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 |
|---|---|---|---|---|
| Ghs fb removal from muscle - complicated CPT 20525 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Ghs fb removal - incisional CPT 10121 | $3,392.40 | $6,168.00 | $1,225.21 – $4,761.00 | 6 |
| Ghs fb removal - non-incisional CPT 20520 | not published | not published | $1,225.21 – $3,152.87 | 6 |
| Ghs febrile agglutinns(mayo) CPT 86000 | $23.65 | $43.00 | $5.24 – $13.47 | 7 |
| Ghs fish cytogen CPT 88271 | $129.25 | $235.00 | $16.06 – $41.34 | 7 |
| Ghs fish hybrid in situ 100-300 CPT 88275 | $271.70 | $494.00 | $38.39 – $98.80 | 7 |
| Ghs flow volume loop CPT 94375 | not published | not published | $160.18 – $412.19 | 4 |
| Ghs gastric intub aspiration lavage CPT 43753 | not published | not published | $160.18 – $2,334.00 | 6 |
| Ghs hcv amplificaiton CPT 87521 | not published | not published | $26.32 – $67.72 | 7 |
| Ghs heavy metals bld (ars,lead,merc) CPT 82715 | not published | not published | $13.00 – $44.33 | 7 |
| Ghs hepatitis c virus (hcv riba) CPT 86804 | not published | not published | $11.62 – $29.90 | 7 |
| Ghs hgb stability-thal CPT 83068 | not published | not published | $7.10 – $18.28 | 7 |
| Ghs histoplasma antigen CPT 87385 | $147.95 | $269.00 | $9.94 – $25.57 | 7 |
| Ghs HIV antibody CPT 86703 | not published | not published | $10.28 – $26.46 | 7 |
| Ghs hla-dr/dq, multiple antigens CPT 86817 | not published | not published | $79.60 – $204.85 | 7 |
| Ghs i and d abscess/hematoma scrotum CPT 54700 | $4,470.95 | $8,129.00 | $1,550.71 – $7,791.00 | 6 |
| Ghs i and d perirectal abscess 46040 CPT 46040 | $2,517.90 | $4,578.00 | $887.71 – $4,761.00 | 6 |
| Ghs i and d pilonidal cyst complex CPT 10081 | $1,354.10 | $2,462.00 | $525.32 – $3,030.00 | 6 |
| Ghs i and d pilonidal cyst simple CPT 10080 | $1,354.10 | $2,462.00 | $525.32 – $3,030.00 | 6 |
| Ghs immun0electrophoresis CPT 86320 | not published | not published | $22.44 – $57.75 | 7 |
| Ghs incision thrombosed ext hemorrhoid CPT 46083 | $540.10 | $982.00 | $185.35 – $2,334.00 | 6 |
| Ghs indirect laryngoscopy/w fb removal CPT 31511 | not published | not published | $148.07 – $2,334.00 | 6 |
| Ghs inf midline insertion CPT 36140 | $2,365.55 | $4,301.00 | $1,887.00 – $5,512.00 | 3 |
| Ghs inhibitor screen CPT 85335 | $132.00 | $240.00 | $9.65 – $24.84 | 7 |
| Ghs init tx 1st degree burn CPT 16000 | $213.40 | $388.00 | $148.84 – $2,334.00 | 6 |
| Ghs inj neurolytic intercostal nerve CPT 64620 | $1,899.15 | $3,453.00 | $656.13 – $3,030.00 | 6 |
| Ghs inj neurolytic other perph nerve CPT 64640 | $1,442.10 | $2,622.00 | $656.13 – $3,030.00 | 6 |
| Ghs inj tendon origin/insertion CPT 20551 | $744.15 | $1,353.00 | $227.71 – $2,334.00 | 6 |
| Ghs inj transforaminal cerv ea add bil CPT 64480 | $3,154.25 | $5,735.00 | $1,887.00 – $5,512.00 | 3 |
| Ghs inj transforaminal cerv single bil CPT 64479 | $3,908.85 | $7,107.00 | $656.13 – $3,030.00 | 6 |
| Ghs insertion of needle - bone CPT 36680 | $434.50 | $790.00 | $331.39 – $2,334.00 | 6 |
| Ghs intermed repair 12.6 - 20.0 cm-12035 CPT 12035 | $937.75 | $1,705.00 | $301.57 – $2,334.00 | 6 |
| Ghs intermed repair 20.1 - 30.0 cm-12036 CPT 12036 | $1,134.10 | $2,062.00 | $548.27 – $2,334.00 | 6 |
