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 |
|---|---|---|---|---|
| Apply intrcav radiat simple CPT 77761 | not published | not published | $409.89 – $1,054.79 | 4 |
| Apply of finger splint 29131 CPT 29131 | not published | not published | $43.76 – $2,334.00 | 6 |
| Apply rem fixation device CPT 20660 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Apply rigid leg cast 29445 CPT 29445 | $925.65 | $1,683.00 | $207.48 – $2,334.00 | 6 |
| Apply short leg castambul type 29425 CPT 29425 | not published | not published | $207.48 – $2,334.00 | 6 |
| Apply surf ldr radionuclide CPT 77789 | not published | not published | $75.69 – $194.77 | 4 |
| App mltpln uni xtrnl fix 1st CPT 20696 | not published | not published | $8,657.00 – $51,798.34 | 6 |
| App mltpln uni xtrnl fix xch CPT 20697 | not published | not published | $1,192.86 – $3,069.63 | 6 |
| App skn cll ssp f/n/g/hf 1st CPT 15017 | not published | not published | $1,530.61 – $3,938.76 | 4 |
| App skn cl ssp agrft t/a/l 1 CPT 15015 | not published | not published | $1,530.61 – $3,938.76 | 4 |
| Aprepitant 130 mg/18 ml (7.2 mg/ml) intravenous emulsion HCPCS J0185 | not published | not published | $1.19 – $4.64 | 8 |
| #aptt mix-1:1 incubated CPT 87532 | not published | not published | $26.32 – $67.72 | 7 |
| Aqaprn-4 antb flo cytmtry ea CPT 86053 | $62.15 | $113.00 | $12.05 – $72.82 | 7 |
| Aquaporin-4 antibody cba each CPT 86052 | $593.45 | $1,079.00 | $9.04 – $23.26 | 7 |
| Aquaporin-4 antibody elisa CPT 86051 | not published | not published | $8.65 – $22.25 | 7 |
| Aqua therapy w/exercise/ea 15 min 97113 CPT 97113 | $89.10 | $162.00 | $26.98 – $69.42 | 4 |
| Aquatic exercise - group charge CPT 97150 | $50.05 | $91.00 | $13.10 – $33.72 | 4 |
| Aqueous shunt eye w/graft CPT 66180 | not published | not published | $3,947.51 – $16,106.00 | 6 |
| Aqueous shunt eye without graft CPT 66179 | not published | not published | $3,947.51 – $16,106.00 | 6 |
| Argatroban nonesrd (accord) HCPCS J0891 | not published | not published | $1.36 – $4.95 | 5 |
| Argatroban nonesrd (auromed) HCPCS J0898 | not published | not published | $1.47 – $3.86 | 3 |
| Argatroban nonesrd use 1mg HCPCS J0883 | not published | not published | $0.65 – $2.18 | 6 |
| Aripiprazole 441 mg/1.6 ml inj HCPCS J1944 | not published | not published | $2.67 – $8.79 | 8 |
| Aripiprazole injection HCPCS J0400 | not published | not published | $0.87 – $0.87 | 1 |
| Arsenic trioxide 2 mg/ml intravenous solution HCPCS J9017 | not published | not published | $5.07 – $12.74 | 5 |
| Art byp aor celiac msn and renal 35631 CPT 35631 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art byp aortofemoral 35647 CPT 35647 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art byp aortoiliac 35637 CPT 35637 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art bypass aorsubcl/carot/innom 35626 CPT 35626 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art bypass aortobifemoral 35646 CPT 35646 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art bypass aortobi-iliac 35638 CPT 35638 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art bypass axillary-femoral 35621 CPT 35621 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art bypass axill-fem-femoral 35654 CPT 35654 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art bypass carotid-subclavian 35606 CPT 35606 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art bypass common ipsi carotid 35601 CPT 35601 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art bypass fem-ant-post tib/prl 35666 CPT 35666 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art bypass femoral-femoral 35661 CPT 35661 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art bypass femoral-popliteal 35656 CPT 35656 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art bypass iliofemoral 35665 CPT 35665 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art bypass subclav-subclavian 35612 CPT 35612 | $12,057.10 | $21,922.00 | $4,428.00 – $4,428.00 | 1 |
| Art byp axillary-axillary 35650 CPT 35650 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art byp grft aortbifemoral 35540 CPT 35540 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art byp grft aortobi-iliac 35538 CPT 35538 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art byp grft fem-femoral 35558 CPT 35558 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art byp grft fem-popliteal 35556 CPT 35556 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art byp ilioiliac 35663 CPT 35663 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Art byp pop-tibl-prl-other 35571 CPT 35571 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Arterial blood draw/perc 36620 CPT 36620 | $198.55 | $361.00 | $1,887.00 – $5,512.00 | 3 |
| Artery by graft; iliofemoral 35565 CPT 35565 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Artery to vein shunt CPT 36835 | not published | not published | $2,342.32 – $8,770.00 | 6 |
