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 |
|---|---|---|---|---|
| Igh gene rearrang dir probe CPT 81262 | not published | not published | $51.41 – $132.30 | 7 |
| Igh gene rearrange amp meth CPT 81261 | not published | not published | $148.49 – $382.12 | 7 |
| Igh@ var region somatic mutation analy CPT 81263 | not published | not published | $220.89 – $568.42 | 7 |
| Igk rearrangeabn clonal pop CPT 81264 | not published | not published | $129.55 – $333.37 | 7 |
| Ihc/icc per specimen each additional single antibody stain CPT 88341 | $259.60 | $472.00 | $64.60 – $88.96 | 2 |
| Ihc/icc per specimen each multiplex antibody stain CPT 88344 | $410.85 | $747.00 | $188.36 – $684.27 | 5 |
| Ihc/icc per specimen initial single antibody stain CPT 88342 | $343.20 | $624.00 | $99.41 – $325.23 | 5 |
| Iiv3 vacc no prsv 0.25 ml im CPT 90655 | not published | not published | $35.06 – $35.06 | 1 |
| Ikbkap gene CPT 81260 | not published | not published | $29.48 – $75.87 | 7 |
| Ileostomy/jejunostomy non-tube 44310 CPT 44310 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Iliac bone graft microvasc CPT 20956 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Iliac/fem angio cath insert HCPCS G0278 | $518.65 | $943.00 | not published | 0 |
| Iliac revasc add-on 37222 CPT 37222 | $6,013.15 | $10,933.00 | $5,512.00 – $18,364.00 | 3 |
| Iloprost non-comp unit dose HCPCS Q4074 | not published | not published | $163.64 – $403.59 | 4 |
| Imbrication/diaphragm/transthor/transabd 39545 CPT 39545 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Imetelstat 188 mg intravenous solution HCPCS J0870 | not published | not published | $44.65 – $151.02 | 6 |
| Img rta detcj/mntr ds staff CPT 92227 | not published | not published | $43.76 – $112.62 | 4 |
| Img rta detc/mntr ds phy/qhp CPT 92228 | not published | not published | $27.71 – $71.30 | 4 |
| Img rta detc/mntr ds poc aly CPT 92229 | not published | not published | $43.76 – $112.62 | 4 |
| Immob elbow child sm HCPCS L3762 | not published | not published | $90.19 – $232.08 | 4 |
| Immobilizer shldr cntor adlt HCPCS L3670 | not published | not published | $95.36 – $245.40 | 4 |
| Immobilizer shldr dlx str 24-36in med HCPCS L1830 | not published | not published | $53.06 – $136.55 | 4 |
| Immobilizer shldr sling med HCPCS L3660 | not published | not published | $86.68 – $223.05 | 4 |
| Immt breast prosthesis 19340 CPT 19340 | not published | not published | $6,019.00 – $16,106.00 | 6 |
| Immune complex assay CPT 86332 | not published | not published | $18.28 – $47.03 | 7 |
| Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution HCPCS J1569 | not published | not published | $36.98 – $126.49 | 8 |
| Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution HCPCS J1566 | not published | not published | $60.72 – $221.69 | 8 |
| Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution HCPCS J1568 | not published | not published | $35.29 – $134.23 | 8 |
| Immune globulin ig human im use 90281 CPT 90281 | not published | not published | $162.64 – $162.64 | 1 |
| Immunoassay tumor antigen quantitative ca 125 CPT 86304 | $166.65 | $303.00 | $15.61 – $40.16 | 7 |
| Immunoassay tumor antigen quantitative ca 19-9 CPT 86301 | $168.30 | $306.00 | $15.61 – $40.16 | 7 |
| Immunoassay tumor qual CPT 86294 | not published | not published | $19.18 – $49.35 | 7 |
| Immunodiff gel qual ea antigen/ab CPT 86331 | $12.87 | $23.40 | $8.98 – $23.12 | 7 |
| Immunodiffusion nes CPT 86329 | not published | not published | $10.54 – $27.12 | 7 |
| Immunoelectrophoresis assay CPT 86327 | not published | not published | $37.40 – $52.36 | 3 |
| Immunofixation electrophoresis serum CPT 86334 | $134.20 | $244.00 | $16.76 – $43.12 | 7 |
| Immunofluorescence per specimen each additional single antibody stain CPT 88350 | $82.50 | $150.00 | $62.03 – $63.88 | 2 |
| Immunofluorescence per specimen initial single antibody stain CPT 88346 | $76.45 | $139.00 | $78.58 – $325.23 | 5 |
| Immunoglobulin assay CPT 86023 | $156.20 | $284.00 | $9.34 – $24.05 | 7 |
| Impact tooth remov part bony HCPCS D7230 | not published | not published | $479.59 – $1,234.13 | 4 |
| Impedence cardiogram CPT 93701 | not published | not published | $98.70 – $253.99 | 4 |
| Imp extar knee shck absrb HCPCS C8003 | not published | not published | $7,609.00 – $33,471.73 | 4 |
| Impl absrb msh/prsth dly cls CPT 15778 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Implant 11 volt lithium-ion backup battery for controller pocket HCPCS Q0506 | not published | not published | $788.78 – $2,029.80 | 4 |
| Implantation iris prosthesis CPT 66683 | not published | not published | $3,388.00 – $31,423.41 | 4 |
| Implant biventricular device 33976 CPT 33976 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Implant brain electrodes CPT 61531 | not published | not published | $3,579.00 – $6,779.00 | 3 |
| Implant brain electrodes CPT 61533 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Implant brain electrodes CPT 61760 | not published | not published | $3,579.00 – $6,779.00 | 3 |
