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 |
|---|---|---|---|---|
| Gardner vag dna quant CPT 87512 | not published | not published | $31.32 – $80.60 | 7 |
| Gastric analy w/ph ea spec CPT 82930 | not published | not published | $5.03 – $12.95 | 7 |
| Gastric emptying imag study CPT 78265 | not published | not published | $296.56 – $763.16 | 4 |
| Gastric emptying imag study CPT 78266 | not published | not published | $402.79 – $1,036.52 | 4 |
| Gastric motility studies CPT 91020 | not published | not published | $276.82 – $2,334.00 | 6 |
| Gastric mucosa imaging CPT 78261 | not published | not published | $296.56 – $763.16 | 4 |
| Gastrin test CPT 82938 | not published | not published | $13.27 – $34.14 | 7 |
| Gastroduodenostomy CPT 43810 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Gastroesophageal reflux study CPT 78262 | $1,936.00 | $3,520.00 | $296.56 – $763.16 | 4 |
| Gastroesophageal reflux test CPT 91034 | not published | not published | $276.82 – $2,334.00 | 6 |
| Gastrointestinal repair CPT 43360 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Gastrointestinal repair CPT 43361 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Gastrojejunostomy;w/o vagotomy 43820 CPT 43820 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Gastrojejunostomy w/vagotomy CPT 43825 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Gastroplasty duodenal switch CPT 43845 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Gastrostomy open neonatal CPT 43831 | not published | not published | $672.83 – $4,761.00 | 6 |
| Gated heart multiple CPT 78473 | not published | not published | $296.56 – $763.16 | 4 |
| Gba gene CPT 81251 | not published | not published | $35.44 – $91.19 | 7 |
| Gc stocking full lngth 18-30 HCPCS A6536 | not published | not published | $55.46 – $142.72 | 4 |
| Gc stocking full lngth 30-40 HCPCS A6537 | not published | not published | $65.75 – $169.20 | 4 |
| Gc stocking full lngth 40+ HCPCS A6538 | not published | not published | $76.99 – $198.11 | 4 |
| Gc stocking thighlngth 18-30 HCPCS A6533 | not published | not published | $41.14 – $105.88 | 4 |
| Gc stocking thighlngth 30-40 HCPCS A6534 | not published | not published | $46.99 – $120.91 | 4 |
| Gc stocking thighlngth 40+ HCPCS A6535 | not published | not published | $54.10 – $139.21 | 4 |
| Gc stocking waistlngth 18-30 HCPCS A6539 | not published | not published | $73.40 – $188.87 | 4 |
| Gc stocking waistlngth 30-40 HCPCS A6540 | not published | not published | $87.51 – $225.19 | 4 |
| Gc stocking waistlngth 40+ HCPCS A6541 | not published | not published | $103.66 – $266.75 | 4 |
| Gefitinib oral HCPCS J8565 | not published | not published | $792.25 – $792.25 | 1 |
| Gel cap app device for trach HCPCS L8515 | not published | not published | $58.30 – $150.04 | 4 |
| Gel cap for trach voice pros HCPCS L8512 | not published | not published | $2.01 – $5.17 | 4 |
| Gel-one HCPCS J7326 | not published | not published | $400.19 – $1,433.07 | 8 |
| Gel-syn injection 0.1 mg HCPCS J7328 | not published | not published | $0.44 – $1.52 | 8 |
| Gemcitabine 1 gram intravenous solution HCPCS J9201 | not published | not published | $3.10 – $7.82 | 5 |
| Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln HCPCS J9203 | not published | not published | $185.53 – $634.67 | 8 |
