CMS Price Transparency Data

Trauma team activation

Facility: SSM Health St Agnes Hospital-Fond Du Lac

Billing Code: G0390 (HCPCS)

The BaseRate · fair price medium confidence

A fair price for this

$1,681

about 1.2× the $1,362 Medicare rate · typically $1,333–$4,370

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,332

Below the fair price — a good deal

about $349 under the fair price · 1.0× Medicare

Medicare pays $1,362 Fair price $1,681 This hospital $1,332 Cash price $4,544 Hospital's list price $8,262

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 $988 Priciest $1,332

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

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Trauma team activation is about $1,681 (about 1.2× the $1,362 Medicare rate). SSM Health St Agnes Hospital-Fond Du Lac charges insurers about $1,332, or about $4,544 in cash — below the fair price — a good deal. 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.

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

✓ Blue Cross Blue Shield UnitedHealthcareAetnaCignaHumanaKaiser 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
Blue Cross Blue Shieldmajor	$1,318	97%
Molina	$989	73%
WellCare	$1,345	99%
+ 1 smaller / regional plan	$2,544

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 (about 4,544), 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 HCPCS code on your bill matches exactly: G0390.

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 HCPCS code G0390.
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: Trauma team activation at other WI hospitals

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