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 |
|---|---|---|---|---|
| Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV HCPCS J0283 | not published | not published | $2.73 – $6.86 | 5 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | not published | not published | $0.36 – $1.06 | 5 |
| Amitriptyline (elavil) -sendout CPT 80335 | $194.70 | $354.00 | $35.06 – $35.06 | 1 |
| Amivantamab-vmjw 50 mg/ml intravenous solution HCPCS J9061 | not published | not published | $17.41 – $58.69 | 8 |
| Ammonia CPT 82140 | $126.50 | $230.00 | $10.93 – $28.12 | 7 |
| Amniocentesisdiagnostic 59000 CPT 59000 | not published | not published | $683.26 – $3,030.00 | 6 |
| Amniocentesis therapeutic CPT 59001 | not published | not published | $226.06 – $2,334.00 | 6 |
| Amniotic fluid scan CPT 82143 | not published | not published | $7.01 – $18.05 | 7 |
| Amp f/th 1/2 jt/phalanx w/neurect local flap CPT 26952 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Amphetamine confirm urine -sendout CPT 80324 | $188.65 | $343.00 | $35.06 – $35.06 | 1 |
| Amphetamines 5 or more CPT 80326 | $188.65 | $343.00 | not published | 0 |
| Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr HCPCS J0285 | not published | not published | $54.21 – $136.32 | 5 |
| Amphotericin b lipid complex HCPCS J0287 | not published | not published | $11.33 – $28.05 | 3 |
| Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J0289 | not published | not published | $14.88 – $65.29 | 8 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | not published | not published | $0.66 – $1.93 | 5 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | not published | not published | $1.73 – $4.47 | 5 |
| Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis CPT 81515 | not published | not published | $197.24 – $507.57 | 7 |
| Amp metatarsal w/toe single 28810 CPT 28810 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Amp thigh through femur re-amp 27596 CPT 27596 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Amputate hand at wrist CPT 25922 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Amputate metacarpal bone 26910 CPT 26910 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Amputate thigh through femur 27590 CPT 27590 | not published | not published | $2,427.27 – $27,583.00 | 6 |
| Amputation follow-up surgery CPT 24925 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Amputation follow-up surgery CPT 25907 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Amputation follow-up surgery CPT 25909 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Amputation follow-up surgery CPT 25929 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Amputation follow-up surgery CPT 25931 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Amputation follow-up surgery CPT 27594 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Amputation follow-up surgery CPT 27884 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Amputation leg thr tib/fib 27880 CPT 27880 | not published | not published | $3,735.00 – $27,583.00 | 6 |
| Amputation leg; tib/fib f/u 27886 CPT 27886 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Amputation of foot at ankle CPT 27889 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Amputation of lower leg CPT 27882 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Amputation of midtarsal 28800 CPT 28800 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Amputation thru metatarsal CPT 28805 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Amputation toe interphalangeal joint CPT 28825 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Amputation toe metatarsophalangeal joint CPT 28820 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Amylase CPT 82150 | $62.70 | $114.00 | $4.86 – $12.51 | 7 |
| Anacaulase-bcdb 8.8% gel 1 g HCPCS J7353 | not published | not published | $155.15 – $155.15 | 1 |
| Ana ds-dna CPT 86226 | not published | not published | $9.08 – $23.37 | 7 |
| Analgesics non-opioid definitive assay 1 or 2 acetaminophen CPT 80329 | $34.65 | $63.00 | $35.06 – $35.06 | 1 |
| Anal pressure record CPT 91122 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Anal/urinary muscle study CPT 51784 | $464.97 | $845.40 | $95.45 – $2,334.00 | 6 |
| Anal/urinary muscle study CPT 51785 | $602.80 | $1,096.00 | $185.35 – $2,334.00 | 6 |
| Analysis gene f2 20210g>a variant CPT 81240 | $315.70 | $574.00 | $49.27 – $126.78 | 7 |
| Analysis gene f5 leiden variant CPT 81241 | $434.50 | $790.00 | $55.03 – $141.60 | 7 |
| Analysis nerve CPT 88356 | not published | not published | $38.66 – $99.48 | 5 |
| Analysis; simple cranial nerv pulse gen prgrmg 95976 CPT 95976 | $216.48 | $393.60 | $27.69 – $71.25 | 4 |
| Analysis tumor CPT 88358 | not published | not published | $56.20 – $325.23 | 5 |
| Anaplsma phgcytophlm amp prb CPT 87468 | $64.90 | $118.00 | $26.32 – $67.72 | 7 |