| Implant cartilage 10mm synthetic HCPCS L8699 | $1,407.18 | $2,558.50 | not published | 0 |
| Implant cochlear device CPT 69930 | not published | not published | $8,923.00 – $62,943.16 | 6 |
| Implant eye drug system CPT 67027 | not published | not published | $8,923.00 – $26,635.93 | 6 |
| Implant hormone pellet(s) 11980 CPT 11980 | not published | not published | $331.39 – $2,334.00 | 6 |
| Implant nerve end CPT 64787 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Implant neuroelectrde addl CPT 61864 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Implant neuroelectrde addl CPT 61868 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Implant neuroelectrode CPT 61863 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Implant neuroelectrode CPT 61867 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Implant neuroelectrodes CPT 63655 | not published | not published | $8,923.00 – $37,034.45 | 6 |
| Implant neuroelectrodes CPT 64553 | not published | not published | $7,609.00 – $21,271.19 | 6 |
| Implant neuroelectrodes CPT 64555 | not published | not published | $4,727.69 – $18,364.00 | 6 |
| Implant neuroelectrodes CPT 64561 | $2,763.09 | $5,023.80 | $4,727.69 – $18,364.00 | 6 |
| Implant neuroelectrodes CPT 61850 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Implant neuroelectrodes CPT 61860 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Implant neurostim arrays CPT 61886 | not published | not published | $8,923.00 – $58,906.76 | 6 |
| Implant open hernia repair w/mesh 49568 CPT 49568 | not published | not published | $5,415.00 – $5,415.00 | 1 |
| Implant power module patient cable cable 14 volt HCPCS Q0477 | not published | not published | $716.51 – $1,843.83 | 4 |
| Implant/replace hearing aid CPT 69710 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Implant single ventricular device 33975 CPT 33975 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Implant spinal canal cath CPT 62351 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Implant spine infusion pump CPT 62361 | not published | not published | $8,923.00 – $44,873.00 | 6 |
| Implant spine infusion pump CPT 62362 | not published | not published | $8,923.00 – $44,873.00 | 6 |
| Implant tcat pulm vlv perq CPT 33477 | $20,174.55 | $36,681.00 | $6,019.00 – $6,019.00 | 1 |
| Implant ureter in bowel CPT 50800 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Implant ureth bulk agent HCPCS L8606 | $540.31 | $982.39 | not published | 0 |
| Impl ear abutment ba300 9mm HCPCS L8693 | not published | not published | $1,400.35 – $3,603.56 | 4 |
| Impl eye bio-eye 16mm HCPCS L8042 | not published | not published | $3,100.45 – $7,978.48 | 4 |
| Impl neurostim electr perc CPT 63650 | not published | not published | $4,727.69 – $18,364.00 | 6 |
| Implnt bio implnt for soft tiss reinforcement 15777 CPT 15777 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Implnt spinl canal catheter 62350 CPT 62350 | not published | not published | $4,428.00 – $16,752.93 | 6 |
| Impl oi implt sk tc esp<100 CPT 69716 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Impl oi implt sk tc esp>=100 CPT 69729 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Impl oi implt skull perq esp CPT 69714 | not published | not published | $7,609.00 – $27,583.00 | 6 |
| Impl/rplcmt gstr nstim eltrd CPT 43881 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Implt brain chemotx add-on 61517 CPT 61517 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Impltj ntrstrml crnl rng seg CPT 65785 | not published | not published | $3,066.31 – $16,106.00 | 6 |
| Impltj tot rplcmt hrt sys CPT 33927 | not published | not published | $8,923.00 – $8,923.00 | 1 |
| Implt neurostim elctr each HCPCS L8680 | $4,637.51 | $8,431.84 | not published | 0 |
| Imported lipodox inj HCPCS Q2049 | not published | not published | $224.06 – $1,439.82 | 5 |
| Impres&prep auricular prosth CPT 21086 | not published | not published | $2,459.51 – $16,106.00 | 6 |
| Impres&prep def obt prosth CPT 21080 | not published | not published | $2,459.51 – $16,106.00 | 6 |
| Impres&prep facial prosth CPT 21088 | not published | not published | $2,459.51 – $16,106.00 | 6 |
| Impres&prep intrm obt prosth CPT 21079 | not published | not published | $2,459.51 – $16,106.00 | 6 |
| Impres&prep mndbl res prosth CPT 21081 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Impres&prep nasal prosth CPT 21087 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Impres&prep oral surg splint CPT 21085 | not published | not published | $175.70 – $2,334.00 | 6 |
| Impres&prep orbital prosth CPT 21077 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Impres&prep paltl aug prosth CPT 21082 | not published | not published | $2,459.51 – $16,106.00 | 6 |
| Impres&prep paltl lft prosth CPT 21083 | not published | not published | $2,459.51 – $16,106.00 | 6 |
| Impres&prep sp aid prosth CPT 21084 | not published | not published | $2,459.51 – $16,106.00 | 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.