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 |
|---|---|---|---|---|
| Incision of neck of femur CPT 27161 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Incision of palm tendon CPT 26450 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Incision of prostate CPT 52450 | not published | not published | $2,614.94 – $7,791.00 | 6 |
| Incision of pyloric muscle 43520 CPT 43520 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Incision of rectal abscess CPT 46060 | not published | not published | $2,059.07 – $5,298.68 | 6 |
| Incision of small bowel 44010 CPT 44010 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Incision of sperm duct CPT 55200 | not published | not published | $2,614.94 – $7,791.00 | 6 |
| Incision of spinal nerve 64772 CPT 64772 | not published | not published | $1,448.59 – $7,791.00 | 6 |
| Incision of stomach nerves CPT 64755 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Incision of tendon & muscle CPT 23405 | $4,147.55 | $7,541.00 | $5,382.89 – $13,851.98 | 6 |
| Incision of tendon sheath CPT 25000 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Incision of thigh CPT 27448 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Incision of thigh CPT 27450 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Incision of thigh tendon CPT 27306 | $3,100.35 | $5,637.00 | $2,427.27 – $7,791.00 | 6 |
| Incision of thigh tendon CPT 27390 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Incision of thigh tendons CPT 27307 | $2,375.45 | $4,319.00 | $2,427.27 – $8,770.00 | 6 |
| Incision of thigh tendons CPT 27391 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Incision of thigh tendons CPT 27392 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Incision of tibia CPT 27705 | not published | not published | $5,382.89 – $16,106.00 | 6 |
| Incision of tibia & fibula CPT 27709 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Incision of toe tendons 28011 CPT 28011 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Incision of tongue fold CPT 41010 | $3,078.35 | $5,597.00 | $1,151.01 – $4,761.00 | 6 |
| Incision of tongue nerve CPT 64740 | not published | not published | $1,448.59 – $7,791.00 | 6 |
| Incision of urethra CPT 53000 | not published | not published | $1,550.71 – $7,791.00 | 6 |
| Incision of urethra CPT 53010 | not published | not published | $3,977.55 – $10,235.57 | 6 |
| Incision of urethra CPT 53020 | not published | not published | $1,550.71 – $7,791.00 | 6 |
| Incision of urethra CPT 53025 | not published | not published | $1,550.71 – $7,791.00 | 6 |
| Incision of vagus nerve CPT 64760 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Incision of windpipe CPT 31601 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Incision of windpipe CPT 31610 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Incision of wrist capsule CPT 25085 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Incision secondary cataract CPT 66820 | not published | not published | $1,712.02 – $4,405.59 | 6 |
| Incision tendon sheath CPT 26055 | $2,850.65 | $5,183.00 | $1,192.86 – $4,761.00 | 6 |
| Incisn of toe tndn CPT 28010 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Incisn windpipe CPT 31600 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Incis spine 3 column adl seg CPT 22208 | not published | not published | $1,887.00 – $6,779.00 | 3 |
| Incis spine 3 column lumbar CPT 22207 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Incis spine 3 column thorac CPT 22206 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Incobotulinumtoxin a HCPCS J0588 | not published | not published | $3.96 – $14.45 | 8 |
| Inc&subq plmt crnl bone grf CPT 61316 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Induced ab 1+vag supp d&c CPT 59856 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Induced ab 1+vag supp hyst CPT 59857 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Induced ab 1+ vag sup w/dlv fetus CPT 59855 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Induced abortion 1+njx d&c CPT 59851 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Induced abortion 1+njx hyst CPT 59852 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Induced abortion d&c CPT 59840 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Induced abortion dilat&evac CPT 59841 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Inf agt nucleic acid human papillomavirus separately reported high-risk types pooled result(s) CPT 87626 | not published | not published | $52.65 – $135.49 | 7 |
| Infect ag drug suscept pheno predict CPT 87900 | $537.90 | $978.00 | $97.76 – $251.58 | 7 |
| Infect ag eia chlamydia trachomatis CPT 87320 | not published | not published | $11.25 – $28.95 | 7 |
| Infect ag eia influenza a or b ea CPT 87400 | not published | not published | $10.60 – $27.27 | 7 |
| Infect ag genotype na cytomegalovirus CPT 87910 | not published | not published | $193.09 – $496.88 | 7 |
| Infect ag genotype na dna hepatitis b CPT 87912 | not published | not published | $193.09 – $496.88 | 7 |
