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 |
|---|---|---|---|---|
| Floor of mouth biopsy 41108 CPT 41108 | not published | not published | $1,225.21 – $3,152.87 | 6 |
| Florbetaben f18 diagnostic HCPCS Q9983 | not published | not published | $1,188.50 – $3,467.81 | 5 |
| Flortaucipir inj 1 millicuri HCPCS A9601 | not published | not published | $278.25 – $10,100.48 | 5 |
| Flotufolastat f18 diag 1 mci HCPCS A9608 | not published | not published | $545.67 – $1,774.18 | 5 |
| Flow cytometry interp 16 or more CPT 88189 | not published | not published | $88.78 – $165.40 | 2 |
| Flow cytometry marker each additional CPT 88185 | $98.45 | $179.00 | $22.38 – $65.57 | 2 |
| Flow cytometry one marker technical component CPT 88184 | $101.75 | $185.00 | $108.05 – $684.27 | 5 |
| Floweramnioflo, 0.1 cc HCPCS Q4177 | not published | not published | $490.05 – $490.05 | 1 |
| Floweramniopatch, per sq cm HCPCS Q4178 | not published | not published | $92.32 – $237.56 | 7 |
| #flow interp 9 - 15 markers CPT 88188 | not published | not published | $66.04 – $133.82 | 2 |
| Floxuridine injection HCPCS J9200 | not published | not published | $3,297.37 – $10,861.80 | 8 |
| Flt3 gene CPT 81245 | $441.10 | $802.00 | $124.13 – $319.43 | 7 |
| Flt3 gene analysis CPT 81246 | $221.10 | $402.00 | $62.25 – $160.19 | 7 |
| Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback HCPCS J1450 | not published | not published | $2.58 – $6.50 | 5 |
| Fludarabine 50 mg intravenous solution HCPCS J9185 | not published | not published | $65.48 – $458.21 | 5 |
| Fluidotherapy charges pt CPT 97022 | $46.75 | $85.00 | $11.30 – $29.07 | 4 |
| Fluid pressure muscle 20950 CPT 20950 | $535.15 | $973.00 | $525.32 – $3,030.00 | 6 |
| Fluocinol acet intravit imp HCPCS J7313 | not published | not published | $387.30 – $1,344.04 | 8 |
| Fluocinolone acetonide implt HCPCS J7311 | not published | not published | $254.10 – $907.22 | 8 |
| Fluorescein angioscopy i&r CPT 92230 | not published | not published | $276.82 – $712.35 | 4 |
| Fluorescein angrph mltiframe CPT 92235 | not published | not published | $160.18 – $412.19 | 4 |
| Fluorescein&icg angiography CPT 92242 | not published | not published | $160.18 – $412.19 | 4 |
| Fluorescent antibody titer dna CPT 86256 | $101.20 | $184.00 | $9.04 – $23.26 | 7 |
| Fluorodopa f-18 diag per mci HCPCS A9602 | not published | not published | $641.66 – $1,651.21 | 5 |
| Fluoroestradiol f 18 HCPCS A9591 | not published | not published | $345.32 – $1,357.64 | 5 |
| Fluoroguide for spine inject 77003-26 CPT 77003 | $365.20 | $664.00 | $186.06 – $186.06 | 1 |
| Fluoroguide needle placement CPT 77002 | $365.20 | $664.00 | $215.78 – $215.78 | 1 |
| Fluoro polarize fetal lung CPT 83663 | not published | not published | $14.18 – $36.50 | 7 |
| Fluoroscopy up to 1 hour CPT 76000 | $603.90 | $1,098.00 | $127.84 – $455.49 | 4 |
| Fluorouracil 50 mg/ml intravenous solution (wrapper) HCPCS J9190 | not published | not published | $2.41 – $6.07 | 5 |
| Fluphenazine decanoate 25 mg/ml injection solution HCPCS J2680 | not published | not published | $9.71 – $25.62 | 5 |
| Flutemetamol f18 diagnostic HCPCS Q9982 | not published | not published | $1,458.01 – $3,751.94 | 5 |
