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 |
|---|---|---|---|---|
| Laryngoplasty cricoid split CPT 31587 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Laryngoplasty fx rdctj fixj CPT 31584 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Laryngoplasty laryngeal sten CPT 31551 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Laryngoplasty laryngeal sten CPT 31552 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Laryngoplasty laryngeal sten CPT 31553 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Laryngoplasty laryngeal sten CPT 31554 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Laryngoplasty laryngeal web CPT 31580 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Laryngoplasty medialization CPT 31591 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Laryngoscope w/vc inj CPT 31570 | not published | not published | $2,765.81 – $7,117.34 | 6 |
| Laryngoscopic sensory vid CPT 92614 | not published | not published | $39.20 – $100.88 | 4 |
| Laryngoscop w/arytenoidectom CPT 31560 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Laryngoscop w/vc inj + scope CPT 31571 | not published | not published | $2,765.81 – $7,791.00 | 6 |
| Laryngoscopy and dilation CPT 31528 | not published | not published | $2,765.81 – $7,791.00 | 6 |
| Laryngoscopy and dilation CPT 31529 | not published | not published | $2,765.81 – $7,791.00 | 6 |
| Laryngoscopy direct w/wo tracheoscopy dx exc newborn CPT 31525 | not published | not published | $1,320.39 – $4,761.00 | 6 |
| Laryngoscopy for treatment CPT 31527 | not published | not published | $2,765.81 – $7,791.00 | 6 |
| Laryngoscopy telescopic CPT 31579 | not published | not published | $290.14 – $2,334.00 | 6 |
| Laryngoscopy w/biopsy CPT 31535 | not published | not published | $2,765.81 – $7,791.00 | 6 |
| Laryngoscopy w/bx & op scope CPT 31536 | not published | not published | $2,765.81 – $7,791.00 | 6 |
| Laryngoscopy w/exc of tumor CPT 31540 | not published | not published | $2,765.81 – $7,791.00 | 6 |
| Laryngoscopy w/fb & op scope CPT 31531 | not published | not published | $2,765.81 – $7,117.34 | 6 |
| Laryngoscopy w/fb removal CPT 31530 | $3,105.30 | $5,646.00 | $1,320.39 – $4,761.00 | 6 |
| Laryngoscopy with biopsy CPT 31576 | not published | not published | $1,320.39 – $4,761.00 | 6 |
| Laryngoscopy with biopsy 31510 CPT 31510 | not published | not published | $2,765.81 – $7,117.34 | 6 |
| Laryngoscopy w/w/o tracheoscopy aspiration CPT 31515 | not published | not published | $290.14 – $2,334.00 | 6 |
| Larynscop remve cart + scop CPT 31561 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Larynscop w/tumr exc + scope CPT 31541 | not published | not published | $2,765.81 – $7,791.00 | 6 |
| Laser surgery eye strands CPT 67031 | not published | not published | $408.01 – $3,030.00 | 6 |
| Laser surgery of cervix 57513 CPT 57513 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Laser surgery of prostate CPT 52647 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Laser surgery of prostate CPT 52648 | not published | not published | $3,977.55 – $16,106.00 | 6 |
| Laser surg penis lesion(s) CPT 54057 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Laser treatment of retina CPT 67039 | not published | not published | $3,066.31 – $16,106.00 | 6 |
| Laser treatment of retina CPT 67040 | not published | not published | $3,066.31 – $16,106.00 | 6 |
| Lateral canthopexy CPT 21282 | not published | not published | $2,459.51 – $6,329.15 | 6 |
| Lateral thoracic extension HCPCS L1210 | not published | not published | $225.51 – $580.31 | 4 |
| Lateral trochanteric pad HCPCS L1290 | not published | not published | $71.62 – $184.30 | 4 |
| Latex suspension sleeve each HCPCS L6632 | not published | not published | $59.66 – $153.51 | 4 |
| Lat retinacular release open CPT 27425 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Lavage cannulation maxillary sinus CPT 31000 | not published | not published | $175.70 – $2,334.00 | 6 |
| Lavh >250 gms 58553 CPT 58553 | not published | not published | $7,609.00 – $20,292.15 | 6 |
| Lb with mastopexy 15839 CPT 15839 | not published | not published | $2,154.81 – $5,545.05 | 6 |
| Lead capillary CPT 83655 | $70.40 | $128.00 | $9.08 – $23.37 | 7 |
| Lead ingevity 45cm pfret MRI HCPCS C1898 | $517.50 | $940.90 | not published | 0 |
| Leads any type vad, rep only HCPCS Q0487 | not published | not published | $315.23 – $811.20 | 4 |
| Lead tachy durata sj4 58cm HCPCS C1777 | $4,304.30 | $7,826.00 | not published | 0 |
| Lefort i-1 piece without graft CPT 21141 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Lefort i-2 piece without graft CPT 21142 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Lefort i-3/> piece with graft CPT 21147 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Lefort i-3/> piece without graft CPT 21143 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Lefort ii anterior intrusion CPT 21150 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Legg perthes orth newington HCPCS L1710 | not published | not published | $1,826.09 – $4,699.14 | 4 |
