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 |
|---|---|---|---|---|
| Bfb train 1st 15min cntct 90912 CPT 90912 | $134.75 | $245.00 | $27.01 – $69.50 | 4 |
| Bfb train ea addl 15 min 90913 CPT 90913 | $134.75 | $245.00 | $15.16 – $39.01 | 4 |
| B-hexosaminidase ea assay CPT 83080 | not published | not published | $12.65 – $32.56 | 7 |
| Bilateral laminotomy addl lumbar 63044 CPT 63044 | not published | not published | $5,512.00 – $8,770.00 | 3 |
| Bilateral n blobk inj pudendal 64430 CPT 64430 | $1,067.00 | $1,940.00 | $656.13 – $3,030.00 | 6 |
| Bilateral n block inj occipital 64405 CPT 64405 | $1,378.30 | $2,506.00 | $227.71 – $2,334.00 | 6 |
| Bilateral n block inj trigeminal 64400 CPT 64400 | $834.90 | $1,518.00 | $227.71 – $2,334.00 | 6 |
| Bile acids cholylglycine CPT 82240 | not published | not published | $19.94 – $51.30 | 7 |
| Bile duct endoscopy add-on 47550 CPT 47550 | not published | not published | $2,334.00 – $3,735.00 | 3 |
| Biliary endo perq dx w/speci CPT 47552 | not published | not published | $3,735.00 – $12,358.40 | 6 |
| Biliary endoscopy thru skin CPT 47553 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Biliary endoscopy thru skin CPT 47554 | not published | not published | $5,257.00 – $20,292.15 | 6 |
| Biliary endoscopy thru skin CPT 47555 | not published | not published | $3,735.00 – $12,358.40 | 6 |
| Biliary endoscopy thru skin CPT 47556 | not published | not published | $5,257.00 – $20,292.15 | 6 |
| Bilicheck CPT 88720 | $11.55 | $21.00 | $3.76 – $9.69 | 7 |
| Bilirubin direct CPT 82248 | $18.15 | $33.00 | $3.76 – $9.69 | 7 |
| Bilirubin total CPT 82247 | $18.15 | $33.00 | $3.76 – $9.69 | 7 |
| Bilobectomy 32482 CPT 32482 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Binder abdominal lg 12 x 62-74 HCPCS L0625 | not published | not published | $27.25 – $70.12 | 4 |
| Biofeedback, pt CPT 90901 | $118.25 | $215.00 | $12.03 – $30.96 | 4 |
| Biopsy abdominal mass CPT 49180 | $2,493.15 | $4,533.00 | $1,225.21 – $4,761.00 | 6 |
| Biopsy arm/elbow soft tissue CPT 24066 | not published | not published | $2,154.81 – $5,545.05 | 6 |
| Biopsy, bone open deep CPT 20245 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Biopsy bone trocar/needle superficial CPT 20220 | $1,166.55 | $2,121.00 | $1,225.21 – $3,152.87 | 6 |
| Biopsy cervixsingle/multiple 57500 CPT 57500 | not published | not published | $683.26 – $3,030.00 | 6 |
| Biopsy conjunctiva CPT 68100 | not published | not published | $1,763.69 – $4,538.57 | 6 |
| Biopsy/excision of lymph node(s); open deep 38530 CPT 38530 | not published | not published | $2,904.59 – $7,791.00 | 6 |
| Biopsy external ear 69100 CPT 69100 | not published | not published | $175.70 – $2,334.00 | 6 |
| Biopsy eyelid & lid margin CPT 67810 | not published | not published | $235.46 – $2,334.00 | 6 |
| Biopsy eye muscle CPT 67346 | not published | not published | $2,916.44 – $8,770.00 | 6 |
| Biopsy finger joint lining CPT 26105 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Biopsy finger joint lining CPT 26110 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Biopsy forearm soft tissues CPT 25066 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Biopsy hand joint lining CPT 26100 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Biopsy(ies) & aspiration(s) bone marrow diagnostic (both sides) CPT 38222 | $2,388.10 | $4,342.00 | $2,154.81 – $5,545.05 | 6 |
| Biopsy knee joint lining CPT 27330 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Biopsy lower leg soft tissue CPT 27613 | not published | not published | $1,225.21 – $3,152.87 | 6 |
| Biopsy lower leg soft tissue 27610 CPT 27610 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Biopsy muscle percutaneous needle CPT 20206 | $1,152.80 | $2,096.00 | $1,225.21 – $4,761.00 | 6 |
| Biopsy needle liver percutaneous CPT 47000 | $2,982.65 | $5,423.00 | $1,225.21 – $4,761.00 | 6 |
| Biopsy needle lymph node superficial CPT 38505 | $1,392.60 | $2,532.00 | $1,225.21 – $4,761.00 | 6 |
| Biopsy of cornea CPT 65410 | not published | not published | $1,763.69 – $4,538.57 | 6 |
| Biopsy of epididymis CPT 54800 | not published | not published | $1,225.21 – $3,152.87 | 6 |
| Biopsy of foot joint lining CPT 28050 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Biopsy of foot joint lining CPT 28052 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Biopsy of heart lining CPT 93505 | not published | not published | $2,342.32 – $8,770.00 | 6 |
| Biopsy of hip joint CPT 27052 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Biopsy of inestine 44100 CPT 44100 | not published | not published | $672.83 – $4,761.00 | 6 |
| Biopsy of lip 40490 CPT 40490 | not published | not published | $175.70 – $2,334.00 | 6 |
| Biopsy of nail unit 11755 CPT 11755 | not published | not published | $525.32 – $3,030.00 | 6 |
