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 |
|---|---|---|---|---|
| Prgrmg eval implantable dfb CPT 93284 | $135.30 | $246.00 | $27.69 – $71.25 | 4 |
| Prgr stim/pace a/iv drug CPT 93623 | $3,119.05 | $5,671.00 | $1,887.00 – $2,334.00 | 2 |
| Prim art mech thrmbc non-intracranial CPT 37184 | $3,644.30 | $6,626.00 | $6,019.00 – $34,994.75 | 6 |
| Prim art mech thrmbc non-intracranial add-on CPT 37185 | $1,595.55 | $2,901.00 | $1,887.00 – $5,512.00 | 3 |
| Prin care mgmt staff 1st 30 CPT 99426 | not published | not published | $75.36 – $193.93 | 4 |
| Pr incision & drainage abscess complicated/multiple CPT 10061 | $670.45 | $1,219.00 | $301.57 – $2,334.00 | 6 |
| Pr incision & drainage abscess simple/single CPT 10060 | $563.20 | $1,024.00 | $148.84 – $2,334.00 | 6 |
| Pr incision & drainage abscess vulva/perineal CPT 56405 | $638.55 | $1,161.00 | $226.06 – $2,334.00 | 6 |
| Pr incision & removal foreign body subcutaneous tissues simple CPT 10120 | $733.70 | $1,334.00 | $301.57 – $2,334.00 | 6 |
| Pr management transitional care high w/in 7 days of discharge CPT 99496 | $282.22 | $513.13 | $98.76 – $254.15 | 4 |
| Pr management transitional care moderate w/in 14 days of discharge CPT 99495 | $192.42 | $349.85 | $98.76 – $254.15 | 4 |
| Pr moderate sedation same physician >= 5 years initial 15 minutes CPT 99152 | $95.15 | $173.00 | not published | 0 |
| Pr neuroplasty and/or transposition ulnar nerve at elbow CPT 64718 | not published | not published | $1,448.59 – $7,791.00 | 6 |
| Probe cryo 1150mm endo flex ster disp HCPCS C2618 | $3,000.59 | $5,455.62 | not published | 0 |
| Probe nasolacrimal duct CPT 68810 | not published | not published | $235.46 – $2,334.00 | 6 |
| Probe nasolacrimal duct CPT 68811 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Probe nasolacrimal duct CPT 68815 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Probe nl duct w/balloon CPT 68816 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Procainamide 100 mg/ml injection (wrapper) HCPCS J2690 | not published | not published | $198.18 – $570.05 | 8 |
| Procalcitonin CPT 84145 | $112.75 | $205.00 | $20.42 – $52.53 | 7 |
| Prochlorperazine edisylate 10 mg/2 ml (5 mg/ml) injection solution HCPCS J0780 | not published | not published | $3.20 – $8.04 | 5 |
| Prochlorperazine maleate 5 mg tablet HCPCS Q0164 | not published | not published | $2.15 – $2.15 | 1 |
| Proctectomy combined abd pull-thru px 45112 CPT 45112 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Proctectomy complete abd w/clst 45110 CPT 45110 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Proctosigmoidoscopy ablate CPT 45320 | not published | not published | $2,059.07 – $7,791.00 | 6 |
| Proctosigmoidoscopy control bleed 45317 CPT 45317 | not published | not published | $887.71 – $4,761.00 | 6 |
| Proctosigmoidoscopy dilate 45303 CPT 45303 | not published | not published | $887.71 – $4,761.00 | 6 |
| Proctosigmoidoscopy dx 45300 CPT 45300 | not published | not published | $689.87 – $3,030.00 | 6 |
| Proctosigmoidoscopy removal CPT 45308 | not published | not published | $2,059.07 – $5,298.68 | 6 |
| Proctosigmoidoscopy removal CPT 45309 | not published | not published | $887.71 – $4,761.00 | 6 |
| Proctosigmoidoscopy tumor removal 45315 CPT 45315 | not published | not published | $887.71 – $4,761.00 | 6 |
