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 |
|---|---|---|---|---|
| Elisa hiv-1/hiv-2 screen HCPCS G0433 | not published | not published | $13.72 – $35.30 | 7 |
| Elliotts b solution per ml HCPCS J9175 | not published | not published | $31.42 – $31.42 | 1 |
| Elosulfase alfa, injection HCPCS J1322 | not published | not published | $239.64 – $800.20 | 8 |
| Elotuzumab 300 mg intravenous solution HCPCS J9176 | not published | not published | $6.14 – $21.02 | 8 |
| Elranatamab-bcmm 40 mg/ml subcutaneous solution HCPCS J1323 | not published | not published | $144.36 – $483.65 | 8 |
| Embedded ip cath exit-site 49436 CPT 49436 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Embolization s&i CPT 75894 | $874.50 | $1,590.00 | $2,922.55 – $2,922.55 | 1 |
| Embo or occlude vascular arterial s&i CPT 37242 | $8,031.65 | $14,603.00 | $7,609.00 – $34,994.75 | 6 |
| Embo or occlude vascular hemorrhage s&i CPT 37244 | $9,557.90 | $17,378.00 | $7,609.00 – $27,583.00 | 6 |
| Embo or occlude vascular tumor/organ/infarct s&i CPT 37243 | $9,191.05 | $16,711.00 | $7,609.00 – $27,583.00 | 6 |
| Embo or occlude vascular venous s&i CPT 37241 | $9,325.25 | $16,955.00 | $7,609.00 – $27,583.00 | 6 |
| Embryo hatching CPT 89253 | not published | not published | $126.39 – $325.23 | 5 |
| Embryo transfer intrauterine CPT 58974 | not published | not published | $683.26 – $3,030.00 | 6 |
| Emb/throm/fempop/aor/ilia/leg inc 34201 CPT 34201 | $3,838.45 | $6,979.00 | $4,127.91 – $18,364.00 | 6 |
| Emb/throm/pop-tib-pero art/leg inc 34203 CPT 34203 | not published | not published | $4,127.91 – $18,364.00 | 6 |
| Emb w/colposcopy 58110 CPT 58110 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Emb without cervical dilation 58100 CPT 58100 | $259.60 | $472.00 | $149.98 – $2,334.00 | 6 |
| Emg 2 ext w-w/o paraspinal area 95861 CPT 95861 | $225.50 | $410.00 | $98.70 – $253.99 | 4 |
| Emg 3 ext w-w/o paraspinal area 95863 CPT 95863 | not published | not published | $95.45 – $245.63 | 4 |
| Emg cranial nerve bilateral CPT 95868 | $361.35 | $657.00 | $160.18 – $412.19 | 4 |
| Emg needle test 1-extremity CPT 95860 | $166.10 | $302.00 | $98.70 – $253.99 | 4 |
| Emg needle test 4-extremities CPT 95864 | not published | not published | $95.45 – $245.63 | 4 |
| Emg thor paraspinal without t1/t2 CPT 95869 | not published | not published | $160.18 – $412.19 | 4 |
| Emr hd pmp elec/combo, rep HCPCS Q0494 | not published | not published | $198.14 – $509.89 | 4 |
| Emr pwr cbl combo vad, rep HCPCS Q0493 | not published | not published | $234.16 – $602.58 | 4 |
| Emr pwr cbl elec vad, rep HCPCS Q0492 | not published | not published | $82.25 – $211.66 | 4 |
| Emr pwr source combo vad rep HCPCS Q0491 | not published | not published | $1,020.82 – $2,626.92 | 4 |
| Emr pwr source elec vad, rep HCPCS Q0490 | not published | not published | $649.34 – $1,670.96 | 4 |
| Encephalitis, california igg/igm CPT 86651 | $48.95 | $89.00 | $9.89 – $25.46 | 7 |
| Encephalitis, st louis igg/igm CPT 86653 | $34.10 | $62.00 | $9.89 – $25.46 | 7 |
| Encephalitis, western equine igg/igm CPT 86654 | $35.20 | $64.00 | $9.89 – $25.46 | 7 |
| Endo abl/incom vein/ext/laser/#1 36478 CPT 36478 | $3,237.85 | $5,887.00 | $2,342.32 – $8,770.00 | 6 |
| Endo abl/incom vein/ext/rad fre/#1 36475 CPT 36475 | $3,525.50 | $6,410.00 | $2,342.32 – $8,770.00 | 6 |