| Ghs intermed repair over 30 cm - 12037 CPT 12037 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Ghs intro needle/intracath vein - 36000 CPT 36000 | $84.70 | $154.00 | $1,887.00 – $5,512.00 | 3 |
| Ghs irrigate corpora cavernosa for priapism CPT 54220 | $633.05 | $1,151.00 | $185.35 – $2,334.00 | 6 |
| Ghs IV inf sq injection, on-body injector CPT 96377 | $101.75 | $185.00 | $34.74 – $89.39 | 4 |
| Ghs IV thrombolytics - cerebral CPT 37195 | $509.85 | $927.00 | $245.03 – $2,334.00 | 6 |
| Ghs lac repair mouth.ant tong 2.5cm/less CPT 41250 | $627.55 | $1,141.00 | $331.39 – $2,334.00 | 6 |
| Ghs layer closure 2.5 cm or less - 12031 CPT 12031 | $737.55 | $1,341.00 | $301.57 – $2,334.00 | 6 |
| Ghs layer closure 2.5 cm or less - 12041 CPT 12041 | $737.55 | $1,341.00 | $301.57 – $2,334.00 | 6 |
| Ghs layer closure 2.5cm or less - 12051 CPT 12051 | $737.55 | $1,341.00 | $301.57 – $2,334.00 | 6 |
| Ghs layer closure 2.6 - 5.0 cm - 12052 CPT 12052 | $737.55 | $1,341.00 | $301.57 – $2,334.00 | 6 |
| Ghs layer closure 2.6 - 7.5 cm - 12042 CPT 12042 | $790.90 | $1,438.00 | $301.57 – $2,334.00 | 6 |
| Ghs layer closure 5.1 - 7.5 cm - 12053 CPT 12053 | $737.55 | $1,341.00 | $301.57 – $2,334.00 | 6 |
| Ghs layer closure 7.6 - 12.5 cm - 12034 CPT 12034 | $746.35 | $1,357.00 | $301.57 – $2,334.00 | 6 |
| Ghs layer closure 7.6 - 12.5 cm - 12044 CPT 12044 | $1,134.10 | $2,062.00 | $548.27 – $2,334.00 | 6 |
| Ghs layer closure 7.6 - 12.5 cm - 12054 CPT 12054 | $737.55 | $1,341.00 | $301.57 – $2,334.00 | 6 |
| Ghs layered repair 12.6 - 20.0 cm -12045 CPT 12045 | $1,184.15 | $2,153.00 | $548.27 – $2,334.00 | 6 |
| Ghs layered repair 12.6 - 20.0 cm -12055 CPT 12055 | $1,669.25 | $3,035.00 | $301.57 – $2,334.00 | 6 |
| Ghs layered repair 20.1 - 30.0 cm -12046 CPT 12046 | $1,256.75 | $2,285.00 | $548.27 – $3,030.00 | 6 |
| Ghs layered repair 20.1 - 30.0 cm -12056 CPT 12056 | not published | not published | $301.57 – $2,334.00 | 6 |
| Ghs layered repair over 30.0 cm -12047 CPT 12047 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Ghs layered repair over 3.0 cm -12057 CPT 12057 | not published | not published | $301.57 – $2,334.00 | 6 |
| Ghs leukocyte alkaline phos (mayo) CPT 85540 | not published | not published | $6.45 – $16.60 | 7 |
| Ghs mbp CPT 83873 | $139.70 | $254.00 | $12.90 – $33.20 | 7 |
| Ghs moderate sedation < 5 yr, 30 min CPT 99151 | $95.15 | $173.00 | not published | 0 |
| Ghs moderate sedation < 5 yr, 30 min, other CPT 99155 | $95.15 | $173.00 | not published | 0 |
| Ghs moderate sedation, > 5 yr, 30 min, other CPT 99156 | $95.15 | $173.00 | not published | 0 |
| Ghs moderate sedation ea addtl 15 min CPT 99153 | $95.70 | $174.00 | not published | 0 |
| Ghs moderate sedation ea addtl 15 min, other CPT 99157 | $70.95 | $129.00 | not published | 0 |
| Ghs musc test done w/n test comp CPT 95886 | $264.02 | $480.04 | not published | 0 |
| Ghs musc tst done w/nerv tst lim CPT 95885 | $174.50 | $317.27 | not published | 0 |
| Ghs myocardial strain img spckl track CPT 93356 | $229.90 | $418.00 | not published | 0 |
| Ghs nailbed repair/nail removal CPT 11760 | $1,128.60 | $2,052.00 | $548.27 – $2,334.00 | 6 |
| Ghs nerve blk intercostal, ea addtl level CPT 64421 | $866.25 | $1,575.00 | $656.13 – $3,030.00 | 6 |
