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 |
|---|---|---|---|---|
| Fth/gft fr trnk each addl CPT 15201 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Ft insert ucb berkeley shell HCPCS L3000 | not published | not published | $289.54 – $745.10 | 4 |
| Ftl cgen abnor 3 proteins CPT 81509 | not published | not published | $1,115.53 – $2,870.62 | 7 |
| Ftl cgen abnor five anal CPT 81512 | not published | not published | $52.14 – $134.17 | 7 |
| Ftl cgen abnor four anal CPT 81511 | $154.00 | $280.00 | $115.12 – $296.26 | 7 |
| Ftl cgen abnor three anal CPT 81510 | not published | not published | $41.66 – $107.19 | 7 |
| Ftl cgen abnor two proteins CPT 81508 | not published | not published | $40.72 – $104.80 | 7 |
| Ft prosth multiaxial ankl/ft HCPCS L5978 | not published | not published | $287.58 – $740.04 | 4 |
| Full field erg w/i&r CPT 92273 | not published | not published | $160.18 – $412.19 | 4 |
| Full mouth x-ray of teeth CPT 70320 | not published | not published | $133.79 – $455.49 | 4 |
| Full sole/heel wedge btween HCPCS L3420 | not published | not published | $50.41 – $129.72 | 4 |
| Full thick gft/nose/ear/lid/lip/20sqcm or< 15260 CPT 15260 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Full thick gft/scalp/arm/leg/20sqcm or< 15220 CPT 15220 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Full thick gft/scalp/arm/leg/add 20sqcm 15221 CPT 15221 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Full thick gft w/close donor fccmnaghf <=20sqcm 15240 CPT 15240 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Fundus photography with i&r 92250 CPT 92250 | not published | not published | $98.70 – $253.99 | 4 |
| Furnsh initial orthosis only HCPCS L1200 | not published | not published | $1,649.43 – $4,244.53 | 4 |
| Furosemide 10 mg/ml injection solution HCPCS J1938 | not published | not published | $0.02 – $0.04 | 2 |
| Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr HCPCS J1940 | not published | not published | $0.41 – $1.06 | 3 |
| Fuse bile ducts and bowel 47785 CPT 47785 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Fuse esophagus & intestine CPT 43340 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Fuse esophagus & intestine CPT 43341 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Fuse esophagus & stomach CPT 43320 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Fuse gallbladder & bowel CPT 47740 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Fuse gallbladder & bowel CPT 47741 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Fuse/graft added joint CPT 26863 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Fuse liver ducts & bowel CPT 47765 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Fuse pancreas and bowel CPT 48548 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Fuse pancreas cyst and bowel CPT 48540 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Fuse pancreas cyst and bowel 48520 CPT 48520 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Fuse upper gi structures CPT 47721 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Fusion/graft of finger joint CPT 26862 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Fusion/graft of hand joint CPT 26844 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Fusion of ankle joint open CPT 27870 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Fusion of big toe joint CPT 28750 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Fusion of big toe joint CPT 28755 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Fusion of facial/other nerve CPT 64866 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Fusion of finger jnt add-on CPT 26861 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Fusion of finger joint CPT 26860 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Fusion of finger tendons CPT 26471 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Fusion of finger tendons CPT 26474 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Fusion of foot bones CPT 28730 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Fusion of foot bones CPT 28735 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Fusion of foot bones CPT 28740 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Fusion of hand joint CPT 26843 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Fusion of knee CPT 27580 | not published | not published | $3,735.00 – $24,508.80 | 6 |
| Fusion of knuckle CPT 26850 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Fusion of knuckle joint CPT 26516 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Fusion of knuckle joints CPT 26517 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Fusion of knuckle joints CPT 26518 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Fusion of knuckle with graft CPT 26852 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Fusion of skull arteries CPT 61711 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Fusion of spermatic ducts CPT 54900 | not published | not published | $1,550.71 – $7,791.00 | 6 |
