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 |
|---|---|---|---|---|
| Blind/nonblind trans atrial HCPCS C9792 | not published | not published | $7,079.89 – $27,583.00 | 5 |
| Blink reflex test CPT 95933 | not published | not published | $43.76 – $112.62 | 4 |
| Blm gene CPT 81209 | not published | not published | $29.48 – $75.87 | 7 |
| Bln 1.2 mono emrg 15x1.2 HCPCS C1725 | $476.66 | $866.66 | not published | 0 |
| Bln 30frx10mmx12cm renal nephromax HCPCS C1726 | $773.06 | $1,405.57 | not published | 0 |
| Bln inpact admiral 4x150x130cm HCPCS C2623 | $2,560.98 | $4,656.32 | not published | 0 |
| Block brachial plexus w/cath plmt w/img CPT 64416 | $1,306.25 | $2,375.00 | $656.13 – $3,030.00 | 6 |
| Block femoral nerve cont infusion cath w/img CPT 64448 | $1,312.85 | $2,387.00 | $656.13 – $3,030.00 | 6 |
| Block paracervical nrv CPT 64435 | not published | not published | $523.65 – $3,030.00 | 6 |
| Block plantar digital nerve CPT 64455 | $601.15 | $1,093.00 | $227.71 – $2,334.00 | 6 |
| Block tap inj(s) w/wo img bi CPT 64488 | $1,413.50 | $2,570.00 | $1,887.00 – $5,512.00 | 3 |
| Block tap inj(s) w/wo img uni CPT 64486 | $779.90 | $1,418.00 | $1,887.00 – $5,512.00 | 3 |
| Blood Clotting (PT/INR) Test CPT 85610 | $31.35 | $57.00 | $3.22 – $8.28 | 7 |
| Blood Clotting (PTT) Test CPT 85730 | $19.80 | $36.00 | $4.51 – $11.60 | 7 |
| Blood Count (CBC) Test CPT 85025 | $75.35 | $137.00 | $5.83 – $15.00 | 7 |
| Blood Count (CBC) Test (without differential) CPT 85027 | $59.40 | $108.00 | $4.85 – $12.49 | 7 |
| Blood count spun microhematocrit CPT 85013 | not published | not published | $4.79 – $13.51 | 7 |
| Blood Culture Test CPT 87040 | $126.50 | $230.00 | $7.74 – $19.92 | 7 |
| Blood draw capillary 36416 CPT 36416 | $14.85 | $27.00 | $2.89 – $4.08 | 2 |
| Blood gases o2 saturation direct measurement CPT 82805 | $156.75 | $285.00 | $57.42 – $152.03 | 7 |
| Blood gases ph venous CPT 82800 | $62.70 | $114.00 | $8.25 – $21.23 | 7 |
| Blood occult fecal hemoglobin immunoassay qualitative 1-3 simultaneous determinations diagnostic CPT 82274 | $89.10 | $162.00 | $11.94 – $30.73 | 7 |
| Blood occult feces 1-3 determinations other than neoplasm screening qualitative CPT 82272 | $18.70 | $34.00 | $3.17 – $8.16 | 7 |
| Blood occult feces colorectal neoplasm screening qualitative CPT 82270 | not published | not published | $3.28 – $8.45 | 7 |
| Blood occult peroxidase activity qualitative gastric CPT 82271 | $28.60 | $52.00 | $3.99 – $10.27 | 7 |
| Blood smear interpretation CPT 85060 | not published | not published | $25.26 – $36.24 | 2 |
| Blood smear microscopic w manual differential wbc count CPT 85007 | $12.10 | $22.00 | $2.85 – $7.33 | 7 |
| Blood typing abo CPT 86900 | $166.65 | $303.00 | $2.99 – $253.99 | 7 |
| Blood typing ag donor ea ag CPT 86902 | $457.60 | $832.00 | $6.35 – $684.27 | 7 |
| Blood typing patient serum CPT 86904 | $89.65 | $163.00 | $16.34 – $112.62 | 7 |
| Blood typing rbc ag non abo/rh ea CPT 86905 | $457.60 | $832.00 | $3.83 – $684.27 | 7 |
| Blood typing rh (d) CPT 86901 | $159.50 | $290.00 | $2.99 – $71.30 | 7 |
| Blood typing rh phenotype complete reference CPT 86906 | $43.45 | $79.00 | $7.75 – $71.30 | 7 |
| Blood volume CPT 78122 | not published | not published | $263.54 – $1,036.52 | 4 |
