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 |
|---|---|---|---|---|
| Optx rdl&uln shft fx rds/uln CPT 25574 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Optx scapular fx w/int fixj CPT 23585 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Optx sho dislc fx CPT 23670 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Optx sho dislc neck fx fixj CPT 23680 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Optx strclv dslc aq/chrn grf CPT 23532 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Optx strnclav dislc aqt/chrn CPT 23530 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Optx thigh fx CPT 27269 | not published | not published | $3,579.00 – $13,851.98 | 6 |
| Optx tmprmand dislocation CPT 21490 | not published | not published | $2,459.51 – $16,106.00 | 6 |
| Optx trns-scphprlnr fx dislc CPT 25685 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Optx ulnar shft fx int fixj CPT 25545 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Optx ulnar styloid fracture CPT 25652 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Oral aprepitant HCPCS J8501 | not published | not published | $3.10 – $7.79 | 5 |
| Oral busulfan HCPCS J8510 | not published | not published | $7.59 – $229.27 | 5 |
| Oral everolimus HCPCS J7527 | not published | not published | $2.22 – $6.32 | 5 |
| Oral hiv-1/hiv-2 screen HCPCS G0435 | not published | not published | $8.98 – $23.12 | 7 |
| Oral methotrexate (jylamvo) HCPCS J8611 | not published | not published | $12.35 – $51.65 | 6 |
| Oral methotrexate (xatmep) HCPCS J8612 | not published | not published | $17.19 – $56.38 | 6 |
| Oral netupitant, palonosetro HCPCS J8655 | not published | not published | $355.53 – $1,088.65 | 8 |
| Orbitocranial approach/skull CPT 61584 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Orbitocranial approach/skull CPT 61585 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Orbitocranial approach/skull CPT 61592 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Orchiectomy partial CPT 54522 | not published | not published | $2,614.94 – $7,791.00 | 6 |
| Orchiopexy (fowler-stephens) CPT 54650 | not published | not published | $2,656.06 – $8,770.00 | 6 |
| Orchiopexy ingun/scrot appr CPT 54640 | not published | not published | $2,656.06 – $8,770.00 | 6 |
| Organic acids total quant ea spec CPT 83918 | not published | not published | $17.70 – $45.55 | 7 |
| Oritavancin 1,200 mg intravenous solution HCPCS J2406 | not published | not published | $35.56 – $117.94 | 8 |
| Oritavancin 400 mg intravenous solution HCPCS J2407 | not published | not published | $22.30 – $77.67 | 8 |
| Oropharyngeal biopsy 42800 CPT 42800 | not published | not published | $1,151.01 – $3,030.00 | 6 |
| Orphenadrine citrate 30 mg/ml injection solution HCPCS J2360 | not published | not published | $13.56 – $38.08 | 5 |
| Ortho dvc repair per 15 min HCPCS L4205 | not published | not published | $22.44 – $57.75 | 4 |
| Ortho elbow without jnt cstm w/fit&adj HCPCS L3702 | $248.53 | $451.88 | $242.23 – $623.33 | 4 |
| Ortho elbow w/lock w/ft&adj HCPCS L3760 | not published | not published | $419.52 – $1,079.56 | 4 |
| Ortho ewhf rigd without jnt cstm w HCPCS L3765 | not published | not published | $1,075.61 – $2,767.91 | 4 |
| Ortho ewh rgd without jnt cstm w/fit&adj HCPCS L3763 | $587.60 | $1,068.37 | $627.74 – $1,615.39 | 4 |
| Ortho hnd/fngr without jnt cstm w/fit&adj HCPCS L3913 | $210.67 | $383.04 | $227.18 – $584.60 | 4 |
| Ortho hnd/fngr w/jnt cstm w/fit&adj HCPCS L3921 | $268.51 | $488.20 | $269.46 – $693.41 | 4 |
| Ortho hnd metcrpl fx prefb w/fit&adj HCPCS L3917 | not published | not published | $88.58 – $227.95 | 4 |
| Ortho hnd without jnt w/fit&adj HCPCS L3919 | $214.81 | $390.57 | $227.18 – $584.60 | 4 |
| Orthopantogram CPT 70355 | $304.15 | $553.00 | $30.40 – $166.13 | 4 |
| Orthopedic shoe add rub insl HCPCS L3510 | not published | not published | $26.95 – $69.34 | 4 |
| Orthop traing supvj phys/qhp CPT 92066 | not published | not published | $43.76 – $112.62 | 4 |
| Ortho shoe add full sole HCPCS L3540 | not published | not published | $46.89 – $120.66 | 4 |
| Ortho shoe add half sole HCPCS L3530 | not published | not published | $29.31 – $75.42 | 4 |
| Ortho shoe add leather insol HCPCS L3500 | not published | not published | $26.95 – $69.34 | 4 |
| Ortho shoe add march bar HCPCS L3595 | not published | not published | $38.66 – $99.47 | 4 |
| Ortho sidebar disconnect HCPCS L2768 | not published | not published | $120.08 – $309.01 | 4 |
| Orthosis lso rigd frm hyperex HCPCS L0472 | not published | not published | $373.17 – $960.29 | 4 |
| Orthovisc inj per dose HCPCS J7324 | not published | not published | $75.25 – $250.85 | 8 |
| Ortho whf rigd without jnt cstm w/fit&adj HCPCS L3808 | $319.09 | $580.17 | $298.82 – $768.97 | 4 |
| Ortho wrst/hnd w/jnt cstm w/fit&adj HCPCS L3905 | not published | not published | $831.87 – $2,140.68 | 4 |
