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 |
|---|---|---|---|---|
| Insj stablj dev w/dcmprn CPT 22867 | not published | not published | $13,007.15 – $33,471.73 | 6 |
| Insj stablj dev w/dcmprn CPT 22868 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Insj stablj dev without dcmprn CPT 22869 | not published | not published | $9,524.15 – $24,508.80 | 6 |
| Insj stablj dev without dcmprn CPT 22870 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Ins left heart vent thor inscn ecmo CPT 33988 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Ins lv lead exist pm/icd CPT 33224 | $21,388.40 | $38,888.00 | $7,609.00 – $43,643.00 | 6 |
| Ins mark abd/pel for right perq CPT 49411 | $1,264.45 | $2,299.00 | $1,026.79 – $4,761.00 | 6 |
| Ins mark thor for right perq CPT 32553 | $1,294.70 | $2,354.00 | $1,026.79 – $4,761.00 | 6 |
| Insole orthotic freedom sz6 6816 HCPCS L3060 | not published | not published | $67.99 – $174.95 | 4 |
| Ins picad w subq port 5yr> CPT 36571 | $2,494.80 | $4,536.00 | $2,342.32 – $8,770.00 | 6 |
| Ins picc wo subq prt/pmp w image guidnc <5yr CPT 36572 | not published | not published | $465.35 – $3,030.00 | 6 |
| Ins pm gen exist dual lead CPT 33230 | not published | not published | $8,923.00 – $54,996.00 | 6 |
| Ins pm gen w/exist mlt leads CPT 33221 | $3,353.35 | $6,097.00 | $8,923.00 – $36,770.21 | 6 |
| Ins pq tunnld ip cath w/img CPT 49418 | $3,232.90 | $5,878.00 | $2,656.06 – $8,770.00 | 6 |
| Ins/rplcm prq eltrd ra pn ea CPT 64597 | not published | not published | $2,334.00 – $5,512.00 | 2 |
| Ins/rplcmt prq eltrd ra pn 1 CPT 64596 | not published | not published | $7,609.00 – $27,583.00 | 5 |
| Ins/rplc spi npg/rcvr pocket CPT 63685 | not published | not published | $8,923.00 – $58,906.76 | 6 |
| Ins/rpl ldless pm right vent w img & eval CPT 33274 | $13,364.45 | $24,299.00 | $8,923.00 – $44,873.00 | 6 |
| Ins/rpl pm gen exist dual lead CPT 33213 | not published | not published | $7,609.00 – $27,583.00 | 6 |
| Ins/rpl pm gen exist sgl lead CPT 33212 | $2,857.25 | $5,195.00 | $6,138.95 – $27,583.00 | 6 |
| Ins/rpl pm w/tv ld atrl CPT 33206 | $5,883.35 | $10,697.00 | $7,609.00 – $27,583.00 | 6 |
| Ins/rpl prph sac/gstr npg/r CPT 64590 | not published | not published | $8,923.00 – $44,873.00 | 6 |
| Ins/rpl wireless pulm art sensor incl s&i CPT 33289 | $33,184.25 | $60,335.00 | $8,923.00 – $54,996.00 | 6 |
| Insrt/redo neurostim 1 array CPT 61885 | not published | not published | $8,923.00 – $58,906.76 | 6 |
| Ins sk-mnt crnl nstm pg/rcvr CPT 61889 | not published | not published | $8,923.00 – $8,923.00 | 1 |
| Ins subq extnsn pertneal cath CPT 49435 | not published | not published | $3,579.00 – $5,512.00 | 3 |
| Install spinal shunt CPT 63740 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Install spinal shunt 63741 CPT 63741 | not published | not published | $4,428.00 – $16,752.93 | 6 |
| Inst fibrinolysis agent ini day CPT 32561 | $712.25 | $1,295.00 | $465.35 – $3,030.00 | 6 |
| Inst fibrinolysis agent sbsq d CPT 32562 | $712.25 | $1,295.00 | $465.35 – $3,030.00 | 6 |
| Insti hexaminolevulinate hcl HCPCS A9589 | not published | not published | $1,516.25 – $3,753.54 | 4 |
| Instillation anticarcinogenic agent bladder CPT 51720 | $548.29 | $996.89 | $517.28 – $2,334.00 | 6 |
| Instill, bupivac and meloxic HCPCS C9088 | not published | not published | $2.10 – $2.10 | 1 |
| Instill pharm renal pelvis HCPCS C9789 | not published | not published | $907.99 – $7,791.00 | 5 |
| Instll rx agnt into rnal tub CPT 50391 | not published | not published | $185.35 – $2,334.00 | 6 |
| Ins trurl ablt trnsdc thr Ultrasound CPT 51721 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Inst tauro 1.35mg/hep 100u HCPCS J0911 | not published | not published | $3.16 – $23.58 | 5 |
| Ins tun cvad 2 cath w/subq port(s) CPT 36566 | not published | not published | $4,127.91 – $18,364.00 | 6 |
| Ins tun cv cath wo subq prt/pm CPT 36557 | $11,149.60 | $20,272.00 | $4,127.91 – $18,364.00 | 6 |
| Ins tun cv cath wo subq prt/pm CPT 36558 | $2,621.85 | $4,767.00 | $2,342.32 – $8,770.00 | 6 |
| Ins tun intraperit dia cath CPT 49421 | not published | not published | $2,656.06 – $8,770.00 | 6 |
| Inst via cath agent pleurds CPT 32560 | $1,576.85 | $2,867.00 | $465.35 – $3,030.00 | 6 |
| Insulin for insulin pump use HCPCS J1817 | not published | not published | $2.58 – $6.48 | 5 |
| Insulin suppression panel CPT 80432 | not published | not published | $115.64 – $319.63 | 7 |
| Insulin tolerance panel CPT 80434 | not published | not published | $204.72 – $550.11 | 7 |
| Insulin tolerance panel CPT 80435 | not published | not published | $77.25 – $198.79 | 7 |
| Insulin total CPT 83525 | $100.10 | $182.00 | $8.57 – $22.06 | 7 |
| Ins vag brachytx device CPT 57156 | not published | not published | $226.06 – $2,334.00 | 6 |
| Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm HCPCS Q4114 | not published | not published | $1,643.79 – $4,357.67 | 4 |
