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 |
|---|---|---|---|---|
| Intraoral i+d tongue/floor lingual 41000 CPT 41000 | not published | not published | $400.09 – $2,334.00 | 6 |
| Intraoral periapical first HCPCS D0220 | not published | not published | $64.56 – $166.13 | 4 |
| Intrapul surf admin endo tube CPT 94610 | not published | not published | $162.44 – $418.02 | 4 |
| Intrauterine transfusion ftl CPT 36460 | not published | not published | $327.28 – $2,334.00 | 6 |
| Intraventricular pacing CPT 93612 | not published | not published | $3,579.00 – $14,889.41 | 6 |
| Intrinsic factor antibody CPT 86340 | $83.60 | $152.00 | $11.31 – $29.10 | 7 |
| Intrm oph exam est patient CPT 92012 | not published | not published | $98.76 – $254.15 | 4 |
| Intro cath dialysis circuit CPT 36901 | $672.10 | $1,222.00 | $1,167.76 – $4,761.00 | 6 |
| Intro cath dialysis circuit w/pta CPT 36902 | $6,267.25 | $11,395.00 | $4,222.18 – $18,364.00 | 6 |
| Intro cath dialysis circuit w/stent plcmnt CPT 36903 | $10,910.35 | $19,837.00 | $8,563.85 – $27,583.00 | 6 |
| Intro catheter aorta CPT 36200 | $1,636.25 | $2,975.00 | $1,887.00 – $5,512.00 | 3 |
| Intro cath svc/ivc CPT 36010 | $1,023.00 | $1,860.00 | $1,887.00 – $5,512.00 | 3 |
| Intro long gi tube CPT 44500 | $200.75 | $365.00 | $672.83 – $4,761.00 | 6 |
| Intro long gi tube w/mult fluo CPT 74340 | $276.65 | $503.00 | $268.66 – $268.66 | 1 |
| Intro windpipe wire/tube CPT 31730 | not published | not published | $1,320.39 – $4,761.00 | 6 |
| Intrvasc Ultrasound noncoronary 1st vessel CPT 37252 | $3,192.75 | $5,805.00 | $1,887.00 – $5,512.00 | 3 |
| Intrvasc Ultrasound noncoronary addl vessel CPT 37253 | $3,192.75 | $5,805.00 | $1,887.00 – $5,512.00 | 3 |
| Intubation endotracheal emergency procedure CPT 31500 | $884.95 | $1,609.00 | $175.70 – $2,334.00 | 6 |
| Io anal gast n-stim subsq CPT 95981 | not published | not published | $43.76 – $112.62 | 4 |
| Iodine i-123 sod iodide mil HCPCS A9509 | $743.60 | $1,352.00 | $419.18 – $419.18 | 1 |
| Iodine i-125 sodium iodide HCPCS A9527 | not published | not published | $297.24 – $764.90 | 5 |
| Io ga n-stim subsq w/reprog CPT 95982 | not published | not published | $27.69 – $71.25 | 4 |
| Ionm in operatng room 15 min CPT 95940 | $37.95 | $69.00 | not published | 0 |
| Iopamidol 250 mg iodine/ml (51 %) intravenous solution HCPCS Q9966 | not published | not published | $0.45 – $1.12 | 4 |
| Iopamidol 300 mg iodine/ml (61 %) intravenous solution HCPCS Q9967 | not published | not published | $0.15 – $0.38 | 4 |
| Io radiation tx management CPT 77469 | not published | not published | $1,093.87 – $1,093.87 | 1 |
| Io rad tx deliver by elctrns CPT 77425 | not published | not published | $5,463.81 – $14,060.20 | 4 |
| Io rad tx delivery by x-ray CPT 77424 | not published | not published | $5,463.81 – $14,060.20 | 4 |
| Ipilimumab 5 mg/ml intravenous solution (wrapper) HCPCS J9228 | not published | not published | $142.82 – $490.18 | 8 |
| Ipratropium bromide non-comp HCPCS J7644 | not published | not published | $0.40 – $1.01 | 5 |
| Irinotecan 20 mg/ml intravenous solution (wrapper) HCPCS J9206 | not published | not published | $1.80 – $5.36 | 5 |
| Irinotecan liposomal 4.3 mg/ml intravenous HCPCS J9205 | not published | not published | $49.40 – $174.83 | 8 |
| Iron CPT 83540 | $55.00 | $100.00 | $4.85 – $12.49 | 7 |