| Oscillation chest wall mechanical per session CPT 94669 | $106.15 | $193.00 | $162.44 – $418.02 | 4 |
| O shoe add felt w leath insl HCPCS L3520 | not published | not published | $29.31 – $75.42 | 4 |
| O shoe add horseshoe toe tap HCPCS L3560 | not published | not published | $21.08 – $54.25 | 4 |
| O shoe add instep extension HCPCS L3570 | not published | not published | $78.56 – $202.15 | 4 |
| O shoe add instep velcro clo HCPCS L3580 | not published | not published | $59.78 – $153.82 | 4 |
| O shoe add standard toe tap HCPCS L3550 | not published | not published | $8.24 – $21.21 | 4 |
| O shoe convert to sof counte HCPCS L3590 | not published | not published | $49.24 – $126.72 | 4 |
| Osmolality blood CPT 83930 | $58.30 | $106.00 | $4.96 – $12.76 | 7 |
| Osmolality urine CPT 83935 | $55.00 | $100.00 | $5.12 – $13.16 | 7 |
| Ostectomy complete 1st metatarsal head 28111 CPT 28111 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Ostectomy scapula partial CPT 23190 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Osteoart algrft w/surf & b1 CPT 20932 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Osteochondral knee allograft CPT 27415 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Osteochondral knee autograft CPT 27416 | not published | not published | $5,382.89 – $16,106.00 | 6 |
| Osteochondral talus autogrft CPT 28446 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Osteoplasty humerus CPT 24420 | not published | not published | $5,382.89 – $16,106.00 | 6 |
| Osteot dsc ant 1 vrt sgm crv CPT 22220 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Osteot dsc ant 1vrt sgm ea CPT 22226 | not published | not published | $1,887.00 – $7,609.00 | 3 |
| Osteot dsc ant 1vrt sgm lmbr CPT 22224 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Osteot dsc ant 1vrt sgm thrc CPT 22222 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Osteot humerus w/wo int fixj CPT 24400 | not published | not published | $5,382.89 – $16,106.00 | 6 |
| Osteot mlt relignmt imed rod CPT 27712 | not published | not published | $3,735.00 – $24,508.80 | 6 |
| Osteotomy/graft tarsal/calcaneus/talus 28305 CPT 28305 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Ot evaluation high complexity patient/family CPT 97167 | $154.00 | $280.00 | $73.70 – $189.64 | 4 |
| Ot evaluation low complexity patient/family CPT 97165 | $113.85 | $207.00 | $73.70 – $189.64 | 4 |
| Ot evaluation moderate complexity patient/family CPT 97166 | $134.75 | $245.00 | $73.70 – $189.64 | 4 |
| Other bone graft microvasc CPT 20962 | not published | not published | $5,382.89 – $16,106.00 | 6 |
| Other immunoelectrophoresis CPT 86325 | not published | not published | $17.35 – $44.64 | 7 |
| Oth resp proc, group HCPCS G0239 | $129.25 | $235.00 | $27.71 – $71.30 | 4 |
| Oth resp proc, indiv HCPCS G0238 | $41.80 | $76.00 | $21.46 – $55.21 | 4 |
| Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes CPT 97763 | $48.95 | $89.00 | $36.34 – $93.51 | 4 |
| Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes CPT 97760 | $67.10 | $122.00 | $33.48 – $86.16 | 4 |
| Ot manual therpy techniques >=1 region each 15 minutes CPT 97140 | $68.20 | $124.00 | $20.20 – $51.99 | 4 |
| Otoplasty 69300 CPT 69300 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Ot re-evaluation patient/family CPT 97168 | $85.25 | $155.00 | $50.05 – $128.79 | 4 |
| Ot therapeutic activities direct patient contact each 15 minutes CPT 97530 | $61.60 | $112.00 | $25.50 – $65.62 | 4 |
| Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes CPT 97130 | $54.45 | $99.00 | $13.70 – $35.26 | 4 |
| Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes CPT 97129 | $54.45 | $99.00 | $14.52 – $37.36 | 4 |
| Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes CPT 97110 | $68.75 | $125.00 | $21.19 – $54.52 | 4 |
| Ot therapeutic procedure neuromuscular reeducate each 15 minutes CPT 97112 | $66.55 | $121.00 | $23.88 – $61.45 | 4 |
| Ot training self care/home management direct contact each 15 minutes CPT 97535 | $48.40 | $88.00 | $23.59 – $60.70 | 4 |
| Outflow tarct agmntj heart chamber 33478 CPT 33478 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Outrigger HCPCS L1080 | not published | not published | $48.22 – $124.10 | 4 |
| Outrigger bil with vert extens HCPCS L1085 | not published | not published | $161.45 – $415.47 | 4 |
| Ovarian cystectomy 58925 CPT 58925 | not published | not published | $3,710.98 – $9,549.58 | 6 |
| Ovine, 1000 usp units HCPCS J3472 | not published | not published | $289.72 – $289.72 | 1 |
| Ovulation tests CPT 84830 | not published | not published | $9.52 – $24.51 | 7 |
| Oxacillin in ns IV syringe 40 mg/ml (neo/ped) - cnr HCPCS J2700 | not published | not published | $0.70 – $2.92 | 5 |
| Oxaliplatin 5 mg/ml desensitization HCPCS J9263 | not published | not published | $0.06 – $0.21 | 5 |
| Oxymorphone hcl injection HCPCS J2410 | not published | not published | $6.15 – $6.15 | 1 |
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.