| Integra meshed bil wound mat HCPCS C9363 | $3,306.93 | $6,012.60 | not published | 0 |
| Intens behave ther cardio dx HCPCS G0446 | not published | not published | $27.80 – $71.53 | 4 |
| Intens cardiac rehab no exer HCPCS G0423 | not published | not published | $95.63 – $246.08 | 4 |
| Intens cardiac rehab w/exerc HCPCS G0422 | not published | not published | $95.63 – $246.08 | 4 |
| Intercalary algrft compl CPT 20934 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Interdental fixation CPT 21110 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Interdental wirg oth/thn fx CPT 21497 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Interdiscal perq aspir dx CPT 62267 | $556.05 | $1,011.00 | $525.32 – $3,030.00 | 6 |
| Interferon alfa-2a inj HCPCS J9213 | not published | not published | $92.45 – $92.45 | 1 |
| Interferon alfa-2b inj HCPCS J9214 | not published | not published | $34.35 – $34.35 | 1 |
| Interferon alfacon-1 inj HCPCS J9212 | not published | not published | $16.75 – $16.75 | 1 |
| Interferon alfa-n3 inj HCPCS J9215 | not published | not published | $98.39 – $98.39 | 1 |
| Interferon beta-1a 30 mcg/0.5 ml im injection (wrapper) HCPCS Q3027 | not published | not published | $102.90 – $151.42 | 2 |
| Interferon beta-1a inj HCPCS J1826 | not published | not published | $5,998.05 – $5,998.05 | 1 |
| Interferon beta-1b / .25 mg HCPCS J1830 | not published | not published | $1,333.45 – $1,333.45 | 1 |
| Interferon gamma 1-b inj HCPCS J9216 | not published | not published | $26,600.24 – $26,600.24 | 1 |
| Interfyl, 1 mg HCPCS Q4171 | not published | not published | $13.34 – $32.42 | 4 |
| Intermediate visual field xm CPT 92082 | not published | not published | $43.76 – $112.62 | 4 |
| Internal nerve revision 64727 CPT 64727 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Interrogate subq defib CPT 93261 | not published | not published | $27.69 – $71.25 | 4 |
| Interrogation vad in person CPT 93750 | not published | not published | $70.53 – $2,334.00 | 6 |
| Interrog dev eval icpms ip CPT 93290 | $144.10 | $262.00 | $27.69 – $71.25 | 4 |
| Interrog dev eval scrms ip CPT 93291 | $133.10 | $242.00 | $21.46 – $55.21 | 4 |
| Interrog device eval heart CPT 93289 | $168.30 | $306.00 | $27.69 – $71.25 | 4 |
| Interrog evl pm/ldls pm ip CPT 93288 | $143.00 | $260.00 | $27.69 – $71.25 | 4 |
| Interscap-thor myoelectronic HCPCS L6975 | not published | not published | $16,375.66 – $42,140.03 | 4 |
| Interscapular-thor switch CT HCPCS L6970 | not published | not published | $14,856.76 – $38,231.41 | 4 |
| Interthoracoscplr amputation CPT 23900 | not published | not published | $3,735.00 – $24,508.80 | 6 |
| Intestinal stricturoplasty CPT 44615 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Intestine transplnt cadaver CPT 44135 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Int hrhc lig 1 hroid without img CPT 46945 | not published | not published | $2,059.07 – $7,791.00 | 6 |
| Int hrhc lig 2+hroid without img CPT 46946 | not published | not published | $2,059.07 – $7,791.00 | 6 |
| Intl custm cong/latyp insert HCPCS L5681 | not published | not published | $1,214.80 – $3,126.10 | 4 |
| Intra-atrial pacing CPT 93610 | not published | not published | $3,579.00 – $14,889.41 | 6 |
| Intra-atrial recording CPT 93602 | $7,333.70 | $13,334.00 | $3,579.00 – $14,889.41 | 6 |
| Intracard echo interv w/s&i CPT 93662 | $5,370.75 | $9,765.00 | $1,887.00 – $2,334.00 | 2 |
| Intracran angioplsty w/stent CPT 61635 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Intracranial angioplasty CPT 61630 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Intracranial complete study CPT 93886 | not published | not published | $177.00 – $455.49 | 4 |
| Intracranial limited study CPT 93888 | not published | not published | $77.56 – $199.58 | 4 |
| Intracranial vessel surgery CPT 61680 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Intracranial vessel surgery CPT 61682 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Intracranial vessel surgery CPT 61684 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Intracranial vessel surgery CPT 61686 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Intracranial vessel surgery CPT 61690 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Intracranial vessel surgery CPT 61692 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Intranasal biopsy 30100 CPT 30100 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Intranasal reconstruction CPT 30620 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Intraop colon lavage add-on CPT 44701 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Intraop epicard/endocard/pace/map/ 93631 CPT 93631 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Intraop hipec px 1st 60 min CPT 96547 | not published | not published | $2,334.00 – $2,334.00 | 1 |
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.