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 |
|---|---|---|---|---|
| Kit sound processor cochlear osia 2 HCPCS L8691 | not published | not published | $1,590.44 – $4,092.72 | 4 |
| Kit tissue closure sealant adhesive air leak progel 4 ml pleura HCPCS C2615 | $1,509.41 | $2,744.39 | not published | 0 |
| Knee Arthroscopy (Cartilage Repair) CPT 29877 | not published | not published | $2,427.27 – $8,770.00 | 7 |
| Knee arthroscopy/drainage CPT 29871 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Knee arthroscopy dx CPT 29870 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Knee Arthroscopy (Meniscus Repair) CPT 29881 | not published | not published | $2,427.27 – $8,770.00 | 7 |
| Knee arthroscopy/surgery CPT 29850 | not published | not published | $1,192.86 – $8,770.00 | 6 |
| Knee arthroscopy/surgery CPT 29851 | not published | not published | $1,192.86 – $18,364.00 | 6 |
| Knee arthroscopy/surgery CPT 29873 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Knee arthroscopy/surgery CPT 29874 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Knee arthroscopy/surgery CPT 29875 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Knee arthroscopy/surgery CPT 29876 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Knee arthroscopy/surgery CPT 29879 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Knee arthroscopy/surgery CPT 29880 | not published | not published | $2,427.27 – $8,770.00 | 7 |
| Knee arthroscopy/surgery CPT 29882 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Knee arthroscopy/surgery CPT 29883 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Knee arthroscopy/surgery CPT 29884 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Knee arthroscopy/surgery CPT 29886 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Knee arthroscopy/surgery CPT 29887 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Knee arthroscopy/surgery CPT 29888 | not published | not published | $5,382.89 – $18,364.00 | 7 |
| Knee arthroscopy/surgery CPT 29889 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Knee cap medial or lateral p HCPCS L2800 | not published | not published | $92.82 – $238.86 | 4 |
| Knee control condylar pad HCPCS L2810 | not published | not published | $75.28 – $193.73 | 4 |
| Knee control full kneecap HCPCS L2795 | not published | not published | $75.60 – $194.54 | 4 |
| Knee disart expand wall sock HCPCS L5653 | not published | not published | $624.61 – $1,607.32 | 4 |
| Knee disarticulat leather so HCPCS L5640 | not published | not published | $676.66 – $1,741.27 | 4 |
| Knee disc/dial lock/adj flex HCPCS L2425 | not published | not published | $132.13 – $340.01 | 4 |
| Knee jnt ratchet lock ea jnt HCPCS L2430 | not published | not published | $132.13 – $340.01 | 4 |
| Knee joint cam lock each joi HCPCS L2415 | not published | not published | $111.98 – $288.15 | 4 |
| Knee joint drop lock ea jnt HCPCS L2405 | not published | not published | $80.36 – $206.78 | 4 |
| Knee lift loop drop lock rin HCPCS L2492 | not published | not published | $108.11 – $278.21 | 4 |
| Knee MRI (with and without contrast) CPT 73723 | $2,532.20 | $4,604.00 | $258.81 – $665.99 | 4 |
| Knee MRI (with contrast) CPT 73722 | $2,411.75 | $4,385.00 | $581.54 – $1,496.49 | 4 |
| Knee MRI (without contrast) CPT 73721 | $2,296.80 | $4,176.00 | $177.00 – $455.49 | 4 |
| Knee orth pos locking joint HCPCS L1831 | not published | not published | $271.28 – $698.08 | 4 |
| Knee-shin exo fluid swing ph HCPCS L5724 | not published | not published | $1,595.45 – $4,105.63 | 4 |
| Knee-shin exo frct swg & sta HCPCS L5718 | not published | not published | $851.19 – $2,190.40 | 4 |
| Knee-shin exo frict swg & st HCPCS L5712 | not published | not published | $395.64 – $1,018.11 | 4 |
| Knee-shin exo mech stance ph HCPCS L5716 | not published | not published | $796.02 – $2,048.42 | 4 |
| Knee-shin exo mnl lock ultra HCPCS L5711 | not published | not published | $554.23 – $1,426.21 | 4 |
| Knee-shin exo variable frict HCPCS L5714 | not published | not published | $402.56 – $1,035.93 | 4 |
| Knee-shin ext jnts fld swg e HCPCS L5726 | not published | not published | $1,899.45 – $4,887.92 | 4 |
| Knee-shin fluid swg & stance HCPCS L5728 | not published | not published | $2,225.95 – $5,728.10 | 4 |
| Knee-shin pneum/hydra pneum HCPCS L5780 | not published | not published | $1,225.55 – $3,153.76 | 4 |
| Knee-shin pneum swg frct exo HCPCS L5722 | not published | not published | $1,035.11 – $2,663.69 | 4 |
| Knee-shin pro flex/ext cont HCPCS L5859 | not published | not published | $13,399.60 – $34,481.65 | 4 |
| Knee-shin sys hydraul stance HCPCS L5848 | not published | not published | $993.09 – $2,555.55 | 4 |
| Knee-shin sys stance flexion HCPCS L5845 | not published | not published | $1,655.29 – $4,259.61 | 4 |
| Knee X-ray CPT 73564 | $304.15 | $553.00 | $77.56 – $199.58 | 4 |
| Kne-shin exo sng axi mnl loc HCPCS L5710 | not published | not published | $330.23 – $849.80 | 4 |
