoids destroy 46930 CPT 46930 | not published | not published | $887.71 – $3,030.00 | 6 |
| Destroy premlg lesns;1st lesn 17000 CPT 17000 | $123.42 | $224.40 | $148.84 – $2,334.00 | 6 |
| Destroy vulva lesion extensive 56515 CPT 56515 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Destroy vulva lesion simple 56501 CPT 56501 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Destruct ben lesion 15/> 17111 CPT 17111 | not published | not published | $148.84 – $2,334.00 | 6 |
| Destruct cut vasl lesions 10-50cm 17107 CPT 17107 | not published | not published | $548.27 – $2,334.00 | 6 |
| Destruct cut vasl lesions <10cm 17106 CPT 17106 | not published | not published | $301.57 – $2,334.00 | 6 |
| Destruct cut vasl lesions >50cm 17108 CPT 17108 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Destruction 2-14 lesions 17003 CPT 17003 | $25.74 | $46.80 | $1,887.00 – $5,512.00 | 3 |
| Destruction anal lesion(s) CPT 46910 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Destruction anal lesion(s) CPT 46924 | not published | not published | $2,059.07 – $7,791.00 | 6 |
| Destruction anal lesion(s) smpl chem 46900 CPT 46900 | not published | not published | $301.57 – $2,334.00 | 6 |
| Destruction benign lesions < 14 lesions CPT 17110 | $406.45 | $739.00 | $148.84 – $2,334.00 | 6 |
| Destruction by injection tx of nerve 64630 CPT 64630 | not published | not published | $656.13 – $3,030.00 | 6 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) CPT 64636 | $3,483.70 | $6,334.00 | $1,887.00 – $5,512.00 | 3 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | $5,696.90 | $10,358.00 | $1,448.59 – $7,791.00 | 6 |
| Destruction ciliary body CPT 66700 | not published | not published | $1,712.02 – $4,761.00 | 6 |
| Destruction ciliary body CPT 66720 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Destruction ciliary body CPT 66740 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Destruction cryosurgery anal lesion(s) simpl 46916 CPT 46916 | not published | not published | $148.84 – $2,334.00 | 6 |
| Destruction laser surgery anal lesions 46917 CPT 46917 | not published | not published | $2,059.07 – $7,791.00 | 6 |
| Destruction les conjunctiva CPT 68135 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Destruction mal lsn s/n/h/f/g 2.1-3cm CPT 17273 | not published | not published | $301.57 – $2,334.00 | 6 |
| Destruction mal lsn s/n/h/f/g 3.1-4cm CPT 17274 | not published | not published | $301.57 – $2,334.00 | 6 |
| Destruction mal lsn t/a/l 3.1-4cm CPT 17264 | not published | not published | $301.57 – $2,334.00 | 6 |
| Destruction mal lsn t/a/l >4cm CPT 17266 | not published | not published | $301.57 – $2,334.00 | 6 |
| Destruction penis lesion(s) chem 54050 CPT 54050 | not published | not published | $301.57 – $2,334.00 | 6 |
| Destruction penis lesion(s) exten 54065 CPT 54065 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Destruction premal lesions 15/> 17004 CPT 17004 | not published | not published | $301.57 – $2,334.00 | 6 |
| Destruction rectal tumor 45190 CPT 45190 | not published | not published | $2,059.07 – $7,791.00 | 6 |
| Destruction vag lesions complex 57065 CPT 57065 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Destruction vag lesions simple 57061 CPT 57061 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Destruct penis les/smp/electrodesi 54055 CPT 54055 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Detect agent nos dna dir CPT 87797 | not published | not published | $22.52 – $57.96 | 7 |
| Detect agnt mult dna direc CPT 87800 | $316.25 | $575.00 | $32.75 – $84.28 | 7 |
| Devel tst phys/qhp 1st hr CPT 96112 | not published | not published | $95.45 – $245.63 | 4 |
| Device hemospray 7frx220cm endo hemostat min access HCPCS C1052 | $2,870.52 | $5,219.12 | not published | 0 |
| Device intraute mirena HCPCS J7298 | not published | not published | $3,779.24 – $3,779.24 | 1 |
| Device sut capio slim opn HCPCS C2631 | $719.28 | $1,307.79 | not published | 0 |
| Device tiss remov myosure reach HCPCS C1782 | $1,266.58 | $2,302.88 | not published | 0 |
| Devise bowel pouch CPT 44316 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Devlopment test interpt&rep HCPCS G0451 | not published | not published | $75.36 – $193.93 | 4 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $304.15 | $553.00 | $56.56 – $166.13 | 4 |
