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 prostatic acid phosphatase (mayo) CPT 84066 | not published | not published | $7.24 – $18.64 | 7 |
| Ghs protein, misc fluid CPT 84160 | $24.75 | $45.00 | $4.21 – $10.83 | 7 |
| Ghs protoporphyrins fract CPT 84202 | $70.95 | $129.00 | $10.76 – $27.70 | 7 |
| Ghs pr without cont pulse ox CPT 94625 | $132.55 | $241.00 | $43.76 – $112.62 | 4 |
| Ghs pseudocholinesterase,dibucain-inhibi CPT 82638 | not published | not published | $9.19 – $23.64 | 7 |
| Ghs pt - work hardening/int 2hrs CPT 97545 | $221.65 | $403.00 | not published | 0 |
| Ghs quinidine CPT 80194 | not published | not published | $10.95 – $28.18 | 7 |
| Ghs refill of implantable pump CPT 95990 | $505.45 | $919.00 | $245.03 – $2,334.00 | 6 |
| Ghs removal intranasal foreign body CPT 30300 | $273.35 | $497.00 | $98.70 – $2,334.00 | 6 |
| Ghs removal pharyngeal foreign body CPT 42809 | $561.00 | $1,020.00 | $331.39 – $2,334.00 | 6 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | not published | not published | $11.77 – $30.67 | 7 |
| Ghs reticulocyte count CPT 85044 | not published | not published | $3.23 – $8.32 | 7 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | not published | not published | $10.43 – $26.85 | 7 |
| Ghs sedimentation rate CPT 85651 | not published | not published | $3.20 – $8.24 | 7 |
| Ghs semen analysis fert CPT 89320 | not published | not published | $9.23 – $23.76 | 7 |
| Ghs semen analysis, post-vas CPT 89300 | not published | not published | $7.38 – $18.99 | 7 |
| Ghs sensitivity (per antimicro) CPT 87184 | $77.55 | $141.00 | $5.61 – $14.44 | 7 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $662.20 | $1,204.00 | $301.57 – $2,334.00 | 6 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $737.55 | $1,341.00 | $301.57 – $2,334.00 | 6 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $699.60 | $1,272.00 | $301.57 – $2,334.00 | 6 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $737.55 | $1,341.00 | $301.57 – $2,334.00 | 6 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $656.15 | $1,193.00 | $148.84 – $2,334.00 | 6 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $610.50 | $1,110.00 | $148.84 – $2,334.00 | 6 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $413.60 | $752.00 | $148.84 – $2,334.00 | 6 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $737.55 | $1,341.00 | $148.84 – $2,334.00 | 6 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | not published | not published | $148.84 – $2,334.00 | 6 |
| Ghs sleep study unattended CPT 95800 | $613.80 | $1,116.00 | $160.18 – $412.19 | 4 |
| Ghs somatosensory testing lower extremit CPT 95926 | $793.65 | $1,443.00 | $160.18 – $412.19 | 4 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | $1,357.40 | $2,468.00 | $637.04 – $1,639.32 | 4 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $122.10 | $222.00 | $35.06 – $90.21 | 4 |
| Ghs sphenopalatine ganglion block CPT 64505 | $662.20 | $1,204.00 | $227.71 – $2,334.00 | 6 |
| Ghs spont nystagmus CPT 92541 | not published | not published | $98.70 – $253.99 | 4 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $155.10 | $282.00 | $75.09 – $193.23 | 4 |
| Ghs st - eval for alt comm CPT 92567 | not published | not published | $27.71 – $71.30 | 4 |
| Ghs strapping shoulder - 29240 CPT 29240 | $240.35 | $437.00 | $98.70 – $2,334.00 | 6 |
| Ghs st - re-eval for alt comm CPT 92597 | $374.00 | $680.00 | $52.09 – $134.04 | 4 |
| Ghs subcutaneous infus, for therapy ea. add. hr CPT 96370 | not published | not published | $34.74 – $89.39 | 4 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | not published | not published | $157.79 – $406.05 | 4 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $1,247.95 | $2,269.00 | $548.27 – $2,334.00 | 6 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $952.05 | $1,731.00 | $301.57 – $2,334.00 | 6 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Ghs trypsin (fecal) CPT 84488 | not published | not published | $5.48 – $14.09 | 7 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $526.35 | $957.00 | $182.99 – $2,334.00 | 6 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | not published | not published | $182.99 – $2,334.00 | 6 |
| Ghs urine, hydroxproline total CPT 83505 | not published | not published | $18.22 – $46.90 | 7 |
| Ghs urine, porphyrins quant CPT 84120 | $129.25 | $235.00 | $11.03 – $28.39 | 7 |
| Ghs vaginal delivery only CPT 59409 | $4,484.70 | $8,154.00 | $2,401.40 – $7,791.00 | 6 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | not published | not published | $276.82 – $712.35 | 4 |
| Ghs windowing of cast CPT 29730 | not published | not published | $120.55 – $2,334.00 | 6 |