| Proctosigmoidoscopy volvul CPT 45321 | not published | not published | $2,059.07 – $7,791.00 | 6 |
| Proctosigmoidoscopy w/bx 45305 CPT 45305 | not published | not published | $887.71 – $4,761.00 | 6 |
| Proctosigmoidoscopy w/fb remove 45307 CPT 45307 | not published | not published | $2,059.07 – $7,791.00 | 6 |
| Proctosigmoidoscopy w/stent CPT 45327 | not published | not published | $4,428.00 – $11,589.23 | 6 |
| Progenamatrix, per sq cm HCPCS Q4222 | not published | not published | $92.32 – $318.42 | 7 |
| Progesterone CPT 84144 | $165.00 | $300.00 | $15.64 – $40.26 | 7 |
| Prolactin CPT 84146 | $174.90 | $318.00 | $14.54 – $37.40 | 7 |
| Prolng off/op e/m ea 15 min 99417 CPT 99417 | $76.45 | $139.00 | not published | 0 |
| Prolonged IV inf, req pump HCPCS C8957 | not published | not published | $157.79 – $406.05 | 4 |
| Promethazine 25 mg tablet HCPCS Q0169 | not published | not published | $0.76 – $0.76 | 1 |
| Promethazine hcl injection HCPCS J2550 | not published | not published | $3.64 – $9.72 | 5 |
| Proph rta dtchmnt crtx dthrm CPT 67141 | not published | not published | $235.46 – $2,334.00 | 6 |
| Proph rta dtchmnt pc CPT 67145 | not published | not published | $408.01 – $3,030.00 | 6 |
| Proph tx w/wo mthylmthcrylt CPT 24498 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Prophylactic tx radius CPT 25490 | not published | not published | $5,382.89 – $16,106.00 | 6 |
| Prophylactic tx radius&ulna CPT 25492 | not published | not published | $2,427.27 – $16,106.00 | 6 |
| Prophylactic tx ulna CPT 25491 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Propofol infusion 10 mg/ml HCPCS J2704 | not published | not published | $0.09 – $0.21 | 5 |
| _propoxygc/msur CPT 80367 | not published | not published | $35.06 – $35.06 | 1 |
| Propranolol in ns IV syringe 0.1 mg/ml (neo/ped) - cnr HCPCS J1800 | not published | not published | $27.51 – $27.51 | 1 |
| Pros sheath/sock w gel cushn HCPCS L8417 | not published | not published | $69.46 – $178.76 | 4 |
| Pros soc insert gasket/seal HCPCS L7700 | not published | not published | $138.16 – $355.54 | 4 |
| Pros sock multi ply upper lm HCPCS L8435 | not published | not published | $20.73 – $53.35 | 4 |
| Pros sock single ply ak HCPCS L8480 | not published | not published | $8.45 – $21.75 | 4 |
| Pros sock single ply upper l HCPCS L8485 | not published | not published | $11.38 – $29.28 | 4 |
| Prostate biopsy, any mthd HCPCS G0416 | $686.95 | $1,249.00 | $265.91 – $684.27 | 5 |
| Prostatectomy (turp) CPT 52601 | not published | not published | $3,977.55 – $16,106.00 | 6 |
| Prostate laser enucleation CPT 52649 | not published | not published | $3,977.55 – $16,106.00 | 6 |
| Prostatic microwave thermotx CPT 53850 | not published | not published | $2,614.94 – $6,729.12 | 6 |
| Prostatic rf thermotx CPT 53852 | not published | not published | $2,614.94 – $16,106.00 | 6 |
| Prosthesis voc advantage 20f 14mm HCPCS L8509 | not published | not published | $100.86 – $259.55 | 4 |
| Prosthesis voc lopres 20f 22mm HCPCS L8507 | not published | not published | $38.66 – $99.49 | 4 |
| Prosthetic sock multi ply bk HCPCS L8420 | not published | not published | $19.26 – $49.56 | 4 |
| Prosthetic type socket molde HCPCS L2350 | not published | not published | $767.94 – $1,976.17 | 4 |
| Prost sock sgl ply blw knee ea HCPCS L8470 | not published | not published | $6.13 – $15.77 | 4 |
