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 |
|---|---|---|---|---|
| Sarscov coronavirus ag ia CPT 87426 | $55.55 | $101.00 | $26.50 – $68.19 | 7 |
| Sarscov & inf vir a&b ag ia CPT 87428 | not published | not published | $45.96 – $135.66 | 7 |
| S bowel endoscope w/stent CPT 44379 | not published | not published | $4,428.00 – $11,589.23 | 6 |
| Sbrt management CPT 77435 | not published | not published | $2,138.13 – $2,138.13 | 1 |
| Sbsq psyc collab care mgmt CPT 99493 | not published | not published | $75.36 – $193.93 | 4 |
| Scan duplex abd/pelvis/retroperitoneal complete CPT 93975 | $1,599.40 | $2,908.00 | $177.00 – $455.49 | 4 |
| Scan duplex abd/pelvis/retroperitoneal limited CPT 93976 | $684.75 | $1,245.00 | $77.56 – $199.58 | 4 |
| Scan duplex aorta/ivc/iliac or bypass grafts complete CPT 93978 | $750.20 | $1,364.00 | $177.00 – $455.49 | 4 |
| Scan duplex aorta/ivc/iliac unilateral/limited CPT 93979 | not published | not published | $77.56 – $199.58 | 4 |
| Scan duplex extracranial arteries unilateral/limited study CPT 93882 | $481.80 | $876.00 | $77.56 – $199.58 | 4 |
| Scan duplex extremity veins unilateral/limited study CPT 93971 | $782.65 | $1,423.00 | $77.56 – $199.58 | 4 |
| Scan duplex lower extremity arteries complete bilateral CPT 93925 | $1,456.95 | $2,649.00 | $177.00 – $455.49 | 4 |
| Scan duplex lower extremity arteries unilateral/limited study left CPT 93926 | $725.45 | $1,319.00 | $77.56 – $199.58 | 4 |
| Scan duplex upper extremity arteries unilateral/limited study left CPT 93931 | $420.20 | $764.00 | $77.56 – $199.58 | 4 |
| Scan proc cranial extra CPT 61782 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Scan proc cranial intra 61781 CPT 61781 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Scan proc spinal CPT 61783 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Scap thorac prosth tiss shap HCPCS L6570 | not published | not published | $4,663.39 – $12,000.45 | 4 |
| Sclerotherapy fluid collection pq w/img CPT 49185 | $749.10 | $1,362.00 | $1,225.21 – $3,152.87 | 6 |
| Scope plantar fasciotomy CPT 29893 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Scope uretscp lithovue dig disp HCPCS C1747 | $1,959.99 | $3,563.62 | not published | 0 |
| Scr c/v cyto, automated sys HCPCS G0147 | not published | not published | $13.90 – $35.78 | 7 |
| Scr c/v cyto,autosys and md HCPCS G0141 | not published | not published | $26.35 – $26.35 | 1 |
| Scr c/v cyto, autosys, rescr HCPCS G0148 | not published | not published | $21.40 – $61.64 | 7 |
| Scr c/v cyto,thinlayer,rescr HCPCS G0144 | not published | not published | $32.98 – $84.86 | 7 |
| Scr c/v cyto,thinlayer,rescr HCPCS G0145 | not published | not published | $19.87 – $51.13 | 7 |
| Scr c/v cyto,thinlayer,rescr HCPCS G0143 | not published | not published | $20.29 – $52.21 | 7 |
| Screen cerv/vag thin layer HCPCS G0123 | not published | not published | $15.20 – $39.10 | 7 |
| Screen c/v thin layer by md HCPCS G0124 | not published | not published | $26.35 – $26.35 | 1 |
| Screening Colonoscopy (average risk) HCPCS G0121 | not published | not published | $689.87 – $3,030.00 | 6 |
| Screening Colonoscopy (high risk) HCPCS G0105 | not published | not published | $689.87 – $3,030.00 | 6 |
| Screening colorectal cancer fecal occult blood immunoassay 1-3 simultaneous determinations HCPCS G0328 | not published | not published | $13.54 – $34.84 | 7 |
