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 |
|---|---|---|---|---|
| Explore/treat eye socket CPT 67420 | not published | not published | $2,916.44 – $8,770.00 | 6 |
| Explore/treat eye socket CPT 67430 | not published | not published | $2,916.44 – $8,770.00 | 6 |
| Explore/treat eye socket 67413 CPT 67413 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Explore/treat finger joint CPT 26075 | $6,129.20 | $11,144.00 | $2,427.27 – $6,246.19 | 6 |
| Explore/treat finger joint CPT 26080 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Explore/treat knee joint CPT 27331 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Explore/treat wrist joint CPT 25101 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Explore wound abdomen 20102 CPT 20102 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Explore woundchest 20101 CPT 20101 | $4,071.65 | $7,403.00 | $1,530.61 – $4,761.00 | 6 |
| Explore wound neck 20100 CPT 20100 | $990.00 | $1,800.00 | $400.09 – $2,334.00 | 6 |
| Explor not followed by surg repair artery; low extrem 35703 CPT 35703 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Explor not followed by surg repair artery; up extrem 35702 CPT 35702 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Explr/decompress eye socket CPT 67414 | not published | not published | $2,916.44 – $8,770.00 | 6 |
| Explr/decompress eye socket CPT 67445 | not published | not published | $2,916.44 – $8,770.00 | 6 |
| Expose art endoprosth iliac 34820 CPT 34820 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Expose endoprosth brachial 34834 CPT 34834 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Exp w remove/deep fb/forearm/wrist 25248 CPT 25248 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Ex sq tumor/face or scalp < 2 cm 21011 CPT 21011 | not published | not published | $1,225.21 – $3,152.87 | 6 |
| Ex sq tumor/face or scalp 2 cm/> 21012 CPT 21012 | not published | not published | $1,225.21 – $3,152.87 | 6 |
| Ext antenna phren nerve stim HCPCS L8696 | not published | not published | $200.14 – $515.04 | 4 |
| Ext ecg>48hr<7d scan a/r CPT 93243 | not published | not published | $98.70 – $253.99 | 4 |
| Ext ecg>7d<15d scan a/r CPT 93247 | not published | not published | $98.70 – $253.99 | 4 |
| Extended culture of oocytes CPT 89272 | not published | not published | $597.68 – $1,538.03 | 5 |
| Extended steel shank HCPCS L2360 | not published | not published | $47.53 – $122.30 | 4 |
| Extended visual field xm CPT 92083 | not published | not published | $98.70 – $253.99 | 4 |
| Extension per extension per HCPCS L2760 | not published | not published | $52.36 – $134.75 | 4 |
| Extensive ear canal surgery 69150 CPT 69150 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Extensive ear/neck surgery 69155 CPT 69155 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Extensive hand surgery CPT 26250 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Extensive hysterectomy CPT 58285 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Extensive jaw surgery CPT 21045 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Extensive mastoid surgery CPT 69511 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Extensive mastoid surgery CPT 69530 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Extensive prostate surgery CPT 55810 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Extensive prostate surgery CPT 55812 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Extensive prostate surgery CPT 55815 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Extensive prostate surgery CPT 55840 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Extensive prostate surgery CPT 55842 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Extensive prostate surgery CPT 55845 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Extensive prostate surgery CPT 55862 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Extensive prostate surgery CPT 55865 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Extensive removal of liver CPT 47122 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Extensive sternum surgery CPT 21632 | not published | not published | $17,314.00 – $18,364.00 | 2 |
| Extensive surgery of throat CPT 42842 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Extensive surgery of throat CPT 42844 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Extensive surgery of throat CPT 42845 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Extensive testis surgery CPT 54535 | not published | not published | $2,614.94 – $8,770.00 | 6 |
| Extensive thyroid surgery CPT 60254 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Extensive vulva surgery CPT 56632 | not published | not published | $4,428.00 – $27,583.00 | 3 |
| External cannula declotting CPT 36860 | not published | not published | $1,167.76 – $3,030.00 | 6 |