| Endo ak/hip alignable system HCPCS L5920 | not published | not published | $487.18 – $1,253.69 | 4 |
| Endo ak/hip knee extens assi HCPCS L5850 | not published | not published | $117.46 – $302.26 | 4 |
| Endo ak ultra-light material HCPCS L5950 | not published | not published | $714.35 – $1,838.27 | 4 |
| Endo assay seven anal CPT 81506 | not published | not published | $51.69 – $133.02 | 7 |
| Endo below knee alignable sy HCPCS L5910 | not published | not published | $332.54 – $855.74 | 4 |
| Endo bk ultra-light material HCPCS L5940 | not published | not published | $460.58 – $1,185.21 | 4 |
| Endo cath bile duct s&i CPT 74328 | $276.65 | $503.00 | $274.59 – $274.59 | 1 |
| Endo cath panc duct s&i CPT 74329 | $276.65 | $503.00 | $220.21 – $220.21 | 1 |
| Endocerv curettage w/scope 57456 CPT 57456 | not published | not published | $226.06 – $2,334.00 | 6 |
| Endocervical curettage 57505 CPT 57505 | not published | not published | $683.26 – $3,030.00 | 6 |
| Endo cholangiopancreatograph CPT 43261 | not published | not published | $2,860.11 – $7,791.00 | 6 |
| Endo cholangiopancreatograph CPT 43262 | not published | not published | $2,860.11 – $7,791.00 | 6 |
| Endo defect closure gi tract HCPCS C9901 | not published | not published | $7,885.55 – $20,292.15 | 4 |
| Endo hip ultra-light materia HCPCS L5960 | not published | not published | $1,068.14 – $2,748.69 | 4 |
| Endo knee-shin fluid swg/sta HCPCS L5828 | not published | not published | $2,721.37 – $7,002.99 | 4 |
| Endo knee-shin fluid swing p HCPCS L5824 | not published | not published | $1,529.07 – $3,934.81 | 4 |
| Endo knee-shin frct swg & st HCPCS L5812 | not published | not published | $545.48 – $1,403.71 | 4 |
| Endo knee-shin frct swg & st HCPCS L5818 | not published | not published | $881.75 – $2,269.04 | 4 |
| Endo knee-shin hydral swg ph HCPCS L5814 | not published | not published | $3,429.84 – $8,826.12 | 4 |
| Endo knee-shin mnl lck ultra HCPCS L5811 | not published | not published | $724.85 – $1,865.29 | 4 |
| Endo knee-shin pneum swg frc HCPCS L5822 | not published | not published | $1,617.56 – $4,162.53 | 4 |
| Endo knee-shin pneum/swg pha HCPCS L5830 | not published | not published | $1,834.93 – $4,721.88 | 4 |
| Endo knee-shin polyc mch sta HCPCS L5816 | not published | not published | $780.87 – $2,009.44 | 4 |
| Endoluminal bx biliary tree CPT 47543 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Endoluminal bx urtr rnl plvs CPT 50606 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Endoluminl ivus oct c 1st CPT 92978 | $2,329.80 | $4,236.00 | $1,887.00 – $2,334.00 | 2 |
| Endoluminl ivus oct c ea CPT 92979 | $2,215.95 | $4,029.00 | $1,887.00 – $2,334.00 | 2 |
| Endome abla/them without hystero guide 58353 CPT 58353 | not published | not published | $3,710.98 – $9,549.58 | 6 |
| Endometrial cryoablation w/us 58356 CPT 58356 | not published | not published | $3,710.98 – $16,106.00 | 6 |
| Endo outlet restrict w/tube HCPCS C9785 | not published | not published | $7,609.00 – $20,292.15 | 5 |
| Endo poly hip, pneu/hyd/rot HCPCS L5961 | not published | not published | $4,408.21 – $11,343.79 | 4 |
| Endoscopic injection/implant CPT 51715 | not published | not published | $2,614.94 – $8,770.00 | 6 |
