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 |
|---|---|---|---|---|
| Potassium chloride 10 meq/100ml in sterile water intravenous piggyback HCPCS J3480 | not published | not published | $0.11 – $0.32 | 5 |
| Potassium hydroxide preps HCPCS Q0112 | not published | not published | $4.37 – $11.25 | 7 |
| Potassium serum/plasma/whole blood CPT 84132 | $47.85 | $87.00 | $3.57 – $9.19 | 7 |
| Ppp2r2b gen detc abnor allel CPT 81343 | not published | not published | $102.75 – $264.41 | 7 |
| Pq biliary strict dil s&i CPT 74363 | not published | not published | $264.39 – $264.39 | 1 |
| Pq dr cath chg w cont s&i CPT 75984 | $400.40 | $728.00 | $237.15 – $237.15 | 1 |
| Pq kyphplsty 1 bdy lumb w/img CPT 22514 | $7,137.90 | $12,978.00 | $5,382.89 – $18,364.00 | 6 |
| Pq thr inj ext pse CPT 36002 | $1,497.10 | $2,722.00 | $465.35 – $3,030.00 | 6 |
| Pq vrtbrplst 1 bdy inj crv-thr/lmb-scr w/img addl CPT 22512 | $4,516.60 | $8,212.00 | $1,887.00 – $5,512.00 | 3 |
| Pq vrtbrplst 1 bdy inj crv-thr w/img ini CPT 22510 | $4,538.60 | $8,252.00 | $2,427.27 – $8,770.00 | 6 |
| Pq vrtbrplst 1 bdy inj lmb-scr w/img ini CPT 22511 | $4,538.60 | $8,252.00 | $2,427.27 – $8,770.00 | 6 |
| Pralatrexate injection HCPCS J9307 | not published | not published | $289.59 – $1,017.59 | 8 |
| Pralidoxime 1 gram solution for injection HCPCS J2730 | not published | not published | $283.26 – $283.26 | 1 |
| Pr amput fgr/thumb prim/sec any joint/phal sgl incl neurectomies w dir clsr CPT 26951 | $3,223.00 | $5,860.00 | $2,427.27 – $6,246.19 | 6 |
| Pr application of long arm splint CPT 29105 | $314.60 | $572.00 | $120.55 – $2,334.00 | 6 |
| Pr application splint static short arm CPT 29125 | $285.45 | $519.00 | $98.70 – $2,334.00 | 6 |
| Pr assessment emotional/behavioral per instrument brief CPT 96127 | not published | not published | $27.71 – $71.30 | 4 |
| Pr biopsy skin punch single lesion CPT 11104 | $591.80 | $1,076.00 | $301.57 – $2,334.00 | 6 |
| Pr correction hallux valgus (bunionectomy) with sesamoidectomy when performed with first metatarsal and cuneiform joint arthrodesis any method CPT 28297 | not published | not published | $6,779.00 – $24,508.80 | 6 |
| Pr correction hammertoe CPT 28285 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Pr counseling smoke/tobacco intermediate greater 3 - 10 minutes CPT 99406 | $30.80 | $56.00 | $27.80 – $71.53 | 4 |
| Prcrd drg 0-5yr or w/anomly CPT 33018 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Prcrd drg 6+yr without anomly CPT 33017 | $1,243.00 | $2,260.00 | $3,388.00 – $3,388.00 | 1 |
| Pr cystourethroscopy with insertion indwelling ureteral stent CPT 52332 | $834.24 | $1,516.80 | $2,614.94 – $7,791.00 | 7 |
| Pr debridement open wound topical appl/wound asmt per session 20 sq cm/< CPT 97597 | $278.85 | $507.00 | $148.84 – $2,334.00 | 6 |
| Prealbumin CPT 84134 | $69.30 | $126.00 | $10.94 – $28.16 | 7 |
| Prednisolone sodium phosphate 15 mg/5 ml (3 mg/ml) oral solution HCPCS J7510 | not published | not published | $0.52 – $1.55 | 5 |
| Prednisone 1 mg tablet HCPCS J7512 | not published | not published | $0.01 – $0.03 | 5 |
| Prefab glove for term device HCPCS L6890 | not published | not published | $184.45 – $474.64 | 4 |
| Pregabalin - sendout CPT 80366 | $188.65 | $343.00 | $35.06 – $35.06 | 1 |
| Pr egd flexible transoral w/placement percutaneous gastrostomy tube CPT 43246 | $1,156.65 | $2,103.00 | $1,423.51 – $4,761.00 | 6 |
| Pregnancy associated plasma protein-a CPT 84163 | not published | not published | $11.29 – $29.05 | 7 |
| Pregnancy Ultrasound (complete, after first trimester) CPT 76805 | $460.90 | $838.00 | $77.56 – $199.58 | 4 |
| Pregnancy Ultrasound (first trimester) CPT 76801 | $460.90 | $838.00 | $77.56 – $199.58 | 4 |
| Prenatal Care Only (4-6 visits) CPT 59425 | not published | not published | $5,512.00 – $5,512.00 | 1 |
| Prenatal Care Only (7+ visits) CPT 59426 | not published | not published | $5,512.00 – $5,512.00 | 1 |
| Pre-op service lvrs 10-15dos HCPCS G0303 | not published | not published | $160.18 – $412.19 | 4 |
| Pre-op service lvrs 1-9 dos HCPCS G0304 | not published | not published | $276.82 – $712.35 | 4 |
| Pre-op service lvrs complete HCPCS G0302 | not published | not published | $276.82 – $712.35 | 4 |
| Prep ak ischial direct form HCPCS L5570 | not published | not published | $2,092.44 – $5,384.55 | 4 |
| Prep ak ischial laminated HCPCS L5590 | not published | not published | $2,707.66 – $6,967.71 | 4 |
| Prep ak ischial plast molded HCPCS L5560 | not published | not published | $2,155.96 – $5,548.02 | 4 |
| Prep ak ischial thermo mold HCPCS L5580 | not published | not published | $2,597.03 – $6,683.03 | 4 |
| Preparation for bladder xray CPT 51605 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Preparation palate mold CPT 42280 | not published | not published | $400.09 – $2,334.00 | 6 |
| Prepare donor heart CPT 33944 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Prepare donor heart/lung CPT 33933 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Prepare donor intestine CPT 44715 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Prepare donor lung double CPT 32856 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Prepare donor lung single CPT 32855 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Prepare embryo for transfer CPT 89255 | not published | not published | $38.66 – $99.48 | 5 |