| External chromosome analysis 20-25 cells CPT 88264 | $170.64 | $310.25 | $108.46 – $279.10 | 7 |
| External newborn metabolic screening panel HCPCS S3620 | $276.10 | $502.00 | not published | 0 |
| External ocular photography CPT 92285 | not published | not published | $27.71 – $71.30 | 4 |
| External pretreatment of serum for use in antibody identification by dilution CPT 86976 | not published | not published | $21.46 – $55.21 | 5 |
| External profiling gene expression oncology (breast) mrna 21 genes CPT 81519 | $7,285.30 | $13,246.00 | $2,904.75 – $7,474.89 | 7 |
| External recharg sys extern HCPCS L8695 | not published | not published | $15.40 – $39.62 | 4 |
| External recharg sys intern HCPCS L8689 | not published | not published | $1,593.02 – $4,099.38 | 4 |
| External tissue culture neoplastic disorders bone marrow/blood cells CPT 88237 | $201.46 | $366.29 | $100.79 – $277.44 | 7 |
| Extnd color vision xm CPT 92283 | not published | not published | $43.76 – $112.62 | 4 |
| Extractable nuclear antigen/antibody any method each antibody centromere CPT 86235 | $147.95 | $269.00 | $13.45 – $34.60 | 7 |
| Extraction erupted tooth/exr HCPCS D7140 | not published | not published | $479.59 – $1,234.13 | 4 |
| Extraction of lens CPT 66930 | not published | not published | $3,066.31 – $7,890.63 | 6 |
| Extraction of lens CPT 66940 | not published | not published | $1,712.02 – $4,761.00 | 6 |
| Extraction of lens 66920 CPT 66920 | not published | not published | $1,712.02 – $7,791.00 | 6 |
| Extrnl counterpulse, per tx HCPCS G0166 | not published | not published | $98.70 – $253.99 | 4 |
| Eye allergy tests CPT 95060 | not published | not published | $98.70 – $253.99 | 4 |
| Eye photodynamic ther add-on CPT 67225 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Eye surgery follow-up add-on CPT 67331 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Eye suture during surgery CPT 67335 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Ezh2 gene common variants CPT 81237 | not published | not published | $131.55 – $338.52 | 7 |
| Ezh2 gene full gene sequence CPT 81236 | not published | not published | $212.16 – $545.96 | 7 |
| F-18 fdg pet diag HCPCS A9552 | $1,384.35 | $2,517.00 | $1,136.88 – $1,136.88 | 1 |
| F-18 florbetapir less than or equal to 10 mci HCPCS A9586 | not published | not published | $1,369.23 – $5,974.85 | 5 |
| F-18 fluciclovine per mci HCPCS A9588 | not published | not published | $241.70 – $730.77 | 5 |
| F-18 sodium fluoride HCPCS A9580 | not published | not published | $713.33 – $713.33 | 1 |
| F9 full gene sequence CPT 81238 | not published | not published | $450.00 – $1,158.00 | 7 |
| Face bone graft CPT 21210 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Facial bones <3 CPT 70140 | $304.15 | $553.00 | $62.49 – $166.13 | 4 |
| Facial nerve function test CPT 92516 | not published | not published | $160.18 – $412.19 | 4 |
| Facility svs dental rehab HCPCS G0330 | not published | not published | $2,459.51 – $6,329.15 | 4 |
| Factor ix CPT 85250 | $167.20 | $304.00 | $14.28 – $36.75 | 7 |
| Factor ix alprolix recomb HCPCS J7201 | not published | not published | $2.78 – $9.75 | 8 |
| Factor ix complex HCPCS J7194 | not published | not published | $1.31 – $4.52 | 8 |
| Factor ix idelvion inj HCPCS J7202 | not published | not published | $4.13 – $14.19 | 8 |
| Factor ix non-recombinant HCPCS J7193 | not published | not published | $1.05 – $3.65 | 8 |
| Factor ix recomb gly rebinyn HCPCS J7203 | not published | not published | $3.51 – $11.95 | 8 |
| Factor ix recombinan rixubis HCPCS J7200 | not published | not published | $1.29 – $4.49 | 8 |
| Factor ix recombinant nos HCPCS J7195 | not published | not published | $1.40 – $5.02 | 8 |
| Factor viia recomb sevenfact HCPCS J7212 | not published | not published | $1.65 – $6.40 | 8 |
| Factor viii CPT 85240 | $62.15 | $113.00 | $13.42 – $34.55 | 7 |
| Factor viii HCPCS J7190 | not published | not published | $0.93 – $3.05 | 8 |
| Factor viii fc fusion recomb HCPCS J7205 | not published | not published | $1.93 – $6.37 | 8 |
| Factor viii nuwiq recomb 1iu HCPCS J7209 | not published | not published | $0.92 – $3.38 | 8 |
| Factor viii pegylated recomb HCPCS J7207 | not published | not published | $1.59 – $5.73 | 8 |
| Factor viii recombinant nos HCPCS J7192 | not published | not published | $1.18 – $4.19 | 8 |
| Factor viii recomb novoeight HCPCS J7182 | not published | not published | $1.08 – $3.89 | 8 |
| Factor viii recomb obizur HCPCS J7188 | not published | not published | $2.43 – $8.79 | 8 |
| Factor xiii anti-hem factor HCPCS J7180 | not published | not published | $8.43 – $28.51 | 8 |
| Factor xiii recomb a-subunit HCPCS J7181 | not published | not published | $14.34 – $46.74 | 8 |
| Fallopian tube recnl CPT 58345 | not published | not published | $2,401.40 – $7,791.00 | 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.