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 |
|---|---|---|---|---|
| Skin full graft add-on 15241 CPT 15241 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Skin pedicle flap arms/legs CPT 15572 | not published | not published | $2,628.85 – $8,770.00 | 6 |
| Skin pedicle flap trunk CPT 15570 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Skin split graft addl 100sq cm 15101 CPT 15101 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Skin test unlisted antigen ea CPT 86486 | not published | not published | $6.91 – $55.21 | 5 |
| Skull base/brainstem surgery CPT 61575 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Skull base/brainstem surgery CPT 61576 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Skyla, 13.5 mg HCPCS J7301 | not published | not published | $3,146.83 – $3,146.83 | 1 |
| Slco1b1 gene com variants CPT 81328 | not published | not published | $131.11 – $337.38 | 7 |
| Sleep study attended CPT 95807 | $3,598.65 | $6,543.00 | $276.82 – $712.35 | 4 |
| Sleep Study (Polysomnography) CPT 95810 | $3,920.95 | $7,129.00 | $637.04 – $1,639.32 | 4 |
| Sleep study unattended CPT 95806 | not published | not published | $160.18 – $412.19 | 4 |
| Sleeve fing rolyan med HCPCS L3933 | $178.85 | $325.18 | $178.98 – $460.58 | 4 |
| Sleeve pneumonectomy CPT 32442 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Sling pelv split sam med HCPCS L0621 | not published | not published | $48.70 – $125.33 | 4 |
| Sling suprapubic suburetheral HCPCS C1771 | $1,340.82 | $2,437.85 | not published | 0 |
| Slitting of prepuce CPT 54000 | not published | not published | $2,614.94 – $7,791.00 | 6 |
| Slitting of prepuce CPT 54001 | not published | not published | $1,550.71 – $7,791.00 | 6 |
| Slp stdy unatnd w/anal CPT 95801 | not published | not published | $43.76 – $112.62 | 4 |
| Sm-153 lexidron ther HCPCS A9604 | not published | not published | $2,369.85 – $11,747.34 | 5 |
| Small animal inoculation CPT 87003 | not published | not published | $12.63 – $32.50 | 7 |
| Small bowel endoscopy CPT 44360 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Small bowel endoscopy CPT 44364 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Small bowel endoscopy CPT 44366 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Small bowel endoscopy CPT 44369 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Small bowel endoscopy CPT 44376 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Small bowel endoscopy CPT 44378 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Small bowel endoscopy CPT 44382 | not published | not published | $672.83 – $4,761.00 | 6 |
| Small bowel endoscopy CPT 44384 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Small bowel endoscopy >2nd w/remove 44363 CPT 44363 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Small bowel endoscopy 44365 CPT 44365 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Small bowel endoscopy/biopsy CPT 44361 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Small bowel endoscopy/biopsy CPT 44377 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Small bowel endoscopy br/wa CPT 44380 | not published | not published | $672.83 – $4,761.00 | 6 |
| Small bowel endoscopy br/wa CPT 44381 | not published | not published | $1,423.51 – $4,761.00 | 6 |
| Small bowel endoscopy/stent 44370 CPT 44370 | not published | not published | $4,428.00 – $11,589.23 | 6 |
| Smallpox&monkeypox vac 0.5ml CPT 90611 | not published | not published | $0.01 – $0.03 | 5 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $64.35 | $117.00 | $4.04 – $10.40 | 7 |
| Smear gram stain CPT 87205 | $47.30 | $86.00 | $3.20 – $8.24 | 7 |
| Smear nasal eosinophil CPT 89190 | not published | not published | $4.34 – $11.17 | 7 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $73.15 | $133.00 | $4.49 – $11.56 | 7 |
| Smear wet mount CPT 87210 | $51.70 | $94.00 | $4.36 – $11.23 | 7 |
| Smn1 gene full gene sequence CPT 81336 | not published | not published | $226.01 – $581.61 | 7 |
| Smn1 gen nown famil seq vrnt CPT 81337 | not published | not published | $138.90 – $357.44 | 7 |
| Smpd1 gene common variants CPT 81330 | not published | not published | $35.25 – $90.71 | 7 |
| Snrpn/ube3a gene CPT 81331 | not published | not published | $38.30 – $98.57 | 7 |
| So airplane w/wo joint cf HCPCS L3674 | not published | not published | $991.54 – $2,551.58 | 4 |
| So cap design without jnts cf HCPCS L3671 | not published | not published | $755.84 – $1,945.03 | 4 |
| Socket insert above knee HCPCS L5658 | not published | not published | $419.20 – $1,078.75 | 4 |
| Socket insert below knee HCPCS L5655 | not published | not published | $261.42 – $672.72 | 4 |
| Socket insert knee articulat HCPCS L5656 | not published | not published | $397.16 – $1,022.01 | 4 |
