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 |
|---|---|---|---|---|
| Peritoneal cath sub q resv per CPT 49419 | not published | not published | $4,127.91 – $18,364.00 | 6 |
| Peritoneogram rs&i CPT 74190 | $932.25 | $1,695.00 | $116.54 – $1,043.10 | 4 |
| Perit-vens shunt pat tst CPT 78291 | $1,936.00 | $3,520.00 | $296.56 – $763.16 | 4 |
| Peroneal straps pair pre ots HCPCS L0980 | not published | not published | $15.74 – $40.51 | 4 |
| Perp bk ptb thermopls direct HCPCS L5520 | not published | not published | $1,457.79 – $3,751.38 | 4 |
| Perphenazine 4mg oral HCPCS Q0175 | not published | not published | $1.77 – $1.77 | 1 |
| Perq art m-thrombect &/nfs CPT 61645 | $3,479.30 | $6,326.00 | $6,019.00 – $6,019.00 | 1 |
| Perq clsr tcat l atr apndge CPT 33340 | $20,724.55 | $37,681.00 | not published | 0 |
| Perq dev breast 1st mr guide CPT 19287 | $653.40 | $1,188.00 | $525.32 – $3,030.00 | 6 |
| Perq dev breast 1st strtctc CPT 19283 | $653.40 | $1,188.00 | $525.32 – $3,030.00 | 6 |
| Perq nl/pl lithotrp cplx>2cm CPT 50081 | not published | not published | $7,022.52 – $18,071.30 | 6 |
| Perq nl/pl lithotrp smpl<2cm CPT 50080 | $4,258.10 | $7,742.00 | $7,022.52 – $18,071.30 | 6 |
| Perq p-art revsc 1 abnor bi CPT 33903 | not published | not published | $7,609.00 – $27,583.00 | 6 |
| Perq p-art revsc 1 abnor uni CPT 33902 | not published | not published | $8,923.00 – $34,994.75 | 6 |
| Perq p-art revsc 1 nm nt bi CPT 33901 | not published | not published | $7,609.00 – $27,583.00 | 6 |
| Perq p-art revsc 1 nm nt uni CPT 33900 | not published | not published | $7,609.00 – $27,583.00 | 6 |
| Perq p-art revsc each addl CPT 33904 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Perq plmt bile duct stent CPT 47538 | not published | not published | $4,484.77 – $18,364.00 | 6 |
| Perq plmt bile duct stent CPT 47539 | not published | not published | $4,484.77 – $18,364.00 | 6 |
| Perq plmt bile duct stent CPT 47540 | not published | not published | $4,484.77 – $18,364.00 | 6 |
| Perq rplcmt g-tube req revsn gstrst trk CPT 43763 | $664.95 | $1,209.00 | $185.35 – $2,334.00 | 6 |
| Perq skel fix rad/uln dislc CPT 25671 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Perq skel fix ulnar styld fx CPT 25651 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Perq transcath closure each CPT 93592 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Perq transcath closure pda CPT 93582 | not published | not published | $13,599.00 – $43,643.00 | 6 |
| Perq transcath cls aortic CPT 93591 | not published | not published | $13,599.00 – $44,873.00 | 6 |
| Perq transcath cls mitral CPT 93590 | not published | not published | $13,599.00 – $44,873.00 | 6 |
| Perq trluml angp nt/recr coa CPT 33897 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Perq tx big toe fracture w/manip 28496 CPT 28496 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Perq tx malar fracture CPT 21355 | not published | not published | $2,459.51 – $16,106.00 | 6 |
| Perq tx mndblr fx xtrnl fixj CPT 21452 | not published | not published | $3,579.00 – $11,300.84 | 6 |
| Perq tx nasoethmoid fx CPT 21340 | not published | not published | $2,459.51 – $16,106.00 | 6 |
