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 |
|---|---|---|---|---|
| Prq skel fix epcndylr hum fx CPT 24566 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Prq skel fix sprcndlr hum fx CPT 24538 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Prq skel fix talus fx w/mnpj CPT 28436 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Prq skel fix tarsl fx w/mnpj CPT 28456 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Prq tcat plmt ntrac st 1 les CPT 92928 | $7,262.20 | $13,204.00 | $8,563.85 – $22,037.64 | 6 |
| Prq tcat plmt ntrac st 2+les CPT 92930 | not published | not published | $13,599.00 – $34,994.75 | 4 |
| Prq trlml c athrc st angiop1 CPT 92933 | $10,491.80 | $19,076.00 | $13,599.00 – $34,994.75 | 6 |
| Prq trl rvs ch occ ant&rtrgr CPT 92945 | not published | not published | $8,563.85 – $22,037.64 | 4 |
| Prq trluml c angiop 1art&/br CPT 92920 | $6,612.65 | $12,023.00 | $4,222.18 – $18,364.00 | 6 |
| Prq trluml c athrc 1 art&/br CPT 92924 | $11,948.20 | $21,724.00 | $8,563.85 – $27,583.00 | 6 |
| Prq trluml revsc ch occ ant CPT 92943 | $7,643.35 | $13,897.00 | $8,563.85 – $22,037.64 | 6 |
| Pr removal drug delivery implant CPT 11982 | $404.25 | $735.00 | $331.39 – $2,334.00 | 6 |
| Pr removal foreign body external auditory canal without anesthesia CPT 69200 | $275.55 | $501.00 | $98.70 – $2,334.00 | 6 |
| Pr removal intrauterine device CPT 58301 | $426.25 | $775.00 | $226.06 – $2,334.00 | 6 |
| Pr repair intermediate wounds scalp/axillae/trunk/extremities 2.6 - 7.5 cm CPT 12032 | $737.55 | $1,341.00 | $301.57 – $2,334.00 | 6 |
| Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb <= 2.5 cm CPT 12011 | $516.45 | $939.00 | $148.84 – $2,334.00 | 6 |
| Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb 2.6-5.0 cm CPT 12013 | $598.95 | $1,089.00 | $148.84 – $2,334.00 | 6 |
| Pr repair sprfcl wounds simple scalp/neck/axillae/gent/trunk/ext <= 2.5 cm CPT 12001 | $492.25 | $895.00 | $148.84 – $2,334.00 | 6 |
| Pr repair superficial wd simple scalp/neck/ax/gent/trunk/ext 2.6-7.5 cm CPT 12002 | $563.20 | $1,024.00 | $148.84 – $2,334.00 | 6 |
| Pr robotic surgical system HCPCS S2900 | not published | not published | $5,512.00 – $5,512.00 | 1 |
| Pr split-thickness autograft trunk/arm/leg 1st 100 sq cm/<tbsa infant/child CPT 15100 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Prtl exc bone olecrn process CPT 24147 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Prtl exc bone radial h/n CPT 24145 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Prtl exchange transfuse nb CPT 36456 | not published | not published | $327.28 – $2,334.00 | 6 |
| Prtl excision bone clavicle CPT 23180 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Prtl excision bone scapula CPT 23182 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Pr tube thoracostomy w/connection to drainage open CPT 32551 | $1,329.35 | $2,417.00 | $1,167.76 – $3,030.00 | 6 |
| PSA (Prostate) Test CPT 84153 | $146.85 | $267.00 | $13.79 – $35.49 | 7 |
| Psych/neuropsych test admin automated result 96146 CPT 96146 | $51.15 | $93.00 | $21.46 – $55.21 | 4 |
| Psychoanalysis CPT 90845 | not published | not published | $131.67 – $338.84 | 4 |
| Psychoeducation 45 min + HCPCS G0177 | $106.70 | $194.00 | not published | 0 |
| Psychophysiological therapy CPT 90875 | $158.40 | $288.00 | not published | 0 |
