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 |
|---|---|---|---|---|
| Dilate esophagus CPT 43453 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Dilate esophagus 1/mult pass CPT 43450 | $2,283.60 | $4,152.00 | $672.83 – $4,761.00 | 6 |
| Dilate ic vasospasm ea add vsl diff territory CPT 61642 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Dilate ic vasospasm ea add vsl same territory CPT 61641 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Dilate ic vasospasm init CPT 61640 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Dilate tear duct opening CPT 68801 | not published | not published | $331.39 – $2,334.00 | 6 |
| Dilate urethra stricture CPT 53600 | $634.15 | $1,153.00 | $185.35 – $2,334.00 | 6 |
| Dilate urethra stricture CPT 53601 | not published | not published | $98.70 – $2,334.00 | 6 |
| Dilate urethra stricture CPT 53605 | not published | not published | $2,614.94 – $6,729.12 | 6 |
| Dilate urethra stricture CPT 53621 | not published | not published | $185.35 – $2,334.00 | 6 |
| Dilation/female urethra/initial 53660 CPT 53660 | not published | not published | $95.45 – $2,334.00 | 6 |
| Dilation of anal sphincter CPT 45905 | not published | not published | $887.71 – $4,761.00 | 6 |
| Dilation of cervical canal 57800 CPT 57800 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Dilation of rectal stricture 45910 CPT 45910 | not published | not published | $887.71 – $4,761.00 | 6 |
| Dilation of salivary duct CPT 42660 | not published | not published | $400.09 – $2,334.00 | 6 |
| Dilation of urethra CPT 53661 | not published | not published | $98.70 – $2,334.00 | 6 |
| Dilation of urethra CPT 53665 | not published | not published | $1,550.71 – $7,791.00 | 6 |
| Dilation of vagina CPT 57400 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Dilation salivary duct 42650 CPT 42650 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Dilation/urethral strict/male/ini 53620 CPT 53620 | not published | not published | $517.28 – $3,030.00 | 6 |
| Dilat xst trc ndurlgc px CPT 50436 | not published | not published | $2,614.94 – $7,791.00 | 6 |
| Dilat xst trc new access rcs CPT 50437 | not published | not published | $2,614.94 – $8,770.00 | 6 |
| Diltiazem 5 mg/ml intravenous solution HCPCS J1163 | not published | not published | $0.07 – $0.07 | 1 |
| Dimecaprol injection HCPCS J0470 | not published | not published | $174.74 – $174.74 | 1 |
| Dimenhydrinate injection HCPCS J1240 | not published | not published | $9.19 – $23.61 | 5 |
| Dimethyl sulfoxide 50% 50 ml HCPCS J1212 | not published | not published | $561.66 – $1,947.64 | 8 |
| Diphenhydramine 12.5 mg/5 ml oral elixir HCPCS Q0163 | not published | not published | $3.55 – $3.55 | 1 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | not published | not published | $0.73 – $1.98 | 5 |
| Diphtheria-tetanus toxoids 0.5 ml (peds) CPT 90702 | not published | not published | $45.79 – $45.79 | 1 |
| Dipyridamole injection HCPCS J1245 | not published | not published | $4.19 – $10.54 | 5 |
| Dir nsl mucous membrane test CPT 95065 | not published | not published | $27.71 – $71.30 | 4 |
| Disability dlco CPT 94727 | $531.85 | $967.00 | $160.18 – $412.19 | 4 |
| Disaccharidases CPT 82657 | $165.55 | $301.00 | $16.63 – $42.79 | 7 |
| Disarticulation sho sec clsr CPT 23921 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Disarticulation shoulder CPT 23920 | not published | not published | $3,735.00 – $24,508.80 | 6 |
| Discectomy ant dcmprn cord thoracic 1 ntrspc 63077 CPT 63077 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Discectomy ant dcmprn cord thoracic ea ntrsp 63078 CPT 63078 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Discography cerv/thor spine CPT 72285 | $3,359.40 | $6,108.00 | $176.56 – $3,727.72 | 4 |
| Disconnect insert locking wr HCPCS L6616 | not published | not published | $59.56 – $153.26 | 4 |
| Disconnect locking wrist uni HCPCS L6615 | not published | not published | $197.85 – $509.13 | 4 |
| Dise eval slp do brth flx dx CPT 42975 | not published | not published | $1,320.39 – $3,397.79 | 6 |
| Dissect brain w/scope CPT 62161 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Dis site tele svcs rhc/fqhc HCPCS G2025 | not published | not published | $91.42 – $91.42 | 1 |
| Dist revas ligation hemo CPT 36838 | not published | not published | $4,127.91 – $18,364.00 | 6 |
| Div aberrant vsl w/reanast CPT 33803 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Diverticulectomy/hypophar/esoph 43130 CPT 43130 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Division of fallopian tube 58605 CPT 58605 | not published | not published | $3,579.00 – $4,761.00 | 3 |
| #d/lmeth-l-methamphetamine CPT 80374 | not published | not published | $35.06 – $35.06 | 1 |
| Dlyd plmt xtn prosth ea addl CPT 34711 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Dmd dup/delet analysis CPT 81161 | not published | not published | $208.18 – $538.47 | 7 |
