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 |
|---|---|---|---|---|
| Partial removal tear gland CPT 68505 | not published | not published | $2,916.44 – $8,770.00 | 6 |
| Partial thyroid excision CPT 60210 | not published | not published | $4,484.77 – $18,364.00 | 6 |
| Partial thyroid lobect w/contratlat stot lobec 60212 CPT 60212 | not published | not published | $4,484.77 – $18,364.00 | 6 |
| Particle matristem matrix 1000mg micron-q4118-cost per mg HCPCS Q4118 | not published | not published | $2.81 – $6.91 | 4 |
| Part removal hip bone deep CPT 27071 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Part removal of metatarsal CPT 28110 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Part removal of metatarsal CPT 28113 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Part removal of metatarsal 28112 CPT 28112 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Part remove hip bone super CPT 27070 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Passy muir valve metal trach HCPCS L8501 | $95.54 | $173.71 | $110.91 – $285.41 | 4 |
| Path clin consltj high 41-60 CPT 80505 | not published | not published | $126.39 – $325.23 | 5 |
| Path clin consltj mod 21-40 CPT 80504 | not published | not published | $73.64 – $325.23 | 5 |
| Path clin consltj prolng svc CPT 80506 | not published | not published | $43.26 – $66.35 | 2 |
| Path clin consltj sf 5-20 CPT 80503 | not published | not published | $34.57 – $99.48 | 5 |
| Patient recorded spirometry CPT 94014 | not published | not published | $331.39 – $852.79 | 4 |
| Patient recorded spirometry CPT 94015 | not published | not published | $160.18 – $412.19 | 4 |
| Patten bottom HCPCS L2370 | not published | not published | $294.98 – $759.09 | 4 |
| Pca3/klk3 antigen CPT 81313 | not published | not published | $191.29 – $492.25 | 7 |
| Pcv21 vaccine im CPT 90684 | not published | not published | $360.68 – $892.68 | 4 |
| Pdgfra gene CPT 81314 | $783.20 | $1,424.00 | $247.13 – $635.95 | 7 |
| Pd hl 3.5in 4d med rbr mld 6432 HCPCS L3350 | not published | not published | $21.08 – $54.25 | 4 |
| Pdt dstr prmlg les phys/qhp CPT 96573 | not published | not published | $148.84 – $2,334.00 | 6 |
| Pedcle fh/ch/ch/m/n/ax/g/h/f CPT 15574 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Ped home apnea mntr att only CPT 94775 | not published | not published | $95.45 – $245.63 | 4 |
| Ped home apnea mntr dl&alys CPT 94776 | not published | not published | $95.45 – $245.63 | 4 |
| Pediatric electric hand HCPCS L7008 | not published | not published | $5,230.76 – $13,460.50 | 4 |
| Pediatric electric hook HCPCS L7045 | not published | not published | $1,484.09 – $3,819.06 | 4 |
| Pedicle enel/ntroral 15576 CPT 15576 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Ped term dev, hand, vol clos HCPCS L6714 | not published | not published | $1,222.05 – $3,144.74 | 4 |
| Ped term dev, hand, vol open HCPCS L6713 | not published | not published | $1,442.80 – $3,712.82 | 4 |
| Ped term dev, hook, vol clos HCPCS L6712 | not published | not published | $1,143.21 – $2,941.86 | 4 |
| Ped term dev, hook, vol open HCPCS L6711 | not published | not published | $620.89 – $1,597.75 | 4 |
| Pegademase bovine, 25 iu HCPCS J2504 | not published | not published | $420.95 – $420.95 | 1 |
| Pegaptanib sodium injection HCPCS J2503 | not published | not published | $2,471.06 – $2,471.06 | 1 |
