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 |
|---|---|---|---|---|
| Shlder disart int lock elbow HCPCS L6300 | not published | not published | $4,099.28 – $10,548.80 | 4 |
| Shldr disar prosth tiss shap HCPCS L6550 | not published | not published | $4,177.28 – $10,749.54 | 4 |
| Shldr disartic myoelectronic HCPCS L6965 | not published | not published | $13,879.78 – $35,717.29 | 4 |
| Sho arthrs dx +- synovial bx CPT 29805 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Sho arthrs srg bicp tenodsis CPT 29828 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Sho arthrs srg capsulorraphy CPT 29806 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Sho arthrs srg compl synvct CPT 29821 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Sho arthrs srg lmtd dbrdmt CPT 29822 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Sho arthrs srg lss&rescj ads CPT 29825 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Sho arthrs srg prtl synvct CPT 29820 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Sho arthrs srg rmvl loose/fb CPT 29819 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Sho arthrs srg rpr slap les CPT 29807 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Sho arthrs srg xtnsv dbrdmt CPT 29823 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Shoe clubfoot wedge HCPCS L3380 | not published | not published | $45.72 – $117.65 | 4 |
| Shoe dennis browne splint bo HCPCS L3640 | not published | not published | $39.87 – $102.60 | 4 |
| Shoe heel new leather standa HCPCS L3455 | not published | not published | $37.52 – $96.54 | 4 |
| Shoe heel new rubber standar HCPCS L3460 | not published | not published | $31.66 – $81.48 | 4 |
| Shoe heel pad & depress for HCPCS L3480 | not published | not published | $57.43 – $147.78 | 4 |
| Shoe heel sach cushion type HCPCS L3450 | not published | not published | $97.27 – $250.30 | 4 |
| Shoe heel thomas extend to b HCPCS L3470 | not published | not published | $57.43 – $147.78 | 4 |
| Shoe heel thomas with wedge HCPCS L3465 | not published | not published | $53.96 – $138.84 | 4 |
| Shoe lift elev heel/sole neo HCPCS L3310 | not published | not published | $75.04 – $193.10 | 4 |
| Shoe metatarsal bar between HCPCS L3410 | not published | not published | $85.57 – $220.19 | 4 |
| Shoe metatarsal bar wedge ro HCPCS L3400 | not published | not published | $37.52 – $96.54 | 4 |
| Shoe outflare wedge HCPCS L3390 | not published | not published | $45.72 – $117.65 | 4 |
| Shoe sole wedge between sole HCPCS L3370 | not published | not published | $45.72 – $117.65 | 4 |
| Shoe sole wedge outside sole HCPCS L3360 | not published | not published | $32.82 – $84.46 | 4 |
| Shoe wedge sach HCPCS L3340 | not published | not published | $78.56 – $202.15 | 4 |
| Sho heel count plast reinfor HCPCS L3430 | not published | not published | $147.70 – $380.09 | 4 |
| Sho insert w arch toe filler HCPCS L5000 | not published | not published | $529.28 – $1,362.02 | 4 |
| Sho lift taper to metatarsal HCPCS L3300 | not published | not published | $48.08 – $123.71 | 4 |
| Shortening of hand tendon CPT 26479 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Shortening of thigh bone CPT 27465 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Shorten/lengthen thighs CPT 27468 | not published | not published | $3,735.00 – $18,364.00 | 3 |
| Shorten radius or ulna CPT 25390 | not published | not published | $5,382.89 – $16,106.00 | 6 |
| Shorten radius & ulna CPT 25392 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Shoulder abduction joint pai HCPCS L6640 | not published | not published | $310.94 – $800.14 | 4 |
| Shoulder Arthroscopy (Rotator Cuff Repair) CPT 29827 | not published | not published | $5,382.89 – $18,364.00 | 7 |
| Shoulder flexion-abduction j HCPCS L6645 | not published | not published | $336.26 – $865.32 | 4 |
| Shoulder harness HCPCS L5699 | not published | not published | $188.32 – $484.62 | 4 |
| Shoulder lock actuator HCPCS L6647 | not published | not published | $479.54 – $1,234.02 | 4 |
| Shoulder MRI (with and without contrast) CPT 73223 | $2,514.05 | $4,571.00 | $258.81 – $665.99 | 4 |
| Shoulder MRI (with contrast) CPT 73222 | $2,394.70 | $4,354.00 | $581.54 – $1,496.49 | 4 |
| Shoulder MRI (without contrast) CPT 73221 | $2,280.30 | $4,146.00 | $177.00 – $455.49 | 4 |
| Shoulder prosthesis removal CPT 23334 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Shoulder prosthesis removal CPT 23335 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Shoulder universal joint HCPCS L6650 | not published | not published | $364.72 – $938.54 | 4 |
| Shoulder X-ray CPT 73030 | $304.15 | $553.00 | $63.69 – $166.13 | 4 |
| Shrinker prosth above knee HCPCS L8460 | not published | not published | $61.19 – $157.47 | 4 |
| Shrinker prosth below knee HCPCS L8440 | not published | not published | $43.05 – $110.78 | 4 |