| Dmpk gene charac alleles CPT 81239 | not published | not published | $206.12 – $530.42 | 7 |
| Dmpk gene detc abnor allele CPT 81234 | not published | not published | $102.75 – $264.41 | 7 |
| Dna antibody native/double stranded CPT 86225 | $115.50 | $210.00 | $10.30 – $26.52 | 7 |
| Dna gardnerella CPT 87510 | not published | not published | $15.04 – $38.70 | 7 |
| Dna probe chlamydia CPT 87490 | not published | not published | $17.06 – $43.91 | 7 |
| Dna probe gc CPT 87590 | not published | not published | $20.16 – $51.88 | 7 |
| Dna trichomonas CPT 87660 | not published | not published | $15.04 – $38.70 | 7 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | not published | not published | $8.00 – $20.11 | 5 |
| Docetaxel 20 mg/ml intravenous solution (wrapper) HCPCS J9171 | not published | not published | $0.67 – $1.98 | 5 |
| Docetaxel (docivyx), 1 mg HCPCS J9172 | not published | not published | $34.72 – $142.15 | 8 |
| Dolasetron mesylate HCPCS J1260 | not published | not published | $9.69 – $9.69 | 1 |
| Dolasetron mesylate oral HCPCS Q0180 | not published | not published | $391.41 – $391.41 | 1 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | not published | not published | $0.78 – $2.10 | 5 |
| Doppler echo complete CPT 93320 | $424.60 | $772.00 | not published | 0 |
| Doppler intravascular pressure flow initial vessel CPT 93571 | $2,637.25 | $4,795.00 | $1,887.00 – $2,334.00 | 2 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $552.75 | $1,005.00 | $160.18 – $412.19 | 4 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $538.45 | $979.00 | $98.70 – $253.99 | 4 |
| Doripenem 50 mg/ml inj 10 ml HCPCS J1267 | not published | not published | $1.77 – $1.77 | 1 |
| Dornase alfa non-comp unit HCPCS J7639 | not published | not published | $58.02 – $145.89 | 5 |
| Dorsi & plantar flex ass/res HCPCS L2220 | not published | not published | $74.57 – $191.90 | 4 |
| Dostarlimab-gxly 50 mg/ml intravenous solution HCPCS J9272 | not published | not published | $188.47 – $653.57 | 8 |
| Double transfer toe-hand CPT 26554 | not published | not published | $3,735.00 – $16,106.00 | 6 |
| Doxorubicin 2 mg/ml intravenous solution (wrapper) HCPCS J9000 | not published | not published | $3.47 – $9.04 | 5 |
| Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension HCPCS Q2050 | not published | not published | $87.45 – $370.39 | 7 |
| Doxycycline hyclate 100 mg intravenous powder for solution HCPCS J1271 | not published | not published | $0.13 – $0.22 | 2 |
| Dpyd gene common variants CPT 81232 | $464.75 | $845.00 | $131.11 – $337.38 | 7 |
| Drainage absc/cyst/hmtma/vestibule mouth smpl CPT 40800 | $1,354.10 | $2,462.00 | $525.32 – $3,030.00 | 6 |
| Drainage ext aud canal abscess 69020 CPT 69020 | $1,489.40 | $2,708.00 | $525.32 – $3,030.00 | 6 |
| Drainage external ear complex 69005 CPT 69005 | not published | not published | $1,225.21 – $4,761.00 | 6 |
| Drainage external ear simple 69000 CPT 69000 | $1,489.40 | $2,708.00 | $525.32 – $3,030.00 | 6 |
| Drainage lymph node lesion 38300 CPT 38300 | not published | not published | $2,154.81 – $5,545.05 | 6 |
| Drainage lymph node lesion 38305 CPT 38305 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Drainage mouth roof lesion CPT 42000 | $481.80 | $876.00 | $175.70 – $2,334.00 | 6 |
| Drainage of abdomen CPT 48000 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Drainage of arm bursa 23931 CPT 23931 | $2,599.30 | $4,726.00 | $1,225.21 – $4,761.00 | 6 |
| Drainage of bladder abscess CPT 51080 | not published | not published | $2,154.81 – $5,545.05 | 6 |
| Drainage of bone lesion CPT 26992 | not published | not published | $2,427.27 – $16,106.00 | 6 |
| Drainage of bone lesion CPT 27303 | not published | not published | $2,427.27 – $16,106.00 | 6 |
| Drainage of eye CPT 65800 | not published | not published | $1,712.02 – $4,405.59 | 6 |
| Drainage of eye CPT 65810 | not published | not published | $1,712.02 – $7,791.00 | 6 |
| Drainage of eye CPT 65815 | not published | not published | $1,712.02 – $7,791.00 | 6 |
| Drainage of forearm bursa CPT 25031 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Drainage of kidney lesion CPT 50390 | $1,617.55 | $2,941.00 | $525.32 – $3,030.00 | 6 |
| Drainage of mouth lesion CPT 41005 | $647.90 | $1,178.00 | $175.70 – $2,334.00 | 6 |
| Drainage of mouth lesion CPT 41006 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Drainage of mouth lesion CPT 41007 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Drainage of mouth lesion CPT 41008 | $6,171.55 | $11,221.00 | $2,459.51 – $6,329.15 | 6 |
| Drainage of mouth lesion CPT 41009 | not published | not published | $400.09 – $2,334.00 | 6 |
| Drainage of mouth lesion CPT 41015 | not published | not published | $400.09 – $2,334.00 | 6 |
| Drainage of mouth lesion CPT 41016 | not published | not published | $4,391.52 – $11,300.84 | 6 |
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.