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 |
|---|---|---|---|---|
| Place gastrostomy tube perc CPT 49440 | $1,114.30 | $2,026.00 | $1,423.51 – $4,761.00 | 6 |
| Placement bile duct support CPT 47801 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides) CPT 19281 | $653.40 | $1,188.00 | $1,225.21 – $4,761.00 | 6 |
| Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left CPT 19282 | $272.25 | $495.00 | $1,887.00 – $5,512.00 | 3 |
| Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides) CPT 19285 | $653.40 | $1,188.00 | $525.32 – $3,030.00 | 6 |
| Placement nephrostomy catheter (both sides) CPT 50432 | $3,081.10 | $5,602.00 | $1,550.71 – $7,791.00 | 6 |
| Placement occlusive device venous/arterial access site post procedure HCPCS G0269 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Placement of drain pancreas CPT 48001 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Placement of seton CPT 46020 | not published | not published | $2,059.07 – $7,791.00 | 6 |
| Placement stent(s) intravascular transcatheter artery initial CPT 37236 | $13,879.25 | $25,235.00 | $7,609.00 – $27,583.00 | 6 |
| Place ndl musc/tis for right CPT 20555 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Place needles h&n for right CPT 41019 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Place needles pelvic for right CPT 55920 | not published | not published | $3,710.98 – $9,549.58 | 6 |
| Place non-slctv cath thoracic arta CPT 36221 | $3,956.70 | $7,194.00 | $2,342.32 – $8,770.00 | 6 |
| Placental lactogen CPT 83632 | not published | not published | $15.16 – $39.02 | 7 |
| Place po breast cath for rad CPT 19296 | not published | not published | $6,063.28 – $18,364.00 | 6 |
| Place right device/marker pros CPT 55876 | $380.75 | $692.28 | $1,026.79 – $4,761.00 | 6 |
| Place slctv cath carotd art uni CPT 36224 | $8,045.95 | $14,629.00 | $4,127.91 – $18,364.00 | 6 |
| Place slctv cath carotid/inom art excrn uni CPT 36222 | $6,458.10 | $11,742.00 | $2,342.32 – $8,770.00 | 6 |
| Place slctv cath carotid/inom art intcrn uni CPT 36223 | $8,085.55 | $14,701.00 | $4,127.91 – $18,364.00 | 6 |
| Place slctv cath subclavian art CPT 36225 | $6,620.90 | $12,038.00 | $2,342.32 – $8,770.00 | 6 |
| Place slctv cath vertebral art uni CPT 36226 | $8,202.70 | $14,914.00 | $4,127.91 – $18,364.00 | 6 |
| Plasma volume multiple CPT 78111 | not published | not published | $293.22 – $2,471.46 | 4 |
| Plasma volume single CPT 78110 | not published | not published | $289.65 – $2,471.46 | 4 |
| Plas shoe insert w ank joint HCPCS L2180 | not published | not published | $122.19 – $314.44 | 4 |
| Plastic mod low ext pad/line HCPCS L2275 | not published | not published | $120.14 – $309.17 | 4 |
| Plastic mold recipro hip & c HCPCS L2627 | not published | not published | $1,969.94 – $5,069.30 | 4 |
| Plastic surgery neck CPT 15819 | not published | not published | $3,579.00 – $4,761.00 | 2 |
| Plast socket jts/thgh lacer HCPCS L5105 | not published | not published | $3,555.80 – $9,150.27 | 4 |
| Platelet aggregation each agent teg CPT 85576 | not published | not published | $18.68 – $48.08 | 7 |
| Platelet automated CPT 85049 | $36.30 | $66.00 | $3.36 – $8.65 | 7 |
| Platelet deplete of harvest CPT 38213 | not published | not published | $327.28 – $2,334.00 | 6 |
| Platelets hla matched leukocytes reduced apheresis/pheresis each unit HCPCS P9052 | $568.15 | $1,033.00 | not published | 0 |
