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 |
|---|---|---|---|---|
| Fam adapt bhv tx gdn phy/qhp CPT 97156 | not published | not published | $27.80 – $71.53 | 4 |
| Family therapy without pt 50min 90846 CPT 90846 | $130.90 | $238.00 | $131.67 – $338.84 | 4 |
| Family therapy with patient 50 min 90847 CPT 90847 | $130.90 | $238.00 | $131.67 – $338.84 | 4 |
| Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr HCPCS J1308 | not published | not published | $0.01 – $0.02 | 2 |
| Fam-trastuzumab deruxtecan-nxki 100 mg intravenous solution HCPCS J9358 | not published | not published | $24.66 – $78.44 | 8 |
| Fancc gene CPT 81242 | not published | not published | $27.46 – $70.68 | 7 |
| Fasciotomy hip/thigh any typ CPT 27025 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Fat/lipids feces qualitative CPT 82705 | $41.80 | $76.00 | $3.82 – $9.84 | 7 |
| Fatty acids nonesterified CPT 82725 | $33.55 | $61.00 | $14.08 – $36.23 | 7 |
| Fda ide #g240020 carry bag HCPCS Q0499 | not published | not published | $154.13 – $396.63 | 4 |
| Fecal bilirubin test CPT 82252 | not published | not published | $3.42 – $8.80 | 7 |
| Fecal microbiota, live-jslm 150 ml rectal suspension enema HCPCS J1440 | not published | not published | $49.20 – $173.15 | 8 |
| Fecal microbiota prep instil HCPCS G0455 | not published | not published | $689.87 – $1,775.27 | 4 |
| #fecal-sodium CPT 84302 | not published | not published | $3.64 – $9.38 | 7 |
| Feeding tube reposition CPT 74355 | not published | not published | $345.63 – $345.63 | 1 |
| Fees w/laryngeal sense test CPT 92616 | not published | not published | $58.14 – $149.61 | 4 |
| Felbamate (felbatol(r)) - sendout CPT 80167 | $30.80 | $56.00 | $13.98 – $35.98 | 7 |
| Fem focal defic constant fri HCPCS L5230 | not published | not published | $4,403.82 – $11,332.50 | 4 |
| Femoral endovas graft add-on 34813 CPT 34813 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Femoral lgth sock fx or equa HCPCS L2850 | not published | not published | $55.76 – $143.48 | 4 |
| Fem/popl revasc w/stent CPT 37226 | $10,742.60 | $19,532.00 | $7,609.00 – $27,583.00 | 3 |
| Feno poc CPT 95012 | not published | not published | $27.71 – $71.30 | 4 |
| Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper) HCPCS J3010 | not published | not published | $0.92 – $2.31 | 5 |
| Fern test HCPCS Q0114 | not published | not published | $7.30 – $18.80 | 7 |
| Ferric carboxymaltose 50 mg iron/ml intravenous solution HCPCS J1439 | not published | not published | $0.85 – $3.02 | 8 |
| Ferritin CPT 82728 | $118.80 | $216.00 | $10.22 – $26.31 | 7 |
| Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution HCPCS Q0138 | not published | not published | $0.28 – $1.04 | 7 |
| Ferumoxytol, esrd use HCPCS Q0139 | not published | not published | $0.28 – $1.04 | 7 |
| Fetal aneuploidy trisom risk CPT 81507 | not published | not published | $596.25 – $1,534.35 | 7 |
| Fetal biophys profile w/nst 76818 CPT 76818 | $409.20 | $744.00 | $77.56 – $199.58 | 4 |
| Fetal chrmoml microdeltj CPT 81422 | not published | not published | $569.29 – $1,464.97 | 7 |
| Fetal chrom aneuploidy gsa panel CPT 81420 | not published | not published | $569.29 – $1,464.97 | 7 |
| Fetal contract stress test 59020 - 26 CPT 59020 | not published | not published | $149.98 – $2,334.00 | 6 |
| Fetal cord puncture prenatal CPT 59012 | not published | not published | $226.06 – $2,334.00 | 6 |
| Fetal fibronectin CPT 82731 | $506.00 | $920.00 | $48.31 – $124.31 | 7 |
| Fetal fluid drainage w/us CPT 59074 | not published | not published | $226.06 – $2,334.00 | 6 |
| Fetal hemoglobin (kleihauer betke) CPT 85460 | $70.40 | $128.00 | $5.80 – $14.92 | 7 |
| Fetal hemoglobin rosette CPT 85461 | $73.15 | $133.00 | $7.02 – $18.06 | 7 |
| Fetal lung maturity assess lam body dnst CPT 83664 | not published | not published | $14.49 – $37.29 | 7 |
| Fetal monitor/interpret only CPT 59051 | not published | not published | $5,512.00 – $5,512.00 | 1 |
| Fetal monitor w/report CPT 59050 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Fetal non stress test CPT 59025 | $428.45 | $779.00 | $149.98 – $2,334.00 | 6 |
| Fetal scalp blood sampling 59030 CPT 59030 | not published | not published | $226.06 – $2,334.00 | 6 |
| Fetal shunt placement w/us CPT 59076 | not published | not published | $226.06 – $2,334.00 | 6 |
| #_fet/norfentcnfrmur CPT 80354 | $102.85 | $187.00 | $35.06 – $35.06 | 1 |
| Fiasp for insulin pump use HCPCS J1811 | not published | not published | $7.34 – $21.52 | 5 |
| Fibrin degradation d dimer quantitative CPT 85379 | $69.30 | $126.00 | $7.64 – $19.65 | 7 |
| Fibrin degradation products CPT 85362 | $12.65 | $23.00 | $5.17 – $13.30 | 7 |
| Fibrin degrade semiquant CPT 85378 | not published | not published | $7.29 – $18.76 | 7 |
| Fibrin degradj d-dimer CPT 85380 | not published | not published | $7.64 – $19.65 | 7 |
| Fibrinogen activity CPT 85384 | $55.00 | $100.00 | $7.29 – $18.76 | 7 |