| Prepare fecal microbiota CPT 44705 | not published | not published | $2,654.00 – $2,654.00 | 1 |
| Prepare heart-aorta conduit CPT 33404 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Prepare penis study CPT 54230 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Prepare sperm duct x-ray CPT 55300 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Prep bk ptb laminated socket HCPCS L5540 | not published | not published | $1,892.12 – $4,869.04 | 4 |
| Prep bk ptb open end socket HCPCS L5535 | not published | not published | $1,786.46 – $4,597.14 | 4 |
| Prep bk ptb plaster molded HCPCS L5510 | not published | not published | $1,626.32 – $4,185.05 | 4 |
| Prep bk ptb thermopls molded HCPCS L5530 | not published | not published | $1,916.36 – $4,931.44 | 4 |
| Prep cadaver renal allograft CPT 50323 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Prep corneal endo allograft CPT 65757 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Prep donor intestine/artery CPT 44721 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Prep donor intestine/venous CPT 44720 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Prep donor liver 3-segment CPT 47144 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Prep donor liver/arterial CPT 47147 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Prep donor liver lobe split CPT 47145 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Prep donor liver/venous CPT 47146 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Prep donor liver whole CPT 47143 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Prep donor pancreas CPT 48551 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Prep donor pancreas/venous CPT 48552 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Prep donor renal graft CPT 50325 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Prepj skn cll ssp agrft 1st CPT 15013 | not published | not published | $2,654.00 – $13,547.63 | 4 |
| Prepj tum cav iort prtl mast CPT 19294 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Pre-plan 3d model w/ccta HCPCS C9793 | not published | not published | $637.04 – $1,639.32 | 4 |
| Prep renal graft/arterial CPT 50328 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Prep renal graft/ureteral CPT 50329 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Prep renal graft/venous CPT 50327 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Prep skin to 100cm2 other CPT 15004 | not published | not published | $301.57 – $2,334.00 | 6 |
| Prep skin to 100cm2 trk/ext CPT 15002 | not published | not published | $548.27 – $4,761.00 | 6 |
| Prep skn trk/ext adl 100cm2 CPT 15003 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Pressure max expiratory/inspiratory CPT 94799 | $397.65 | $723.00 | $95.45 – $245.63 | 4 |
| Pressure treatment esophagus CPT 43460 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Pressure velocity wire add ves CPT 93572 | $1,416.80 | $2,576.00 | $1,887.00 – $2,334.00 | 2 |
| Pre-tibial shell molded to p HCPCS L2340 | not published | not published | $385.18 – $991.21 | 4 |
| Pretreatment serum by diff red cell adsorption patient rbc/known phenotype each adsorption ref CPT 86977 | $226.05 | $411.00 | $48.28 – $325.23 | 5 |
| Pretreat rbc absorption reference CPT 86978 | $136.40 | $248.00 | $33.43 – $112.62 | 5 |
| Pretreat rbc density gradient separation reference CPT 86972 | $226.05 | $411.00 | $55.91 – $325.23 | 5 |
| Pretreat rbc w chem/drugs reference CPT 86970 | $446.60 | $812.00 | $33.43 – $112.62 | 5 |
| Pretreat rbc w enzyme reference CPT 86971 | $446.60 | $812.00 | $32.03 – $325.23 | 5 |
| Pr evaluation psychiatric diagnostic w/medical services CPT 90792 | $195.80 | $356.00 | $131.67 – $338.84 | 4 |
| Pr exam init preventive phys new visit during 1st 12 mo of mcare enrollment HCPCS G0402 | $175.75 | $319.54 | $98.76 – $254.15 | 4 |
| Pr excision benign lesion scalp/neck/hands/feet/genitalia <= 0.5 cm CPT 11420 | $3,407.80 | $6,196.00 | $1,225.21 – $3,152.87 | 6 |
| Pr excision benign lesion trunk/arms/legs 3.1 - 4.0 cm CPT 11404 | $3,292.30 | $5,986.00 | $1,225.21 – $4,761.00 | 6 |
| Pr excision nail/nail matrix partial/complete permanent removal CPT 11750 | $1,167.65 | $2,123.00 | $301.57 – $2,334.00 | 6 |
| Pr gastrorrhaphy suture perforated duodenal or gastric ulcer/wound/ injury CPT 43840 | not published | not published | $2,860.11 – $8,770.00 | 6 |
| Prgrmg dev eval impltbl sys CPT 93260 | not published | not published | $27.69 – $71.25 | 4 |
| Prgrmg dev eval pm/ldls pm CPT 93279 | $96.25 | $175.00 | $27.69 – $71.25 | 4 |
| Prgrmg dev eval scrms ip CPT 93285 | $91.30 | $166.00 | $27.69 – $71.25 | 4 |
| Prgrmg eval implantable dfb CPT 93282 | $121.55 | $221.00 | $27.69 – $71.25 | 4 |
| Prgrmg eval implantable dfb CPT 93283 | $145.20 | $264.00 | $27.69 – $71.25 | 4 |
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.