| Ghs nerve blk intercostal, single level CPT 64420 | $949.30 | $1,726.00 | $523.65 – $3,030.00 | 6 |
| Ghs nerve block axillary nerve CPT 64417 | $1,730.85 | $3,147.00 | $656.13 – $3,030.00 | 6 |
| Ghs nerve block brachial plexus CPT 64415 | $1,316.15 | $2,393.00 | $656.13 – $3,030.00 | 6 |
| Ghs nerve block celiac plexus CPT 64530 | $1,177.00 | $2,140.00 | $656.13 – $3,030.00 | 6 |
| Ghs nerve block interscaline CPT 64510 | $1,053.80 | $1,916.00 | $656.13 – $3,030.00 | 6 |
| Ghs nerve block lumbar or thoracic symp CPT 64520 | $1,185.25 | $2,155.00 | $656.13 – $3,030.00 | 6 |
| Ghs nerve block sciatic nerve CPT 64445 | $880.00 | $1,600.00 | $523.65 – $3,030.00 | 6 |
| Ghs nerve block suprascapular CPT 64418 | $856.90 | $1,558.00 | $523.65 – $3,030.00 | 6 |
| Ghs ng placement w fluoro guidance CPT 43752 | $602.25 | $1,095.00 | $331.39 – $2,334.00 | 6 |
| Ghs o2 saturation CPT 82810 | $54.45 | $99.00 | $7.33 – $18.86 | 7 |
| Ghs o2 uptake rest & exercise CPT 94680 | not published | not published | $95.45 – $245.63 | 4 |
| Ghs o2 uptake rest & indirect CPT 94690 | not published | not published | $43.76 – $112.62 | 4 |
| Ghs ob unlisted IV or art inj or infusion CPT 96379 | not published | not published | $34.74 – $89.39 | 4 |
| Ghs opcc repair cvp without subq port CPT 36575 | $714.45 | $1,299.00 | $465.35 – $3,030.00 | 6 |
| Ghs opcc repair cvp w subq port CPT 36576 | not published | not published | $1,167.76 – $3,030.00 | 6 |
| Ghs optokenetic CPT 92544 | not published | not published | $95.45 – $245.63 | 4 |
| Ghs oscillating trac CPT 92545 | not published | not published | $160.18 – $412.19 | 4 |
| Ghs ot dds rom CPT 95851 | not published | not published | $4.81 – $12.37 | 4 |
| Ghs ot group caregiver training CPT 97552 | $85.80 | $156.00 | $6.80 – $17.51 | 4 |
| Ghs ot prosthetic training/15 min CPT 97761 | $50.60 | $92.00 | $29.40 – $75.66 | 4 |
| Ghs ot sensory integrative tech/15min CPT 97533 | $52.80 | $96.00 | $44.02 – $113.27 | 4 |
| Ghs ot work hardening-additional hours CPT 97546 | $103.95 | $189.00 | not published | 0 |
| Ghs pacing - transcutaneous CPT 92953 | $981.20 | $1,784.00 | $490.31 – $3,030.00 | 6 |
| Ghs paravert facet/nerve cerv ea add bil CPT 64492 | $3,199.35 | $5,817.00 | $1,887.00 – $5,512.00 | 3 |
| Ghs paravert facet/nerve lumb ea add bil CPT 64495 | $3,955.05 | $7,191.00 | $433.00 – $5,512.00 | 4 |
| Ghs path - pap (papanicolau) smear - vagina CPT 88141 | not published | not published | $26.35 – $46.84 | 2 |
| Ghs peritonsillar abscess i andd CPT 42700 | $481.80 | $876.00 | $175.70 – $2,334.00 | 6 |
| Ghs phenylketonurid CPT 84030 | not published | not published | $4.12 – $10.62 | 7 |
| Ghs picc line insert < 5 CPT 36568 | $1,809.50 | $3,290.00 | $1,167.76 – $3,030.00 | 6 |
| Ghs plngl fx pm cl CPT 26725 | $526.35 | $957.00 | $182.99 – $2,334.00 | 6 |
| Ghs plt ct-manual CPT 85032 | not published | not published | $3.23 – $8.32 | 7 |
| Ghs polysom <6 yrs 4/> parameters CPT 95782 | $3,788.40 | $6,888.00 | $637.04 – $1,639.32 | 4 |
| Ghs pos nystagmus CPT 92542 | not published | not published | $98.70 – $253.99 | 4 |
| Ghs ppd (tb intradermal) CPT 86580 | $34.10 | $62.00 | $10.98 – $55.21 | 5 |
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.