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 |
|---|---|---|---|---|
| High inten beh couns std 30m HCPCS G0445 | not published | not published | $75.36 – $193.93 | 4 |
| Hinge extension/flex wrist/f HCPCS L3900 | $1,410.00 | $2,563.64 | $1,358.89 – $3,496.87 | 4 |
| Hinge ext/flex wrist finger HCPCS L3901 | not published | not published | $1,780.90 – $4,582.84 | 4 |
| Hip adj flex ext abduct cont HCPCS L2624 | not published | not published | $359.64 – $925.47 | 4 |
| Hip arthr0 w/debridement CPT 29862 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Hip arthr0 w/synovectomy CPT 29863 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Hip arthro acetabuloplasty CPT 29915 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Hip arthroscopy dx CPT 29860 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Hip arthro w/fb removal CPT 29861 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Hip arthro w/femoroplasty CPT 29914 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Hip arthro w/labral repair CPT 29916 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Hip canad sing axi cons fric HCPCS L5250 | not published | not published | $5,163.61 – $13,287.68 | 4 |
| Hip clevis/thrust bearing fr HCPCS L2600 | not published | not published | $196.59 – $505.89 | 4 |
| Hip clevis/thrust bearing lo HCPCS L2610 | not published | not published | $217.24 – $559.02 | 4 |
| Hip clevis type 2 posit jnt HCPCS L2570 | not published | not published | $410.50 – $1,056.37 | 4 |
| Hip disart canadian sach ft HCPCS L5331 | not published | not published | $4,832.34 – $12,435.22 | 4 |
| Hip disartic sach thermopls HCPCS L5595 | not published | not published | $4,231.36 – $10,888.71 | 4 |
| Hip disart sach laminat mold HCPCS L5600 | not published | not published | $4,815.92 – $12,392.97 | 4 |
| Hip flexible cover system HCPCS L5966 | not published | not published | $1,333.59 – $3,431.77 | 4 |
| Hip flex inner socket ext fr HCPCS L5643 | not published | not published | $1,850.05 – $4,760.79 | 4 |
| Hip joint adjustable flexion HCPCS L2622 | not published | not published | $293.30 – $754.77 | 4 |
| Hip X-ray CPT 73502 | $304.15 | $553.00 | $64.56 – $166.13 | 4 |
| Histamine CPT 83088 | not published | not published | $22.15 – $56.99 | 7 |
| Histochemical stains add-on CPT 88314 | $97.90 | $178.00 | $75.43 – $77.57 | 2 |
| Histoplasmosis skin test CPT 86510 | not published | not published | $8.44 – $71.30 | 5 |
| Hiv-1 ag ia CPT 87390 | not published | not published | $18.04 – $46.44 | 7 |
| Hiv-1 dna dir probe CPT 87534 | not published | not published | $16.44 – $42.31 | 7 |
| Hiv-2 ag ia CPT 87391 | not published | not published | $16.42 – $42.27 | 7 |
| HIV 2 pcr qual - sendout CPT 87537 | not published | not published | $16.44 – $42.31 | 7 |
| Hiv-2 quant&revrse trnscripj CPT 87539 | not published | not published | $43.96 – $113.14 | 7 |
| HIV prep counsel, clin staff HCPCS G0013 | not published | not published | $27.80 – $71.53 | 4 |
| HIV prep, ftc/taf 200/25mg HCPCS J0751 | not published | not published | $53.57 – $194.09 | 8 |
| HIV prep, ftc/tdf 200/300mg HCPCS J0750 | not published | not published | $0.34 – $4.95 | 8 |
| HIV prep, inj, cabotegravir HCPCS J0739 | not published | not published | $5.47 – $18.76 | 8 |
| Hizentra injection HCPCS J1559 | not published | not published | $11.16 – $37.14 | 8 |
| Hkafo torsion ball bearing j HCPCS L2060 | not published | not published | $561.81 – $1,445.72 | 4 |
| Hkafo torsion bil rot straps HCPCS L2040 | not published | not published | $186.47 – $479.86 | 4 |
| Hkafo torsion cable hip pelv HCPCS L2050 | not published | not published | $449.16 – $1,155.84 | 4 |
| Hkafo torsion unilat rot str HCPCS L2070 | not published | not published | $143.06 – $368.15 | 4 |
| Hkafo unilat torsion ball br HCPCS L2090 | not published | not published | $458.30 – $1,179.37 | 4 |
| Hkafo unilat torsion cable HCPCS L2080 | not published | not published | $343.97 – $885.16 | 4 |
| Hla class i high defin qual CPT 86832 | not published | not published | $242.81 – $624.84 | 7 |
| Hla class ii high defin qual CPT 86833 | not published | not published | $233.40 – $628.79 | 7 |
| Hla class i&ii antibody qual CPT 86828 | $181.50 | $330.00 | $48.14 – $123.89 | 7 |
| Hla class i/ii antibody qual CPT 86829 | not published | not published | $48.14 – $123.89 | 7 |
| Hla class ii phenotype qual CPT 86831 | not published | not published | $61.41 – $158.03 | 7 |
| Hla class ii semiquant panel CPT 86835 | not published | not published | $242.22 – $623.31 | 7 |
| Hla class i phenotype qual CPT 86830 | not published | not published | $71.64 – $184.35 | 7 |
| Hla class i semiquant panel CPT 86834 | not published | not published | $268.17 – $690.09 | 7 |