| Legg perthes orthosis trilat HCPCS L1720 | not published | not published | $1,359.70 – $3,498.97 | 4 |
| Legg perthes orth scottish r HCPCS L1730 | not published | not published | $1,147.89 – $2,953.90 | 4 |
| Legg perthes patten bottom t HCPCS L1755 | not published | not published | $1,650.34 – $4,246.87 | 4 |
| Legion pneumo dna dir prob CPT 87540 | not published | not published | $15.04 – $38.70 | 7 |
| Legion pneumo dna quant CPT 87542 | not published | not published | $31.32 – $80.60 | 7 |
| Leg perthes orth toronto typ HCPCS L1700 | not published | not published | $1,434.03 – $3,690.24 | 4 |
| Leg vein fusion 34530 CPT 34530 | not published | not published | $2,342.32 – $8,770.00 | 6 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $1,358.50 | $2,470.00 | $177.00 – $455.49 | 4 |
| Leishmania antibody CPT 86717 | not published | not published | $9.19 – $23.64 | 7 |
| Lengthening of hand tendon CPT 26478 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Lengthening of palate CPT 42227 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Lengthening of palate+pharyngeal flap 42226 CPT 42226 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Lengthening of thigh bone CPT 27466 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Lengthening of thigh tendon CPT 27393 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Lengthening of thigh tendons CPT 27394 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Lengthening of thigh tendons CPT 27395 | not published | not published | $2,427.27 – $16,106.00 | 6 |
| Lengthening or shortening - tibia and fibula 27715 CPT 27715 | not published | not published | $3,735.00 – $24,508.80 | 6 |
| Lengthen metacarpal/finger CPT 26568 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Lengthen radius or ulna CPT 25391 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Lengthen radius & ulna CPT 25393 | not published | not published | $3,735.00 – $16,106.00 | 6 |
| Lens, intraocular (new tech) HCPCS C1780 | $740.54 | $1,346.44 | not published | 0 |
| Lens iol 23.0 d 1.5 cyl eyhance toric HCPCS V2787 | $810.60 | $1,473.82 | not published | 0 |
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | $342.63 | $622.97 | not published | 0 |
| Lens iol ant chamb 10.5 HCPCS V2630 | $144.56 | $262.84 | not published | 0 |
| Lepirudin HCPCS J1945 | not published | not published | $395.42 – $395.42 | 1 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | not published | not published | $3.86 – $11.32 | 5 |
| Leukacyte transfusion CPT 86950 | not published | not published | $104.21 – $325.23 | 5 |
| Leukocyte phagocytosis CPT 86344 | not published | not published | $7.79 – $20.05 | 7 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | not published | not published | $120.26 – $492.20 | 8 |
| Leuprolide 3.75 mg intramuscular syringe kit HCPCS J1950 | not published | not published | $1,380.95 – $4,537.81 | 8 |
| Leuprolide acetate injeciton HCPCS J9218 | not published | not published | $9.65 – $24.26 | 3 |
| Leuprolide depot cipla 7.5mg HCPCS J1954 | not published | not published | $242.81 – $1,326.46 | 8 |
| Leuprolide inj, camcevi, 1mg HCPCS J1952 | not published | not published | $31.54 – $152.21 | 8 |
| Levalbuterol comp unit HCPCS J7615 | not published | not published | $5.28 – $5.28 | 1 |
| Levalbuterol non-comp con HCPCS J7612 | not published | not published | $0.31 – $0.79 | 5 |
| Levalbuterol non-comp unit HCPCS J7614 | not published | not published | $0.09 – $0.25 | 5 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | not published | not published | $0.06 – $0.13 | 5 |
| Levetiracetam therapeutic drug level CPT 80177 | $151.80 | $276.00 | $9.94 – $25.57 | 7 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | not published | not published | $1.13 – $5.15 | 5 |
| Levonorgestrel implant sys HCPCS J7306 | not published | not published | $1,023.31 – $1,023.31 | 1 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | not published | not published | $5.84 – $14.67 | 5 |
| L hrt cath chd nm/abn nt cnj CPT 93595 | not published | not published | $2,404.97 – $16,106.00 | 6 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | not published | not published | $0.17 – $0.17 | 1 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | not published | not published | $0.01 – $0.03 | 4 |
| Lidocaine therapeutic drug level CPT 80176 | $24.20 | $44.00 | $11.02 – $28.35 | 7 |
| Lift assist for elbow HCPCS L6635 | not published | not published | $190.70 – $490.72 | 4 |
| Lift heel adj small gl60404sm HCPCS L3332 | not published | not published | $67.99 – $174.95 | 4 |
| Lift heel adjustable med HCPCS L3334 | not published | not published | $35.15 – $90.46 | 4 |
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.