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 |
|---|---|---|---|---|
| Lifts elevation metal extens HCPCS L3330 | not published | not published | $521.63 – $1,342.33 | 4 |
| Ligate esophagus veins CPT 43400 | not published | not published | $4,428.00 – $18,364.00 | 3 |
| Ligate leg veins open CPT 37761 | not published | not published | $2,342.32 – $6,027.57 | 6 |
| Ligate leg veins radical 37760 CPT 37760 | not published | not published | $2,342.32 – $8,770.00 | 6 |
| Ligate oviduct(s) add-on 58611 CPT 58611 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Ligate/staple esophagus CPT 43405 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Ligate/strip long leg vein CPT 37722 | not published | not published | $2,342.32 – $8,770.00 | 6 |
| Ligate/strip short leg vein CPT 37718 | not published | not published | $2,342.32 – $8,770.00 | 6 |
| Ligate/transect fallopian tubes 58600 CPT 58600 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | not published | not published | $1,225.21 – $4,761.00 | 6 |
| Ligation common iliac vein CPT 37660 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Ligation/divis of long saph vein 37700 CPT 37700 | not published | not published | $2,342.32 – $8,770.00 | 6 |
| Ligation external carotid artery 37600 CPT 37600 | not published | not published | $2,342.32 – $8,770.00 | 6 |
| Ligation internal/common carotid artery 37605 CPT 37605 | not published | not published | $2,342.32 – $8,770.00 | 6 |
| Ligation internal jugular vein 37565 CPT 37565 | not published | not published | $2,342.32 – $6,027.57 | 6 |
| Ligation major artery chest CPT 37616 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Ligation/major artery/extremity 37618 CPT 37618 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Ligation major artery neck CPT 37615 | $5,715.60 | $10,392.00 | $2,342.32 – $6,027.57 | 6 |
| Ligation nasal sinus artery CPT 30915 | not published | not published | $2,342.32 – $8,770.00 | 6 |
| Ligation of abdomen artery 37617 CPT 37617 | not published | not published | $3,735.00 – $10,622.50 | 6 |
| Ligation of femoral vein CPT 37650 | not published | not published | $2,342.32 – $8,770.00 | 6 |
| Ligation of inf vena cava CPT 37619 | not published | not published | $4,127.91 – $18,364.00 | 6 |
| Ligation of neck artery CPT 37606 | not published | not published | $2,342.32 – $8,770.00 | 6 |
| Ligation of salivary duct CPT 42665 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Ligation of shunt CPT 49428 | not published | not published | $3,579.00 – $4,761.00 | 3 |
| Ligation upper jaw artery CPT 30920 | not published | not published | $2,342.32 – $8,770.00 | 6 |
| Ligation vericose vein cluster(s) 1 leg CPT 37785 | not published | not published | $2,342.32 – $8,770.00 | 6 |
| Lig/band angioaccess av fistula CPT 37607 | $2,615.80 | $4,756.00 | $2,342.32 – $8,770.00 | 6 |
| Lig&div&compl strpg saph vn CPT 37735 | not published | not published | $2,342.32 – $8,770.00 | 6 |
| Liletta, 52 mg HCPCS J7297 | not published | not published | $2,899.00 – $2,899.00 | 1 |
| Limb exercise test CPT 95875 | not published | not published | $95.45 – $245.63 | 4 |
| Limb nerve surgery add-on CPT 64783 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Limited ankle motion ea jnt HCPCS L2200 | not published | not published | $46.31 – $119.18 | 4 |
| Limited autopsy CPT 88036 | not published | not published | $103.58 – $164.68 | 2 |
| Limited autopsy CPT 88037 | not published | not published | $92.03 – $146.38 | 2 |
| Limited motion knee joint HCPCS L2184 | not published | not published | $106.76 – $274.74 | 4 |
| Limited visual field xm CPT 92081 | not published | not published | $43.76 – $112.62 | 4 |
| Lincomycin injection HCPCS J2010 | not published | not published | $6.86 – $18.32 | 5 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | not published | not published | $3.23 – $8.12 | 5 |
| Lipase CPT 83690 | $66.00 | $120.00 | $5.17 – $13.30 | 7 |
| Lip exc/transverse wedge/w closure 40510 CPT 40510 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Lipoprotein blood high res frac & quant CPT 83701 | not published | not published | $25.40 – $65.35 | 7 |
| Lipoprotein blood quant CPT 83704 | $267.85 | $487.00 | $25.64 – $65.99 | 7 |
| Lipoprotein direct measurement hdl CPT 83718 | $67.10 | $122.00 | $6.14 – $15.81 | 7 |
| Lipoprotein direct measurement ldl CPT 83721 | $77.55 | $141.00 | $7.88 – $20.26 | 7 |
| Lipoprtn dir meas sd ldl chl CPT 83722 | not published | not published | $25.64 – $65.99 | 7 |
| Lip surgery procedure CPT 40799 | not published | not published | $175.70 – $2,334.00 | 6 |
| Lisocabtagene mara car pos t HCPCS Q2054 | not published | not published | $434,677.96 – $1,406,133.05 | 7 |
| Listeria monocytogenes CPT 86723 | not published | not published | $9.89 – $25.46 | 7 |