| Iron binding capacity CPT 83550 | $15.40 | $28.00 | $6.56 – $16.87 | 7 |
| Iron dextran 50 mg/ml injection solution HCPCS J1750 | not published | not published | $14.24 – $47.37 | 8 |
| Iron stain peripheral blood CPT 85536 | not published | not published | $5.16 – $13.28 | 7 |
| Iron sucrose 20 mg iron/ml intravenous solution (wrapper) HCPCS J1756 | not published | not published | $0.24 – $0.63 | 5 |
| Irradiation of blood product each unit reference CPT 86945 | $102.85 | $187.00 | $27.71 – $71.30 | 5 |
| Irrigation implantable venous access device for drug delivery systems CPT 96523 | $71.50 | $130.00 | $43.76 – $112.62 | 4 |
| Irrigation sphenoid sinus CPT 31002 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Irrigation vagina and/or appl medicament tx disease CPT 57150 | not published | not published | $43.76 – $2,334.00 | 6 |
| Isatuximab-irfc 20 mg/ml intravenous solution HCPCS J9227 | not published | not published | $66.12 – $216.03 | 8 |
| Island pedicle flap graft CPT 15740 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Ivc venogram s&i CPT 75825 | $2,500.30 | $4,546.00 | $266.85 – $6,027.57 | 4 |
| IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour CPT 96367 | $151.80 | $276.00 | $53.41 – $137.45 | 4 |
| IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 | $151.80 | $276.00 | not published | 0 |
| IV infusion therapy/prophylaxis/diagnosis each additional 1 hour CPT 96366 | $151.80 | $276.00 | $34.74 – $89.39 | 4 |
| IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour CPT 96365 | $300.85 | $547.00 | $157.79 – $406.05 | 4 |
| IV inj ra drug dx study CPT 78808 | not published | not published | $155.22 – $763.16 | 4 |
| IV njx tst vasc flo flap/grf CPT 15860 | not published | not published | $331.39 – $2,334.00 | 6 |
| Ivp w/nephrotomography CPT 74415 | $469.15 | $853.00 | $130.12 – $334.84 | 4 |
| Ivp w/wo kub w/wo tomography CPT 74400 | $437.80 | $796.00 | $130.12 – $334.84 | 4 |
| Ixabepilone 15 mg intravenous solution HCPCS J9207 | not published | not published | $104.82 – $371.43 | 8 |
| Jak2 targeted sequence analysis CPT 81279 | $493.90 | $898.00 | $138.90 – $357.44 | 7 |
| Jaw arthroscopy/surgery CPT 29800 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Jaw arthroscopy/surgery CPT 29804 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Jejunstmy tube plcmt CPT 44372 | $1,179.20 | $2,144.00 | $1,423.51 – $4,761.00 | 6 |
| John cunningham antibody CPT 86711 | not published | not published | $12.67 – $32.60 | 7 |
| J-tube placement CPT 44015 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Kafo dbl solid stirrup band/ HCPCS L2020 | not published | not published | $1,015.75 – $2,613.86 | 4 |
| Kafo dbl solid stirrup without j HCPCS L2030 | not published | not published | $998.39 – $2,569.20 | 4 |
| Kafo fem fx cast molded to p HCPCS L2128 | not published | not published | $1,477.83 – $3,802.95 | 4 |
| Kafo fem fx cast semi-rigid HCPCS L2134 | not published | not published | $1,062.18 – $2,733.34 | 4 |
| Kafo fem fx cast thermoplas HCPCS L2126 | not published | not published | $1,176.93 – $3,028.63 | 4 |
| Kafo femoral fx cast rigid HCPCS L2136 | not published | not published | $1,162.40 – $2,991.23 | 4 |
| Kafo femoral fx cast soft HCPCS L2132 | not published | not published | $897.02 – $2,308.32 | 4 |
