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 |
|---|---|---|---|---|
| Hc nm kidney imaging with flow CPT 78701 | not published | not published | $296.56 – $763.16 | 4 |
| Hc nm myocard infarct avid plnr tomo spect w/wo quant CPT 78469 | $2,256.65 | $4,103.00 | $402.79 – $1,036.52 | 4 |
| Hc pet myocardial imaging metabolic eval single study CPT 78459 | $2,375.45 | $4,319.00 | $960.41 – $2,471.46 | 4 |
| Hc transcatheter placement and sbsq removal cepd perq CPT 33370 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Hdr rdncl ntrstl/icav brchtx CPT 77770 | not published | not published | $516.67 – $1,329.56 | 4 |
| Hdr rdncl ntrstl/icav brchtx CPT 77771 | not published | not published | $516.67 – $1,329.56 | 4 |
| Hdr rdncl ntrstl/icav brchtx CPT 77772 | not published | not published | $516.67 – $1,329.56 | 4 |
| Hdr rdncl skn surf brachytx CPT 77767 | not published | not published | $286.12 – $736.29 | 4 |
| Hdr rdncl skn surf brachytx CPT 77768 | not published | not published | $286.12 – $736.29 | 4 |
| Head CT scan (with and without contrast) CPT 70470 | $1,515.80 | $2,756.00 | $130.12 – $334.84 | 4 |
| Head CT scan (with contrast) CPT 70460 | $1,443.75 | $2,625.00 | $130.12 – $334.84 | 4 |
| Head CT scan (without contrast) CPT 70450 | $1,375.00 | $2,500.00 | $77.56 – $199.58 | 4 |
| Hearing loss dup/del analys CPT 81431 | not published | not published | $509.68 – $1,311.57 | 7 |
| Hearing loss sequence analys CPT 81430 | not published | not published | $1,218.75 – $3,136.25 | 7 |
| Heart first pass add-on CPT 78496 | not published | not published | $68.42 – $68.42 | 1 |
| Heart first pass multiple CPT 78483 | not published | not published | $402.79 – $1,036.52 | 4 |
| Heart image spect CPT 78494 | not published | not published | $296.56 – $763.16 | 4 |
| Heart infarct image CPT 78466 | not published | not published | $296.56 – $763.16 | 4 |
| Heart infarct image (ef) CPT 78468 | not published | not published | $402.79 – $1,036.52 | 4 |
| Heart revascularize (tmr) CPT 33140 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Heart tmr w/other procedure 33141 CPT 33141 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Heavy duty control cable HCPCS L6660 | not published | not published | $94.68 – $243.64 | 4 |
| Heavy metal qual any number CPT 83015 | not published | not published | $15.70 – $40.41 | 7 |
| Heel leather reinforced HCPCS L3440 | not published | not published | $70.33 – $180.98 | 4 |
| Heinz bodies direct CPT 85441 | not published | not published | $3.15 – $8.11 | 7 |
| Heinz bodies induced CPT 85445 | not published | not published | $5.12 – $13.16 | 7 |
| Helicobacter pylori antibody igm CPT 86677 | not published | not published | $11.77 – $32.52 | 7 |
| Helicoll, per square cm HCPCS Q4164 | not published | not published | $92.32 – $4,111.19 | 6 |
| Hemagglutination inhibition CPT 86280 | not published | not published | $6.14 – $15.81 | 7 |
| Hematocrit CPT 85014 | $20.35 | $37.00 | $1.78 – $4.57 | 7 |
| Hematopoietic nuclear tx CPT 79403 | $2,461.80 | $4,476.00 | $173.10 – $445.43 | 4 |
| Hemicrt intrclry algrft prtl CPT 20933 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Hemiepiphyseal arrest CPT 24470 | not published | not published | $2,427.27 – $16,106.00 | 6 |