| Artery transpose/endovas taa CPT 33889 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Artery-vein nonautograft CPT 36830 | not published | not published | $4,127.91 – $18,364.00 | 6 |
| Artery xray each vessel 7577426 CPT 75774 | $1,551.55 | $2,821.00 | $233.59 – $233.59 | 1 |
| Artery xray of abdomen 75726-26 CPT 75726 | $3,287.35 | $5,977.00 | $312.01 – $10,622.50 | 4 |
| Artery x-rays adrenal gland CPT 75731 | not published | not published | $382.80 – $6,027.57 | 4 |
| Artery x-rays adrenals CPT 75733 | not published | not published | $400.15 – $6,027.57 | 4 |
| Artery x-rays arm/leg 75710-26 CPT 75710 | $6,262.85 | $11,387.00 | $356.66 – $6,027.57 | 4 |
| Artery x-rays arms/legs 75716-26 CPT 75716 | $6,262.85 | $11,387.00 | $408.47 – $6,027.57 | 4 |
| Artery x-rays chest CPT 75756 | not published | not published | $366.18 – $6,027.57 | 4 |
| Artery x-rays lung CPT 75741 | $3,296.15 | $5,993.00 | $290.61 – $6,027.57 | 4 |
| Artery x-rays lung CPT 75746 | $1,094.50 | $1,990.00 | $318.65 – $6,027.57 | 4 |
| Artery x-rays lungs CPT 75743 | $5,560.50 | $10,110.00 | $294.18 – $6,027.57 | 4 |
| Artery xrays of pelvis 75736 26 CPT 75736 | $1,778.15 | $3,233.00 | $348.37 – $10,622.50 | 4 |
| Artery x-rays spine CPT 75705 | $6,262.85 | $11,387.00 | $430.34 – $10,622.50 | 4 |
| Art expos/graft artery perfusion 33987 CPT 33987 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Arthrd ant ntrbd min dsc crv CPT 22554 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Arthrd ant ntrbd min dsc lum CPT 22558 | not published | not published | $3,735.00 – $51,798.34 | 6 |
| Arthrd ant ntrbdy cervical CPT 22551 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Arthrd cmbn 1ntrspc lumbar CPT 22633 | not published | not published | $7,609.00 – $51,798.34 | 6 |
| Arthrd dst rad/ul jt sgm rsc CPT 25830 | not published | not published | $5,382.89 – $16,106.00 | 6 |
| Arthrd elbow jt autog graft CPT 24802 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Arthrd glenohumeral jt w/grf CPT 23802 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Arthrd pst tq 1ntrspc lum CPT 22630 | not published | not published | $7,609.00 – $51,798.34 | 6 |
| Arthrd si jt perq/min nvas CPT 27279 | not published | not published | $8,923.00 – $33,471.73 | 6 |
| Arthrd si jt prq wo tfxj dev CPT 27278 | not published | not published | $8,923.00 – $33,471.73 | 5 |
| Arthrd wrist complete wo grf CPT 25800 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Arthrd wrist lmtd without b1 grf CPT 25820 | not published | not published | $5,382.89 – $16,106.00 | 6 |
| Arthrd wrist with autograft CPT 25825 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Arthrd wrist w/sliding graft CPT 25805 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Arthrd wrst iliac/oth agrft CPT 25810 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right CPT 20605 | $958.65 | $1,743.00 | $227.71 – $2,334.00 | 6 |
| Arthrocentesis/aspiration/injection intermediate joint/bursa w/ultrasound guidance (both sides) CPT 20606 | $1,568.05 | $2,851.00 | $523.65 – $3,030.00 | 6 |
| Arthrocentesis/aspiration/injection major joint/bursa w/ultrasound guidance (both sides) CPT 20611 | $1,576.30 | $2,866.00 | $227.71 – $2,334.00 | 6 |
| Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance CPT 20600 | $749.10 | $1,362.00 | $227.71 – $2,334.00 | 6 |
| Arthrocentesis/aspiration/inj major joint/bursa without Ultrasound guidance (both sides) CPT 20610 | $982.30 | $1,786.00 | $227.71 – $2,334.00 | 6 |
| Arthrocentesis aspir+/injection small jt/bursa with Ultrasound 20604 CPT 20604 | $1,147.85 | $2,087.00 | $227.71 – $2,334.00 | 6 |
| Arthrodes/ant/cerv below c2 ea add 22552 CPT 22552 | not published | not published | $5,512.00 – $16,106.00 | 3 |
| Arthrodesis big toe joint 28760 CPT 28760 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Arthrodesis/cerv/thor/lumb/ea add 22585 CPT 22585 | not published | not published | $5,512.00 – $18,364.00 | 3 |
| Arthrodesis/combine app/ea add 22634 CPT 22634 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Arthrodesis elbw joint local CPT 24800 | not published | not published | $5,382.89 – $16,106.00 | 6 |
| Arthrodesis glenohumeral jt CPT 23800 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Arthrodesis pantalar CPT 28705 | not published | not published | $8,923.00 – $33,471.73 | 6 |
| Arthrodesis/post interbdy/ea add 22632 CPT 22632 | not published | not published | $1,887.00 – $7,609.00 | 3 |
| Arthrodesis presacral intrbod with instr l5-s1 22586 CPT 22586 | not published | not published | $7,609.00 – $33,471.73 | 6 |
| Arthrodesis/sg level/cerv/below c2 22600 CPT 22600 | not published | not published | $7,609.00 – $33,471.73 | 6 |
| Arthrodesis/sng lev/ea add ver seg 22614 CPT 22614 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Arthrodesis subtalar CPT 28725 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Arthrodesis triple CPT 28715 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Arthroplasty finger joint 26535 CPT 26535 | not published | not published | $2,427.27 – $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.