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 |
|---|---|---|---|---|
| Esophagoscp rig trnso biopsy CPT 43193 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Esophagoscp rig trnso inject CPT 43192 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Esophagoscp rig trnso rem fb CPT 43194 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Esophagotomy thrc rmvl fb CPT 43045 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Esophagus endoscopy/ligation CPT 43205 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Esophagus motility study CPT 91010 | $1,289.20 | $2,344.00 | $276.82 – $2,334.00 | 6 |
| Esoph balloon distension tst CPT 91040 | not published | not published | $276.82 – $2,334.00 | 6 |
| Esoph egd dilation <30 mm CPT 43249 | not published | not published | $1,423.51 – $4,761.00 | 7 |
| Esoph endoscopy dilation CPT 43226 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Esoph fundoplasty lap 43327 CPT 43327 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Esoph fundoplasty thor 43328 CPT 43328 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Esophgl motil w/stim/perfus CPT 91013 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Esoph imped function test CPT 91037 | $409.75 | $745.00 | $160.18 – $2,334.00 | 6 |
| Esoph imped funct test > 1hr CPT 91038 | not published | not published | $276.82 – $2,334.00 | 6 |
| Esoph optical endomicroscopy CPT 43206 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Esoph scope w/sclerosis inj CPT 43204 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Esoph scope w/submucous inj CPT 43201 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Esphg dstl 2/3 w/laps moblj 43287 CPT 43287 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Esphg thrsc moblj CPT 43288 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Esphg tot w/laps moblj CPT 43286 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Esphg tot w/thrcm CPT 43112 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Essure 58565 CPT 58565 | not published | not published | $3,710.98 – $16,106.00 | 6 |
| Establish access to aorta CPT 36160 | $2,774.20 | $5,044.00 | $1,887.00 – $5,512.00 | 3 |
| Establish access to artery CPT 36100 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Establish brain cavity shunt CPT 62223 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Establish brain cavity shunt CPT 62180 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Establish brain cavity shunt CPT 62190 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Establish brain cavity shunt CPT 62192 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Establish brain cavity shunt CPT 62200 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Establish brain cavity shunt CPT 62220 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Established Patient Office Visit (level 1) CPT 99211 | $5,355.90 | $9,738.00 | not published | 0 |
| Established Patient Office Visit (level 2) CPT 99212 | $176.55 | $321.00 | not published | 0 |
| Established Patient Office Visit (level 3) CPT 99213 | $187.00 | $340.00 | not published | 0 |
| Established Patient Office Visit (level 4) CPT 99214 | $210.65 | $383.00 | not published | 0 |
| Established Patient Office Visit (level 5) CPT 99215 | $267.30 | $486.00 | not published | 0 |
| Estim aid bone healg invasiv CPT 20975 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Estradiol total CPT 82670 | $249.15 | $453.00 | $20.96 – $53.92 | 7 |
| Estradiol valerate 10 mg inj HCPCS J1380 | not published | not published | $8.03 – $21.62 | 5 |
| Estrogens total-sendout CPT 82672 | not published | not published | $16.28 – $41.88 | 7 |
| Etanercept injection HCPCS J1438 | not published | not published | $2,152.90 – $2,152.90 | 1 |
| Ethanolamine oleate 100 mg HCPCS J1430 | not published | not published | $410.45 – $1,338.51 | 8 |
| Eth estr and eton monthly HCPCS J7295 | not published | not published | $508.98 – $508.98 | 1 |
| Ethmoidectomy extranasal total 31205 CPT 31205 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Ethylene glycol -sendout CPT 82693 | $132.55 | $241.00 | $11.18 – $28.76 | 7 |
| Etonogestrel implant system HCPCS J7307 | not published | not published | $3,968.20 – $3,968.20 | 1 |
| Etoposide 20 mg/ml intravenous solution HCPCS J9181 | not published | not published | $1.05 – $2.67 | 5 |
| Etoposide 50 mg cap HCPCS J8560 | not published | not published | $66.04 – $208.33 | 8 |
| Euflexxa inj per dose HCPCS J7323 | not published | not published | $73.60 – $328.55 | 8 |
| Euglobulin lysis CPT 85360 | not published | not published | $6.31 – $16.23 | 7 |
| Evacuate mole of uterus CPT 59870 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Eval aud rehab status/first hr 92626 CPT 92626 | not published | not published | $95.45 – $245.63 | 4 |
