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 |
|---|---|---|---|---|
| Ecmo/ecls repos perph cnula 6yrs&older opn 33962 CPT 33962 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls repos perph cnula 6yrs&older perq 33958 CPT 33958 | $182.60 | $332.00 | $3,388.00 – $3,388.00 | 1 |
| Ecog impltd brn npgt <30 d CPT 95836 | not published | not published | $27.69 – $71.25 | 4 |
| E coli 0157 ag ia CPT 87335 | not published | not published | $9.50 – $24.43 | 7 |
| Ecp ciliary body destruction CPT 66711 | not published | not published | $1,712.02 – $7,791.00 | 6 |
| Eculizumab 300 mg/30 ml intravenous solution HCPCS J1299 | not published | not published | $33.15 – $85.30 | 5 |
| Eculizumab injection HCPCS J1300 | not published | not published | $242.70 – $610.27 | 3 |
| Edetate calcium disodium inj HCPCS J0600 | not published | not published | $4,642.12 – $16,563.97 | 8 |
| Edetate disodium per 150 mg HCPCS J3520 | not published | not published | $0.87 – $0.87 | 1 |
| Ed svc ckd grp per session HCPCS G0421 | not published | not published | $19.72 – $50.74 | 4 |
| Ed svc ckd ind per session HCPCS G0420 | not published | not published | $81.71 – $210.27 | 4 |
| Eeg 41-60 minutes 95812-26 CPT 95812 | $956.45 | $1,739.00 | $160.18 – $412.19 | 4 |
| Eeg/cerebral death evaluation only 95824 -26 CPT 95824 | $757.35 | $1,377.00 | $276.82 – $712.35 | 4 |
| Eeg during surgery CPT 95955 | $429.00 | $780.00 | not published | 0 |
| Eeg monitoring/function test CPT 95958 | not published | not published | $637.04 – $1,639.32 | 4 |
| Eeg monitoring/giving drugs CPT 95954 | not published | not published | $276.82 – $712.35 | 4 |
| Eeg monitor/record/awake/drowsy 95816 CPT 95816 | $661.65 | $1,203.00 | $160.18 – $412.19 | 4 |
| Eeg over 1 hour 95813 - 26 CPT 95813 | $851.40 | $1,548.00 | $160.18 – $412.19 | 4 |
| Eeg/record in coma or sleep only 95822 CPT 95822 | $326.70 | $594.00 | $160.18 – $412.19 | 4 |
| Eeg recording awake and asleep CPT 95819 | $778.80 | $1,416.00 | $160.18 – $412.19 | 4 |
| Eeg without vid 2-12hr cont mntr CPT 95707 | not published | not published | $160.18 – $412.19 | 4 |
| Eeg without vid 2-12 hr unmntr CPT 95705 | not published | not published | $160.18 – $412.19 | 4 |
| Eeg without vid ea 12-26hr cont CPT 95710 | not published | not published | $276.82 – $712.35 | 4 |
| Eeg without vid ea 12-26hr intmt CPT 95709 | not published | not published | $276.82 – $712.35 | 4 |
| Eeg wo vid 2-12hr intmt mntr CPT 95706 | not published | not published | $160.18 – $412.19 | 4 |
| Eeg wo vid ea 12-26hr unmntr CPT 95708 | not published | not published | $276.82 – $712.35 | 4 |
| E equine encephalitis igg CPT 86652 | $34.10 | $62.00 | $9.89 – $25.46 | 7 |
| Efgartigimod alfa-fcab 20 mg/ml intravenous solution HCPCS J9332 | not published | not published | $24.41 – $88.34 | 8 |
| Egd balloon dil esoph30 mm/> CPT 43233 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Egd control bleeding any CPT 43255 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Egd dilate stricture CPT 43245 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Egd endo mucosal resection CPT 43254 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Egd endoscopic stent place CPT 43266 | not published | not published | $4,428.00 – $11,589.23 | 6 |
| Egd esophagogastrc fndoplsty CPT 43210 | not published | not published | $7,609.00 – $20,292.15 | 6 |
| Egd flx trnsorl dplmnt balo CPT 43290 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Egd flx trnsorl rmvl balo CPT 43291 | not published | not published | $672.83 – $4,761.00 | 6 |
| Egd guide wire insertion CPT 43248 | not published | not published | $672.83 – $4,761.00 | 6 |
| Egd injection varices CPT 43243 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Egd/insert intraluminal tube/cath 43241 CPT 43241 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Egd lesion ablation CPT 43270 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Egd optical endomicroscopy CPT 43252 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Egd remove foreign body CPT 43247 | not published | not published | $672.83 – $4,761.00 | 6 |
| Egd remove lesion snare CPT 43251 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Egd/remov tum/polyp/hot bx forcep 43250 CPT 43250 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Egd Ultrasound exam duodenum/jejunum CPT 43259 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Egd Ultrasound fine needle bx/aspir CPT 43238 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Egd Ultrasound fine needle bx/aspir CPT 43242 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Egd Ultrasound transmural injxn/mark CPT 43253 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Egd varices ligation CPT 43244 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Egd w/thrml txmnt gerd CPT 43257 | not published | not published | $2,860.11 – $7,791.00 | 6 |