| Fluvirin vacc, 3 yrs & >, im HCPCS Q2037 | not published | not published | $32.59 – $32.59 | 1 |
| Fluzone vacc, 3 yrs & >, im HCPCS Q2038 | not published | not published | $135.09 – $135.09 | 1 |
| Fmri brain by phys/psych CPT 70555 | not published | not published | $177.00 – $455.49 | 4 |
| Fmri brain by tech CPT 70554 | $1,824.90 | $3,318.00 | $177.00 – $455.49 | 4 |
| Fna bx w/ct gdn 1st les CPT 10009 | $2,856.15 | $5,193.00 | $525.32 – $3,030.00 | 6 |
| Fna bx w/ct gdn ea addl CPT 10010 | $2,142.25 | $3,895.00 | $1,887.00 – $5,512.00 | 3 |
| Fna bx w/mr gdn 1st les CPT 10011 | not published | not published | $525.32 – $3,030.00 | 6 |
| Fna bx w/mr gdn ea addl CPT 10012 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Foam stability fetal lung CPT 83662 | not published | not published | $14.18 – $36.50 | 7 |
| Folic acid CPT 82746 | $128.70 | $234.00 | $11.02 – $28.37 | 7 |
| Folic acid 5 mg/ml injection solution HCPCS J1808 | not published | not published | $0.07 – $0.11 | 2 |
| Follow-up angiography CPT 75898 | $673.75 | $1,225.00 | $152.28 – $6,027.57 | 4 |
| Followup eval of foot pt lop HCPCS G0246 | not published | not published | $98.76 – $254.15 | 4 |
| Follow-up surgery of eye CPT 66250 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Fomepizole 1 gram/ml intravenous solution HCPCS J1451 | not published | not published | $4.64 – $16.76 | 5 |
| Fondaparinux sodium HCPCS J1652 | not published | not published | $0.72 – $1.83 | 5 |
| Fo nontorsion joint cf HCPCS L3935 | not published | not published | $185.30 – $476.85 | 4 |
| Foot arch support remov prem HCPCS L3030 | not published | not published | $70.33 – $180.98 | 4 |
| Foot arch supp premold metat HCPCS L3050 | not published | not published | $43.38 – $111.63 | 4 |
| Foot drp splt w/exp heel lg HCPCS L4398 | not published | not published | $71.19 – $183.20 | 4 |
| Foot external keel sach foot HCPCS L5970 | not published | not published | $200.60 – $516.22 | 4 |
| Foot insert plastazote or eq HCPCS L3002 | not published | not published | $148.86 – $383.07 | 4 |
| Foot insert remov molded spe HCPCS L3001 | not published | not published | $121.92 – $313.74 | 4 |
| Foot insert silicone gel eac HCPCS L3003 | not published | not published | $160.58 – $413.23 | 4 |
| Foot lamin/prepreg composite HCPCS L3031 | not published | not published | $112.88 – $290.48 | 4 |
| Foot longitudinal arch suppo HCPCS L3010 | $183.59 | $333.80 | $160.58 – $413.23 | 4 |
| Foot longitud/metatarsal sup HCPCS L3020 | $209.19 | $380.34 | $182.87 – $470.59 | 4 |
| Foot plas heel stabi pre ots HCPCS L3170 | not published | not published | $46.89 – $120.66 | 4 |
| Foot plate molded stirrup at HCPCS L2250 | not published | not published | $307.88 – $792.26 | 4 |
| Foot single axis ankle/foot HCPCS L5974 | not published | not published | $213.97 – $550.61 | 4 |
| Foot X-ray CPT 73630 | $304.15 | $553.00 | $64.56 – $166.13 | 4 |
| Forearm/arm cuffs ext/flex a HCPCS L3730 | not published | not published | $760.24 – $1,956.36 | 4 |
| Forearm/arm cuffs free motio HCPCS L3720 | not published | not published | $573.16 – $1,474.94 | 4 |
| Forehead flap w/vasc pedicle 15731 CPT 15731 | not published | not published | $2,628.85 – $8,770.00 | 6 |
| Forensic autopsy (necropsy) CPT 88040 | not published | not published | $575.63 – $914.88 | 2 |