| Lith ion batt cid, ear level HCPCS L8624 | not published | not published | $148.93 – $383.24 | 4 |
| Lith ion batt cid,non-earlvl HCPCS L8623 | $24,235.34 | $44,064.25 | $59.74 – $153.72 | 4 |
| Lithium ion battery charger HCPCS L7368 | not published | not published | $466.10 – $1,199.42 | 4 |
| Lithium therapeutic drug level CPT 80178 | $70.95 | $129.00 | $4.96 – $12.76 | 7 |
| Lithotripsy transluminal coronary percutaneous CPT 92972 | $2,472.25 | $4,495.00 | not published | 0 |
| Litt icr 1 traj 1 smpl les CPT 61736 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Litt icr mlt trj mlt/cplx ls CPT 61737 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Liver abs/cyst dr opn 1-2 stge CPT 47010 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Liver ds alys 3 bmrk srm alg CPT 81517 | not published | not published | $132.14 – $340.05 | 7 |
| Liver elastography 91200 CPT 91200 | $322.30 | $586.00 | $50.62 – $245.63 | 4 |
| Liver Function Test CPT 80076 | $93.50 | $170.00 | $6.13 – $15.77 | 7 |
| Liver hem/re-expl wnd/remove pack 47362 CPT 47362 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Liver imaging CPT 78201 | not published | not published | $402.79 – $1,036.52 | 4 |
| Liver imag w/vasclr flow CPT 78202 | $2,256.65 | $4,103.00 | $402.79 – $1,036.52 | 4 |
| Liver/spleen imag static only CPT 78215 | $1,936.00 | $3,520.00 | $296.56 – $763.16 | 4 |
| Liver/spleen imag w/vasclr flow CPT 78216 | $1,936.00 | $3,520.00 | $296.56 – $763.16 | 4 |
| Lmtd oph exam general anes CPT 92019 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Lockingelbow forearm cntrbal HCPCS L6693 | not published | not published | $2,621.89 – $6,746.99 | 4 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | not published | not published | $1.02 – $3.42 | 4 |
| Loncastuximab tesirine-lpyl 10 mg intravenous solution HCPCS J9359 | not published | not published | $169.96 – $577.50 | 8 |
| Long tongue stirrup HCPCS L2265 | not published | not published | $123.91 – $318.86 | 4 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | not published | not published | $1.46 – $3.68 | 5 |
| Lo rig pos pnl l1-l5 pre ots HCPCS L0641 | not published | not published | $38.55 – $99.20 | 4 |
| Lo sag rig pnl stays pre cst HCPCS L0626 | not published | not published | $71.84 – $184.87 | 4 |
| Loudness balance test CPT 92562 | not published | not published | $160.18 – $412.19 | 4 |
| Low back disk surgery CPT 63030 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Low cost skin substitute app HCPCS C5271 | $1,442.10 | $2,622.00 | $1,887.00 – $2,334.00 | 2 |
| Low cost skin substitute app HCPCS C5273 | $2,985.95 | $5,429.00 | $3,579.00 – $4,761.00 | 2 |
| Low cost skin substitute app HCPCS C5275 | $1,372.80 | $2,496.00 | $1,887.00 – $2,334.00 | 2 |
| Low cost skin substitute app HCPCS C5277 | $3,015.10 | $5,482.00 | $1,887.00 – $2,334.00 | 2 |
| Low cost skin substitute app HCPCS C5272 | $309.10 | $562.00 | $1,887.00 – $2,334.00 | 2 |
| Low cost skin substitute app HCPCS C5274 | $994.40 | $1,808.00 | $1,887.00 – $2,334.00 | 2 |
| Low cost skin substitute app HCPCS C5276 | $322.85 | $587.00 | $1,887.00 – $2,334.00 | 2 |
| Low cost skin substitute app HCPCS C5278 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $1,648.90 | $2,998.00 | $130.12 – $334.84 | 4 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $1,570.25 | $2,855.00 | $258.81 – $665.99 | 4 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $1,495.45 | $2,719.00 | $77.56 – $199.58 | 4 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $2,488.75 | $4,525.00 | $258.81 – $665.99 | 4 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $2,369.95 | $4,309.00 | $258.81 – $665.99 | 4 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $2,257.20 | $4,104.00 | $177.00 – $455.49 | 4 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $304.15 | $553.00 | $77.56 – $199.58 | 4 |
| Lower jaw bone graft CPT 21215 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Low frequency non-thermal Ultrasound CPT 97610 | not published | not published | $148.84 – $383.01 | 4 |
| Loxapine for inhalation 1 mg HCPCS J2062 | not published | not published | $49.01 – $49.01 | 1 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | $5,257.00 – $20,292.15 | 6 |
| Lsh uterus above 250 g CPT 58543 | not published | not published | $7,609.00 – $20,292.15 | 6 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $7,609.00 – $20,292.15 | 6 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | $7,609.00 – $20,292.15 | 6 |
| Lso corset front HCPCS L0972 | not published | not published | $89.66 – $230.71 | 4 |
| Lso flex no ri stays pre ots HCPCS L0628 | not published | not published | $41.49 – $106.77 | 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.