| Blue light cysto imag agent HCPCS C9738 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Bone biopsy open superficial CPT 20240 | $6,503.75 | $11,825.00 | $2,154.81 – $7,791.00 | 6 |
| Bone Density Scan (DEXA) CPT 77080 | $304.15 | $553.00 | $77.56 – $199.58 | 4 |
| Bone imaging multiple areas CPT 78305 | not published | not published | $296.56 – $763.16 | 4 |
| Bone/joint imaging ltd area CPT 78300 | $1,936.00 | $3,520.00 | $296.56 – $763.16 | 4 |
| Bone marrow;aspiration only 38220 CPT 38220 | $1,587.30 | $2,886.00 | $1,225.21 – $3,152.87 | 6 |
| Bone marrow biopsyneedle/trocar 38221 CPT 38221 | $1,881.00 | $3,420.00 | $1,225.21 – $3,152.87 | 6 |
| Bone marrow harvest allogen CPT 38230 | not published | not published | $1,155.35 – $4,761.00 | 6 |
| Bone marrow harvest autolog CPT 38232 | not published | not published | $3,231.05 – $16,106.00 | 6 |
| Bone marrow imaging body CPT 78104 | $1,936.00 | $3,520.00 | $296.56 – $763.16 | 4 |
| Bone marrow imaging ltd CPT 78102 | $1,936.00 | $3,520.00 | $296.56 – $763.16 | 4 |
| Bone marrow imaging mult CPT 78103 | not published | not published | $296.56 – $763.16 | 4 |
| Bone marrow interpretation CPT 85097 | not published | not published | $73.38 – $1,538.03 | 5 |
| Bone/skin graft great toe CPT 20973 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Bone/skin graft metatarsal CPT 20972 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Bone survey-lead poisoning CPT 77074 | $304.15 | $553.00 | $77.56 – $199.58 | 4 |
| Boot j walker l HCPCS L4386 | $180.46 | $328.11 | $146.14 – $376.08 | 4 |
| Boot mlti podous univ xlg HCPCS L4396 | not published | not published | $154.67 – $398.02 | 4 |
| Boot softgait shrt m HCPCS L4387 | not published | not published | $146.14 – $376.08 | 4 |
| Boot walker genesis full shell 3-strap s HCPCS L4360 | not published | not published | $238.64 – $614.09 | 4 |
| Boot walker genesis mid-calf full shell s HCPCS L4361 | not published | not published | $238.64 – $614.09 | 4 |
| Borrelia antibody CPT 86619 | not published | not published | $10.04 – $25.82 | 7 |
| Borrelia burgdorferi (lyme disease) antibody nonspecific CPT 86618 | $135.85 | $247.00 | $12.77 – $32.87 | 7 |
| Borrelia miyamotoi amp prb CPT 87478 | not published | not published | $26.32 – $67.72 | 7 |
| Bortezomib 3.5 mg (2.5 mg/ml) solution for subcutaneous injection HCPCS J9041 | not published | not published | $2.40 – $6.04 | 5 |
| (both sides) smear without diff wbc count CPT 85008 | $11.00 | $20.00 | $2.57 – $6.62 | 7 |
| Bowel imaging CPT 78290 | $1,936.00 | $3,520.00 | $296.56 – $763.16 | 4 |
| Brace adj motion lerman type HCPCS L2186 | not published | not published | $141.98 – $365.37 | 4 |
| Brace afo dbl upright cust HCPCS L1990 | not published | not published | $430.72 – $1,108.40 | 4 |
| Brace afo lg left 6607 HCPCS L1930 | not published | not published | $232.20 – $597.53 | 4 |
| Brace afopos solid ankle cust HCPCS L1960 | not published | not published | $571.35 – $1,470.27 | 4 |
| Brace afo spiral prefab HCPCS L1951 | not published | not published | $774.07 – $1,991.93 | 4 |
| Brace ank aftr bioskn med lg HCPCS L1906 | not published | not published | $103.65 – $266.73 | 4 |