| Giardia ag if CPT 87269 | not published | not published | $10.21 – $26.27 | 7 |
| Giardia lamblia antibody CPT 86674 | not published | not published | $11.04 – $28.41 | 7 |
| Gi endoscopic ultrasound CPT 76975 | not published | not published | $177.00 – $455.49 | 4 |
| Gi inhouse confirmation CPT 87045 | $117.70 | $214.00 | $7.08 – $18.22 | 7 |
| Gingivoplasty each quadrant CPT 41872 | not published | not published | $2,459.51 – $16,106.00 | 6 |
| Gi protein loss CPT 78282 | not published | not published | $162.42 – $763.16 | 4 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | $2,550.35 | $4,637.00 | $672.83 – $4,761.00 | 6 |
| Gi trc img intral colon i&r CPT 91113 | not published | not published | $689.87 – $1,775.27 | 4 |
| Gi trc img intral esophagus CPT 91111 | not published | not published | $672.83 – $4,761.00 | 6 |
| Gi wireless capsule measure CPT 91112 | not published | not published | $672.83 – $4,761.00 | 6 |
| Gjb2 gene full sequence CPT 81252 | not published | not published | $75.84 – $195.16 | 7 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $46.14 – $118.73 | 7 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $26.25 – $67.55 | 7 |
| Glassia injection HCPCS J0257 | not published | not published | $4.19 – $15.00 | 8 |
| Glaucoma scrn hgh risk direc HCPCS G0117 | not published | not published | $21.46 – $55.21 | 4 |
| Glaucoma scrn hgh risk direc HCPCS G0118 | not published | not published | $27.71 – $71.30 | 4 |
| Glaucoma surgery CPT 66150 | not published | not published | $3,066.31 – $7,890.63 | 6 |
| Glaucoma surgery CPT 66155 | not published | not published | $3,066.31 – $7,890.63 | 6 |
| Glaucoma surgery CPT 66160 | not published | not published | $1,712.02 – $7,791.00 | 6 |
| Glaucoma surgery CPT 66170 | not published | not published | $1,712.02 – $7,791.00 | 6 |
| Glove finger flexion right lg xl HCPCS L3912 | not published | not published | $88.38 – $227.43 | 4 |
| Glucagon 1 mg solution for injection HCPCS J1610 | not published | not published | $88.00 – $501.44 | 8 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | not published | not published | $96.96 – $304.67 | 8 |
| Glucagon plasma - sendout CPT 82943 | $26.95 | $49.00 | $10.72 – $27.58 | 7 |
| Glucagon tolerance panel CPT 80422 | not published | not published | $34.55 – $88.92 | 7 |
| Glucagon tolerance panel CPT 80424 | not published | not published | $37.88 – $97.46 | 7 |
| Glucagon tolerance test CPT 82946 | not published | not published | $13.33 – $34.30 | 7 |
| Glucose 1 hr post dose CPT 82950 | not published | not published | $3.56 – $9.17 | 7 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | not published | not published | $4.54 – $11.68 | 7 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $25.30 | $46.00 | $2.46 – $6.33 | 7 |
| Glucose blood quantitative CPT 82947 | $29.15 | $53.00 | $2.95 – $7.58 | 7 |
| Glucose body fluid CPT 82945 | $44.00 | $80.00 | $2.95 – $7.58 | 7 |
| Glucose monitoring continual min 72hr pt CPT 95249 | $162.25 | $295.00 | $43.76 – $112.62 | 4 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $37.40 | $68.00 | $9.65 – $24.84 | 7 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $37.40 | $68.00 | $2.94 – $7.57 | 7 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | not published | not published | $0.56 – $1.58 | 5 |
| Gold sodium thiomaleate inj HCPCS J1600 | not published | not published | $36.10 – $36.10 | 1 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | not published | not published | $8.28 – $28.69 | 8 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $107.25 | $195.00 | $13.94 – $35.86 | 7 |
| Gonadotropin hormone panel CPT 80426 | not published | not published | $111.31 – $286.43 | 7 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $152.90 | $278.00 | $13.89 – $35.74 | 7 |
| Gonioscopy CPT 92020 | not published | not published | $98.70 – $253.99 | 4 |
| Goniotomy CPT 65820 | not published | not published | $3,066.31 – $7,890.63 | 6 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | not published | not published | $761.22 – $1,914.08 | 5 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | not published | not published | $33.40 – $237.56 | 7 |
| Graft bone flex 2.5cm x 5cm grafton-cost per sq cm HCPCS Q4205 | not published | not published | $92.32 – $3,157.04 | 7 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | not published | not published | $69.98 – $237.56 | 7 |
| Graft hand or finger tendon CPT 26416 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $12,177.38 | $22,140.70 | not published | 0 |
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.