| Psychotherapy group therapy CPT 90853 | $124.30 | $226.00 | $75.36 – $193.93 | 4 |
| Psychotherapy patient individual therapy 30 minutes CPT 90832 | $102.30 | $186.00 | $131.67 – $338.84 | 4 |
| Psychotherapy patient individual therapy 45 minutes CPT 90834 | $278.85 | $507.00 | $131.67 – $338.84 | 4 |
| Psychotherapy patient individual therapy 60 minutes CPT 90837 | $347.05 | $631.00 | $131.67 – $338.84 | 4 |
| Psych test eval svc phys/qhp 1st hr CPT 96130 | $264.55 | $481.00 | $160.18 – $412.19 | 4 |
| Psych test eval svc phys/qhp ea addl hr CPT 96131 | $199.10 | $362.00 | not published | 0 |
| Psychthrp grp 45-50min mcr HCPCS G0410 | $131.45 | $239.00 | not published | 0 |
| Psycl/nrpsyc tech 1st CPT 96138 | $92.40 | $168.00 | $331.39 – $852.79 | 4 |
| Psy/npsy phys/qhp 2> tst 1st 30 min CPT 96136 | $50.05 | $91.00 | $98.70 – $253.99 | 4 |
| Psy/npsy phys/qhp 2> tst ea l 30 min CPT 96137 | $50.05 | $91.00 | not published | 0 |
| Psy/npsy tst admin tech 2> ea l 30 min CPT 96139 | $93.50 | $170.00 | not published | 0 |
| Psytx complex interactive CPT 90785 | $44.55 | $81.00 | not published | 0 |
| Psytx pt w/e&m 16-37 min CPT 90833 | $92.95 | $169.00 | not published | 0 |
| Psytx pt w/e&m 38-52 min CPT 90836 | $95.15 | $173.00 | not published | 0 |
| Psytx pt w/e&m 53+ min CPT 90838 | $118.25 | $215.00 | not published | 0 |
| Pt application of modality >=1 area electrical stimulation each 15 minutes CPT 97032 | $54.45 | $99.00 | $10.66 – $27.43 | 4 |
| Pt application of modality >=1 area hot/cold packs CPT 97010 | $12.10 | $22.00 | not published | 0 |
| Pt application of modality >=1 area iontophoresis each 15 minutes CPT 97033 | $66.00 | $120.00 | $13.79 – $35.49 | 4 |
| Pt application of modality >=1 area ultrasound each 15 minutes CPT 97035 | $52.80 | $96.00 | $10.38 – $26.71 | 4 |
| Pt application of modality traction mechanical CPT 97012 | $55.55 | $101.00 | $10.41 – $26.79 | 4 |
| Pten gene dup/delet variant CPT 81323 | not published | not published | $129.94 – $579.00 | 7 |
| Pten gene full sequence CPT 81321 | not published | not published | $450.00 – $1,158.00 | 7 |
| Pten gene known fam variant CPT 81322 | $124.30 | $226.00 | $34.95 – $89.94 | 7 |
| Pterygomaxillary fossa surg any appr 31040 CPT 31040 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Pt evaluation high complexity patient/family CPT 97163 | $155.10 | $282.00 | $71.78 – $184.70 | 4 |
| Pt evaluation low complexity patient/family CPT 97161 | $112.75 | $205.00 | $71.78 – $184.70 | 4 |
| Pt evaluation moderate complexity patient/family CPT 97162 | $134.20 | $244.00 | $71.78 – $184.70 | 4 |
| Pt-focused hlth risk assmt CPT 96160 | not published | not published | $27.80 – $71.53 | 4 |
| Pt init/spiromet rec/review/interp 94016 CPT 94016 | not published | not published | $17.97 – $46.24 | 4 |
| Pt prgrm for implt neurostim HCPCS L8681 | not published | not published | $1,053.28 – $2,710.45 | 4 |
| Pt re-evaluation patient/family CPT 97164 | $91.30 | $166.00 | $49.33 – $126.94 | 4 |
| Pt repositioning canalith procedure(s) per day CPT 95992 | $119.35 | $217.00 | $21.80 – $56.11 | 4 |
| Pt stimulation electrial unattended >= 1 area other than wound care part of therapy plan HCPCS G0283 | $68.20 | $124.00 | $9.14 – $23.53 | 4 |