| Brace ank air stirrup univ HCPCS L4350 | not published | not published | $89.18 – $229.48 | 4 |
| Brace ankle joint dflxn assist HCPCS L2210 | not published | not published | $57.93 – $149.07 | 4 |
| Brace ankle stablizing lg HCPCS L1902 | not published | not published | $68.80 – $177.04 | 4 |
| Brace back epic lo 627 HCPCS L0642 | not published | not published | $203.31 – $523.18 | 4 |
| Brace back epic lso 637 HCPCS L0650 | not published | not published | $587.48 – $1,511.79 | 4 |
| Brace back epic tslo 456 HCPCS L0457 | not published | not published | $491.80 – $1,265.58 | 4 |
| Brace back pinnacle lo 627 lumbar HCPCS L0627 | not published | not published | $378.85 – $974.90 | 4 |
| Brace back pinnacle tlso 464 HCPCS L0464 | not published | not published | $1,370.09 – $3,525.70 | 4 |
| Brace back t-lso custom HCPCS L0486 | not published | not published | $1,886.09 – $4,853.54 | 4 |
| Brace back vista 464 tlso HCPCS L0648 | not published | not published | $507.74 – $1,306.59 | 4 |
| Brace cust back lso HCPCS L0631 | not published | not published | $946.20 – $2,434.89 | 4 |
| Brace fx hum ovr shldr lg HCPCS L3981 | not published | not published | $844.35 – $2,172.79 | 4 |
| Brace fx hum ovr shldr sm HCPCS L3980 | not published | not published | $324.52 – $835.09 | 4 |
| Brace halo bremer l2830 HCPCS L2830 | not published | not published | $80.97 – $208.36 | 4 |
| Brace kafo dbl upright cust HCPCS L2036 | not published | not published | $1,708.82 – $4,397.37 | 4 |
| Brace knee 32in univ t-scope short lt/rt HCPCS L1852 | not published | not published | $481.29 – $1,238.52 | 4 |
| Brace knee extender plus 22-30in HCPCS L1832 | not published | not published | $634.88 – $1,633.76 | 4 |
| Brace knee hing pat open med HCPCS L1820 | $109.90 | $199.82 | $130.99 – $337.07 | 4 |
| Brace knee playmaker ii x-rom hook and loop xl HCPCS L1833 | $202.94 | $368.99 | $382.22 – $983.59 | 4 |
| Brace knee postop tscope xl HCPCS L1845 | $658.79 | $1,197.80 | $772.11 – $1,986.90 | 4 |
| Brace knee support neoprene padded open patella med HCPCS L1810 | not published | not published | $94.89 – $244.18 | 4 |
| Brace m arm board HCPCS L3809 | not published | not published | $209.75 – $539.76 | 4 |
| Brace ortho exos 28-50in sm HCPCS L0637 | not published | not published | $1,194.10 – $3,072.81 | 4 |
| Brace ortho tlso 2xl 19in strnl y bar wst belt pd shldr HCPCS L0456 | not published | not published | $916.73 – $2,359.06 | 4 |
| Brace oths wrist hnd fngr without HCPCS L3807 | $260.39 | $473.44 | $209.75 – $539.76 | 4 |
| Brace tlso flex cust HCPCS L0450 | not published | not published | $92.38 – $237.72 | 4 |
| Brace wrist classic lft sm HCPCS L3908 | $66.19 | $120.35 | $61.50 – $158.26 | 4 |
| Brachioplasty 15836 CPT 15836 | not published | not published | $2,154.81 – $5,545.05 | 6 |
| Brach/thor cath 1st CPT 36215 | $1,686.85 | $3,067.00 | $1,887.00 – $5,512.00 | 3 |
| Brach/thor cath 2nd CPT 36216 | $1,940.40 | $3,528.00 | $1,887.00 – $5,512.00 | 3 |
| Brach/thor cath 3rd CPT 36217 | $3,131.15 | $5,693.00 | $1,887.00 – $5,512.00 | 3 |
| Brach/thor cath addl CPT 36218 | $3,766.40 | $6,848.00 | $1,887.00 – $5,512.00 | 3 |
| Brachytx isodose complex CPT 77318 | not published | not published | $277.76 – $714.78 | 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.