| Screening hepatitis b non-obstetric high risk HCPCS G0499 | not published | not published | $21.20 – $54.56 | 7 |
| Screening hepatitis c antibody high risk HCPCS G0472 | not published | not published | $28.88 – $89.46 | 7 |
| Screening HIV antigen/antibody combination assay HCPCS G0475 | not published | not published | $18.06 – $46.47 | 7 |
| Screening Mammogram CPT 77067 | $217.25 | $395.00 | $65.36 – $168.18 | 4 |
| Screening pap smear by phys HCPCS P3001 | not published | not published | $26.35 – $26.35 | 1 |
| Screening prostate cancer PSA HCPCS G0103 | $136.95 | $249.00 | $14.48 – $37.27 | 7 |
| Screen pap by tech w md supv HCPCS P3000 | not published | not published | $13.90 – $35.78 | 7 |
| Screen/visual acuity/bilat/quant 99173 CPT 99173 | $6.60 | $12.00 | not published | 0 |
| Screw cortex 2.0 x 10mm HCPCS C1713 | $1,147.61 | $2,086.57 | not published | 0 |
| Sc ther infusion reset pump CPT 96371 | not published | not published | $53.41 – $137.45 | 4 |
| Sec abd wall suture evisceration/dehsn 49900 CPT 49900 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Sec art mech thrmbc non-intracranial add-on CPT 37186 | $1,500.95 | $2,729.00 | $1,887.00 – $5,512.00 | 3 |
| Sedation moderate same physician performing a gastrointestinal endoscopic service >= 5 years initial 15 minutes intra-service time HCPCS G0500 | $95.15 | $173.00 | not published | 0 |
| Sedimentation rate erythrocyte automated CPT 85652 | $29.15 | $53.00 | $2.02 – $5.21 | 7 |
| Seg acet and eth estr yearly HCPCS J7294 | not published | not published | $7,907.94 – $7,907.94 | 1 |
| Segmentectomy 32484 CPT 32484 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Select picture audiometry CPT 92583 | not published | not published | $43.76 – $112.62 | 4 |
| Self-meas bp pt educaj/train CPT 99473 | not published | not published | $21.46 – $55.21 | 4 |
| Semen analysis HCPCS G0027 | not published | not published | $4.88 – $12.54 | 7 |
| Semen analysis presence/motility CPT 89321 | $94.60 | $172.00 | $9.04 – $23.26 | 7 |
| Semen analysis w/count CPT 89310 | not published | not published | $6.46 – $16.62 | 7 |
| Sensorimotor examination CPT 92060 | not published | not published | $43.76 – $112.62 | 4 |
| Sensorineural acuity lvl tst CPT 92575 | not published | not published | $27.71 – $71.30 | 4 |
| Separate eyelid adhesions CPT 68340 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Sept9 promoter methylation analysis CPT 81327 | not published | not published | $124.28 – $370.56 | 7 |
| Sequestrectomy olecrn proces CPT 24138 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Sequestrectomy radial h/n CPT 24136 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Sequestrectomy shft/dstl hum CPT 24134 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Sermorelin acetate injection HCPCS Q0515 | not published | not published | $3.51 – $3.51 | 1 |
| Serpina1 gene CPT 81332 | $116.05 | $211.00 | $32.74 – $84.24 | 7 |
| Sertraline (zoloft) - sendout CPT 80332 | $188.65 | $343.00 | $35.06 – $35.06 | 1 |
| Set radiation therapy field CPT 77280 | $633.05 | $1,151.00 | $99.71 – $256.58 | 4 |
| Set radiation therapy field CPT 77285 | $1,033.45 | $1,879.00 | $277.76 – $714.78 | 4 |
| Set radiation therapy field CPT 77290 | $1,352.45 | $2,459.00 | $277.76 – $714.78 | 4 |
| Set-up cardiovert-defibrill CPT 93745 | not published | not published | $227.84 – $2,334.00 | 6 |
