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 |
|---|---|---|---|---|
| Antibody influenza virus CPT 86710 | not published | not published | $10.16 – $26.15 | 7 |
| Antibody lymphocytic choriomeningitis CPT 86727 | not published | not published | $9.65 – $24.84 | 7 |
| Antibody screen rbc CPT 86850 | $76.45 | $139.00 | $7.75 – $99.48 | 7 |
| Antibody tetanus CPT 86774 | not published | not published | $11.10 – $28.56 | 7 |
| Antidepressant not specified CPT 80338 | $188.10 | $342.00 | not published | 0 |
| Antigen therapy services CPT 95145 | not published | not published | $34.74 – $89.39 | 4 |
| Antigen therapy services CPT 95146 | not published | not published | $34.74 – $89.39 | 4 |
| Antigen therapy services CPT 95147 | not published | not published | $53.41 – $137.45 | 4 |
| Antigen therapy services CPT 95148 | not published | not published | $53.41 – $137.45 | 4 |
| Antigen therapy services CPT 95149 | not published | not published | $53.41 – $137.45 | 4 |
| Antigen therapy services CPT 95165 | not published | not published | $34.74 – $89.39 | 4 |
| Antigen therapy services CPT 95170 | not published | not published | $34.74 – $89.39 | 4 |
| Antihemophilic factor-vwf 250 unit-600 unit intravenous solution HCPCS J7187 | not published | not published | $1.15 – $3.94 | 8 |
| Antihemophilic viii/vwf comp HCPCS J7186 | not published | not published | $0.95 – $3.27 | 8 |
| Anti-inhibitor HCPCS J7198 | not published | not published | $1.84 – $6.42 | 8 |
| Anti mog serum - sendout CPT 86362 | $69.85 | $127.00 | $9.04 – $23.26 | 7 |
| Antineutrophil cytoplasmic antibody screen each antibody CPT 86036 | $19.80 | $36.00 | $9.04 – $23.26 | 7 |
| Antineutrophil cytoplasmic antibody titer each antibody CPT 86037 | not published | not published | $9.04 – $23.26 | 7 |
| Ant instr 2-3 vert segm 22845 CPT 22845 | not published | not published | $5,512.00 – $18,364.00 | 3 |
| Ant instrumentation/4-7 vert seg 22846 CPT 22846 | not published | not published | $3,388.00 – $18,364.00 | 3 |
| Antinuclear antibodies CPT 86038 | $89.10 | $162.00 | $9.07 – $23.33 | 7 |
| Antinuclear antibodies titer CPT 86039 | $94.05 | $171.00 | $8.37 – $21.54 | 7 |
| Antiphosphatidylserine antibody CPT 86148 | not published | not published | $11.77 – $31.02 | 7 |
| Antistreptolysin o screen CPT 86063 | not published | not published | $4.33 – $11.14 | 7 |
| Antistreptolysin o titer CPT 86060 | $62.70 | $114.00 | $5.48 – $14.09 | 7 |
| Antithrombin iii activity CPT 85300 | $102.85 | $187.00 | $8.89 – $22.87 | 7 |
| Antithrombin iii injection HCPCS J7197 | not published | not published | $3.13 – $10.77 | 8 |
| Anti-thymocyte glob (equine)(1:1000) intradermal test dose HCPCS J7504 | not published | not published | $4,161.72 – $11,858.47 | 8 |
| Antithymocyte globuln rabbit HCPCS J7511 | not published | not published | $793.34 – $2,587.08 | 8 |
| Ant/post colporrhap/enterocele rpr 57265 CPT 57265 | not published | not published | $3,710.98 – $16,106.00 | 6 |
| Ant sgm img ir flrscn angrph CPT 92287 | not published | not published | $98.70 – $253.99 | 4 |
| Ant sgm img i&r speclr mic CPT 92286 | not published | not published | $98.70 – $253.99 | 4 |
| Aortic circulation assist 33971 CPT 33971 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Aortic dysfunction/dilation CPT 81410 | not published | not published | $378.00 – $972.72 | 7 |
| Aortic dysfunction/dilation CPT 81411 | not published | not published | $1,012.64 – $2,605.87 | 7 |
| Aortic hemiarch graft 33866 CPT 33866 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Apc gene dup/delet variants CPT 81203 | not published | not published | $150.00 – $386.00 | 7 |
| Apc gene full sequence CPT 81201 | not published | not published | $585.00 – $1,505.40 | 7 |
| Apc gene known fam variants CPT 81202 | not published | not published | $210.00 – $540.40 | 7 |
| Aphakia prosth service temp CPT 92358 | not published | not published | $43.76 – $112.62 | 4 |
| Apheresis immunoads slctv CPT 36516 | not published | not published | $3,231.05 – $16,106.00 | 6 |
| Apheresis plasma CPT 36514 | not published | not published | $1,155.35 – $4,761.00 | 6 |
| Apheresis platelets CPT 36513 | not published | not published | $327.28 – $2,334.00 | 6 |
| Apheresis rbc CPT 36512 | not published | not published | $1,155.35 – $4,761.00 | 6 |
| Apheresis wbc CPT 36511 | not published | not published | $1,155.35 – $4,761.00 | 6 |
| Apl(pml-rara) quant - sendout CPT 81315 | not published | not published | $155.48 – $400.11 | 7 |
| Appendectomy CPT 44950 | not published | not published | $3,735.00 – $12,358.40 | 6 |
| Appendectomy add-on 44955 CPT 44955 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Appendectomy/open/rup/w/absc/peri 44960 CPT 44960 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Appendix Removal (Laparoscopic) CPT 44970 | not published | not published | $4,484.77 – $18,364.00 | 6 |