| Anastamo/extrahep bil duct/gi trac 47760 CPT 47760 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Anastamo/roux-en-y/extrahep bil/gi 47780 CPT 47780 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Anastomosis of facial/other nerve 64868 CPT 64868 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Anca screen with reflex to titer -quest CPT 86021 | $24.75 | $45.00 | $11.29 – $29.05 | 7 |
| An cholangiogram percutaneous compl CPT 47531 | $2,426.60 | $4,412.00 | $2,656.06 – $8,770.00 | 6 |
| Androstanediol CPT 82154 | not published | not published | $21.62 – $55.64 | 7 |
| An fluoro guide for cvp CPT 77001 | $365.20 | $664.00 | $171.09 – $171.09 | 1 |
| Angio balloon ctrl dialysis seg add-on CPT 36907 | $326.15 | $593.00 | $1,887.00 – $2,334.00 | 2 |
| Angioplasty fem/pop unilat 37224 CPT 37224 | $7,081.80 | $12,876.00 | $6,019.00 – $18,364.00 | 3 |
| Angioplasty/iliac/init ves/unilat 37220 CPT 37220 | $7,102.15 | $12,913.00 | $6,019.00 – $18,364.00 | 3 |
| Angioplasty tib/pero/unilat/ea add 37232 CPT 37232 | $5,981.25 | $10,875.00 | $5,512.00 – $18,364.00 | 3 |
| Angiotensin ii CPT 82163 | not published | not published | $15.39 – $39.60 | 7 |
| Angio tib/peroneal/init ves/unila 37228 CPT 37228 | $8,132.85 | $14,787.00 | $7,609.00 – $18,364.00 | 3 |
| Angio trnslmnl balloon same artery ea addl CPT 37247 | $3,987.50 | $7,250.00 | $1,887.00 – $2,334.00 | 2 |
| Angio trnslmnl balloon same artery ini CPT 37246 | $8,050.90 | $14,638.00 | $4,222.18 – $18,364.00 | 6 |
| Angio trnslmnl balloon same vein ea addl CPT 37249 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Angio trnslmnl balloon same vein ini CPT 37248 | $7,935.95 | $14,429.00 | $4,222.18 – $18,364.00 | 6 |
| Anidulafungin injection HCPCS J0348 | not published | not published | $0.52 – $1.39 | 5 |
| Ankle arthroscopy/surgery CPT 29891 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Ankle arthroscopy/surgery CPT 29892 | not published | not published | $5,382.89 – $16,106.00 | 6 |
| Ankle arthroscopy/surgery CPT 29894 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Ankle arthroscopy/surgery CPT 29895 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Ankle arthroscopy/surgery CPT 29897 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Ankle arthroscopy/surgery CPT 29898 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Ankle arthroscopy/surgery CPT 29899 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Ankle X-ray CPT 73610 | $304.15 | $553.00 | $64.56 – $166.13 | 4 |
| Anl sp inf pmp w/mdreprg&fil CPT 62370 | not published | not published | $227.84 – $2,334.00 | 6 |
| Annual alcohol screen 15 min HCPCS G0442 | not published | not published | $27.80 – $71.53 | 4 |
| Anodyne therapy charges pt CPT 97026 | $37.40 | $68.00 | $4.70 – $12.10 | 4 |
| Anogenital exam child w imag CPT 99170 | not published | not published | $149.98 – $385.94 | 4 |
| Anora (draw only) CPT 99001 | not published | not published | $6.14 – $6.14 | 1 |
| Anorectal myomectomy CPT 45108 | not published | not published | $2,059.07 – $7,791.00 | 6 |
| Anoscopy CPT 46611 | not published | not published | $689.87 – $4,761.00 | 6 |
| Anoscopy ablation lesion 46615 CPT 46615 | not published | not published | $2,059.07 – $7,791.00 | 6 |
| Anoscopy and biopsy CPT 46606 | not published | not published | $887.71 – $4,761.00 | 6 |
| Anoscopy and dilation 46604 CPT 46604 | not published | not published | $887.71 – $4,761.00 | 6 |
| Anoscopy control bleeding 46614 CPT 46614 | not published | not published | $887.71 – $4,761.00 | 6 |
| Anoscopy remove fb 46608 CPT 46608 | $1,208.35 | $2,197.00 | $689.87 – $4,761.00 | 6 |
| Anoscopy remove lesion 46610 CPT 46610 | not published | not published | $2,059.07 – $7,791.00 | 6 |
| Anoscopy remove lesions w/cautery/snare 46612 CPT 46612 | not published | not published | $2,059.07 – $7,791.00 | 6 |
| Ans parasymp & symp w/tilt CPT 95924 | not published | not published | $160.18 – $412.19 | 4 |
| Ant colporrhaphy/rpr cyctocele 57240 CPT 57240 | not published | not published | $3,710.98 – $9,549.58 | 6 |
| Antibody CPT 86744 | not published | not published | $11.77 – $30.86 | 7 |
| Antibody bacterium, not elsewhere specified CPT 86609 | $21.45 | $39.00 | $9.66 – $24.86 | 7 |
| Antibody elution rbc reference CPT 86860 | $99.55 | $181.00 | $43.19 – $325.23 | 5 |
| Antibody htlv/hiv confirm test CPT 86689 | $98.45 | $179.00 | $14.51 – $37.35 | 7 |
| Antibody htlv-i CPT 86687 | not published | not published | $6.82 – $17.54 | 7 |
| Antibody htlv-ii CPT 86688 | not published | not published | $10.50 – $27.02 | 7 |
| Antibody identification platelet antibodies heparin-pf4 igg CPT 86022 | $271.15 | $493.00 | $13.78 – $35.45 | 7 |
| Antibody id rbc panel CPT 86870 | $446.60 | $812.00 | $59.47 – $684.27 | 5 |
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.