| Forensic cytopathology CPT 88125 | not published | not published | $13.51 – $99.48 | 5 |
| Foreskn manip w/lss preputial ads+stretching 54450 CPT 54450 | $644.05 | $1,171.00 | $185.35 – $2,334.00 | 6 |
| Formoterol fumarate, inh HCPCS J7606 | not published | not published | $1.87 – $5.15 | 5 |
| Fosaprepitant 150 mg intravenous powder for solution HCPCS J1453 | not published | not published | $0.13 – $0.33 | 5 |
| Foscarnet sodium injection HCPCS J1455 | not published | not published | $23.79 – $104.21 | 5 |
| Fosphenytoin 50 mg pe/ml injection (wrapper) HCPCS Q2009 | not published | not published | $0.50 – $22.74 | 5 |
| Fractionation ketosteroids CPT 83593 | not published | not published | $21.38 – $55.00 | 7 |
| Fracture assessment via dxa CPT 77086 | $172.15 | $313.00 | $64.56 – $166.13 | 4 |
| _fragile x methylation-sendout CPT 81244 | not published | not published | $33.67 – $86.64 | 7 |
| Fragmenting of kidney stone CPT 50590 | $188.65 | $343.00 | $2,614.94 – $18,364.00 | 6 |
| Frame typ sock above elb/dis HCPCS L6688 | not published | not published | $586.15 – $1,508.35 | 4 |
| Frame typ socket bel elbow/w HCPCS L6687 | not published | not published | $529.62 – $1,362.89 | 4 |
| Frame typ socket shoulder di HCPCS L6689 | not published | not published | $698.58 – $1,797.68 | 4 |
| Frame typ sock interscap-tho HCPCS L6690 | not published | not published | $822.47 – $2,116.50 | 4 |
| Free fascial flap microvasc CPT 15758 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Freeing of bowel adhesion 44005 CPT 44005 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Free jejunum flap microvasc CPT 43496 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Free myo/skin flap microvasc CPT 15756 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Free omental flap microvasc CPT 49906 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Free/remove chest lining 32320 CPT 32320 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Free skin flap microvasc CPT 15757 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Frenectomy 41115 CPT 41115 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Frenotomy 40806 CPT 40806 | not published | not published | $400.09 – $2,334.00 | 6 |
| Frenulotomy of penis CPT 54164 | not published | not published | $1,550.71 – $7,791.00 | 6 |
| Fresh frozen plasma 8-24 hours collection each unit HCPCS P9059 | $227.70 | $414.00 | not published | 0 |
| Fresh frozen plasma thawing ea un CPT 86927 | not published | not published | $27.46 – $325.23 | 5 |
| Frozen blood freeze/thaw CPT 86932 | not published | not published | $27.71 – $71.30 | 5 |
| Frozen blood prep CPT 86930 | not published | not published | $126.39 – $325.23 | 5 |
| Frozen blood thaw CPT 86931 | not published | not published | $119.95 – $325.23 | 5 |
| Frozen cell preparation CPT 88241 | not published | not published | $9.07 – $23.33 | 7 |
| Fructosamine glycated protein CPT 82985 | $100.65 | $183.00 | $12.57 – $32.35 | 7 |
| Ft arch suprt premold longit HCPCS L3040 | not published | not published | $43.38 – $111.63 | 4 |
| Fth/gft fr n/e/e/l each addl CPT 15261 | not published | not published | $1,887.00 – $5,512.00 | 3 |
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.