| Pertussis ag if CPT 87265 | not published | not published | $8.98 – $23.12 | 7 |
| Pertuzumab 30 mg/ml desensitization HCPCS J9306 | not published | not published | $12.90 – $44.07 | 8 |
| Pertuzu, trastuzu, 10 mg HCPCS J9316 | not published | not published | $44.92 – $173.91 | 8 |
| Pet CT skull-mid thgh initial CPT 78815 | $3,657.50 | $6,650.00 | $1,060.78 – $2,729.74 | 4 |
| Pet CT whole body initial CPT 78816 | $3,722.95 | $6,769.00 | $1,060.78 – $2,729.74 | 4 |
| Pet fdg brain metoblic eval sb CPT 78608 | $3,657.50 | $6,650.00 | $1,060.78 – $2,729.74 | 4 |
| Pet image full body CPT 78813 | not published | not published | $1,060.78 – $2,729.74 | 4 |
| Pet image ltd area CPT 78811 | not published | not published | $960.41 – $2,471.46 | 4 |
| Pet image skull-thigh CPT 78812 | not published | not published | $1,060.78 – $2,729.74 | 4 |
| Pet image w/ct lmtd CPT 78814 | $3,488.65 | $6,343.00 | $1,060.78 – $2,729.74 | 4 |
| Pet not otherwise specified HCPCS G0235 | not published | not published | $296.56 – $763.16 | 4 |
| Pet scan brain perf study CPT 78609 | not published | not published | $257.18 – $257.18 | 1 |
| Pfc sigma fem post aug sz3 8mm HCPCS C1776 | $1,606.03 | $2,920.05 | not published | 0 |
| Ph1 assmt&mgmt nqhp 11-20 CPT 98967 | $91.85 | $167.00 | $14.60 – $37.58 | 4 |
| Ph1 assmt&mgmt nqhp 21-30 CPT 98968 | $137.50 | $250.00 | $21.34 – $54.93 | 4 |
| Ph1 assmt&mgmt nqhp 5-10 CPT 98966 | $46.20 | $84.00 | $7.54 – $19.40 | 4 |
| Phalangectomy ea toe 28150 CPT 28150 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Ph body fluid CPT 83986 | $50.05 | $91.00 | $2.68 – $6.91 | 7 |
| Phencyclidine (pcp) CPT 83992 | $158.40 | $288.00 | $29.72 – $43.31 | 2 |
| Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr HCPCS J2560 | not published | not published | $32.38 – $83.74 | 5 |
| Phenobarbital therapeutic drug level CPT 80184 | $104.50 | $190.00 | $11.48 – $29.53 | 7 |
| Phentolaine mesylate inj HCPCS J2760 | not published | not published | $216.47 – $1,074.38 | 8 |
| Phenylephrine 10 mg/ml injection solution HCPCS J2371 | not published | not published | $0.01 – $0.03 | 2 |
| Phenylep ketorolac opth soln HCPCS J1097 | not published | not published | $72.23 – $263.65 | 5 |
| Phenytoin in ns IV syringe 5 mg/ml (neo/ped) - cnr HCPCS J1165 | not published | not published | $0.51 – $1.29 | 5 |
| Phenytoin total therapeutic drug level CPT 80185 | $119.90 | $218.00 | $9.94 – $25.57 | 7 |
| Phlebotomy therapeutic CPT 99195 | $183.70 | $334.00 | $98.70 – $253.99 | 4 |
| Phleb veins 1 extrm 10-20 stab CPT 37765 | $1,222.65 | $2,223.00 | $2,342.32 – $8,770.00 | 6 |
| Phleb veins 1 extrm >20 stab CPT 37766 | $1,483.90 | $2,698.00 | $2,342.32 – $8,770.00 | 6 |
| Phosphorus CPT 84100 | $38.50 | $70.00 | $3.56 – $9.15 | 7 |
| Phosphorus 24 hour urine CPT 84105 | $48.40 | $88.00 | $4.34 – $11.16 | 7 |
| Photchmtx tar&uvb/ptrltm&uvb CPT 96910 | not published | not published | $43.76 – $112.62 | 4 |
| Photochemotherapy puva CPT 96912 | not published | not published | $43.76 – $112.62 | 4 |
| Photochemotherapy uv-a or b CPT 96913 | not published | not published | $301.57 – $776.03 | 4 |