| Hla i & ii type verify lr CPT 81371 | not published | not published | $303.39 – $780.72 | 7 |
| Hla i & ii typing hr CPT 81378 | not published | not published | $259.18 – $666.95 | 7 |
| Hla i & ii typing lr CPT 81370 | not published | not published | $301.59 – $776.09 | 7 |
| Hla ii typing 1 loc hr CPT 81382 | not published | not published | $92.76 – $238.70 | 7 |
| Hla ii typing ag equiv lr CPT 81375 | not published | not published | $165.56 – $426.03 | 7 |
| Hla i low res one antigen equiv ea CPT 81374 | $815.10 | $1,482.00 | $55.75 – $143.46 | 7 |
| Hla i typing 1 locus hr CPT 81380 | not published | not published | $132.94 – $342.09 | 7 |
| Hla i typing complete hr CPT 81379 | not published | not published | $251.54 – $647.28 | 7 |
| Hla i typing complete lr CPT 81372 | not published | not published | $302.69 – $778.93 | 7 |
| Hla i typing high res 1 allele grp ea CPT 81381 | not published | not published | $127.42 – $327.91 | 7 |
| Hla i typing low res one locus ea CPT 81373 | $339.35 | $617.00 | $95.57 – $245.94 | 7 |
| Hla typing a b or c CPT 86813 | not published | not published | $43.50 – $111.94 | 7 |
| Hla typing dr/dq CPT 86816 | not published | not published | $22.63 – $58.23 | 7 |
| Hla x-match noncytotoxc addl CPT 86826 | not published | not published | $27.40 – $70.50 | 7 |
| Hla x-math non-cytotoxic CPT 86825 | not published | not published | $82.12 – $211.32 | 7 |
| Hlth bhv assmt/reassessment CPT 96156 | not published | not published | $75.36 – $193.93 | 4 |
| Hlth bhv ivntj fam 1st 30 CPT 96167 | not published | not published | $27.80 – $71.53 | 4 |
| Hlth bhv ivntj grp 1st 30 CPT 96164 | not published | not published | $27.80 – $71.53 | 4 |
| Hlth bhv ivntj indiv 1st 30 CPT 96158 | not published | not published | $131.67 – $338.84 | 4 |
| Ho abduction hip adjustable HCPCS L1650 | not published | not published | $227.30 – $584.93 | 4 |
| Ho abduction static plastic HCPCS L1660 | not published | not published | $166.56 – $428.61 | 4 |
| Ho bi thighcuffs w sprdr bar HCPCS L1652 | not published | not published | $328.57 – $845.51 | 4 |
| Hocm 250-299mg/ml iodine,1ml HCPCS Q9961 | not published | not published | $0.32 – $0.79 | 4 |
| Hocm 350-399mg/ml iodine,1ml HCPCS Q9963 | not published | not published | $0.24 – $0.59 | 4 |
| Ho flex frejka w/cov pre cst HCPCS L1600 | not published | not published | $118.78 – $305.65 | 4 |
| Ho flex pavlik harns pre cst HCPCS L1620 | not published | not published | $144.82 – $372.68 | 4 |
| Ho frejka cov only pre cst HCPCS L1610 | not published | not published | $50.44 – $129.81 | 4 |
| Home sleep test/type 2 porta HCPCS G0398 | not published | not published | $160.18 – $412.19 | 4 |
| Home sleep test/type 3 porta HCPCS G0399 | $630.30 | $1,146.00 | $160.18 – $412.19 | 4 |
| Home sleep test/type 4 porta HCPCS G0400 | not published | not published | $160.18 – $412.19 | 4 |
| Homocysteine CPT 83090 | $144.10 | $262.00 | $13.44 – $34.59 | 7 |
| Homogenization tissue CPT 87176 | $13.75 | $25.00 | $4.41 – $11.35 | 7 |
| Homovanillic acid (hva) CPT 83150 | not published | not published | $16.81 – $43.25 | 7 |
| Hook to hand cable adapter HCPCS L6670 | not published | not published | $44.03 – $113.31 | 4 |
| Hopd mntl hlt, 15-29 min HCPCS C7900 | not published | not published | $27.80 – $71.53 | 4 |
| Hopd mntl hlt, 30-60 min HCPCS C7901 | not published | not published | $75.36 – $193.93 | 4 |
| Hopd mntl hlt, grp HCPCS C7903 | not published | not published | $27.80 – $71.53 | 4 |
| Ho post-op hip abduction HCPCS L1686 | not published | not published | $863.67 – $2,222.51 | 4 |
| Hpa-15 genotyping CPT 81112 | not published | not published | $91.66 – $235.88 | 7 |
| Hpa-1 genotyping CPT 81105 | not published | not published | $91.66 – $235.88 | 7 |
| Hpa-2 genotyping CPT 81106 | not published | not published | $91.66 – $235.88 | 7 |
| Hpa-3 genotyping CPT 81107 | not published | not published | $91.66 – $235.88 | 7 |
| Hpa-4 genotyping CPT 81108 | not published | not published | $91.66 – $235.88 | 7 |
| Hpa-5 genotyping CPT 81109 | not published | not published | $91.66 – $235.88 | 7 |
| Hpa-6 genotyping CPT 81110 | not published | not published | $91.66 – $235.88 | 7 |
| Hpa-9 genotyping CPT 81111 | not published | not published | $91.66 – $235.88 | 7 |
| Hpv combo assay ca screen HCPCS G0476 | not published | not published | $26.32 – $67.72 | 7 |
| Hpv low-risk types CPT 87623 | not published | not published | $26.32 – $67.72 | 7 |
| Hpv types 16 & 18 only CPT 87625 | not published | not published | $30.41 – $78.26 | 7 |
| H pylori ag ia CPT 87339 | not published | not published | $12.00 – $30.88 | 7 |
| H pylori (c-13) blood CPT 83009 | not published | not published | $50.52 – $130.00 | 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.