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 |
|---|---|---|---|---|
| Brachytx isodose intermed CPT 77317 | not published | not published | $277.76 – $714.78 | 4 |
| Brachytx isodose plan simple CPT 77316 | not published | not published | $277.76 – $714.78 | 4 |
| Braf gene CPT 81210 | $466.40 | $848.00 | $131.55 – $338.52 | 7 |
| Brain biopsy w/ct/mr guide CPT 61751 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Brain cavity shunt w/scope CPT 62201 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Brain flow imaging only CPT 78610 | $1,936.00 | $3,520.00 | $402.79 – $1,036.52 | 4 |
| Brain image < 4 views CPT 78600 | not published | not published | $296.56 – $763.16 | 4 |
| Brain image 4+ views CPT 78605 | not published | not published | $402.79 – $1,036.52 | 4 |
| Brain image w/flow < 4 views CPT 78601 | not published | not published | $296.56 – $763.16 | 4 |
| Brain image w/flow 4 + views CPT 78606 | $1,936.00 | $3,520.00 | $402.79 – $1,036.52 | 4 |
| Brain MRA (blood vessel MRI, with and without contrast) CPT 70546 | $1,857.35 | $3,377.00 | $258.81 – $665.99 | 4 |
| Brain MRA (blood vessel MRI, with contrast) CPT 70545 | $1,769.35 | $3,217.00 | $258.81 – $665.99 | 4 |
| Brain MRA (blood vessel MRI, without contrast) CPT 70544 | $1,685.20 | $3,064.00 | $177.00 – $455.49 | 4 |
| Brain MRI (with and without contrast) CPT 70553 | $1,843.60 | $3,352.00 | $258.81 – $665.99 | 4 |
| Brain MRI (with contrast) CPT 70552 | $1,755.60 | $3,192.00 | $258.81 – $665.99 | 4 |
| Brain MRI (without contrast) CPT 70551 | $1,672.00 | $3,040.00 | $177.00 – $455.49 | 4 |
| Bra surgical elizabeth pink sm HCPCS L8000 | not published | not published | $39.10 – $100.61 | 4 |
| Brca1&2 gene full seq alys CPT 81163 | not published | not published | $351.00 – $936.00 | 7 |
| Brca1&2 gen ful dup/del alys CPT 81164 | not published | not published | $438.17 – $1,127.56 | 7 |
| Brca1 dna gene analy known fam var CPT 81215 | not published | not published | $138.29 – $724.23 | 7 |
| Brca1 gene full dup/del alys CPT 81166 | not published | not published | $226.01 – $581.61 | 7 |
| Brca1 gene full seq alys CPT 81165 | not published | not published | $212.16 – $565.76 | 7 |
| Brca2 dna gene analy full seq analy CPT 81216 | not published | not published | $138.84 – $357.28 | 7 |
| Brca2 dna gene analy known fam var CPT 81217 | not published | not published | $138.29 – $724.23 | 7 |
| Brca2 gene full dup/del alys CPT 81167 | not published | not published | $212.16 – $545.96 | 7 |
| Brcassure ashkenazi panel-sendout CPT 81212 | not published | not published | $262.10 – $849.20 | 7 |
| Brcassure comprehensive panel-sendout CPT 81162 | not published | not published | $1,368.66 – $3,522.02 | 7 |
| Breast augmentation 19325 CPT 19325 | not published | not published | $6,063.28 – $18,364.00 | 6 |
| Breast Biopsy (ultrasound-guided, percutaneous) CPT 19083 | $2,412.85 | $4,387.00 | $1,225.21 – $4,761.00 | 6 |
| Breast punct aspir cyst, bil CPT 19000 | $847.00 | $1,540.00 | $525.32 – $3,030.00 | 6 |
| Breast reconstruction 19357 CPT 19357 | not published | not published | $7,609.00 – $26,307.58 | 6 |
| Breast reconstruction tram flap 19367 CPT 19367 | not published | not published | $6,019.00 – $16,106.00 | 3 |