| Platelets leukocytes reduced each unit HCPCS P9031 | $215.60 | $392.00 | not published | 0 |
| Platelets leukocytes reduced irradiated each unit HCPCS P9033 | $360.25 | $655.00 | not published | 0 |
| Platelets pheresis leukocytes reduced each unit HCPCS P9035 | $705.10 | $1,282.00 | $383.69 – $987.37 | 4 |
| Platelets pheresis leukocytes reduced irradiated each unit HCPCS P9037 | $360.25 | $655.00 | $510.46 – $1,313.58 | 4 |
| Platelet survival CPT 78191 | not published | not published | $296.56 – $763.16 | 4 |
| Plating chrome/nickel pr bar HCPCS L2750 | not published | not published | $72.04 – $185.38 | 4 |
| Plcg2 gene common variants CPT 81320 | not published | not published | $218.52 – $562.32 | 7 |
| Plcmnt biliary drainage cath w/img ext CPT 47533 | $3,340.15 | $6,073.00 | $2,656.06 – $8,770.00 | 6 |
| Plcmnt stent transcath ctrl dialysis seg add-on CPT 36908 | $5,305.30 | $9,646.00 | $1,887.00 – $2,334.00 | 2 |
| Plcmnt ureteral stent pq w/img exstng trct CPT 50693 | $3,441.90 | $6,258.00 | $2,614.94 – $8,770.00 | 6 |
| Plcmnt ureteral stent pq w/img new w/cath CPT 50695 | not published | not published | $2,614.94 – $8,770.00 | 6 |
| Plcmt dlyd xtn pros 1st vsl CPT 34710 | $7,957.95 | $14,469.00 | $6,019.00 – $6,019.00 | 1 |
| Plcmt sft tiss loc pq w/img 1st lsn CPT 10035 | $1,035.65 | $1,883.00 | $525.32 – $3,030.00 | 6 |
| Plcmt sft tiss loc pq w/img ea addl lsn CPT 10036 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Plcmt xtn pros evasc rpr per vsl CPT 34709 | $3,946.80 | $7,176.00 | $6,019.00 – $6,019.00 | 1 |
| Plc pq device breast ea addl lesion MRI guide CPT 19288 | $287.10 | $522.00 | $1,887.00 – $5,512.00 | 3 |
| Plc pq device breast ea addl lesion stereo guide CPT 19284 | $288.20 | $524.00 | $1,887.00 – $5,512.00 | 3 |
| Plc pq device breast ea addl lesion Ultrasound guide CPT 19286 | $287.10 | $522.00 | $1,887.00 – $5,512.00 | 3 |
| Plerixafor injection HCPCS J2562 | not published | not published | $21.37 – $226.99 | 8 |
| Plethysmography lung volumes/airway resistance CPT 94726 | $535.70 | $974.00 | $276.82 – $712.35 | 4 |
| Pleurectomy parietal ; separate 32310 CPT 32310 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Plmt access bil tree sm bwl CPT 47541 | not published | not published | $3,735.00 – $12,358.40 | 6 |
| Plmt biliary drainage cath CPT 47534 | $3,601.40 | $6,548.00 | $2,656.06 – $8,770.00 | 6 |
| Plmt nephroureteral catheter CPT 50433 | $1,543.30 | $2,806.00 | $2,614.94 – $7,791.00 | 6 |
| Plmt ureteral stent prq CPT 50694 | $3,441.90 | $6,258.00 | $2,614.94 – $8,770.00 | 6 |
| Plug insert indwelling 16f HCPCS L8511 | not published | not published | $67.16 – $172.83 | 4 |
| Pm device progr eval dual CPT 93280 | $131.45 | $239.00 | $27.69 – $71.25 | 4 |
| Pm device progr eval multi CPT 93281 | $108.35 | $197.00 | $27.69 – $71.25 | 4 |
| Pml/raralpha 1 breakpoint CPT 81316 | not published | not published | $155.48 – $400.11 | 7 |
| Pmp22 gene dup/delet CPT 81324 | not published | not published | $568.77 – $1,463.63 | 7 |
| Pmp22 gene full sequence CPT 81325 | $2,048.20 | $3,724.00 | $577.18 – $1,485.29 | 7 |
| Pmp22 gene known fam variant CPT 81326 | not published | not published | $34.95 – $89.94 | 7 |
| Pm phone r-strip device eval CPT 93293 | $84.70 | $154.00 | $27.69 – $71.25 | 4 |
| Pms2 gene dup/delet variants CPT 81319 | not published | not published | $152.62 – $392.76 | 7 |