| General health panel CPT 80050 | not published | not published | $47.28 – $64.55 | 2 |
| Generator barostim neo2 2014 HCPCS C1767 | $13,584.80 | $24,699.63 | not published | 0 |
| Generator emblem MRI sicd subq HCPCS C1722 | $24,895.85 | $45,265.18 | not published | 0 |
| Genetic tstg severe inh cond CPT 81443 | not published | not published | $1,836.42 – $4,725.72 | 7 |
| Genioplasty augmentation CPT 21120 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Geniop sldg augmentation CPT 21123 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Geniop sldg osteot 1 CPT 21121 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Geniop sldg osteot 2/> CPT 21122 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Genome re-evaluation CPT 81427 | not published | not published | $1,753.24 – $4,511.66 | 7 |
| Genome sequence analysis CPT 81425 | not published | not published | $3,773.40 – $9,710.22 | 7 |
| Genome sequence analysis CPT 81426 | not published | not published | $2,032.46 – $5,230.20 | 7 |
| Gentamicin 10 mg/ml liquid compound - enteral use only HCPCS J1580 | not published | not published | $2.67 – $6.73 | 5 |
| Gentamicin peak therapeutic drug level CPT 80170 | $154.55 | $281.00 | $12.28 – $31.61 | 7 |
| Genvisc 850, inj, 1mg HCPCS J7320 | not published | not published | $2.86 – $16.80 | 8 |
| G-esoph reflx tst w/electrod CPT 91035 | $2,185.15 | $3,973.00 | $637.04 – $2,334.00 | 6 |
| Gfrg autol fat lipo ea addl CPT 15774 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Ghs abscess perianal iandd CPT 46050 | $1,914.55 | $3,481.00 | $689.87 – $3,030.00 | 6 |
| Ghs abscess postoperative iandd complex CPT 10180 | $5,878.40 | $10,688.00 | $2,154.81 – $7,791.00 | 6 |
| Ghs acetylcholinesterase, rbc CPT 82482 | not published | not published | $7.36 – $18.93 | 7 |
| Ghs alcohol, methyl (methanol)-medtox CPT 84600 | not published | not published | $12.83 – $33.02 | 7 |
| Ghs alpha thalasemia, 7 deletions CPT 81257 | not published | not published | $76.70 – $197.36 | 7 |
| Ghs analysis neurostim without reprogramming CPT 95970 | $350.96 | $638.10 | $98.70 – $253.99 | 4 |
| Ghs antibodies (torch) igm CPT 86694 | $119.90 | $218.00 | $10.79 – $27.77 | 7 |
| Ghs aspiration bladder - needle CPT 51100 | not published | not published | $185.35 – $2,334.00 | 6 |
| Ghs bladder cath - complex-foley CPT 51703 | $536.25 | $975.00 | $95.45 – $2,334.00 | 6 |
| Ghs bleeding time (ivy) CPT 85002 | not published | not published | $3.62 – $9.30 | 7 |
| Ghs block ilioinguinal/gentitofemoral CPT 64425 | $693.55 | $1,261.00 | $523.65 – $3,030.00 | 6 |
| Ghs central line insert < age 5, failed CPT 36555 | not published | not published | $2,342.32 – $6,027.57 | 6 |
| Ghs change cysto/gastrost CPT 43762 | $496.65 | $903.00 | $185.35 – $2,334.00 | 6 |
| Ghs chemo >8 hrs CPT 96416 | $491.70 | $894.00 | $245.03 – $630.55 | 4 |
| Ghs chemo infusion >8 hrs CPT 96425 | not published | not published | $245.03 – $630.55 | 4 |
| Ghs chemo IV push, ea addtl CPT 96411 | $237.92 | $432.58 | $53.41 – $137.45 | 4 |
| Ghs chlamydia pneumoniae by pcr (arup) (306630) CPT 87486 | $378.40 | $688.00 | $26.32 – $67.72 | 7 |
| Ghs closd tx interphalang jt disloc w/ma CPT 26770 | $992.75 | $1,805.00 | $182.99 – $2,334.00 | 6 |