| Breast reconstr w/lat flap 19361 CPT 19361 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Breast reduction CPT 19318 | not published | not published | $4,925.89 – $16,106.00 | 6 |
| Breath hydrogen test 91065 CPT 91065 | $607.75 | $1,105.00 | $160.18 – $2,334.00 | 6 |
| Breathing response hypoxia CPT 94450 | not published | not published | $95.45 – $245.63 | 4 |
| Breath recording infant CPT 94772 | not published | not published | $276.82 – $712.35 | 4 |
| Breath test analysis c-14 CPT 78268 | not published | not published | $70.81 – $182.21 | 6 |
| Breath tst attain/anal c-14 CPT 78267 | not published | not published | $8.30 – $21.35 | 6 |
| Brentuximab vedotin 50 mg intravenous solution HCPCS J9042 | not published | not published | $209.41 – $677.70 | 8 |
| Brexucabtagene car pos t HCPCS Q2053 | not published | not published | $382,577.94 – $1,328,720.23 | 7 |
| Bronch/asp/tracheobronch tree/subs 31646 CPT 31646 | not published | not published | $290.14 – $2,334.00 | 6 |
| Bronch ebus ivntj perph les 31654 CPT 31654 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Bronch ebus samplng 1/2 node CPT 31652 | not published | not published | $2,765.81 – $7,791.00 | 6 |
| Bronch ebus samplng 3/> node CPT 31653 | not published | not published | $2,765.81 – $7,791.00 | 6 |
| Bronchial allergy tests CPT 95070 | not published | not published | $276.82 – $712.35 | 4 |
| Bronchial brush biopsy CPT 31717 | not published | not published | $290.14 – $2,334.00 | 6 |
| Bronchial challenge CPT 94070 | $1,166.00 | $2,120.00 | $276.82 – $712.35 | 4 |
| Bronchial valve init insert CPT 31647 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Bronchial valve remov addl CPT 31649 | not published | not published | $1,320.39 – $4,761.00 | 6 |
| Bronchial valve remov init CPT 31648 | not published | not published | $2,765.81 – $8,770.00 | 6 |
| Bronchoscopy bronch stents CPT 31636 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Bronchoscopy clear airways 31645 CPT 31645 | not published | not published | $1,320.39 – $4,761.00 | 6 |
| Bronchoscopy dilate/fx repr CPT 31630 | not published | not published | $2,765.81 – $8,770.00 | 6 |
| Bronchoscopy dilate w/stent CPT 31631 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Bronchoscopy/lung bx addl 31632 CPT 31632 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Bronchoscopy/lung bx each 31628 CPT 31628 | not published | not published | $2,765.81 – $7,117.34 | 6 |
| Bronchoscopy/needle bx addl 31633 CPT 31633 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Bronchoscopy/needle bx each 31629 CPT 31629 | not published | not published | $2,765.81 – $8,770.00 | 6 |
| Bronchoscopy revise stent CPT 31638 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Bronchoscopy treat blockage CPT 31641 | not published | not published | $2,765.81 – $8,770.00 | 6 |
| Bronchoscopy w/biopsy(s) 31625 CPT 31625 | not published | not published | $1,320.39 – $4,761.00 | 6 |
| Bronchoscopy w/fb removal 31635 CPT 31635 | not published | not published | $1,320.39 – $4,761.00 | 6 |
| Bronchoscopy w/markers CPT 31626 | $4,022.15 | $7,313.00 | $5,235.45 – $13,472.56 | 6 |
| Bronchoscopy w/tumor excise CPT 31640 | not published | not published | $2,765.81 – $8,770.00 | 6 |