| Fusion of spermatic ducts CPT 54901 | not published | not published | $2,614.94 – $7,791.00 | 6 |
| Fusion of tendons at wrist CPT 25300 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Fusion of tendons at wrist CPT 25301 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Fusion of thumb CPT 26841 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Fusion of tibiofibular joint CPT 27871 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Fusion of toes CPT 28280 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Fusion of ureter & bowel CPT 50810 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Fusion of ureter & kidney CPT 50740 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Fusion of ureter & kidney CPT 50750 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Fxn gene charac alleles CPT 81285 | not published | not published | $206.12 – $530.42 | 7 |
| Fxn gene detc abnor alleles CPT 81284 | not published | not published | $102.75 – $264.41 | 7 |
| Fxn gene full gene sequence CPT 81286 | not published | not published | $206.12 – $530.42 | 7 |
| Fxn gene known famil variant CPT 81289 | not published | not published | $138.90 – $357.44 | 7 |
| G6pc gene CPT 81250 | not published | not published | $43.87 – $112.89 | 7 |
| G6pd full gene sequence CPT 81249 | not published | not published | $450.00 – $1,158.00 | 7 |
| G6pd gene alys cmn variant CPT 81247 | not published | not published | $131.11 – $337.38 | 7 |
| G6pd known familial variant CPT 81248 | not published | not published | $281.44 – $724.23 | 7 |
| Ga-67 gallium 0.1 mci HCPCS A9556 | not published | not published | $59.90 – $59.90 | 1 |
| Ga-68 gallium 68 dotatate HCPCS A9587 | not published | not published | $37.22 – $139.10 | 5 |
| Gabapentin non-blood CPT 80355 | $188.65 | $343.00 | $35.06 – $35.06 | 1 |
| Gadobutrol 1 mmol/ml intravenous solution (wrapper) HCPCS A9585 | not published | not published | $0.29 – $0.76 | 4 |
| Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper) HCPCS A9579 | not published | not published | $1.64 – $4.03 | 4 |
| Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution HCPCS A9575 | not published | not published | $0.13 – $0.33 | 4 |
| Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution HCPCS A9581 | not published | not published | $16.18 – $40.03 | 4 |
| Galac-1-phosphate uridyltran - sendout CPT 82775 | not published | not published | $15.80 – $40.67 | 7 |
| Galactokinase - sendout CPT 82759 | not published | not published | $16.11 – $41.46 | 7 |
| Galactose transferase test CPT 82776 | not published | not published | $8.80 – $22.66 | 7 |
| Galectin-3 CPT 82777 | not published | not published | $33.19 – $85.40 | 7 |
| Gallbladder Removal (Laparoscopic) CPT 47562 | not published | not published | $4,484.77 – $18,364.00 | 7 |
| Gallium ga-68 dotatoc HCPCS C9067 | not published | not published | $2.71 – $11.02 | 5 |
| Gallium ga-68 psma-11, ucla HCPCS A9594 | not published | not published | $272.62 – $1,013.23 | 5 |
| Gallium ga-68 psma-11 ucsf HCPCS A9593 | not published | not published | $412.60 – $1,456.29 | 5 |
| Gallium illuccix 1 millicure HCPCS A9596 | not published | not published | $358.89 – $2,824.35 | 5 |
| Gallium locametz 1 millicuri HCPCS A9800 | not published | not published | $271.88 – $2,377.95 | 5 |
| Gallium nitrate injection HCPCS J1457 | not published | not published | $3.51 – $3.51 | 1 |
| Galsulfase injection HCPCS J1458 | not published | not published | $394.48 – $1,320.20 | 8 |
| Gamma globulin > 10 cc inj HCPCS J1560 | not published | not published | $121.89 – $1,345.34 | 8 |
| Gamma globulin 1 cc inj HCPCS J1460 | not published | not published | $36.66 – $134.54 | 8 |
| Gammaglobulin iga CPT 82784 | $130.90 | $238.00 | $6.98 – $17.95 | 7 |
| Gammaglobulin ige CPT 82785 | $705.65 | $1,283.00 | $12.34 – $31.77 | 7 |
| Gamma glutamyltransferase CPT 82977 | $64.35 | $117.00 | $5.40 – $13.90 | 7 |
| Gammagraft HCPCS Q4111 | not published | not published | $8.36 – $237.56 | 7 |
| Gammaplex injection HCPCS J1557 | not published | not published | $49.70 – $154.56 | 8 |
| Gamunex-c/gammaked HCPCS J1561 | not published | not published | $36.76 – $133.44 | 8 |
| Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr HCPCS J1570 | not published | not published | $31.12 – $78.24 | 5 |
| Ganciclovir long act implant HCPCS J7310 | not published | not published | $11,175.24 – $11,175.24 | 1 |
| Gardner vag dna amp probe CPT 87511 | not published | not published | $26.32 – $67.72 | 7 |
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.