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 |
|---|---|---|---|---|
| Drainage of mouth lesion CPT 41017 | not published | not published | $2,459.51 – $6,329.15 | 6 |
| Drainage of mouth lesion CPT 41018 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Drainage of nose lesion int 30000 CPT 30000 | $451.00 | $820.00 | $175.70 – $2,334.00 | 6 |
| Drainage of nose lesion sept 30020 CPT 30020 | not published | not published | $400.09 – $2,334.00 | 6 |
| Drainage of pelvis bursa CPT 26991 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Drainage of pelvis lesion 26990 CPT 26990 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Drainage of prostate abscess CPT 52700 | not published | not published | $2,614.94 – $7,791.00 | 6 |
| Drainage of prostate abscess CPT 55720 | not published | not published | $2,614.94 – $7,791.00 | 6 |
| Drainage of prostate abscess CPT 55725 | not published | not published | $2,614.94 – $7,791.00 | 6 |
| Drainage of rectal abscess CPT 45005 | not published | not published | $887.71 – $4,761.00 | 6 |
| Drainage of rectal abscess 45020 CPT 45020 | $5,915.80 | $10,756.00 | $2,059.07 – $5,298.68 | 6 |
| Drainage of salivary gland CPT 42305 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Drainage of salivary gland CPT 42320 | not published | not published | $400.09 – $2,334.00 | 6 |
| Drainage of spinal cyst CPT 63172 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Drainage of spinal cyst CPT 63173 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Drainage of throat abscess CPT 42725 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Drainage of urethra abscess CPT 53040 | not published | not published | $2,614.94 – $7,791.00 | 6 |
| Drainage of urethra abscess 53060 CPT 53060 | $2,959.00 | $5,380.00 | $1,550.71 – $7,791.00 | 6 |
| Drainage of urinary leakage CPT 53080 | not published | not published | $517.28 – $7,791.00 | 6 |
| Drainage of urinary leakage CPT 53085 | not published | not published | $1,550.71 – $7,791.00 | 6 |
| Drain bladder by trocar/cath CPT 51101 | not published | not published | $637.04 – $4,761.00 | 6 |
| Drain blood from under nail 11740 CPT 11740 | $248.05 | $451.00 | $98.70 – $2,334.00 | 6 |
| Drain cath image guided peri/retroperitoneal transvag/transrectal CPT 49407 | $2,529.45 | $4,599.00 | $1,225.21 – $4,761.00 | 6 |
| Drain cath image guided visceral pq CPT 49405 | $2,885.30 | $5,246.00 | $1,225.21 – $4,761.00 | 6 |
| Drain cerebro spinal fluid 62272 CPT 62272 | $1,234.20 | $2,244.00 | $523.65 – $3,030.00 | 6 |
| Drain chest lesion CPT 21502 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Drain finger abscess;simple 26010 CPT 26010 | $565.95 | $1,029.00 | $148.84 – $2,334.00 | 6 |
| Drain lower leg bursa CPT 27604 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Drain lower leg lesion 27603 CPT 27603 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Drain neck/chest lesion 21501 CPT 21501 | $2,160.40 | $3,928.00 | $2,154.81 – $7,791.00 | 6 |
| Drain open lung lesion 32200 CPT 32200 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Drain ovarn cyst abd CPT 58805 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Drain ovary abscess open CPT 58820 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Drain pancreatic pseudocyst 48510 CPT 48510 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Drain penis lesion CPT 54015 | not published | not published | $1,225.21 – $4,761.00 | 6 |
| Drain shoulder bone lesion CPT 23035 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Drain shoulder bursa 23031 CPT 23031 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Drain shoulder lesion CPT 23030 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Drain thigh/knee lesion 27301 CPT 27301 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Drain thyroid/tongue cyst CPT 60000 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Drain to peritoneal cavity CPT 49062 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Dress/debride pt-tck burn/5-10% bs 16025 CPT 16025 | $605.55 | $1,101.00 | $148.84 – $2,334.00 | 6 |
| Dress/debride pt-thick burn/<5% bs 16020 CPT 16020 | $569.80 | $1,036.00 | $148.84 – $2,334.00 | 6 |
| Dress/debrid prtl-thick burn l 16030 CPT 16030 | $626.45 | $1,139.00 | $301.57 – $2,334.00 | 6 |
| Dressing change not for burn w/anes 15852 CPT 15852 | not published | not published | $548.27 – $2,334.00 | 6 |
| Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm HCPCS Q4108 | not published | not published | $55.53 – $237.56 | 7 |
| Drill hole evac+/drg subdural hematoma 61108 CPT 61108 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Drill hole implt ventricular cath/device 61107 CPT 61107 | $1,532.85 | $2,787.00 | $3,388.00 – $3,388.00 | 1 |
| Driver pneumatic vad, rep HCPCS Q0480 | not published | not published | $83,176.32 – $214,040.40 | 4 |
