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 |
|---|---|---|---|---|
| Onc uveal mlnma mrna 15 gene CPT 81552 | not published | not published | $5,832.00 – $15,007.68 | 7 |
| Ondansetron 8 mg disintegrating tablet HCPCS Q0162 | not published | not published | $0.01 – $0.03 | 4 |
| Ondansetron hcl (pf) 2 mg/ml injection (wrapper) HCPCS J2405 | not published | not published | $0.09 – $0.25 | 5 |
| Oocyte identification CPT 89254 | not published | not published | $126.39 – $325.23 | 5 |
| Oophorectomy partial or total 58943 CPT 58943 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Open ablate liver tumor cryo CPT 47381 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Open ablate liver tumor rf CPT 47380 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Open aortic tube prosth repair 34830 CPT 34830 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Open aortofemor prosth repr CPT 34832 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Open aortoiliac prosth repr 34831 CPT 34831 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Open bx/exc inguinofem nodes CPT 38531 | not published | not published | $2,904.59 – $8,770.00 | 6 |
| Open bx of lung pleura 32098 CPT 32098 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Open cor endarterect w cabg/ea ves 33572 CPT 33572 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Open nasoethmoid fx with fixj CPT 21339 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Open nasoethmoid fx without fixj CPT 21338 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Open periprosthetic breast capsule 19370 CPT 19370 | not published | not published | $2,904.59 – $8,770.00 | 6 |
| Open skull for drainage 61312 CPT 61312 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Open tenotomy tendon flexor foot single or multiple 28230 CPT 28230 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Open thrombectomy of av fistula without revision 36831 CPT 36831 | not published | not published | $4,127.91 – $18,364.00 | 6 |
| Open tx compl front sinus fx CPT 21344 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Open tx iliac spine uni/bil HCPCS G0412 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Open tx nose fx w/skele fixj CPT 21330 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Open tx nose & septal fx CPT 21335 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Open tx post pelvic fxcture HCPCS G0415 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Open tx rib 1-3 fx w/fix 21811 CPT 21811 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Open tx rib 4-6 fx w/fix 21812 CPT 21812 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Open tx rib 7+ fx w/fix 21813 CPT 21813 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Open tx/sternum fracture 21825 CPT 21825 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Open wedge/bx lung infiltr CPT 32096 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Open wedge bx lung nodule 32097 CPT 32097 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Ophthalmic biometry CPT 92136 | not published | not published | $98.70 – $253.99 | 4 |
| Ophthalmic endoscope add-on CPT 66990 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Ophthalmodynamometry CPT 92260 | not published | not published | $27.71 – $71.30 | 4 |
| Ophth Ultrasound b & quant a CPT 76510 | not published | not published | $98.70 – $253.99 | 4 |
| Oph Ultrasound dx ant sgm Ultrasound uni/bi CPT 76513 | not published | not published | $77.56 – $199.58 | 4 |
| Oph Ultrasound dx quan a-scan only CPT 76511 | $336.60 | $612.00 | $77.56 – $199.58 | 4 |
| Opn abltj 1/> rnl mas crysrg CPT 50250 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Opn ax/subcla art expos CPT 34715 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Opn exc/dst ntra-abd CPT 49189 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Opn exc/dst ntra-abd 10.1-20 CPT 49188 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Opn exc/dstr ntra-abd >30 cm CPT 49190 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Opn exc/dstr ntra-abd 5.1-10 CPT 49187 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Opn exc/dstr ntra-abd 5 cm/< CPT 49186 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Opn fem art expos cndt crtj 34714 CPT 34714 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Opn ilac art expos cndt crtj CPT 34833 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Opn impltj crnl nrv nea&pg CPT 64568 | not published | not published | $8,923.00 – $84,083.89 | 6 |
| Opn impltj nea neuromuscular CPT 64580 | not published | not published | $8,923.00 – $37,034.45 | 6 |
| Opn impltj nea perph nerve CPT 64575 | not published | not published | $8,266.01 – $27,583.00 | 6 |
| Opn impltj nea sacral nerve CPT 64581 | not published | not published | $4,727.69 – $27,583.00 | 6 |
| Opn mpltj hpglsl nstm ary pg CPT 64582 | not published | not published | $8,923.00 – $58,906.76 | 6 |
| Opn tx complx malar fx CPT 21365 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Opn tx complx malar w/grft CPT 21366 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Opn tx depress front sinus fx 21343 CPT 21343 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Opn tx dprsd zygomatic arch CPT 21356 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Opn tx nasomax fx multple CPT 21347 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Opn tx nasomax fx w/fixj CPT 21346 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Opn tx nasomax fx w/graft CPT 21348 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Opn tx orbit fx combined CPT 21387 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Opn tx orbit fx periorbital CPT 21386 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Opn tx orbit fx transantral CPT 21385 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Opn tx orbit fx w/bone grft CPT 21408 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Opn tx orbit fx w/implant CPT 21407 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Opn tx orbit fx without impl 21406 CPT 21406 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Opn tx orbit periorbtl implt CPT 21390 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Opn tx orbit periorbt w/grft CPT 21395 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Opps service,sched team conf HCPCS G0175 | $221.10 | $402.00 | $309.54 – $796.55 | 4 |
| Oprelvekin injection HCPCS J2355 | not published | not published | $651.65 – $651.65 | 1 |
| Opscpy extnd on/mac draw CPT 92202 | not published | not published | $43.76 – $112.62 | 4 |
| Opscpy extnd rta draw uni/bi CPT 92201 | not published | not published | $43.76 – $112.62 | 4 |
| Optical endomicroscpy interp CPT 88375 | not published | not published | $51.25 – $72.31 | 2 |
| Optx acrclv dslc aq/chrn grf CPT 23552 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Optx acromclv dislc aqt/chrn CPT 23550 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Optx acute shoulder dislc CPT 23660 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Optx carpl scphd fx int fixj CPT 25628 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Optx clavicular fx w/int fix CPT 23515 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Optx complicated mndblr fx CPT 21470 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Optx cranfcl sep comp mlt CPT 21433 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Optx cranfcl sep w/wiring CPT 21432 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Optx crnfcl sep comp mlt int CPT 21436 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Optx crnfc sep comp int&/xtr CPT 21435 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Optx crpl fx oth/thn scph ea CPT 25645 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Optx gr hmrl tbrs fx int fix CPT 23630 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Optx lunate dislocation CPT 25695 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Optx medial ankle fx CPT 27766 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Optx mndblr cndylr fx CPT 21465 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Optx mndblr fx wo ntrdntl CPT 21461 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Optx mndblr fx xtrnl fixj CPT 21454 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Optx mndblr/max alv ridge fx CPT 21445 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Optx palatal/max fracture CPT 21422 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Optx palatal/max fx comp CPT 21423 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Optx partclr fx&/dslc elbw w CPT 24587 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Optx post ankle fx CPT 27769 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Optx prox humrl fx w/int fix CPT 23615 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Optx prx hmrl fx fix rpr rpl CPT 23616 | not published | not published | $8,923.00 – $33,471.73 | 6 |
| Optx radial shaft fracture CPT 25515 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Optx rad/uln dislc aqt/chrnc CPT 25676 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Optx rdcrpl/ntrcrpl dislc 1+ CPT 25670 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Optx rdl shft fx&cltx rad/ul CPT 25525 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Optx rdl shft fx&dstl rad/ul CPT 25526 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Optx rdl&uln shft fx rds&uln CPT 25575 | not published | not published | $5,382.89 – $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.