| Pt therapeutic procedure >=1 area gait training each 15 minutes CPT 97116 | $54.45 | $99.00 | $21.19 – $54.52 | 4 |
| Pt therapeutic procedure >=1 area massage each 15 minutes CPT 97124 | $54.45 | $99.00 | $21.56 – $55.49 | 4 |
| Pt wheelchair management each 15 minutes CPT 97542 | $48.95 | $89.00 | $22.66 – $58.31 | 4 |
| Pul art balloon repr percut CPT 92997 | not published | not published | $8,563.85 – $22,037.64 | 6 |
| Pul art balloon repr percut CPT 92998 | not published | not published | $17,314.00 – $18,364.00 | 2 |
| Pulm ds ipf mrna 190 gen alg CPT 81554 | not published | not published | $4,057.20 – $10,440.53 | 7 |
| Pulm endartercomy w/bypass 33916 CPT 33916 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Pulmonary decortication partial 32225 CPT 32225 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Pulmonary vent imaging CPT 78579 | $1,936.00 | $3,520.00 | $296.56 – $763.16 | 4 |
| Pulse ox continuous overnight monitoring CPT 94762 | $273.35 | $497.00 | $95.45 – $245.63 | 4 |
| Pulse ox multiple CPT 94761 | $65.45 | $119.00 | not published | 0 |
| Punc of shunt for asp or inj CPT 61070 | $1,323.30 | $2,406.00 | $523.65 – $3,030.00 | 6 |
| Puncture arterial withdrawal blood for diagnosis CPT 36600 | $82.50 | $150.00 | $98.70 – $2,334.00 | 6 |
| Puncture aspiration abscess/hematoma/bulla/cyst CPT 10160 | $634.15 | $1,153.00 | $301.57 – $2,334.00 | 6 |
| Puncture/clear windpipe 31612 CPT 31612 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Puncture spinal lumbar diagnostic CPT 62270 | $1,617.00 | $2,940.00 | $523.65 – $3,030.00 | 6 |
| Puraply 1 sq cm HCPCS Q4195 | not published | not published | $92.32 – $279.84 | 7 |
| Puraply xt 1 sq cm HCPCS Q4197 | not published | not published | $80.89 – $237.56 | 7 |
| Pvb thoracic 2nd+ inj site CPT 64462 | $597.85 | $1,087.00 | $1,887.00 – $5,512.00 | 3 |
| Pvb thoracic cont infusion CPT 64463 | $1,177.00 | $2,140.00 | $523.65 – $3,030.00 | 6 |
| Pvb thoracic single inj site CPT 64461 | $1,177.00 | $2,140.00 | $523.65 – $3,030.00 | 6 |
| Pwr adpt pneum vad, rep veh HCPCS Q0504 | not published | not published | $633.72 – $1,630.77 | 4 |
| Pwr pck base combo vad, rep HCPCS Q0489 | not published | not published | $15,011.60 – $38,629.84 | 4 |
| Pyelotomy w/drg pyelostomy CPT 50125 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Pyelotomy w/exploration CPT 50120 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Pyelotomy w/removal calculus CPT 50130 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Pyloroplasty 43800 CPT 43800 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Pyridoxine hcl 100 mg HCPCS J3415 | not published | not published | $13.83 – $42.97 | 5 |
| Pyruvate CPT 84210 | $95.15 | $173.00 | $10.86 – $27.95 | 7 |
| Pyruvate kinase CPT 84220 | not published | not published | $7.08 – $18.22 | 7 |
| Quadrilateral brim HCPCS L2188 | not published | not published | $258.11 – $664.21 | 4 |
| Quan puplmtry phy/qhp uni/bi CPT 95919 | not published | not published | $98.70 – $253.99 | 4 |
| Quant diff pulm perf and vent w/imaging CPT 78598 | $1,936.00 | $3,520.00 | $402.79 – $1,036.52 | 4 |
| Quant diff pulm perf w/imaging CPT 78597 | $1,936.00 | $3,520.00 | $296.56 – $763.16 | 4 |
| Quest t3 uptake CPT 84479 | $56.10 | $102.00 | $4.85 – $12.49 | 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.