| Kne sing axis fric shin sach HCPCS L5200 | not published | not published | $3,357.02 – $8,638.72 | 4 |
| Ko dbl upright w/air pre cst HCPCS L1847 | not published | not published | $530.14 – $1,364.24 | 4 |
| Ko dbl upright w/air pre ots HCPCS L1848 | not published | not published | $530.14 – $1,364.24 | 4 |
| Ko derot ant cruciate custom HCPCS L1840 | not published | not published | $866.79 – $2,230.54 | 4 |
| Ko elastic w/joints pre ots HCPCS L1812 | not published | not published | $58.88 – $151.52 | 4 |
| Ko rigid without joints pre ots HCPCS L1836 | not published | not published | $75.02 – $193.06 | 4 |
| Ko single upright pre cst HCPCS L1843 | not published | not published | $827.03 – $2,128.23 | 4 |
| Ko single upright prefab ots HCPCS L1851 | not published | not published | $504.50 – $1,298.25 | 4 |
| Ko supracondylar socket mold HCPCS L1860 | not published | not published | $1,149.37 – $2,957.71 | 4 |
| Ko swedish type pre ots HCPCS L1850 | not published | not published | $172.80 – $444.67 | 4 |
| Ko w/0 joint rigid molded to HCPCS L1834 | not published | not published | $669.02 – $1,721.60 | 4 |
| Ko w adj flex/ext rotat mold HCPCS L1846 | not published | not published | $1,078.44 – $2,775.19 | 4 |
| Ko w/adj jt rot cntrl molded HCPCS L1844 | not published | not published | $1,403.63 – $3,612.01 | 4 |
| Kras gene addl variants CPT 81276 | $855.25 | $1,555.00 | $144.94 – $372.97 | 7 |
| Kras gene variants exon 2 CPT 81275 | $855.25 | $1,555.00 | $144.94 – $372.97 | 7 |
| Kyleena, 19.5 mg HCPCS J7296 | not published | not published | $3,779.24 – $3,779.24 | 1 |
| Kyphectomy 1-2 segments CPT 22818 | not published | not published | $6,779.00 – $33,471.73 | 6 |
| Kyphectomy 3 or more CPT 22819 | not published | not published | $6,779.00 – $33,471.73 | 6 |
| Kyphosis pad HCPCS L1020 | not published | not published | $99.32 – $255.59 | 4 |
| Kyphosis pad floating HCPCS L1025 | not published | not published | $143.30 – $368.75 | 4 |
| Lab draw < 3 yrs fem/jugular 36400 CPT 36400 | $64.90 | $118.00 | not published | 0 |
| Labetalol 5 mg/ml IV (wrapper) HCPCS J1920 | not published | not published | $0.32 – $0.79 | 5 |
| Labioplasty 56800 CPT 56800 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Lacer molded to patient mode HCPCS L2330 | not published | not published | $338.41 – $870.84 | 4 |
| Lactate dehydrogenase (ldh) CPT 83615 | $53.35 | $97.00 | $4.53 – $11.66 | 7 |
| Lactated ringers intravenous solution HCPCS J7120 | not published | not published | $2.53 – $6.57 | 5 |
| Lactic acid CPT 83605 | $107.80 | $196.00 | $8.68 – $22.33 | 7 |
| Lactoferrin fecal qualitative CPT 83630 | $117.70 | $214.00 | $14.78 – $38.02 | 7 |
| Lactoferrin fecal quant CPT 83631 | not published | not published | $14.72 – $37.89 | 7 |
| Lam facetc/frmt arthrd lum 1 CPT 63052 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Lam facetec & foramot crv CPT 63045 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Lam facetec & foramot lumbar CPT 63047 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Lam facetec & foramot thrc CPT 63046 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Lam factc/frmt arthrd lum ea CPT 63053 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Lamie bx/exc idrl spine lesn lmbr 63282 CPT 63282 | not published | not published | $6,779.00 – $27,583.00 | 3 |
| Lamie bx/exc idrl spine lesn thrc 63281 CPT 63281 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Lamie excise intrspinl lesion thrc 63266 CPT 63266 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Lamination collar with couplin HCPCS L6629 | not published | not published | $179.11 – $460.90 | 4 |
| Laminotomy single cervical CPT 63040 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Laminotomy single lumbar CPT 63042 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Lamiotoiotiotinotomy addl cervical 63043 CPT 63043 | not published | not published | $5,512.00 – $8,770.00 | 3 |
| Lam w/cordotomy 1stg thrc CPT 63197 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Lanreotide 120 mg/0.5 ml subcutaneous syringe HCPCS J1930 | not published | not published | $28.07 – $122.46 | 8 |
| Lanthanum carbonate oral 5mg HCPCS J0607 | not published | not published | $0.25 – $0.25 | 1 |
| Laparo ablate liver tumor rf CPT 47370 | not published | not published | $7,609.00 – $27,583.00 | 6 |
| Laparo ablate renal cyst CPT 50541 | not published | not published | $5,257.00 – $20,292.15 | 6 |
| Laparo ablate renal mass CPT 50542 | not published | not published | $7,609.00 – $27,583.00 | 6 |
| Laparo-asst vag hysterectomy CPT 58550 | not published | not published | $4,484.77 – $18,364.00 | 6 |
| Laparo cholecystectomy/explr CPT 47564 | not published | not published | $5,257.00 – $20,292.15 | 6 |
| Laparo cholecystectomy/graph CPT 47563 | not published | not published | $4,484.77 – $18,364.00 | 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.