| Shrinker upper limb HCPCS L8465 | not published | not published | $56.56 – $145.54 | 4 |
| Shunt as-aort to pulm art CPT 33755 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Shunt central w/prostc graft CPT 33764 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Shunt desc aorta to pulm art CPT 33762 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Shuntogram nonvascular supervision & interpretation CPT 75809 | $222.20 | $404.00 | $77.56 – $199.58 | 4 |
| Shunt subclavian to pulm art CPT 33750 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Shunt supr v/c p-art 1 lung CPT 33766 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Shunt supr v/c p-art bth lng CPT 33767 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Sialidase enzyme assay CPT 87905 | not published | not published | $9.16 – $23.58 | 7 |
| Sialography s&i CPT 70390 | $469.15 | $853.00 | $177.00 – $455.49 | 4 |
| Sialolithotomy 42330 CPT 42330 | not published | not published | $2,459.51 – $6,329.15 | 6 |
| Sickling rbc CPT 85660 | $156.20 | $284.00 | $4.13 – $10.63 | 7 |
| Sigmoidoscopy and biopsy CPT 45331 | not published | not published | $689.87 – $3,030.00 | 6 |
| Sigmoidoscopy flex decompression 45337 CPT 45337 | not published | not published | $689.87 – $4,761.00 | 6 |
| Sigmoidoscopy for bleeding CPT 45334 | not published | not published | $887.71 – $4,761.00 | 6 |
| Sigmoidoscopy/submucosal injection 45335 CPT 45335 | not published | not published | $689.87 – $3,030.00 | 6 |
| Sigmoidoscopy w/ablation CPT 45346 | not published | not published | $887.71 – $4,761.00 | 6 |
| Sigmoidoscopy w/fb removal 45332 CPT 45332 | not published | not published | $887.71 – $4,761.00 | 6 |
| Sigmoidoscopy w/plcmt stent CPT 45347 | not published | not published | $3,579.00 – $11,589.23 | 6 |
| Sigmoidoscopy w/resection CPT 45349 | not published | not published | $2,059.07 – $5,298.68 | 6 |
| Sigmoidoscopy w/tumr remove CPT 45338 | not published | not published | $887.71 – $4,761.00 | 6 |
| Sigmoidoscopy w/ultrasound CPT 45341 | not published | not published | $689.87 – $4,761.00 | 6 |
| Sigmoidoscopy w/us guide bx CPT 45342 | not published | not published | $887.71 – $4,761.00 | 6 |
| Sigmoid/rmv tumor/polyp/hot bx for 45333 CPT 45333 | not published | not published | $689.87 – $3,030.00 | 6 |
| Signal avg ecg w or without ecg 93278 CPT 93278 | not published | not published | $43.76 – $112.62 | 4 |
| Sig w/tndsc balloon dilation CPT 45340 | not published | not published | $887.71 – $4,761.00 | 6 |
| Silicon gel insert w/wo lock HCPCS L6692 | not published | not published | $590.65 – $1,519.93 | 4 |
| Sim ang w/prs cath rad emb HCPCS C8004 | not published | not published | $8,563.85 – $22,037.64 | 4 |
| Simple cystometrogram 51725 CPT 51725 | not published | not published | $185.35 – $2,334.00 | 6 |
| Sincalide 5 mcg solution for injection HCPCS J2805 | not published | not published | $123.85 – $311.42 | 5 |
| Single energy x-ray study HCPCS G0130 | not published | not published | $75.56 – $199.58 | 4 |
| Single pivot hinge pair HCPCS L6605 | not published | not published | $215.61 – $554.84 | 4 |
| Single transfer toe-hand CPT 26553 | not published | not published | $3,735.00 – $16,106.00 | 6 |
| Sinus CT scan (with and without contrast) CPT 70488 | $1,506.45 | $2,739.00 | $130.12 – $334.84 | 4 |
| Sinus CT scan (with contrast) CPT 70487 | $1,434.95 | $2,609.00 | $130.12 – $334.84 | 4 |
| Sinus CT scan (without contrast) CPT 70486 | $1,366.75 | $2,485.00 | $77.56 – $199.58 | 4 |
| Sinus/juglr venogram s&i CPT 75860 | $1,096.70 | $1,994.00 | $290.61 – $6,027.57 | 4 |
| Sinusotomy maxillary sinus 31020 CPT 31020 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Sinusotomy sinus remove polyps 31032 CPT 31032 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Sinusotomy sphenoid w/wo bx 31050 CPT 31050 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Sio flex pelvisacral custom HCPCS L0622 | not published | not published | $246.36 – $633.97 | 4 |
| Sio rig pnl pelv/sac pre ots HCPCS L0623 | not published | not published | $87.31 – $224.67 | 4 |
| Sipuleucel-t - su HCPCS Q2043 | not published | not published | $41,949.32 – $151,198.13 | 7 |
| Sirolimus, oral HCPCS J7520 | not published | not published | $1.15 – $2.89 | 5 |
| Sirolimus-protein bound 100 mg intravenous suspension HCPCS J9331 | not published | not published | $68.27 – $319.75 | 8 |
| Six volt bat otto bock/eq ea HCPCS L7360 | not published | not published | $244.32 – $628.72 | 4 |
| Skeletal muscle relaxant 1/2 CPT 80369 | $102.30 | $186.00 | $35.06 – $35.06 | 1 |
| Skin and muscle repair face CPT 15845 | not published | not published | $2,628.85 – $8,770.00 | 6 |
| Skin Biopsy CPT 11102 | $589.60 | $1,072.00 | $301.57 – $2,334.00 | 6 |
| Skin full graft 20sq cm less 15200 CPT 15200 | not published | not published | $1,530.61 – $7,791.00 | 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.