| Eval/fit voice prosthesis iii, st CPT 92607 | $261.25 | $475.00 | $89.62 – $230.62 | 4 |
| Evaluation cervical mucus CPT 89330 | not published | not published | $7.78 – $20.03 | 7 |
| Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen CPT 84112 | $222.75 | $405.00 | $73.58 – $189.35 | 7 |
| Evaluation heart device CPT 93640 | $752.95 | $1,369.00 | $1,887.00 – $2,334.00 | 2 |
| Evaluation of speech fluency 92521 CPT 92521 | $320.10 | $582.00 | $97.95 – $252.06 | 4 |
| Evaluation psychiatric diagnostic CPT 90791 | $327.80 | $596.00 | $131.67 – $338.84 | 4 |
| Evasc prlng admn rx agnt 1st CPT 61650 | $2,327.60 | $4,232.00 | $6,019.00 – $6,019.00 | 1 |
| Evasc prlng admn rx agnt add CPT 61651 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Evasc repair of iliac artery; endograft 34718 CPT 34718 | $6,925.05 | $12,591.00 | $7,609.00 – $7,609.00 | 1 |
| Evasc rpr a-ao ndgft 34701 CPT 34701 | $11,781.55 | $21,421.00 | $7,609.00 – $7,609.00 | 1 |
| Evasc rpr a-ao ndgft rpt 34702 CPT 34702 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Evasc rpr a-biiliac ndgft rptr CPT 34706 | $12,530.10 | $22,782.00 | $7,609.00 – $7,609.00 | 1 |
| Evasc rpr a-iliac ndgft 34717 CPT 34717 | $6,925.05 | $12,591.00 | $7,609.00 – $7,609.00 | 1 |
| Evasc rpr a-unilac ndgft 34703 CPT 34703 | $11,324.50 | $20,590.00 | $7,609.00 – $7,609.00 | 1 |
| Evasc rpr a-unilac ndgft rpt CPT 34704 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Evasc rpr ilio-iliac ndgft CPT 34707 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Evasc rpr ilio-iliac rpt CPT 34708 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Evasc st rpr thrc/aa acrs br CPT 33894 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Evasc st rpr thrc/aa x crsg CPT 33895 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Event monitor CPT 93270 | $349.25 | $635.00 | $27.69 – $71.25 | 4 |
| Evoked auditory tst complete CPT 92588 | not published | not published | $276.82 – $712.35 | 4 |
| Evoked oa emissions ltd CPT 92587 | not published | not published | $160.18 – $412.19 | 4 |
| Evoked potentials auditory screening automated analysis CPT 92650 | $394.90 | $718.00 | not published | 0 |
| Evoked potentials upper limbs CPT 95925 | $789.25 | $1,435.00 | $160.18 – $412.19 | 4 |
| Evoked potential visual not glaucoma CPT 95930 | $785.40 | $1,428.00 | $160.18 – $412.19 | 4 |
| Ewhfo w/joint(s) cf HCPCS L3766 | not published | not published | $1,139.01 – $2,931.05 | 4 |
| Ewho w/joint(s) cf HCPCS L3764 | not published | not published | $656.96 – $1,690.56 | 4 |
| Exam of vagina w/scope 57420 CPT 57420 | not published | not published | $226.06 – $2,334.00 | 6 |
| Exam pelvic add-on CPT 99459 | $35.31 | $64.20 | not published | 0 |
| Exam plvc w/anes othr thn lcl CPT 57410 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Ex arm/elbow tum deep < 5 cm CPT 24076 | not published | not published | $2,154.81 – $5,545.05 | 6 |
| Ex arm/elbow tum deep 5 cm/> CPT 24073 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Exc 1st&/crv rib w/sympth CPT 21616 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Exc abd les sc 3 cm/> CPT 22903 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Exc abdl tum deep < 5 cm CPT 22900 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Exc abdl tum deep 5 cm/> CPT 22901 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Exc abd tum 5 cm or less 49203 CPT 49203 | not published | not published | $7,529.00 – $7,791.00 | 2 |
| Exc abd tum over 10 cm 49205 CPT 49205 | not published | not published | $17,314.00 – $18,364.00 | 2 |
| Exc arm/elbo les sc >=3cm 24071 CPT 24071 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Exc arm/elbo les sc <3cm 24075 CPT 24075 | not published | not published | $1,225.21 – $4,761.00 | 6 |
| Exc aurl glomus tum extended CPT 69554 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Exc aurl glomus tum trnscanl CPT 69550 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Exc aurl glomus tum trnsmstd CPT 69552 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Exc back les sbq <3 cm 21930 CPT 21930 | not published | not published | $1,225.21 – $4,761.00 | 6 |
| Exc back tum deep 5 cm/> CPT 21933 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Exc bartholins gland/cyst CPT 56740 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Exc benign feenlm 3.1-4.0cm 11444 CPT 11444 | not published | not published | $1,225.21 – $3,152.87 | 6 |
| Exc benign feenlm >4.0cm 11446 CPT 11446 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Exc benign snhfg 3.1-4.0cm 11424 CPT 11424 | not published | not published | $1,225.21 – $4,761.00 | 6 |
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.