| Protamine 10 mg/ml intravenous solution HCPCS J2720 | not published | not published | $1.23 – $3.11 | 5 |
| Protect body sock ea pre ots HCPCS L0984 | not published | not published | $62.37 – $160.50 | 4 |
| Protein analysis w/probe CPT 88372 | not published | not published | $26.22 – $46.03 | 4 |
| Protein c activity CPT 85303 | $118.80 | $216.00 | $10.38 – $26.71 | 7 |
| Protein c concentrate HCPCS J2724 | not published | not published | $2.86 – $40.92 | 8 |
| Protein electrophoretic fractionation & quantitation serum CPT 84165 | $108.35 | $197.00 | $8.06 – $20.73 | 7 |
| Protein s total CPT 85305 | $101.20 | $184.00 | $8.71 – $22.41 | 7 |
| Protein total 24 hour urine CPT 84156 | $47.85 | $87.00 | $2.75 – $7.08 | 7 |
| Protein total body fluid CPT 84157 | $52.80 | $96.00 | $3.00 – $7.72 | 7 |
| Protein total serum plasma whole blood CPT 84155 | $52.80 | $96.00 | $2.75 – $7.08 | 7 |
| Protein western blot tissue CPT 88371 | not published | not published | $22.23 – $44.96 | 4 |
| Prothrombin complex kcentra HCPCS J7168 | not published | not published | $1.51 – $6.02 | 5 |
| Prothrombin time substitution plasma fractions each CPT 85611 | $22.55 | $41.00 | $2.96 – $7.60 | 7 |
| Proton treatment complex CPT 77525 | not published | not published | $927.10 – $2,385.73 | 4 |
| Proton trmt intermediate CPT 77523 | not published | not published | $927.10 – $2,385.73 | 4 |
| Proton trmt simple w/comp CPT 77522 | not published | not published | $927.10 – $2,385.73 | 4 |
| Proton trmt simple without comp CPT 77520 | not published | not published | $409.89 – $1,054.79 | 4 |
| Protoporphyrin rbc screen CPT 84203 | not published | not published | $7.30 – $18.80 | 7 |
| Provide inr test mater/equip HCPCS G0249 | not published | not published | $98.76 – $254.15 | 4 |
| Prpertl pel pack hemrrg trma 49013 CPT 49013 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Prp i/hern init block >5 yr CPT 49507 | not published | not published | $2,656.06 – $8,770.00 | 6 |
| Pr planning advance care 1st 30 minutes CPT 99497 | $132.00 | $240.00 | $75.36 – $193.93 | 4 |
| Prq av fstl crtj uxtr 1 acs CPT 36836 | not published | not published | $8,923.00 – $34,994.75 | 6 |
| Prq av fstl crt uxtr sep acs CPT 36837 | not published | not published | $8,923.00 – $34,994.75 | 6 |
| Prq card angio/athrect addl CPT 92925 | $11,834.90 | $21,518.00 | $26,827.00 – $27,583.00 | 2 |
| Prq cardiac angio addl art CPT 92921 | $6,943.75 | $12,625.00 | $17,314.00 – $18,364.00 | 2 |
| Prq card revasc chronic addl CPT 92944 | not published | not published | $17,314.00 – $18,364.00 | 2 |
| Prq card revasc mi 1 vsl CPT 92941 | $7,533.35 | $13,697.00 | $17,314.00 – $18,364.00 | 2 |
| Prq card revasc mi 1 vsl drug-eluting HCPCS C9606 | $7,569.65 | $13,763.00 | $8,923.00 – $8,923.00 | 1 |
| Prq card stent/ath/angio CPT 92934 | not published | not published | $17,314.00 – $18,364.00 | 2 |
| Prq card stent w/angio addl CPT 92929 | $6,725.40 | $12,228.00 | $17,314.00 – $18,364.00 | 2 |
| Prq revasc byp graft 1 art and/or branches CPT 92937 | $7,279.80 | $13,236.00 | $8,563.85 – $22,037.64 | 6 |
| Prq revasc byp graft addl CPT 92938 | $6,501.55 | $11,821.00 | $17,314.00 – $18,364.00 | 2 |
| Prq skel fix clcnl fx w/mnpj CPT 28406 | not published | not published | $5,382.89 – $13,851.98 | 6 |
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.