| Pegaspargase injection HCPCS J9266 | not published | not published | $22,247.97 – $73,699.51 | 8 |
| Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector HCPCS J2506 | not published | not published | $21.64 – $276.44 | 8 |
| Pegfilgrastim-apgf 6 mg/0.6 ml subcutaneous syringe HCPCS Q5122 | not published | not published | $102.68 – $318.57 | 7 |
| Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe HCPCS Q5111 | not published | not published | $111.85 – $369.04 | 7 |
| Pegfilgrastim-fpgk 6 mg/0.6 ml subcutaneous syringe HCPCS Q5127 | not published | not published | $107.75 – $812.15 | 7 |
| Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe HCPCS Q5108 | not published | not published | $50.27 – $341.14 | 7 |
| Pegfilgrastim-pbbk 6 mg/0.6 ml subcutaneous syringe HCPCS Q5130 | not published | not published | $78.83 – $499.64 | 7 |
| Pegloticase 8 mg/ml intravenous solution HCPCS J2507 | not published | not published | $2,947.00 – $9,665.01 | 8 |
| Pegunigalsidase alfa-iwxj HCPCS J2508 | not published | not published | $169.25 – $617.43 | 8 |
| Pelv band/spread bar thigh c HCPCS L1640 | not published | not published | $436.34 – $1,122.85 | 4 |
| Pelvic band & belt thigh fla HCPCS L2192 | not published | not published | $307.30 – $790.78 | 4 |
| Pelvic control band & belt b HCPCS L2640 | not published | not published | $289.63 – $745.31 | 4 |
| Pelvic control band & belt u HCPCS L2630 | not published | not published | $213.41 – $549.18 | 4 |
| Pelvic control hip heavy dut HCPCS L2620 | not published | not published | $230.44 – $592.99 | 4 |
| Pelvic control pelvic sling HCPCS L2580 | not published | not published | $399.99 – $1,029.31 | 4 |
| Pelvic CT scan (with and without contrast) CPT 72194 | $1,636.25 | $2,975.00 | $130.12 – $334.84 | 4 |
| Pelvic CT scan (with contrast) CPT 72193 | $1,558.15 | $2,833.00 | $130.12 – $334.84 | 4 |
| Pelvic CT scan (without contrast) CPT 72192 | $1,484.45 | $2,699.00 | $77.56 – $199.58 | 4 |
| Pelvic exenteration CPT 45126 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Pelvic & hip control thigh c HCPCS L1680 | not published | not published | $1,050.08 – $2,702.21 | 4 |
| Pelvic MRI (with and without contrast) CPT 72197 | $2,336.40 | $4,248.00 | $258.81 – $665.99 | 4 |
| Pelvic MRI (with contrast) CPT 72196 | $2,224.75 | $4,045.00 | $258.81 – $665.99 | 4 |
| Pelvic MRI (without contrast) CPT 72195 | $2,118.60 | $3,852.00 | $177.00 – $455.49 | 4 |
| Pelvic ring fracture uni/bil HCPCS G0413 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Pelvic ring fx treat int fix HCPCS G0414 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Pelvic Ultrasound (complete) CPT 76856 | $400.95 | $729.00 | $77.56 – $199.58 | 4 |
| Pelvic Ultrasound (limited) CPT 76857 | $460.90 | $838.00 | $75.56 – $199.58 | 4 |
| Pelv & thor control gluteal HCPCS L2650 | not published | not published | $127.54 – $328.22 | 4 |
| Pembrolizumab 25 mg/ml intravenous solution HCPCS J9271 | not published | not published | $45.48 – $156.82 | 8 |
| Pemetrexed disodium 100 mg intravenous powder for solution HCPCS J9305 | not published | not published | $4.15 – $14.36 | 8 |
| Peng benzathine/procaine inj HCPCS J0558 | not published | not published | $14.64 – $47.29 | 8 |
| Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe HCPCS J0561 | not published | not published | $24.44 – $73.01 | 8 |
| Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr HCPCS J2540 | not published | not published | $0.81 – $2.05 | 5 |
| Penicillin g procaine inj HCPCS J2510 | not published | not published | $128.47 – $128.47 | 1 |
| Penile injection CPT 54235 | $189.75 | $345.00 | $185.35 – $2,334.00 | 6 |
| Penile vascular study CPT 93980 | $585.20 | $1,064.00 | $77.56 – $199.58 | 4 |
| Penile vascular study CPT 93981 | not published | not published | $77.56 – $199.58 | 4 |
| Penile venous occlusion CPT 37790 | not published | not published | $2,614.94 – $8,770.00 | 6 |
| Penis plastic surgery CPT 54360 | not published | not published | $2,614.94 – $16,106.00 | 6 |
| Penis study CPT 54240 | not published | not published | $160.18 – $2,334.00 | 6 |
| Pentamidine non-comp unit HCPCS J2545 | not published | not published | $85.95 – $216.13 | 5 |
| Pentazocine injection HCPCS J3070 | not published | not published | $72.20 – $72.20 | 1 |
| Pentobarbital sodium inj HCPCS J2515 | not published | not published | $14.47 – $183.83 | 5 |
| Pentostatin 10 mg intravenous solution HCPCS J9268 | not published | not published | $2,023.49 – $7,439.31 | 8 |
| Perc cryo ablate renal tum CPT 50593 | $9,782.85 | $17,787.00 | $7,609.00 – $20,292.15 | 6 |
| Perc d-e cor revasc chro add HCPCS C9608 | $6,628.60 | $12,052.00 | $1,887.00 – $5,512.00 | 3 |
| Perc d-e cor revasc chro sin HCPCS C9607 | $7,680.20 | $13,964.00 | $8,923.00 – $34,994.75 | 6 |
| Perc d-e cor revasc t cabg b HCPCS C9605 | $6,532.35 | $11,877.00 | $1,887.00 – $5,512.00 | 3 |
| Perc d-e cor revasc t cabg s HCPCS C9604 | $7,313.90 | $13,298.00 | $7,609.00 – $27,583.00 | 6 |
| Perc d-e cor stent ather br HCPCS C9603 | $10,491.25 | $19,075.00 | $1,887.00 – $5,512.00 | 3 |
| Perc d-e cor stent ather s HCPCS C9602 | $10,542.40 | $19,168.00 | $8,923.00 – $34,994.75 | 6 |
| Perc drug-el cor stent bran HCPCS C9601 | $6,757.85 | $12,287.00 | $1,887.00 – $5,512.00 | 3 |
| Perc drug-el cor stent sing HCPCS C9600 | $7,279.80 | $13,236.00 | $7,609.00 – $27,583.00 | 6 |
| Perc rf ablate renal tumor CPT 50592 | $8,379.25 | $15,235.00 | $4,484.77 – $18,364.00 | 6 |
| Percut ablate liver rf CPT 47382 | not published | not published | $4,484.77 – $18,364.00 | 6 |
| Percutaneous islet celltrans HCPCS G0341 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Perflutren lipid microspheres 1.1 mg/ml intravenous suspension HCPCS Q9957 | not published | not published | $46.07 – $113.29 | 4 |
| Pericardial drain w/cath pq w/ct guid CPT 33019 | $1,243.00 | $2,260.00 | $3,388.00 – $3,388.00 | 1 |
| Pericardiectomy/sub or com/w bypas 33031 CPT 33031 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Pericardiocentesis wwo imaging CPT 33016 | $1,429.45 | $2,599.00 | $1,167.76 – $3,030.00 | 6 |
| Pericardiotomy/clot/for bod remove 33020 CPT 33020 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Peri-implt capslc brst compl CPT 19371 | not published | not published | $2,904.59 – $8,770.00 | 6 |
| Perineoplasty rpr per nonob CPT 56810 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Peripheral vascular rehab CPT 93668 | $238.15 | $433.00 | $43.76 – $112.62 | 4 |
| Peri-proc device eval icd CPT 93287 | $172.15 | $313.00 | not published | 0 |
| Peri-proc device eval pm CPT 93286 | $129.80 | $236.00 | not published | 0 |
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.