| Photodynamic tx addl 15 min CPT 96571 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Photodynmc tx 30 min add-on CPT 96570 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Photo patch test CPT 95052 | not published | not published | $43.76 – $112.62 | 4 |
| Photopheresis CPT 36522 | not published | not published | $3,231.05 – $16,106.00 | 6 |
| Photosensitivity tests CPT 95056 | not published | not published | $98.70 – $253.99 | 4 |
| Phys blood bank serv authrj CPT 86079 | not published | not published | $38.66 – $99.48 | 5 |
| Phys blood bank serv reactj CPT 86078 | $121.00 | $220.00 | $76.45 – $325.23 | 5 |
| Phys blood bank serv xmatch CPT 86077 | not published | not published | $21.46 – $55.21 | 5 |
| Phytonadione (vitamin k1) 10 mg/ml injection solution HCPCS J3430 | not published | not published | $2.39 – $6.02 | 5 |
| Pierce earlobes 69090 CPT 69090 | not published | not published | $5,512.00 – $5,512.00 | 1 |
| Piflu f-18, dia 1 millicurie HCPCS A9595 | $783.90 | $1,425.27 | $259.87 – $905.07 | 5 |
| Pik3ca gene trgt seq alys CPT 81309 | not published | not published | $206.12 – $530.42 | 7 |
| Pild/placebo control clin tr HCPCS G0276 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Pillow shldr abduc inflat univ HCPCS L3960 | not published | not published | $669.04 – $1,721.66 | 4 |
| Pin caspar distraction 12mm HCPCS C1821 | $52.03 | $94.60 | not published | 0 |
| Pinch graft 1/mlt c> sm ulcer tip/oth area 2cm 15050 CPT 15050 | not published | not published | $548.27 – $2,334.00 | 6 |
| Pin finger dislocation CPT 26776 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Pin finger fracture each CPT 26756 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Pin hand dislocation CPT 26676 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Pin knuckle dislocation CPT 26706 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Pin service 60m per month HCPCS G0023 | not published | not published | $75.36 – $193.93 | 4 |
| Pinworm exam CPT 87172 | $45.10 | $82.00 | $3.20 – $8.24 | 7 |
| Pinworm examinations HCPCS Q0113 | not published | not published | $3.20 – $8.24 | 7 |
| Piperacillin-tazobactam 3.375 gram intravenous solution HCPCS J2543 | not published | not published | $1.23 – $3.10 | 5 |
| Pituitary evaluation panel CPT 80418 | not published | not published | $434.61 – $1,118.40 | 7 |
| Place breast cath for rad CPT 19297 | not published | not published | $5,512.00 – $18,364.00 | 3 |
| Place breast rad tube/caths CPT 19298 | not published | not published | $6,019.00 – $26,307.58 | 6 |
| Place cath intracranial art CPT 36228 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Place cath xtrnl carotid CPT 36227 | $4,252.60 | $7,732.00 | $1,887.00 – $5,512.00 | 3 |
| Place cecostomy tube perc CPT 49442 | not published | not published | $887.71 – $4,761.00 | 6 |
| Place device/marker, non pro HCPCS C9728 | not published | not published | $1,026.79 – $2,642.28 | 4 |
| Place duod/jej tube perc CPT 49441 | $1,197.90 | $2,178.00 | $1,423.51 – $4,761.00 | 6 |
| Place endorectal app HCPCS C9725 | not published | not published | $689.87 – $3,030.00 | 6 |
| Place gastrostomy tube open 43832 CPT 43832 | not published | not published | $3,735.00 – $3,735.00 | 1 |
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.