| App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm CPT 15277 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| App high cost ss f/n/g/h/f >100sq cm addl 100sq cm CPT 15278 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| App high cost ss f/n/g/h/f <100sq cm addl <25sq cm CPT 15276 | $232.65 | $423.00 | $1,887.00 – $5,512.00 | 3 |
| App high cost ss t/a/l >100sq cm 1st 100sq cm CPT 15273 | not published | not published | $1,530.61 – $8,770.00 | 6 |
| App high cost ss t/a/l >100sq cm addl 100sq cm CPT 15274 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| App high cost ss t/a/l <100sq cm addl <25sq cm CPT 15272 | $223.85 | $407.00 | $1,887.00 – $5,512.00 | 3 |
| Appl bdy cst sho to hip 1thi CPT 29044 | not published | not published | $120.55 – $2,334.00 | 6 |
| Appl bdy cst sho to hip b th CPT 29046 | not published | not published | $207.48 – $2,334.00 | 6 |
| Appl bdy cst sho to hip head CPT 29040 | not published | not published | $207.48 – $2,334.00 | 6 |
| Appl body cast sho to hips CPT 29035 | not published | not published | $207.48 – $2,334.00 | 6 |
| Appl cast figure-of-eight CPT 29049 | not published | not published | $207.48 – $2,334.00 | 6 |
| Appl cast plaster velpeau CPT 29058 | not published | not published | $207.48 – $2,334.00 | 6 |
| Appl cast shoulder spica CPT 29055 | not published | not published | $207.48 – $2,334.00 | 6 |
| Appl halo type body cast CPT 29000 | not published | not published | $207.48 – $2,334.00 | 6 |
| Appl hip spica cast1&1/2 CPT 29325 | not published | not published | $207.48 – $2,334.00 | 6 |
| Appl hip spica cast 1 leg CPT 29305 | not published | not published | $207.48 – $2,334.00 | 6 |
| Application clubfoot cast CPT 29450 | not published | not published | $120.55 – $2,334.00 | 6 |
| Application finger splntstatic 29130 CPT 29130 | $179.30 | $326.00 | $98.70 – $2,334.00 | 6 |
| Application halo femoral CPT 20663 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Application halo pelvic CPT 20662 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Application long leg splint 29505 CPT 29505 | $314.60 | $572.00 | $120.55 – $2,334.00 | 6 |
| Application lower leg splint 29515 CPT 29515 | $314.60 | $572.00 | $120.55 – $2,334.00 | 6 |
| Application multi layer compression below knee (both sides) CPT 29581 | $702.90 | $1,278.00 | $120.55 – $2,334.00 | 6 |
| Application of body cast CPT 29010 | not published | not published | $207.48 – $2,334.00 | 6 |
| Application of body cast CPT 29015 | not published | not published | $207.48 – $2,334.00 | 6 |
| Application of cylinder cast 29365 CPT 29365 | not published | not published | $207.48 – $2,334.00 | 6 |
| Application of forearm cast 29075 CPT 29075 | not published | not published | $207.48 – $2,334.00 | 6 |
| Application of long arm cast 29065 CPT 29065 | not published | not published | $207.48 – $2,334.00 | 6 |
| Application of long leg cast CPT 29355 | not published | not published | $207.48 – $2,334.00 | 6 |
| Application of long leg cast 29345 CPT 29345 | $534.05 | $971.00 | $207.48 – $2,334.00 | 6 |
| Application of paste boot 29580 CPT 29580 | $715.00 | $1,300.00 | $120.55 – $2,334.00 | 6 |
| Application short leg cast 29405 CPT 29405 | $605.55 | $1,101.00 | $207.48 – $2,334.00 | 6 |
| Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm CPT 15275 | $1,110.45 | $2,019.00 | $548.27 – $4,761.00 | 6 |
| Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm CPT 15271 | $1,167.10 | $2,122.00 | $548.27 – $4,761.00 | 6 |
| Applicator tag rfid localizer 12gx7cm HCPCS C1819 | $423.40 | $769.81 | not published | 0 |
| Appl long leg cast brace CPT 29358 | not published | not published | $207.48 – $2,334.00 | 6 |
| Appl mltpln uni ext fixj sys CPT 20692 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Appl modality 1/> areas paraffin bath 97018 CPT 97018 | $38.50 | $70.00 | $4.22 – $10.87 | 4 |
| Appl modality 1/> areas vasopneumatic devices 97016 CPT 97016 | $46.75 | $85.00 | $8.66 – $22.29 | 4 |
| Appl modality 1+lllt po pain CPT 97037 | not published | not published | $27.71 – $71.30 | 4 |
| Appl multlay comprs arm/hand CPT 29584 | not published | not published | $120.55 – $2,334.00 | 6 |
| Appl patllr tdn bearing cast CPT 29435 | not published | not published | $207.48 – $2,334.00 | 6 |
| Appl unipln uni ext fixj sys CPT 20690 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Apply finger cast 29086 CPT 29086 | $288.75 | $525.00 | $120.55 – $2,334.00 | 6 |
| Apply forearm splintdynamic 29126 CPT 29126 | not published | not published | $98.70 – $2,334.00 | 6 |
| Apply halo w/removal cranial CPT 20661 | not published | not published | $1,192.86 – $3,069.63 | 6 |
| Apply hand/wrist cast 29085 CPT 29085 | not published | not published | $120.55 – $2,334.00 | 6 |
| Apply interstit radiat compl CPT 77778 | not published | not published | $516.67 – $1,329.56 | 4 |
| Apply intrcav radiat compl CPT 77763 | not published | not published | $516.67 – $1,329.56 | 4 |
| Apply intrcav radiat interm CPT 77762 | not published | not published | $409.89 – $1,054.79 | 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.