| Egd w/transmural drain cyst CPT 43240 | not published | not published | $3,735.00 – $11,589.23 | 6 |
| Egfr gene com variants CPT 81235 | $1,037.30 | $1,886.00 | $243.44 – $626.44 | 7 |
| Ehrlicha chaffeensis amp prb CPT 87484 | $64.90 | $118.00 | $26.32 – $67.72 | 7 |
| Eia hiv-1/hiv-2 screen HCPCS G0432 | not published | not published | $14.68 – $37.77 | 7 |
| EKG tracing for initial prev HCPCS G0404 | $170.50 | $310.00 | $21.46 – $55.21 | 4 |
| Elb disart prosth tiss shap HCPCS L6450 | not published | not published | $3,284.37 – $8,451.78 | 4 |
| Elb mold sock flex hinge pad HCPCS L6100 | not published | not published | $2,323.10 – $5,978.10 | 4 |
| Elbow arthroscopy CPT 29830 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Elbow arthroscopy/surgery CPT 29834 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Elbow arthroscopy/surgery CPT 29835 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Elbow arthroscopy/surgery CPT 29836 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Elbow arthroscopy/surgery CPT 29837 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Elbow arthroscopy/surgery CPT 29838 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Elbow inter loc elbow forarm HCPCS L6250 | not published | not published | $2,972.05 – $7,648.07 | 4 |
| Elbow mold doub splt soc ste HCPCS L6120 | not published | not published | $2,779.65 – $7,152.97 | 4 |
| Elbow mold outsid lock hinge HCPCS L6200 | not published | not published | $3,020.91 – $7,773.81 | 4 |
| Elbow mold sock suspension t HCPCS L6110 | not published | not published | $2,457.68 – $6,324.44 | 4 |
| Elbow socket ins use without lck HCPCS L6695 | not published | not published | $604.87 – $1,556.53 | 4 |
| Elbow socket ins use w/lock HCPCS L6694 | not published | not published | $725.86 – $1,867.89 | 4 |
| Elbow stump activated lock h HCPCS L6130 | not published | not published | $2,932.59 – $7,546.53 | 4 |
| Elec analys infus pump w/reprog 62368 CPT 62368 | not published | not published | $227.84 – $2,334.00 | 6 |
| Elec hand ind art digits HCPCS L6880 | not published | not published | $22,065.16 – $56,781.01 | 4 |
| Elec knee-shin swing/stance HCPCS L5856 | not published | not published | $22,169.84 – $57,050.38 | 4 |
| Elec stim unattend for press HCPCS G0281 | not published | not published | $8.42 – $21.67 | 4 |
| Elect analysis of infusion pump 62367 CPT 62367 | not published | not published | $227.84 – $2,334.00 | 6 |
| Elect anlys sp inf pmp w/reprg&fill 62369 CPT 62369 | not published | not published | $227.84 – $2,334.00 | 6 |
| Electrd sq emblem s-icd HCPCS C1896 | $6,651.56 | $12,093.75 | not published | 0 |
| Electrical bone stim 20974 CPT 20974 | not published | not published | $34.51 – $2,334.00 | 6 |
| Electrocochleography CPT 92584 | not published | not published | $95.45 – $245.63 | 4 |
| Electroconvulsive therapy 90870 CPT 90870 | not published | not published | $637.04 – $1,639.32 | 4 |
| Electrode stimulation brain CPT 95961 | $497.75 | $905.00 | $637.04 – $1,639.32 | 4 |
| Electroejaculation CPT 55870 | not published | not published | $683.26 – $3,030.00 | 6 |
| Electrogastrography CPT 91132 | not published | not published | $160.18 – $2,334.00 | 6 |
| Electrogastrography w/test CPT 91133 | not published | not published | $98.70 – $2,334.00 | 6 |
| Electrolyte panel CPT 80051 | $50.60 | $92.00 | $5.26 – $13.53 | 7 |
| Electromagntic tx for ulcers HCPCS G0329 | not published | not published | $7.58 – $19.51 | 4 |
| Electron elbow child switch HCPCS L7186 | not published | not published | $9,818.33 – $25,265.84 | 4 |
| Electronic elbo simultaneous HCPCS L7181 | not published | not published | $37,003.64 – $95,222.69 | 4 |
| Electronic elbow sequential HCPCS L7180 | not published | not published | $35,939.99 – $92,485.58 | 4 |
| Electron microscopy diagnostic CPT 88348 | $699.05 | $1,271.00 | $380.68 – $1,538.03 | 5 |
| Electro-oculography w/i&r CPT 92270 | not published | not published | $98.70 – $253.99 | 4 |
| Electrophysiologic study CPT 93624 | not published | not published | $5,786.04 – $18,364.00 | 6 |
| Electrophysiology evaluation CPT 93619 | $9,067.30 | $16,486.00 | $5,786.04 – $18,364.00 | 6 |
| Electrophysiology evaluation CPT 93620 | $9,067.30 | $16,486.00 | $5,786.04 – $18,364.00 | 6 |
| Electrophysiology evaluation CPT 93621 | $3,620.10 | $6,582.00 | $1,887.00 – $2,334.00 | 2 |
| Electrophysiology evaluation CPT 93622 | $3,620.10 | $6,582.00 | $1,887.00 – $2,334.00 | 2 |
| Electrophysiology evaluation CPT 93641 | $961.95 | $1,749.00 | $1,887.00 – $2,334.00 | 2 |
| Electrophysiology evaluation CPT 93642 | $1,559.80 | $2,836.00 | $903.21 – $4,761.00 | 6 |
| Electrophysiology evaluation CPT 93644 | $1,553.75 | $2,825.00 | $1,887.00 – $2,334.00 | 2 |
| Electrophys map 3d add-on CPT 93613 | $3,119.05 | $5,671.00 | $1,887.00 – $2,334.00 | 2 |
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.