| Kafo pla sin up w/wo k/a cus HCPCS L2034 | not published | not published | $1,872.44 – $4,818.42 | 4 |
| Kafo plas sing free knee mol HCPCS L2037 | not published | not published | $1,528.52 – $3,933.38 | 4 |
| Kafo plastic pediatric size HCPCS L2035 | not published | not published | $159.68 – $410.92 | 4 |
| Kafo sing fre stirr thi/calf HCPCS L2000 | not published | not published | $1,031.11 – $2,653.38 | 4 |
| Kafo sng/dbl mechanical act HCPCS L2005 | not published | not published | $3,776.95 – $9,719.34 | 4 |
| Kafo sng solid stirrup without j HCPCS L2010 | not published | not published | $804.26 – $2,069.62 | 4 |
| Kafo without joint multi-axis an HCPCS L2038 | not published | not published | $1,232.20 – $3,170.87 | 4 |
| Keratomileusis CPT 65760 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Keratophakia CPT 65765 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Keratoprosthesis CPT 65770 | not published | not published | $7,609.00 – $27,691.88 | 6 |
| Kerecis marigen shld sq cm HCPCS A2019 | not published | not published | $92.32 – $1,860.23 | 5 |
| Ketamine and metabolite screen - quest CPT 80357 | not published | not published | $35.06 – $35.06 | 1 |
| Ketogenic steroids fract CPT 83582 | not published | not published | $11.60 – $29.86 | 7 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $44.00 | $80.00 | $6.13 – $15.77 | 7 |
| Ketorolac 15 mg/ml injection (wrapper) HCPCS J1885 | not published | not published | $0.21 – $2.05 | 8 |
| Kidney endoscopy CPT 50551 | not published | not published | $3,579.00 – $10,235.57 | 6 |
| Kidney endoscopy CPT 50553 | not published | not published | $3,977.55 – $10,235.57 | 6 |
| Kidney endoscopy CPT 50570 | not published | not published | $2,614.94 – $6,729.12 | 6 |
| Kidney endoscopy CPT 50575 | not published | not published | $3,977.55 – $16,106.00 | 6 |
| Kidney endoscopy & biopsy CPT 50555 | not published | not published | $3,579.00 – $18,071.30 | 6 |
| Kidney endoscopy & biopsy CPT 50574 | not published | not published | $2,614.94 – $6,729.12 | 6 |
| Kidney endoscopy & treatment CPT 50557 | not published | not published | $7,022.52 – $18,071.30 | 6 |
| Kidney endoscopy & treatment CPT 50561 | not published | not published | $3,977.55 – $10,235.57 | 6 |
| Kidney endoscopy & treatment CPT 50576 | not published | not published | $3,579.00 – $18,071.30 | 6 |
| Kidney endoscopy & treatment CPT 50580 | not published | not published | $3,579.00 – $10,235.57 | 6 |
| Kidney function study CPT 78725 | not published | not published | $296.56 – $763.16 | 4 |
| Kidney imaging morphology CPT 78700 | not published | not published | $296.56 – $763.16 | 4 |
| Kidney imag w/bld flow multi CPT 78709 | $2,038.30 | $3,706.00 | $402.79 – $1,036.52 | 4 |
| Kidney img w/bldflw sgl without rx CPT 78707 | $1,898.05 | $3,451.00 | $402.79 – $1,036.52 | 4 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $489.50 | $890.00 | $77.56 – $199.58 | 4 |
| Kit cath ivl 2.5x40mm 135cm shockwave s4 HCPCS C1761 | $6,947.19 | $12,631.25 | not published | 0 |
| Kit gene analys d816 variant CPT 81273 | $687.50 | $1,250.00 | $93.65 – $241.00 | 7 |
| Kit lead specify 5-6-5 HCPCS C1778 | $3,957.94 | $7,196.26 | not published | 0 |
| Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm HCPCS Q4105 | not published | not published | $25.58 – $237.56 | 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.