| Endoscopic pancreatoscopy CPT 43273 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Endoscopic Ultrasound exam esoph CPT 43237 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Endoscopic vein harvest 33508 CPT 33508 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Endoscopy bowel pouch/biop CPT 44386 | not published | not published | $689.87 – $4,761.00 | 6 |
| Endoscopy ligate perf veins 37500 CPT 37500 | not published | not published | $4,428.00 – $18,364.00 | 3 |
| Endoscopy maxillary sinus CPT 31267 | not published | not published | $4,956.00 – $13,472.56 | 7 |
| Endoscopy of bowel pouch 44385 CPT 44385 | not published | not published | $689.87 – $4,761.00 | 6 |
| Endoscopy of ureter CPT 50951 | not published | not published | $2,614.94 – $6,729.12 | 6 |
| Endoscopy of ureter CPT 50953 | not published | not published | $2,614.94 – $6,729.12 | 6 |
| Endoscopy swallow (fees) vid CPT 92612 | $394.35 | $717.00 | $39.37 – $101.31 | 4 |
| Endoscpy nsl/sns w/cntrl nsl hmrrgh CPT 31238 | not published | not published | $1,320.39 – $4,761.00 | 6 |
| Endoskeletal axial rotation HCPCS L5984 | not published | not published | $593.80 – $1,528.06 | 4 |
| Endoskel knee-shin mnl lock HCPCS L5810 | not published | not published | $525.25 – $1,351.64 | 4 |
| Endoskel posit rotat unit HCPCS L5926 | not published | not published | $593.80 – $1,528.06 | 4 |
| Endo sleeve gastro w/tube HCPCS C9784 | not published | not published | $7,609.00 – $17,314.00 | 2 |
| Endovasc prosth delayed 33886 CPT 33886 | $5,305.30 | $9,646.00 | $7,609.00 – $7,609.00 | 1 |
| Endovasc rpr a-biiliac endogft 34705 CPT 34705 | $12,057.10 | $21,922.00 | $7,609.00 – $7,609.00 | 1 |
| Endovasc tempory vessel occl CPT 61623 | not published | not published | $7,609.00 – $27,583.00 | 6 |
| Endovasc visc aorta 1 graft CPT 34841 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Endovasc visc aorta 2 graft CPT 34842 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Endovasc visc aorta 3 graft CPT 34843 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Endovasc visc aorta 4 graft CPT 34844 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Endovas iliac a device addon CPT 34808 | $2,690.05 | $4,891.00 | $3,735.00 – $3,735.00 | 1 |
| Endovenous laser vein addon 36479 CPT 36479 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Endovenous mchnchem 1st vein CPT 36473 | not published | not published | $2,342.32 – $8,770.00 | 6 |
| Endovenous mchnchem add-on CPT 36474 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Endovenous rf abl vein addl CPT 36476 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Endoven ther chem adhes 1st 36482 CPT 36482 | $3,403.95 | $6,189.00 | $4,127.91 – $18,364.00 | 6 |
| Endoven ther chem adhes sbsq 36483 CPT 36483 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Energy storing foot HCPCS L5976 | not published | not published | $542.73 – $1,396.63 | 4 |
| Enfortumab vedotin-ejfv 20 mg intravenous solution HCPCS J9177 | not published | not published | $27.49 – $99.78 | 8 |
| Enfuvirtide injection HCPCS J1324 | not published | not published | $2.18 – $2.18 | 1 |
| Enoxaparin 30 mg/0.3 ml subcutaneous syringe HCPCS J1650 | not published | not published | $0.57 – $1.52 | 5 |
| Entamoeba histolytica ag eia - sendout CPT 87337 | not published | not published | $8.98 – $23.12 | 7 |
| Entamoeb hist dispr ag ia CPT 87336 | not published | not published | $12.00 – $30.88 | 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.