| Hemin 350 mg intravenous powder for solution HCPCS J1640 | not published | not published | $26.87 – $90.17 | 8 |
| Hemipelvect canad sing axis HCPCS L5280 | not published | not published | $5,592.40 – $14,391.10 | 4 |
| Hemipelvectomy canadian sach HCPCS L5341 | not published | not published | $5,136.70 – $13,218.45 | 4 |
| Hemoglobin CPT 85018 | $20.90 | $38.00 | $1.78 – $4.57 | 7 |
| Hemoglobin copper sulfate CPT 83026 | not published | not published | $3.01 – $7.74 | 7 |
| Hemoglobin fetal qualitative CPT 83033 | $14.30 | $26.00 | $6.00 – $15.44 | 7 |
| Hemoglobin f (fetal) chemical CPT 83030 | not published | not published | $8.06 – $20.73 | 7 |
| Hemoglobin methemoglobin quantitative CPT 83050 | $25.85 | $47.00 | $5.93 – $15.83 | 7 |
| Hemoglobin-oxygen affinity CPT 82820 | not published | not published | $10.00 – $25.75 | 7 |
| Hemoglobin plasma CPT 83051 | $13.20 | $24.00 | $5.48 – $14.11 | 7 |
| Hemoglobin thermolabile CPT 83065 | not published | not published | $6.75 – $17.37 | 7 |
| Hemoglobin urine CPT 83069 | not published | not published | $2.96 – $7.62 | 7 |
| Hemolysin acid CPT 85475 | not published | not published | $6.65 – $17.12 | 7 |
| Hemolysins/agglutinins auto CPT 86940 | $23.65 | $43.00 | $6.58 – $16.93 | 7 |
| Hemolysins and agglutinins incubated CPT 86941 | $242.55 | $441.00 | $9.08 – $23.37 | 7 |
| Hemophilus influenza antibdy CPT 86684 | not published | not published | $11.88 – $30.57 | 7 |
| Hemorrhoidectomy intern transanal deater 2+ 46948 CPT 46948 | not published | not published | $2,059.07 – $7,791.00 | 6 |
| Hemorrhoidectomy intrnl lig rbbr band ligations CPT 46221 | $1,065.35 | $1,937.00 | $689.87 – $3,030.00 | 6 |
| Hemorrhoidopexy stapling 46947 CPT 46947 | not published | not published | $2,059.07 – $8,770.00 | 6 |
| Hepagam b im injection HCPCS J1571 | not published | not published | $49.21 – $179.52 | 8 |
| Hepagam b intravenous, inj HCPCS J1573 | not published | not published | $49.21 – $179.52 | 8 |
| Heparin assay CPT 85520 | $75.35 | $137.00 | $9.82 – $25.26 | 7 |
| Heparin bolus from bag HCPCS J1644 | not published | not published | $0.22 – $0.54 | 5 |
| Heparin neutralization CPT 85525 | not published | not published | $8.88 – $22.85 | 7 |
| Heparin, porcine (pf) 10 unit/ml flush (wrapper) HCPCS J1642 | not published | not published | $0.02 – $0.05 | 5 |
| Heparin-protamine tolerance CPT 85530 | not published | not published | $9.82 – $25.26 | 7 |
| Hepatectomy removal of liver 47120 CPT 47120 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Hepatitis a antibody igm CPT 86709 | $98.45 | $179.00 | $8.44 – $21.73 | 7 |
| Hepatitis b core antibody igm CPT 86705 | $99.55 | $181.00 | $8.83 – $22.72 | 7 |
| Hepatitis b core antibody total CPT 86704 | $67.65 | $123.00 | $9.04 – $23.26 | 7 |
| Hepatitis b immune globulin greater than 1,560 units/5 ml im solution CPT 90371 | not published | not published | $102.71 – $398.33 | 7 |
| Hepatitis b surface ag quan CPT 87467 | not published | not published | $15.05 – $48.87 | 7 |
| Hepatitis b surface antibody CPT 86706 | $96.80 | $176.00 | $8.06 – $20.73 | 7 |