| Infect ag genotype na hiv-1 other region CPT 87906 | $498.30 | $906.00 | $96.55 – $248.45 | 7 |
| Infect ag genotype na hiv-1 revr trn/prt CPT 87901 | $1,072.50 | $1,950.00 | $193.09 – $496.88 | 7 |
| Infect ag ia direct hiv-1 antgn CPT 87806 | not published | not published | $24.58 – $63.25 | 7 |
| Infect ag ia optc obs chlamydia trach CPT 87810 | not published | not published | $24.26 – $68.11 | 7 |
| Infect ag ia optc obs influenza CPT 87804 | not published | not published | $12.41 – $31.94 | 7 |
| Infect ag if ea plyvlnt antsrm CPT 87300 | not published | not published | $8.98 – $23.12 | 7 |
| Infect ag if hep delta agent CPT 87380 | not published | not published | $13.77 – $35.43 | 7 |
| Infect ag if influenza a CPT 87276 | $35.75 | $65.00 | $12.05 – $31.02 | 7 |
| Infect ag if influenza b CPT 87275 | $27.50 | $50.00 | $9.19 – $23.64 | 7 |
| Infect ag if legionella pneumophila CPT 87278 | $59.40 | $108.00 | $11.70 – $30.11 | 7 |
| Infect ag if nos ea CPT 87299 | $35.75 | $65.00 | $12.08 – $31.07 | 7 |
| Infect ag if pneumocystis carinii CPT 87281 | $26.40 | $48.00 | $8.98 – $23.12 | 7 |
| Infect ag if varicella zoster CPT 87290 | not published | not published | $10.06 – $25.90 | 7 |
| Infect ag na chlamydia trachomatis qnt CPT 87492 | not published | not published | $40.10 – $103.20 | 7 |
| Infect ag na hep b amp CPT 87516 | not published | not published | $26.32 – $67.72 | 7 |
| Infect ag na herpes simplex quant CPT 87530 | not published | not published | $32.13 – $82.68 | 7 |
| Infect ag na hpv high-risk types CPT 87624 | $246.95 | $449.00 | $26.32 – $67.72 | 7 |
| Infect ag na influenza r/amp 1st 2 types CPT 87502 | $364.65 | $663.00 | $71.85 – $184.89 | 7 |
| Infect ag na influenza revr/amp ea type CPT 87501 | not published | not published | $38.48 – $99.03 | 7 |
| Infect ag na orthopoxvirus amp prb each CPT 87593 | $86.35 | $157.00 | $38.48 – $99.03 | 7 |
| Infect ag na resp virus 12-25 targets CPT 87633 | not published | not published | $312.58 – $804.39 | 7 |
| Infect ag phenotype na hiv-1 1-10 drugs CPT 87903 | not published | not published | $366.50 – $943.11 | 7 |
| Infect ag phenotype na hiv-1 ea addl drg CPT 87904 | not published | not published | $19.55 – $50.32 | 7 |
| Infectious agent antigen immunoassay direct optical observation sars-cov-2 CPT 87811 | not published | not published | $31.04 – $79.86 | 7 |
| Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin CPT 87324 | $81.40 | $148.00 | $8.98 – $23.12 | 7 |
| Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans CPT 87327 | not published | not published | $10.06 – $25.90 | 7 |
| Infectious agent antigen immunoassay ql/sq multi step cryptosporidium CPT 87328 | $135.30 | $246.00 | $10.36 – $26.67 | 7 |
| Infectious agent antigen immunoassay ql/sq multi step giardia CPT 87329 | $133.65 | $243.00 | $8.98 – $23.12 | 7 |
| Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool CPT 87338 | $120.45 | $219.00 | $10.78 – $27.75 | 7 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn CPT 87340 | $118.80 | $216.00 | $7.75 – $19.94 | 7 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization CPT 87341 | $17.60 | $32.00 | $7.75 – $19.94 | 7 |
| Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies CPT 87389 | $103.40 | $188.00 | $18.06 – $46.47 | 7 |
| Infectious agent antigen immunoassay ql/sq multi step legionella urine CPT 87449 | $138.05 | $251.00 | $8.98 – $23.12 | 7 |
| Infectious agent antigen immunoassay ql/sq multi step rotavirus CPT 87425 | $89.10 | $162.00 | $8.98 – $23.12 | 7 |
| Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin CPT 87427 | $89.65 | $163.00 | $8.98 – $23.12 | 7 |
| Infectious agent nucleic acid amplified probe CPT 87798 | $386.10 | $702.00 | $26.32 – $67.72 | 7 |
| Infectious agent nucleic acid amplified probe chlamydia trachomatis CPT 87491 | $265.10 | $482.00 | $26.32 – $67.72 | 7 |
| Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s) CPT 87493 | $80.85 | $147.00 | $27.95 – $71.93 | 7 |
| Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets CPT 87483 | $930.05 | $1,691.00 | $312.58 – $804.39 | 7 |
| Infectious agent nucleic acid amplified probe hsv-1 CPT 87529 | $376.75 | $685.00 | $26.32 – $67.72 | 7 |
| Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus CPT 87641 | $151.25 | $275.00 | $26.32 – $67.72 | 7 |
| Infectious agent nucleic acid amplified probe mycobacteria tuberculosis CPT 87556 | $92.95 | $169.00 | $31.26 – $80.44 | 7 |
| Infectious agent nucleic acid amplified probe neisseria gonorrhoeae CPT 87591 | $383.35 | $697.00 | $26.32 – $67.72 | 7 |
| Infectious agent nucleic acid amplified probe sars-cov-2/covid-19 CPT 87635 | $115.50 | $210.00 | $38.48 – $99.03 | 7 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b CPT 87636 | $320.65 | $583.00 | $106.97 – $275.28 | 7 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv CPT 87637 | $318.45 | $579.00 | $106.97 – $275.28 | 7 |
| Infectious agent nucleic acid amplified probe streptococcus group a CPT 87651 | not published | not published | $26.32 – $67.72 | 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.