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 |
|---|---|---|---|---|
| Dstrj extensive retinopathy CPT 67227 | not published | not published | $2,916.44 – $8,770.00 | 6 |
| Dstrj nulyt agt gnclr nrv CPT 64624 | $3,940.75 | $7,165.00 | $1,448.59 – $7,791.00 | 6 |
| Dstr mal les s/n/h/f/g >4.0 CPT 17276 | not published | not published | $301.57 – $2,334.00 | 6 |
| Dstr mal ls f/e/e/n/l/m2.1-3 CPT 17283 | not published | not published | $301.57 – $2,334.00 | 6 |
| Dstr mal ls f/e/e/n/l/m3.1-4 CPT 17284 | not published | not published | $548.27 – $2,334.00 | 6 |
| Dstr mal ls f/e/e/n/l/m>4.0 CPT 17286 | not published | not published | $548.27 – $2,334.00 | 6 |
| Dstry eye lesn,fdr vssl tech HCPCS G0186 | not published | not published | $408.01 – $3,030.00 | 6 |
| Ductogram sgl duct CPT 77053 | $443.30 | $806.00 | $133.79 – $455.49 | 4 |
| Duodenal exclusion CPT 48547 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Duodenal motility study CPT 91022 | not published | not published | $276.82 – $2,334.00 | 6 |
| Duplex scan bilateral study 93985 CPT 93985 | $900.90 | $1,638.00 | $177.00 – $455.49 | 4 |
| Duplex scan unilateral study 93986 CPT 93986 | not published | not published | $77.56 – $199.58 | 4 |
| Dup scan/hemodialysis access 93990 CPT 93990 | $900.90 | $1,638.00 | $77.56 – $199.58 | 4 |
| Dup scan/lwr xtr vasc stdy bilat 93924 CPT 93924 | $750.20 | $1,364.00 | $160.18 – $412.19 | 4 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $799.15 | $1,453.00 | $177.00 – $455.49 | 4 |
| Durvalumab 50 mg/ml intravenous solution HCPCS J9173 | not published | not published | $65.96 – $228.36 | 8 |
| Dxa bone density axl vrt fx CPT 77085 | not published | not published | $77.56 – $199.58 | 4 |
| Dx aly aud oi snd prcsr 1st CPT 92622 | not published | not published | $95.45 – $245.63 | 4 |
| Dx bronchoscope/brush 31623 CPT 31623 | not published | not published | $1,320.39 – $4,761.00 | 6 |
| Dx bronchoscope/lavage 31624 CPT 31624 | $1,724.25 | $3,135.00 | $1,320.39 – $4,761.00 | 6 |
| Dx bronchoscope/wash 31622 CPT 31622 | $1,881.00 | $3,420.00 | $1,320.39 – $4,761.00 | 6 |
| Dx dark adaptation exam i&r CPT 92284 | not published | not published | $331.39 – $852.79 | 4 |
| Dx duod intub w/asp spec 43756 CPT 43756 | not published | not published | $672.83 – $4,761.00 | 6 |
| Dx duod intub w/asp specs CPT 43757 | not published | not published | $672.83 – $4,761.00 | 6 |
| Dx gastr intub w/asp spec CPT 43754 | not published | not published | $160.18 – $2,334.00 | 6 |
| Dx gastr intub w/asp specs CPT 43755 | not published | not published | $95.45 – $2,334.00 | 6 |
| Dx intraop epcar Ultrasound chd i&r CPT 76989 | not published | not published | $99.00 – $99.00 | 1 |
| Dx intraop epicar car Ultrasound chd CPT 76987 | not published | not published | $267.25 – $267.25 | 1 |
| Dx intraop thoracic aorta Ultrasound CPT 76984 | not published | not published | $85.80 – $85.80 | 1 |
| Dx laryngoscopy newborn CPT 31520 | not published | not published | $290.14 – $2,334.00 | 6 |
| Dx laryngoscopy w/oper scope CPT 31526 | not published | not published | $1,320.39 – $4,761.00 | 6 |
| Dx ntrop epcr Ultrasound chd img acq CPT 76988 | not published | not published | $169.27 – $169.27 | 1 |
| Dynamic cavernosometry CPT 54231 | not published | not published | $185.35 – $4,761.00 | 6 |
| Dynamic surface emg CPT 96002 | not published | not published | $160.18 – $412.19 | 4 |
| Ear and throat examination CPT 92502 | not published | not published | $400.09 – $2,334.00 | 6 |
| Ear canal biopsy 69105 CPT 69105 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Ear cartilage graft CPT 21235 | not published | not published | $3,579.00 – $11,300.84 | 6 |
| Ear irrigation 69209 CPT 69209 | $143.55 | $261.00 | $43.76 – $2,334.00 | 6 |
| Ear protector evaluation CPT 92596 | not published | not published | $27.71 – $71.30 | 4 |
| Ecallantide injection HCPCS J1290 | not published | not published | $446.96 – $1,533.05 | 8 |
| Ecg 12 lead tracing only CPT 93005 | $171.60 | $312.00 | $43.76 – $112.62 | 4 |
| Ecg/1-3 leads/tracing only 93041 CPT 93041 | not published | not published | $43.76 – $112.62 | 4 |
| Ecg external < 48 hours recording CPT 93225 | $462.00 | $840.00 | $98.70 – $253.99 | 4 |
| Ecg external < 48 hours scanning analysis w/report CPT 93226 | $1,201.75 | $2,185.00 | $43.76 – $112.62 | 4 |
| Ecg external > 48 hours up to 7 days recording CPT 93242 | $128.15 | $233.00 | $27.71 – $71.30 | 4 |
| Ecg external >7 days up to 15 days recording CPT 93246 | $128.15 | $233.00 | $27.71 – $71.30 | 4 |
| Echocardiogram (Heart Ultrasound) CPT 93306 | $1,695.10 | $3,082.00 | $405.35 – $1,043.10 | 4 |
| Echocardiography doppler color flow mapping CPT 93325 | $455.95 | $829.00 | not published | 0 |
| Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler HCPCS C8929 | $2,168.65 | $3,943.00 | $581.54 – $1,496.49 | 4 |
| Echocardiography transthoracic 2d followup/limited CPT 93308 | $652.30 | $1,186.00 | $177.00 – $455.49 | 4 |
| Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast HCPCS C8924 | $506.00 | $920.00 | $258.81 – $665.99 | 4 |
| Echocardiograpy doppler follow up/limited study CPT 93321 | $179.30 | $326.00 | not published | 0 |
| Echo exam of eye CPT 76516 | not published | not published | $77.56 – $199.58 | 4 |
| Echo exam of eye CPT 76519 | not published | not published | $77.56 – $199.58 | 4 |
| Echo exam of eye CPT 76529 | not published | not published | $64.56 – $166.13 | 4 |
| Echo exam of eye thickness CPT 76514 | not published | not published | $17.34 – $55.21 | 4 |
| Echo exam of fetal heart CPT 76825 | not published | not published | $405.35 – $1,043.10 | 4 |
| Echo exam of fetal heart CPT 76826 | not published | not published | $177.00 – $455.49 | 4 |
| Echo exam of fetal heart CPT 76827 | $301.40 | $548.00 | $77.56 – $199.58 | 4 |
| Echo exam of fetal heart CPT 76828 | not published | not published | $77.56 – $199.58 | 4 |
| Echo exam uterus 76831- CPT 76831 | $409.20 | $744.00 | $177.00 – $455.49 | 4 |
| Echograp trans r pros study CPT 76873 | not published | not published | $77.56 – $199.58 | 4 |
| Echo guidance radiotherapy CPT 76965 | not published | not published | $79.12 – $79.12 | 1 |
| Echo guidance radiotherapy HCPCS G6001 | not published | not published | $73.17 – $73.17 | 1 |
| Echo guide for amniocentesis CPT 76946 | not published | not published | $43.47 – $43.47 | 1 |
| Echo guide for artery repair CPT 76936 | $455.95 | $829.00 | $160.18 – $412.19 | 4 |
| Echo guide for heart biopsy CPT 76932 | not published | not published | $182.67 – $182.67 | 1 |
| Echo guide for transfusion CPT 76941 | not published | not published | $193.37 – $193.37 | 1 |
| Echo guide ova aspiration CPT 76948 | not published | not published | $132.59 – $132.59 | 1 |
| Echo guide villus sampling CPT 76945 | $370.15 | $673.00 | $204.77 – $204.77 | 1 |
| Echo stress CPT 93350 | $862.95 | $1,569.00 | $405.35 – $1,043.10 | 4 |
| Echo tee cngntl wo ctrst probe plcmnt CPT 93316 | not published | not published | $405.35 – $1,043.10 | 4 |
| Echo tee guidance CPT 93355 | $1,403.60 | $2,552.00 | not published | 0 |
| Echo tee probe placement image acquisition interpretation & report CPT 93312 | $1,158.30 | $2,106.00 | $405.35 – $1,043.10 | 4 |
| Echo transesophageal CPT 93313 | $983.95 | $1,789.00 | $405.35 – $1,043.10 | 4 |
| Echo transesophageal CPT 93315 | not published | not published | $405.35 – $1,043.10 | 4 |
| Echo transesophageal intraop CPT 93318 | $843.70 | $1,534.00 | $405.35 – $1,043.10 | 4 |
| Echo transthoracic CPT 93303 | $1,199.00 | $2,180.00 | $405.35 – $1,043.10 | 4 |
| Echo transthoracic CPT 93304 | $862.95 | $1,569.00 | $405.35 – $1,043.10 | 4 |
| Echo tte 2d comp wo ctrst wo clr/dplr CPT 93307 | not published | not published | $177.00 – $455.49 | 4 |
| Ecmo/ecls daily mgmt artery 33949 CPT 33949 | $1,023.55 | $1,861.00 | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls daily mgmt-venous 33948 CPT 33948 | $1,023.55 | $1,861.00 | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls initiation artery 33947 CPT 33947 | $1,728.65 | $3,143.00 | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls initiation venous 33946 CPT 33946 | $1,532.30 | $2,786.00 | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls insj cent cannula 0-5yrs 33955 CPT 33955 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls insj cent cannula 6yrs&older 33956 CPT 33956 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls insj prph cannula 0-5yrs opn 33953 CPT 33953 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls insj prph cannula 0-5yrs perq 33951 CPT 33951 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls insj prph cannula 6yrs&older opn 33954 CPT 33954 | $2,645.50 | $4,810.00 | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls insj prph cannula 6yrs&older perq 33952 CPT 33952 | $1,630.75 | $2,965.00 | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls remove cent cannula 0-5yrs 33985 CPT 33985 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls remove cent cannula 6yrs&older 33986 CPT 33986 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls remove perph cannula 0-5yrs opn 33969 CPT 33969 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls remove perph cannula 0-5yrs perq 33965 CPT 33965 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls remove prph cannula 6yrs&older open 33984 CPT 33984 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls remove prph cannula 6yrs&older perq 33966 CPT 33966 | $374.55 | $681.00 | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls repos cent cnula 6yrs&older 33964 CPT 33964 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls repos cent/perph cnula 0-5yrs 33963 CPT 33963 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls repos perph cnula 0-5yrs opn 33959 CPT 33959 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls repos perph cnula 0-5yrs perq 33957 CPT 33957 | not published | not published | $3,388.00 – $3,388.00 | 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.