| Hepatitis b vaccine 40 mcg/ml inj-adult CPT 90747 | not published | not published | $154.83 – $383.20 | 4 |
| Hepatitis c antibody CPT 86803 | $124.85 | $227.00 | $10.70 – $27.54 | 7 |
| Hepatitis c rna dir probe CPT 87520 | not published | not published | $23.42 – $60.25 | 7 |
| Hepatitis d quantification CPT 87523 | not published | not published | $32.13 – $82.68 | 7 |
| Hepatitis g dna amp probe CPT 87526 | not published | not published | $29.44 – $75.77 | 7 |
| Hepatitis g dna dir probe CPT 87525 | not published | not published | $22.35 – $57.51 | 7 |
| Hepatitis g dna quant CPT 87527 | not published | not published | $31.32 – $80.60 | 7 |
| Hepatobiliary system imaging CPT 78226 | $1,936.00 | $3,520.00 | $296.56 – $763.16 | 4 |
| Hep b vac 3ag 10mcg 3 dos im CPT 90759 | not published | not published | $81.20 – $200.97 | 4 |
| Hepb vacc 3 dose immunsup im CPT 90740 | not published | not published | $180.86 – $430.57 | 4 |
| Hereditary colon ca dsordrs CPT 81435 | not published | not published | $584.90 – $2,516.62 | 7 |
| Hereditary colon ca dsordrs CPT 81436 | not published | not published | $731.13 – $1,183.55 | 3 |
| Hered neuroend tum-rlt do 5+ CPT 81437 | not published | not published | $438.93 – $2,516.62 | 7 |
| Hered rta do gen seq 15 CPT 81434 | not published | not published | $448.43 – $1,153.97 | 7 |
| Heredtry nurondcrn tum dsrdr CPT 81438 | not published | not published | $548.66 – $894.41 | 3 |
| Hernia Repair (Inguinal) CPT 49505 | not published | not published | $2,656.06 – $8,770.00 | 7 |
| Herpes simplex 1 ag if CPT 87274 | not published | not published | $8.98 – $23.12 | 7 |
| Herpes simplex 2 ag if CPT 87273 | not published | not published | $8.98 – $23.12 | 7 |
| Herpes simplex type 1 antibody igg CPT 86695 | $111.65 | $203.00 | $9.89 – $25.46 | 7 |
| Herpes simplex type 2 antibody igg CPT 86696 | $252.45 | $459.00 | $14.51 – $37.35 | 7 |
| Herpes simplex virus isolation CPT 87255 | $75.90 | $138.00 | $25.40 – $65.35 | 7 |
| Heterophile antibodies screening CPT 86308 | $47.85 | $87.00 | $3.88 – $10.00 | 7 |
| Heterophile antibodies titer CPT 86309 | $11.00 | $20.00 | $4.85 – $12.49 | 7 |
| Heterophile antibody absrbj CPT 86310 | not published | not published | $5.53 – $14.22 | 7 |
| Hexa gene CPT 81255 | not published | not published | $38.59 – $99.30 | 7 |
| Hfo nontorsion jnts pre cst HCPCS L3929 | not published | not published | $76.62 – $197.17 | 4 |
| Hfo nontorsion jnts pre ots HCPCS L3930 | not published | not published | $76.62 – $197.17 | 4 |
| Hgb methemoglobin qual CPT 83045 | not published | not published | $4.87 – $12.53 | 7 |
| Hhv-6 dna dir probe CPT 87531 | not published | not published | $40.58 – $111.94 | 7 |
| Hhv-6 dna quant CPT 87533 | not published | not published | $31.32 – $80.60 | 7 |
| Hib-hepb vaccine im CPT 90748 | not published | not published | $125.94 – $125.94 | 1 |
| Hib-mency vacc 6wk-18m0 im CPT 90644 | not published | not published | $59.90 – $59.90 | 1 |
| Hi enrgy eswt plantar fascia CPT 28890 | not published | not published | $1,192.86 – $8,770.00 | 6 |
| High activity knee frame HCPCS L5930 | not published | not published | $3,108.50 – $7,999.19 | 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.