| Pms2 gene full seq analysis CPT 81317 | not published | not published | $507.38 – $1,305.64 | 7 |
| Pms2 known familial variants CPT 81318 | not published | not published | $248.25 – $638.83 | 7 |
| Pneum full leg splnt pre ots HCPCS L4370 | not published | not published | $216.94 – $558.25 | 4 |
| Pneumothrx tx-intraplrl inj ai CPT 32960 | not published | not published | $465.35 – $3,030.00 | 6 |
| #pnh-flow cytometry interp CPT 88187 | not published | not published | $39.34 – $105.50 | 2 |
| Poct blood gases ph pco2 po2 arterial calculated o2 CPT 82803 | $196.90 | $358.00 | $19.55 – $50.32 | 7 |
| Polatuzumab vedotin-piiq 140 mg intravenous solution HCPCS J9309 | not published | not published | $107.71 – $361.88 | 8 |
| Polycentric hinge pair HCPCS L6600 | not published | not published | $209.48 – $539.05 | 4 |
| Polysom <6 yrs cpap/bilvl CPT 95783 | $4,205.30 | $7,646.00 | $637.04 – $1,639.32 | 4 |
| Polysom any age 1-3> param CPT 95808 | not published | not published | $637.04 – $1,639.32 | 4 |
| Polysomnography sleep staging >=4 parameters age >=6 years w/cpap bipap CPT 95811 | $4,205.30 | $7,646.00 | $637.04 – $1,639.32 | 4 |
| Polyvalent mult org ea ag ia CPT 87451 | not published | not published | $7.88 – $20.28 | 7 |
| Porfimer sodium injection HCPCS J9600 | not published | not published | $65,961.87 – $65,961.87 | 1 |
| Positional change of finger CPT 26555 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Post-coital mucous exam HCPCS Q0115 | not published | not published | $11.27 – $48.25 | 7 |
| Post d/c phone follow up HCPCS G0544 | not published | not published | $75.36 – $193.93 | 4 |
| Post non-seg/spine instrumentation 22840 CPT 22840 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Postop applicat rigid dsg on HCPCS L6388 | not published | not published | $475.49 – $1,223.60 | 4 |
| Postop app non-wgt bear dsg HCPCS L5450 | not published | not published | $436.76 – $1,123.94 | 4 |
| Postop app non-wgt bear dsg HCPCS L5460 | not published | not published | $572.86 – $1,474.17 | 4 |
| Postop dress & 1 cast chg bk HCPCS L5400 | not published | not published | $1,473.43 – $3,791.62 | 4 |
| Postop dsg & 1 cast chg ak/d HCPCS L5420 | not published | not published | $1,860.88 – $4,788.66 | 4 |
| Postop dsg ak ea add cast ch HCPCS L5430 | not published | not published | $505.13 – $1,299.87 | 4 |
| Postop dsg bk ea add cast ch HCPCS L5410 | not published | not published | $407.06 – $1,047.51 | 4 |
| Postop dsg cast chg elb dis/ HCPCS L6382 | not published | not published | $1,557.04 – $4,006.78 | 4 |
| Postop dsg cast chg wrst/elb HCPCS L6380 | not published | not published | $1,307.93 – $3,365.75 | 4 |
| Postop ea cast chg & realign HCPCS L6386 | not published | not published | $431.78 – $1,111.12 | 4 |
| Post-operative body jacket HCPCS L1310 | not published | not published | $1,654.61 – $4,257.87 | 4 |
| Post-op hip abduct custom fa HCPCS L1685 | not published | not published | $1,025.14 – $2,638.04 | 4 |
| Post op service lvrs min 6 HCPCS G0305 | not published | not published | $276.82 – $712.35 | 4 |
| Postpartum Care Only CPT 59430 | not published | not published | $5,512.00 – $5,512.00 | 1 |
| Post seg spine instrument/3-6 seg 22842 CPT 22842 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Potassium 24 hour urine CPT 84133 | $40.70 | $74.00 | $3.55 – $9.13 | 7 |
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.