| Fibrinogen test CPT 85370 | not published | not published | $9.32 – $23.99 | 7 |
| Fibrinolysins/coagulopathy screen interpretation/report CPT 85390 | $64.35 | $117.00 | $10.46 – $29.88 | 7 |
| Fibrinolytic antiplasmin CPT 85410 | not published | not published | $5.78 – $14.88 | 7 |
| Fibrinolytic plasmin CPT 85400 | not published | not published | $5.78 – $14.88 | 7 |
| Fibrinolytic plasminogen CPT 85415 | not published | not published | $12.89 – $33.18 | 7 |
| Fibrinolytic plasminogen CPT 85421 | not published | not published | $7.64 – $19.65 | 7 |
| Fibrinolytic plasminogen xcpt antgnc asa CPT 85420 | not published | not published | $4.90 – $12.60 | 7 |
| Fibula bone graft microvasc CPT 20955 | not published | not published | $5,382.89 – $16,106.00 | 6 |
| Filgrastim-aafi 300 mcg/0.5 ml subcutaneous syringe HCPCS Q5110 | not published | not published | $0.24 – $0.79 | 7 |
| Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr HCPCS J1442 | not published | not published | $0.75 – $2.67 | 8 |
| Filgrastim-sndz 300 mcg/0.5 ml injection syringe HCPCS Q5101 | not published | not published | $0.26 – $0.97 | 7 |
| Filleted finger/toe flap CPT 14350 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Filtered speech hearing test CPT 92571 | not published | not published | $27.71 – $71.30 | 4 |
| Filters elec/combo vad, rep HCPCS Q0500 | not published | not published | $28.18 – $72.53 | 4 |
| Filter spider fx 3mmx320cm HCPCS C1884 | $4,116.34 | $7,484.26 | not published | 0 |
| Filter vena cava fem denali HCPCS C1880 | $2,871.52 | $5,220.94 | not published | 0 |
| Fimbrioplasty 58760 CPT 58760 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Fine needle aspiration biopsy w/fluor gdn;1st lesion 10007 CPT 10007 | $1,328.80 | $2,416.00 | $525.32 – $3,030.00 | 6 |
| Fine needle aspiration biopsy w/fluor gdn; ea addtl 10008 CPT 10008 | $974.60 | $1,772.00 | $1,887.00 – $5,512.00 | 3 |
| Fine needle aspiration biopsy without img gdn; ea addtl 10004 CPT 10004 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Fine needle aspiration biopsy w/us gdn; ea addtl 10006 CPT 10006 | $991.65 | $1,803.00 | $1,887.00 – $5,512.00 | 3 |
| Fine needle asp without image guide 10021 CPT 10021 | $732.60 | $1,332.00 | $301.57 – $2,334.00 | 6 |
| Finger tendon transfer CPT 26497 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Finger tendon transfer CPT 26498 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Fistula repair & colostomy CPT 57307 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Fistula repair transperine 57308 CPT 57308 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Fit aphakia spectcl monofocl CPT 92352 | not published | not published | $43.76 – $112.62 | 4 |
| Fit aphakia spectcl multifoc CPT 92353 | not published | not published | $43.76 – $112.62 | 4 |
| Fitg spect low vis 1system CPT 92354 | not published | not published | $27.71 – $71.30 | 4 |
| Fitg spect lw vis cmpnd lens CPT 92355 | not published | not published | $27.71 – $71.30 | 4 |
| Fitting of diaphragm/cap 57170 CPT 57170 | not published | not published | $149.98 – $2,334.00 | 6 |
| Fixation of ankle joint CPT 27860 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Fixation of knee joint CPT 27570 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Fixation of shoulder blade CPT 23400 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Fix g/colon tube w/device CPT 49460 | not published | not published | $672.83 – $4,761.00 | 6 |
| Fixtn pq skel dstl rad fx/epiphysl sep CPT 25606 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Flebogamma injection HCPCS J1572 | not published | not published | $68.06 – $175.13 | 5 |
| Flecainide (tambocor)-sendout CPT 80181 | not published | not published | $13.98 – $35.98 | 7 |
| Fl exam g/colon tube w contrast CPT 49465 | $232.10 | $422.00 | $177.00 – $2,334.00 | 6 |
| Flex/ext wrist w/wo friction HCPCS L6621 | not published | not published | $2,112.38 – $5,435.84 | 4 |
| Flex foot system HCPCS L5980 | not published | not published | $3,508.19 – $9,027.75 | 4 |
| Flexible keel foot HCPCS L5972 | not published | not published | $365.42 – $940.35 | 4 |
| Flexible metal hinge pair HCPCS L6610 | not published | not published | $203.83 – $524.52 | 4 |
| Flexible Sigmoidoscopy CPT 45330 | not published | not published | $689.87 – $3,030.00 | 6 |
| Flexion/extension wrist unit HCPCS L6620 | not published | not published | $345.88 – $890.06 | 4 |
| Flexor-plasty elbow CPT 24330 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Flexor-plasty elbw w/advmnt CPT 24331 | not published | not published | $5,382.89 – $16,106.00 | 6 |
| Flex thermoplastic collar mo HCPCS L0130 | not published | not published | $140.69 – $362.05 | 4 |
| Flex-walk sys low ext prosth HCPCS L5981 | not published | not published | $3,151.20 – $8,109.09 | 4 |
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.