| Biopsy of nerve CPT 64795 | not published | not published | $1,448.59 – $7,791.00 | 6 |
| Biopsy of ovary(s) 58900 CPT 58900 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Biopsy of penis CPT 54105 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Biopsy of penis 54100 CPT 54100 | not published | not published | $1,225.21 – $4,761.00 | 6 |
| Biopsy of prostate CPT 55700 | $367.32 | $667.86 | $3,388.00 – $4,761.00 | 3 |
| Biopsy of prostate CPT 55705 | not published | not published | $2,614.94 – $6,729.12 | 6 |
| Biopsy of rectum wall anal approach 45100 CPT 45100 | not published | not published | $2,059.07 – $5,298.68 | 6 |
| Biopsy of sacroiliac joint CPT 27050 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Biopsy of salivary gland 42400 CPT 42400 | $1,483.35 | $2,697.00 | $525.32 – $3,030.00 | 6 |
| Biopsy of salivary glnd;incisional 42405 CPT 42405 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Biopsy of tear gland CPT 68510 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Biopsy of tear sac CPT 68525 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Biopsy of testis CPT 54500 | not published | not published | $2,154.81 – $5,545.05 | 6 |
| Biopsy of testis CPT 54505 | not published | not published | $2,614.94 – $7,791.00 | 6 |
| Biopsy of toe joint lining CPT 28054 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Biopsy of upper nose/throat CPT 42804 | not published | not published | $2,459.51 – $6,329.15 | 6 |
| Biopsy of urethra CPT 53200 | not published | not published | $1,550.71 – $7,791.00 | 6 |
| Biopsy of wrist joint CPT 25100 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Biopsy oocyte polar body CPT 89291 | not published | not published | $126.39 – $325.23 | 5 |
| Biopsy oocyte polar body <=5 CPT 89290 | not published | not published | $126.39 – $325.23 | 5 |
| Biopsy/removal lymph nodes CPT 38525 | not published | not published | $2,904.59 – $7,791.00 | 6 |
| Biopsy/removal lymph nodes 38520 CPT 38520 | not published | not published | $2,904.59 – $7,791.00 | 6 |
| Biopsy renal percutaneous trocar/needle (both sides) CPT 50200 | $1,399.20 | $2,544.00 | $1,225.21 – $4,761.00 | 6 |
| Biopsy roof of mouth CPT 42100 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Biopsy skin incisional single lesion CPT 11106 | $1,074.15 | $1,953.00 | $548.27 – $3,030.00 | 6 |
| Biopsy/soft tissue/neck or thorax 21550 CPT 21550 | $1,424.50 | $2,590.00 | $1,225.21 – $4,761.00 | 6 |
| Biopsy thigh soft tissues CPT 27324 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Biopsy tongue anterior two-thirds CPT 41100 | not published | not published | $400.09 – $2,334.00 | 6 |
| Biopsy vaginal mucosa xtnsv CPT 57105 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Biopsy vestibule of mouth 40808 CPT 40808 | not published | not published | $400.09 – $2,334.00 | 6 |
| Biopsy vrt bdy open lmbr/crv CPT 20251 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Biopsy vrt bdy open thoracic CPT 20250 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Biospy of bladder CPT 53899 | not published | not published | $185.35 – $2,334.00 | 6 |
| Biotinidase - quest CPT 82261 | not published | not published | $12.65 – $32.56 | 7 |
| Bis xtracell fluid analysis CPT 93702 | not published | not published | $95.45 – $245.63 | 4 |
| Bivalirudin HCPCS J0583 | not published | not published | $0.17 – $0.43 | 5 |
| Bladder irrigate/lavage/instill 51700 CPT 51700 | $627.55 | $1,141.00 | $185.35 – $2,334.00 | 6 |
| Bld exchange truj oth thn nb CPT 36455 | not published | not published | $327.28 – $2,334.00 | 6 |
| Bld prd mix CPT 86965 | not published | not published | $44.72 – $325.23 | 5 |
| Bld push tfuj 2 yr/< CPT 36440 | not published | not published | $327.28 – $2,334.00 | 6 |
| Bleomycin 15 unit solution for injection HCPCS J9040 | not published | not published | $22.64 – $56.93 | 5 |
| Blepharoplasty lower 15820 CPT 15820 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Blepharoplasty upper 15822 CPT 15822 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Blepharoplasty upper eyelid 15823 CPT 15823 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Blepharp lwr eyelid fat pad CPT 15821 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Blinatumomab 35 mcg intravenous solution HCPCS J9039 | not published | not published | $129.68 – $415.21 | 8 |
| Blind cor sinus reducer impl HCPCS C9783 | not published | not published | $7,609.00 – $27,583.00 | 6 |
| Blinded conv. tx mdd clin tr HCPCS G2000 | not published | not published | $276.82 – $712.35 | 4 |
| Blind interatrial shunt ide HCPCS C9758 | not published | not published | $12,707.20 – $44,873.00 | 6 |
| Blind myocar trpl bon marrow HCPCS C9782 | not published | not published | $7,609.00 – $44,873.00 | 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.