| Bronch thermoplsty 1 lobe CPT 31660 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Bronch thermoplsty 2/> lobes CPT 31661 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Bronch w/balloon occlusion CPT 31634 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Bronch w/debrdmt subgltc & uppr trach CPT 31899 | not published | not published | $148.07 – $2,334.00 | 6 |
| Br punct aspir ea add, l CPT 19001 | $618.20 | $1,124.00 | $1,887.00 – $5,512.00 | 3 |
| Brush provox 4-10mm HCPCS L8513 | not published | not published | $4.81 – $12.37 | 4 |
| Bso omentectomy w/tah 58956 CPT 58956 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Budesonide non-comp unit HCPCS J7626 | not published | not published | $1.31 – $3.84 | 5 |
| Bumetanide in d5w IV syringe 0.04 mg/ml (neo/ped) - cnr HCPCS J1939 | not published | not published | $0.63 – $1.58 | 5 |
| Bundled special stain group 1 microorganisms CPT 88312 | $127.60 | $232.00 | $38.66 – $99.48 | 5 |
| Bundled special stain group 2 CPT 88313 | $417.45 | $759.00 | $33.43 – $253.99 | 5 |
| Bundle his recording CPT 93600 | $7,333.70 | $13,334.00 | $3,579.00 – $14,889.41 | 6 |
| Bupivacaine 0.1 % epidural pca - 1 hour dose limit HCPCS J0665 | not published | not published | $0.01 – $0.03 | 5 |
| Buprenorphine 2 mg-naloxone 0.5 mg sublingual tablet HCPCS J0572 | not published | not published | $19.44 – $19.44 | 1 |
| Buprenorphine 8 mg-naloxone 2 mg sublingual tablet HCPCS J0574 | not published | not published | $31.47 – $31.47 | 1 |
| Buprenorphine and metabolite - sendout CPT 80348 | $76.45 | $139.00 | not published | 0 |
| Buprenorphine hydrochloride HCPCS J0592 | not published | not published | $4.60 – $11.72 | 5 |
| Buprenorphine oral 1mg HCPCS J0571 | not published | not published | $3.81 – $3.81 | 1 |
| Buprenorphine X-ray over 100 mg HCPCS Q9992 | not published | not published | $1,551.12 – $5,259.36 | 7 |
| Buprenorph X-ray 100 mg or less HCPCS Q9991 | not published | not published | $1,551.12 – $5,259.36 | 7 |
| Burr hole for vent puncture 61120 CPT 61120 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Burr hole implant ventricular cath/other device CPT 61210 | $8,435.35 | $15,337.00 | $3,388.00 – $3,388.00 | 1 |
| Burr hole skull for biopsy 61140 CPT 61140 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Burr hole skull & remove clot 61154 CPT 61154 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Bur rotalink 2.15mm HCPCS C1724 | $3,111.47 | $5,657.22 | not published | 0 |
| Busulfan injection HCPCS J0594 | not published | not published | $0.77 – $3.86 | 8 |
| Butorphanol tartrate 1 mg HCPCS J0595 | not published | not published | $5.16 – $15.46 | 5 |
| Buttock fasciotomy CPT 27027 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Buttock fasciotomy w/dbrdmt CPT 27057 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Bx arm/elbow soft tissue supf 24065 CPT 24065 | not published | not published | $1,225.21 – $4,761.00 | 6 |
| Bx bone trocar/ndl deep CPT 20225 | $2,209.35 | $4,017.00 | $1,225.21 – $4,761.00 | 6 |
| Bx breast 1st lesion mr imag CPT 19085 | $2,412.85 | $4,387.00 | $1,225.21 – $4,761.00 | 6 |
| Bx breast 1st lesion strtctc CPT 19081 | $2,412.85 | $4,387.00 | $1,225.21 – $4,761.00 | 6 |
| Bx breast add lesion mr imag CPT 19086 | $237.05 | $431.00 | $1,887.00 – $5,512.00 | 3 |
| Bx breast add lesion strtctc CPT 19082 | $237.05 | $431.00 | $1,887.00 – $5,512.00 | 3 |
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.