| Ghs closed reduction ankle dislocation CPT 27840 | $579.15 | $1,053.00 | $182.99 – $2,334.00 | 6 |
| Ghs closed tx bimalleolar fracture w/manip CPT 27810 | $3,438.60 | $6,252.00 | $1,192.86 – $3,069.63 | 6 |
| Ghs closed tx radiocarpal disloc w manip CPT 25660 | not published | not published | $182.99 – $2,334.00 | 6 |
| Ghs closed tx tibial fracture w/manip CPT 27752 | $2,158.20 | $3,924.00 | $1,192.86 – $4,761.00 | 6 |
| Ghs closure surg wound/dehiscence-13160 CPT 13160 | not published | not published | $2,628.85 – $6,764.90 | 6 |
| Ghs clsd red med malleolus fx without manip CPT 27760 | not published | not published | $182.99 – $2,334.00 | 6 |
| Ghs clsd red med malleolus fx w manip CPT 27762 | $3,092.10 | $5,622.00 | $1,192.86 – $4,761.00 | 6 |
| Ghs clsd tx frac distal tibia w/manipulation CPT 27825 | $3,092.10 | $5,622.00 | $1,192.86 – $4,761.00 | 6 |
| Ghs cl tx knee disl; wo anesth CPT 27550 | $581.90 | $1,058.00 | $182.99 – $2,334.00 | 6 |
| Ghs cl tx metacarpophal disloc without anes CPT 26700 | $526.35 | $957.00 | $182.99 – $2,334.00 | 6 |
| Ghs community re-entry 15 minutes CPT 97537 | not published | not published | $23.38 – $60.16 | 4 |
| Ghs conjunctiva foreign body-embed bil CPT 65210 | $217.80 | $396.00 | $331.39 – $2,334.00 | 6 |
| Ghs conjunctiva foreign body-superf bil CPT 65205 | $275.55 | $501.00 | $98.70 – $2,334.00 | 6 |
| Ghs corneal fb without slit lamp bilat CPT 65220 | $495.00 | $900.00 | $331.39 – $2,334.00 | 6 |
| Ghs corneal fb with slit lamp bilat CPT 65222 | $726.00 | $1,320.00 | $98.70 – $2,334.00 | 6 |
| Ghs cricothyroidotomy CPT 31605 | $1,381.60 | $2,512.00 | $175.70 – $2,334.00 | 6 |
| Ghs cutdown placement age 1 and over CPT 36425 | not published | not published | $331.39 – $2,334.00 | 6 |
| Ghs cutdown placement under 1 yr CPT 36420 | not published | not published | $98.70 – $2,334.00 | 6 |
| Ghs diphtheria toxoid ab igg CPT 86648 | not published | not published | $11.41 – $29.36 | 7 |
| Ghs dislocation elbow closed treatment CPT 24600 | $526.35 | $957.00 | $182.99 – $2,334.00 | 6 |
| Ghs ed peritoneal lavage w guidance if performed CPT 49084 | not published | not published | $672.83 – $4,761.00 | 6 |
| Ghs ed rmvl or bivalving cast CPT 29700 | $550.55 | $1,001.00 | $207.48 – $2,334.00 | 6 |
| Ghs ed therapeutic lp, drain csf w fluoro CPT 62329 | $1,543.30 | $2,806.00 | $523.65 – $3,030.00 | 6 |
| Ghs eeg cont rec w/video by tec min 8 chnls CPT 95700 | not published | not published | $160.18 – $412.19 | 4 |
| Ghs electrostagmgraphy CPT 92537 | not published | not published | $95.45 – $245.63 | 4 |
| Ghs elect torsion swing CPT 92546 | not published | not published | $95.45 – $245.63 | 4 |
| Ghs epidermal shaving diameter >2.0 cm CPT 11303 | not published | not published | $301.57 – $2,334.00 | 6 |
| Ghs excision ingrown nail CPT 11765 | $825.00 | $1,500.00 | $301.57 – $2,334.00 | 6 |
| Ghs eye exam CPT 92002 | not published | not published | $98.76 – $254.15 | 4 |
| Ghs eyelid foreign body-embedded - bil CPT 67938 | $581.35 | $1,057.00 | $235.46 – $2,334.00 | 6 |
| Ghs fat & muscle CPT 89160 | not published | not published | $3.64 – $9.36 | 7 |
| Ghs fb removal foot - deep - left CPT 28192 | $3,445.20 | $6,264.00 | $1,225.21 – $4,761.00 | 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.