| Sevelamer carbonate 800 mg tablet HCPCS J0601 | not published | not published | $0.30 – $0.30 | 1 |
| Sevelamer carbonate pdr 20mg HCPCS J0602 | not published | not published | $0.83 – $0.83 | 1 |
| Sever cranial nerve CPT 64771 | not published | not published | $1,448.59 – $7,791.00 | 6 |
| Sewhfo airplane without jnts cf HCPCS L3976 | not published | not published | $1,409.38 – $3,626.80 | 4 |
| Sewhfo airplane w/jnt(s) cf HCPCS L3978 | not published | not published | $1,663.97 – $4,281.96 | 4 |
| Sewhfo cap desgn w/jnt(s) cf HCPCS L3977 | not published | not published | $1,579.50 – $4,064.58 | 4 |
| Sewhfo cap design without jnt cf HCPCS L3975 | not published | not published | $1,409.38 – $3,626.80 | 4 |
| Sewho airplane without jnts cf HCPCS L3967 | not published | not published | $1,663.97 – $4,281.96 | 4 |
| Sewho airplane w/jnt(s) cf HCPCS L3973 | not published | not published | $1,663.97 – $4,281.96 | 4 |
| Sewho cap design without jnts cf HCPCS L3961 | not published | not published | $1,409.38 – $3,626.80 | 4 |
| Sewho cap design w/jnt(s) cf HCPCS L3971 | not published | not published | $1,579.50 – $4,064.58 | 4 |
| Sewho erbs palsey design abd HCPCS L3962 | not published | not published | $605.10 – $1,557.12 | 4 |
| Sex chromatin identification CPT 88130 | not published | not published | $13.48 – $34.70 | 7 |
| Sex chromatin identification CPT 88140 | not published | not published | $5.99 – $15.42 | 7 |
| Sex transformation f to m CPT 55980 | not published | not published | $2,614.94 – $6,729.12 | 4 |
| Sex transformation m to f CPT 55970 | not published | not published | $3,388.00 – $9,549.58 | 4 |
| Sf3b1 gene common variants CPT 81347 | not published | not published | $144.94 – $372.97 | 7 |
| Sgmdsc w/band ligation CPT 45350 | not published | not published | $887.71 – $4,761.00 | 6 |
| Shave sgl skin lsn f/e/e/n/l/m 0.5cm/< CPT 11310 | not published | not published | $148.84 – $2,334.00 | 6 |
| Shave sgl skin lsn f/e/e/n/l/m 0.6-1.0cm CPT 11311 | not published | not published | $148.84 – $2,334.00 | 6 |
| Shave sgl skin lsn f/e/e/n/l/m 1.1-2cm CPT 11312 | not published | not published | $301.57 – $2,334.00 | 6 |
| Shave sgl skin lsn f/e/e/n/l/m >2cm CPT 11313 | not published | not published | $301.57 – $2,334.00 | 6 |
| Shave sgl skin lsn s/n/h/f/g 0.5cm/< CPT 11305 | not published | not published | $148.84 – $2,334.00 | 6 |
| Shave sgl skin lsn s/n/h/f/g 0.6-1.0 cm CPT 11306 | not published | not published | $148.84 – $2,334.00 | 6 |
| Shave sgl skin lsn s/n/h/f/g 1.1-2cm CPT 11307 | not published | not published | $148.84 – $2,334.00 | 6 |
| Shave sgl skin lsn s/n/h/f/g >2cm CPT 11308 | not published | not published | $301.57 – $2,334.00 | 6 |
| Shave sgl skin lsn t/a/l 0.5cm/< CPT 11300 | not published | not published | $301.57 – $2,334.00 | 6 |
| Shave sgl skin lsn t/a/l 0.6-1.0cm CPT 11301 | $176.55 | $321.00 | $148.84 – $2,334.00 | 6 |
| Shave sgl skin lsn t/a/l 1.1-2.0cm CPT 11302 | not published | not published | $148.84 – $2,334.00 | 6 |
| Sheath above knee HCPCS L8410 | not published | not published | $19.02 – $48.94 | 4 |
| Sheath below knee HCPCS L8400 | not published | not published | $14.45 – $37.19 | 4 |
| Sheath upper limb HCPCS L8415 | not published | not published | $19.68 – $50.64 | 4 |
| Shigella antibody CPT 86771 | not published | not published | $18.36 – $47.25 | 7 |
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.