| Drm agrft f/s/n/h/f/g/m ea CPT 15136 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Drm agrft t/a/l ea addl CPT 15131 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Drng appendix abscess open 44900 CPT 44900 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Drng hand tendon sheath 26020 CPT 26020 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Drng of eyelid abscess 67700 CPT 67700 | $870.65 | $1,583.00 | $235.46 – $2,334.00 | 6 |
| Drng of finger abscess comp 26011 CPT 26011 | not published | not published | $1,225.21 – $4,761.00 | 6 |
| Drng of hydrocele 55000 CPT 55000 | not published | not published | $525.32 – $3,030.00 | 6 |
| Drng of mouth lesion 40801 CPT 40801 | not published | not published | $400.09 – $2,334.00 | 6 |
| Drng of ovarian cyst(s) 58800 CPT 58800 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Drng of palm multi bursas 26030 CPT 26030 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Drng of palm single bursa 26025 CPT 26025 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Drng of pelvic abscess transrectal 45000 CPT 45000 | not published | not published | $887.71 – $4,761.00 | 6 |
| Drng of salivary cyst 42409 CPT 42409 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Drng of scrotum abscess 55100 CPT 55100 | $3,131.70 | $5,694.00 | $1,225.21 – $4,761.00 | 6 |
| Drng open retroperitoneal abscess 49060 CPT 49060 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Drng open subdiaphragmatic/subphrenic absc 49040 CPT 49040 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Drng ovary abscess perqt 58822 CPT 58822 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Drng peritoneal abscess open 49020 CPT 49020 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Drng salivary gland simple 42300 CPT 42300 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Drng salivary gland submax/subling 42310 CPT 42310 | not published | not published | $400.09 – $2,334.00 | 6 |
| Dronabinol 2.5mg oral HCPCS Q0167 | not published | not published | $1.63 – $5.03 | 4 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | not published | not published | $9.43 – $33.18 | 3 |
| Drop lock knee HCPCS L2182 | not published | not published | $105.32 – $271.03 | 4 |
| Drop lock retainer each HCPCS L2785 | not published | not published | $27.32 – $70.29 | 4 |
| Drsg interceed 3x4in adh wnd barr absorb HCPCS C1765 | $343.73 | $624.96 | not published | 0 |
| Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm HCPCS Q4103 | not published | not published | $13.78 – $237.56 | 7 |
| Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 | not published | not published | $13.21 – $237.56 | 7 |
| Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm HCPCS Q4124 | not published | not published | $4.71 – $237.56 | 7 |
| Drsg wnd 8.2x9cm sq bilayer theragenesis ster-74sq cm-cost per sq cm HCPCS A2008 | not published | not published | $92.32 – $244.81 | 5 |
| Drsg wnd hyalomatrix 10x10cm -cost per sq cm HCPCS Q4117 | not published | not published | $81.48 – $237.56 | 5 |
| Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm HCPCS Q4104 | not published | not published | $54.77 – $237.56 | 7 |
| Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm HCPCS A2007 | not published | not published | $92.32 – $237.56 | 5 |
| Drug admin & hemodynmic meas CPT 93463 | $327.25 | $595.00 | $1,887.00 – $2,334.00 | 2 |
| Drug assay caffeine CPT 80155 | $63.80 | $116.00 | $28.62 – $74.44 | 7 |
| Drug assay posaconazole CPT 80187 | not published | not published | $20.33 – $52.32 | 7 |
| Drug assay rufinamide CPT 80210 | $64.35 | $117.00 | $20.33 – $52.32 | 7 |
| Drug assay vedolizumab CPT 80280 | $466.40 | $848.00 | $28.93 – $74.44 | 7 |
| Drug assay voriconazole CPT 80285 | $44.55 | $81.00 | $20.33 – $52.32 | 7 |
| Drug asy hydroxychloroquine CPT 80220 | not published | not published | $13.98 – $35.98 | 7 |
| Drug of abuse screen urine CPT 80305 | not published | not published | $9.45 – $24.32 | 7 |
| Drug screening tapentadol CPT 80372 | $188.65 | $343.00 | $35.06 – $35.06 | 1 |
| Drug screen quant tiagabine CPT 80199 | not published | not published | $20.33 – $52.32 | 7 |
| Drug/substance nos 4-6 CPT 80376 | not published | not published | $35.06 – $35.06 | 1 |
| Drug test def 15-21 classes HCPCS G0482 | not published | not published | $149.06 – $383.57 | 7 |
| Drug test def 1-7 classes HCPCS G0480 | $188.65 | $343.00 | $85.82 – $220.85 | 7 |
| Drug test def 22+ classes HCPCS G0483 | not published | not published | $185.19 – $476.56 | 7 |
| Drug test def 8-14 classes HCPCS G0481 | not published | not published | $117.44 – $302.22 | 7 |
| Drug test def simple all cl HCPCS G0659 | not published | not published | $46.60 – $119.93 | 7 |
| Drug test prsmv instrmnt CPT 80306 | $167.75 | $305.00 | $12.86 – $33.08 | 7 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $301.95 | $549.00 | $46.60 – $119.93 | 7 |
| Drvvt confirm - quest CPT 85597 | $32.45 | $59.00 | $13.48 – $34.70 | 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.