| Socket insert symes HCPCS L5654 | not published | not published | $362.08 – $931.75 | 4 |
| Socket insert without lock mech HCPCS L5679 | not published | not published | $604.87 – $1,556.53 | 4 |
| Socket insert w lock mech HCPCS L5673 | not published | not published | $725.86 – $1,867.89 | 4 |
| Sock fracture or equal each HCPCS L3995 | not published | not published | $34.44 – $88.63 | 4 |
| Sock wool above knee HCPCS L8430 | not published | not published | $21.82 – $56.14 | 4 |
| Sodium 24 hour urine CPT 84300 | $44.55 | $81.00 | $3.80 – $9.77 | 7 |
| Sodium chloride 0.9 % intravenous solution HCPCS J7030 | not published | not published | $2.71 – $6.81 | 5 |
| Sodium chloride 0.9 % IV bolus HCPCS J7040 | not published | not published | $1.36 – $3.40 | 5 |
| Sodium chloride 0.9 % IV bolus HCPCS J7050 | not published | not published | $0.68 – $1.72 | 5 |
| Sodium chloride 3 % ivpb HCPCS J7131 | not published | not published | $0.25 – $0.25 | 1 |
| Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous HCPCS J2916 | not published | not published | $2.13 – $5.41 | 5 |
| Sodium hyaluronate 20 mg/2 ml syringe HCPCS J7321 | not published | not published | $79.07 – $198.83 | 5 |
| Sodium serum/plasma/whole blood CPT 84295 | $39.05 | $71.00 | $3.61 – $9.28 | 7 |
| Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution HCPCS J0209 | not published | not published | $0.63 – $2.52 | 5 |
| Soft interface below knee se HCPCS L2820 | not published | not published | $74.84 – $192.59 | 4 |
| Software meas of cardiac vol HCPCS G0183 | not published | not published | $64.56 – $166.13 | 4 |
| So gsap cl fr cpy nmbr&mcrst CPT 81463 | not published | not published | $1,008.98 – $2,596.45 | 7 |
| So gsap cll fr dna/dna&rna CPT 81462 | not published | not published | $896.87 – $2,307.95 | 7 |
| So gsap cll fr mcrstl ins CPT 81464 | not published | not published | $2,466.38 – $6,346.82 | 7 |
| So gsap dna cpy nmbr&mcrstl CPT 81458 | not published | not published | $784.76 – $2,019.46 | 7 |
| Somatosensory testing CPT 95927 | not published | not published | $160.18 – $412.19 | 4 |
| Somatropin injection HCPCS J2941 | not published | not published | $133.19 – $133.19 | 1 |
| So neo gsap dna/dna&rna CPT 81459 | not published | not published | $2,242.16 – $5,769.83 | 7 |
| So neo gsap dna mcrstl ins CPT 81457 | $192.50 | $350.00 | $672.65 – $1,730.96 | 7 |
| Sotalol hydrochloride IV HCPCS C9482 | not published | not published | $62.02 – $62.02 | 1 |
| So vest canvas/web pre ots HCPCS L3675 | not published | not published | $147.23 – $378.88 | 4 |
| Sp bone agrft morsel add-on CPT 20937 | not published | not published | $5,512.00 – $8,770.00 | 3 |
| Sp bone agrft struct add-on CPT 20938 | not published | not published | $5,512.00 – $8,770.00 | 3 |
| Sp bone algrft morsel add-on CPT 20930 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Special physics consult CPT 77370 | $444.95 | $809.00 | $99.71 – $256.58 | 4 |
| Special radiation dosimetry CPT 77331 | $445.50 | $810.00 | $62.49 – $256.58 | 4 |
| Special radiation treatment CPT 77470 | $1,618.65 | $2,943.00 | $160.61 – $1,054.79 | 4 |
| Special teletx port plan CPT 77321 | $949.30 | $1,726.00 | $145.66 – $714.78 | 4 |
| Specific gravity body fluid CPT 84315 | not published | not published | $2.46 – $6.33 | 7 |
| Specimen fat stain CPT 89125 | not published | not published | $4.41 – $11.35 | 7 |
| Speech audiometry complete CPT 92556 | not published | not published | $43.76 – $112.62 | 4 |
| Speech evaluation complex CPT 70371 | not published | not published | $159.92 – $455.49 | 4 |
| Speech recep thresh CPT 92555 | not published | not published | $43.76 – $112.62 | 4 |
| Sperm antibody test CPT 89325 | not published | not published | $8.00 – $20.59 | 7 |
| Sperm evaluation test CPT 89329 | not published | not published | $14.69 – $37.81 | 7 |
| Sperm identification CPT 89257 | not published | not published | $38.66 – $99.48 | 5 |
| Sperm isolation complex CPT 89261 | not published | not published | $38.66 – $99.48 | 5 |
| Sperm isolation simple CPT 89260 | not published | not published | $38.66 – $99.48 | 5 |
| Sperm washing 58323 CPT 58323 | not published | not published | $149.98 – $2,334.00 | 6 |
| Sphenoid sinus surgery CPT 31051 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Sphincteroplasty inc/prolapse adult 46750 CPT 46750 | not published | not published | $2,059.07 – $8,770.00 | 6 |
| Spinal bone allograftstructural 20931 CPT 20931 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Spinal bone autograftlocal 20936 CPT 20936 | not published | not published | $5,512.00 – $8,770.00 | 3 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $2,013.00 | $3,660.00 | $523.65 – $3,030.00 | 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.