| Dexametha opth insert 0.1 mg HCPCS J1096 | not published | not published | $67.51 – $307.51 | 8 |
| Dexamethasone 0.4 mg/0.1 ml intraocular injection - cnr HCPCS J1095 | not published | not published | $7.38 – $7.38 | 1 |
| Dexamethasone 4 mg tablet HCPCS J8540 | not published | not published | $0.03 – $0.17 | 5 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | not published | not published | $0.10 – $0.30 | 5 |
| Dexamethasone intra implant HCPCS J7312 | not published | not published | $152.74 – $559.63 | 8 |
| Dexamethasone panel CPT 80420 | not published | not published | $121.41 – $312.43 | 7 |
| Dexmedetomidine film, 1 mcg HCPCS J1105 | not published | not published | $1.77 – $1.77 | 1 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | not published | not published | $31.08 – $220.19 | 8 |
| Dextran 40 infusion HCPCS J7100 | not published | not published | $140.28 – $140.28 | 1 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | not published | not published | $1.27 – $3.22 | 5 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | not published | not published | $16.47 – $16.47 | 1 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | not published | not published | $1.95 – $4.90 | 5 |
| Dextrose 5 % IV bolus HCPCS J7070 | not published | not published | $3.90 – $9.80 | 5 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $173.80 | $316.00 | $16.67 – $42.90 | 7 |
| Diabetes (HbA1c) Test CPT 83036 | $86.35 | $157.00 | $7.28 – $18.74 | 7 |
| Diabetes training group per 30 min g0109 HCPCS G0136 | not published | not published | $27.80 – $71.53 | 4 |
| Diab manage trn ind/group HCPCS G0109 | $59.95 | $109.00 | $11.62 – $29.90 | 4 |
| Diag bronchoscope/catheter CPT 31643 | not published | not published | $1,320.39 – $4,761.00 | 6 |
| Diag laparo separate proc 49320 CPT 49320 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Diagnostic anoscopy CPT 46601 | not published | not published | $331.39 – $2,334.00 | 6 |
| Diagnostic anoscopy & biopsy CPT 46607 | not published | not published | $887.71 – $4,761.00 | 6 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $172.70 | $314.00 | $98.70 – $2,334.00 | 6 |
| Diagnostic digital breast tomosynthesis bil CPT 77062 | $19.25 | $35.00 | $406.43 – $406.43 | 1 |
| Diagnostic digital breast tomosynthesis unil CPT 77061 | $19.25 | $35.00 | $318.64 – $318.64 | 1 |
| Diagnostic laryngoscopy 31505 CPT 31505 | not published | not published | $148.07 – $2,334.00 | 6 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $235.40 | $428.00 | $148.07 – $2,334.00 | 6 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $399.30 | $726.00 | $79.11 – $203.58 | 4 |
| Diagnostic Mammogram (one breast) CPT 77065 | $199.65 | $363.00 | $61.76 – $158.92 | 4 |
| Diagnostic radio unlisted proc CPT 76499 | not published | not published | $64.56 – $166.13 | 4 |
| Dialysis circuit perm vascular embolization 36909 CPT 36909 | $796.40 | $1,448.00 | $1,887.00 – $2,334.00 | 2 |
| Dialysis one evaluation CPT 90945 | $74.80 | $136.00 | $309.54 – $796.55 | 4 |
| Dialysis repeated eval CPT 90947 | $531.30 | $966.00 | not published | 0 |
| Dialysis training complete CPT 90989 | $746.90 | $1,358.00 | not published | 0 |
| Diathermy eg microwave CPT 97024 | not published | not published | $5.18 – $13.34 | 4 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | not published | not published | $0.09 – $0.20 | 4 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | not published | not published | $6.37 – $23.28 | 5 |
| Dicyclomine injection HCPCS J0500 | not published | not published | $14.15 – $40.57 | 5 |
| Difelikefalin, esrd on dialy HCPCS J0879 | not published | not published | $0.35 – $0.35 | 1 |
| Diffusing capacity CPT 94729 | $393.80 | $716.00 | not published | 0 |
| Digit nerve surgery add-on CPT 64778 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | not published | not published | $5.37 – $24.01 | 5 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | not published | not published | $4,037.49 – $13,803.03 | 8 |
| Digoxin total therapeutic drug level CPT 80162 | $98.45 | $179.00 | $9.96 – $25.63 | 7 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | not published | not published | $44.43 – $184.44 | 5 |
| Dilate biliary duct/ampulla CPT 47542 | not published | not published | $1,887.00 – $5,512.00 | 3 |
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.