CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: SSM Health St Agnes Hospital-Fond Du Lac

Billing Code: 392 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$10,791

about 1.9× the $5,676 Medicare rate · typically $6,328–$12,897

modeled estimate · not a bill or quote

What this hospital charges insurers

$10,431

About the fair price

about $360 under the fair price · 1.8× Medicare

Medicare pays $5,676 Fair price $10,791 This hospital $10,431

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $5,090 Priciest $10,431

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

A fair price for a Digestive disorders treatment (inpatient stay) is about $10,791 (about 1.9× the $5,676 Medicare rate). SSM Health St Agnes Hospital-Fond Du Lac charges insurers about $10,431 — about the fair price. Located in Fond Du Lac, WI.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

3 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Humana AetnaCignaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$5,708 - $11,743	101%
Blue Cross Blue Shieldmajor	$5,708 - $12,159	101%
Humanamajor	$5,708	101%
Dean Health Plan	$5,708	101%
Molina	$4,281	75%
Quartz	$10,659	188%
WellCare	$5,823	103%
+ 9 smaller / regional plans	$5,708 - $16,038

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 392.

Insurance Before you use insurance

Call your insurance company to confirm SSM Health St Agnes Hospital-Fond Du Lac is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 392.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at SSM Health St Agnes Hospital-Fond Du Lac

Compare: Digestive disorders treatment (inpatient stay) at other WI hospitals

Thedacare Medical Center - Shawano · Shawano $5,090
Orthopaedic Hospital of Wisconsin · Glendale $5,344
Sauk Prairie Hospital · Prairie Du Sac $5,510
Oakleaf Surgical Hospital · Altoona $5,521
The Monroe Clinic · Monroe $5,545
Mile Bluff Medical Center · Mauston $5,607
Beloit Health System · Beloit $6,477
Gundersen Boscobel Area Hospital and Clinics · Boscobel $6,834

Insurance negotiated median for the same procedure, sorted lowest first.