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 |
|---|---|---|---|---|
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | not published | not published | $24.59 – $60.85 | 4 |
| Vaccine influenza quadrivalent live (laiv4) intranasal CPT 90672 | not published | not published | $82.73 – $82.73 | 1 |
| Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im CPT 90661 | not published | not published | $40.54 – $100.32 | 4 |
| Vaccine influenza trivalent (iiv3) 0.25ml dose im CPT 90657 | not published | not published | $12.02 – $29.75 | 4 |
| Vaccine mengingoccocal serogroup b 2 dose im CPT 90620 | not published | not published | $678.32 – $678.32 | 1 |
| Vaccine mengingoccocal serogroup b 2 or 3 dose im CPT 90621 | not published | not published | $621.16 – $621.16 | 1 |
| Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im CPT 90619 | not published | not published | $561.41 – $561.41 | 1 |
| Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im CPT 90734 | not published | not published | $494.92 – $494.92 | 1 |
| Vaccine mmr live subcutaneous CPT 90707 | not published | not published | $305.38 – $305.38 | 1 |
| Vaccine mmrv live subcutaneous CPT 90710 | not published | not published | $907.10 – $907.10 | 1 |
| Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im CPT 90732 | not published | not published | $146.82 – $363.38 | 4 |
| Vaccine pneumococcal conjugate 13 valent (pcv13) im CPT 90670 | not published | not published | $283.79 – $702.37 | 4 |
| Vaccine pneumonococcal conjugate 15 valent (pcv15) im CPT 90671 | not published | not published | $287.27 – $690.31 | 4 |
| Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 | not published | not published | $344.19 – $811.42 | 4 |
| Vaccine polio (ipv) subcutaneous/im CPT 90713 | not published | not published | $145.73 – $145.73 | 1 |
| Vaccine rabies im CPT 90675 | not published | not published | $248.98 – $892.39 | 7 |
| Vaccine respiratory syncytial virus bivalent subunit/preservative free im CPT 90678 | not published | not published | $963.77 – $963.77 | 1 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im CPT 90380 | not published | not published | $3,396.05 – $3,396.05 | 1 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im CPT 90381 | not published | not published | $1,698.03 – $1,698.03 | 1 |
| Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im CPT 90679 | not published | not published | $960.50 – $960.50 | 1 |
| Vaccine rotavirus attenuated (rv1) live 2 dose oral CPT 90681 | not published | not published | $301.90 – $301.90 | 1 |
| Vaccine rotavirus pentavalent (rv5) live 3 dose oral CPT 90680 | not published | not published | $322.43 – $322.43 | 1 |
| Vaccine tdap >=7 years im CPT 90715 | not published | not published | $42.98 – $105.17 | 4 |
| Vaccine td preservative free >= 7 years im CPT 90714 | not published | not published | $37.36 – $91.15 | 4 |
| Vaccine typhoid vicps im CPT 90691 | not published | not published | $321.67 – $321.67 | 1 |
| Vaccine varicella live subcutaneous CPT 90716 | not published | not published | $597.45 – $597.45 | 1 |
| Vaccine yellow fever live subcutaneous CPT 90717 | not published | not published | $480.74 – $480.74 | 1 |
| Vaccinia vrs vac 0.3 ml perq CPT 90622 | not published | not published | $0.01 – $0.03 | 5 |
| Vad battery clip set hmii 14-v li-ion HCPCS Q0497 | not published | not published | $432.33 – $1,112.53 | 4 |
| Vad cable power module dc input HCPCS Q0478 | not published | not published | $169.71 – $436.72 | 4 |
| Vad univ batt charger hm 1440 HCPCS Q0495 | not published | not published | $3,857.60 – $9,926.90 | 4 |
| Vag hys/<250g/rmv tube/rpr entero 58263 CPT 58263 | not published | not published | $3,710.98 – $9,549.58 | 6 |
| Vag hyst incl t/o complex CPT 58291 | not published | not published | $3,710.98 – $16,106.00 | 6 |
| Vag hyst including t/o CPT 58262 | not published | not published | $3,710.98 – $9,549.58 | 6 |
| Vag hyst t/o & repair compl CPT 58292 | not published | not published | $5,501.01 – $16,106.00 | 6 |
| Vag hyst w/enterocele compl 58294 CPT 58294 | not published | not published | $3,710.98 – $16,106.00 | 6 |
| Vag hyst w/enterocele repair CPT 58270 | not published | not published | $3,710.98 – $9,549.58 | 6 |
| Vaginal bx CPT 58999 | not published | not published | $149.98 – $2,334.00 | 6 |
| Vaginal delivery after cesarean delivery 59612 CPT 59612 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Vaginal Delivery (full care) CPT 59400 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Vaginal hysterectomy CPT 58260 | not published | not published | $3,710.98 – $9,549.58 | 6 |
| Vaginectomy partial w/nodes CPT 57109 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Vag inser rectal control sys HCPCS A4563 | not published | not published | $1,260.44 – $3,243.52 | 4 |
| Vagnc compl rmvl paravag tis CPT 57111 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Vagnc compl rmvl vag wall CPT 57110 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Vagotomy pfrmd w/prtl dstl gstrct 43635 CPT 43635 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Vagotomy & pylorus repair CPT 43641 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Vagotomy & pylorus repair 43640 CPT 43640 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Valproic acid total therapeutic drug level CPT 80164 | $119.90 | $218.00 | $10.16 – $26.13 | 7 |
| Valrubicin injection HCPCS J9357 | not published | not published | $935.29 – $3,791.14 | 8 |
| Valvuloplasty aortic CPT 92986 | $6,168.25 | $11,215.00 | $4,222.18 – $18,364.00 | 6 |
| Valvuloplasty mitral CPT 92987 | $10,877.90 | $19,778.00 | $8,563.85 – $22,037.64 | 6 |
| Valvuloplasty pulmonary CPT 92990 | not published | not published | $8,563.85 – $22,037.64 | 6 |
| Valvuloplasty/tv without ring insert 33463 CPT 33463 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Valvuloplasty/tv w/ring insertion 33464 CPT 33464 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Vancomycin 1,000 mg intravenous injection HCPCS J3373 | not published | not published | $0.06 – $0.06 | 1 |
| Vancomycin 750 mg intravenous solution HCPCS J3374 | not published | not published | $0.23 – $0.23 | 1 |
| Vancomycin hcl injection HCPCS J3370 | not published | not published | $2.01 – $5.07 | 4 |
| Vancomycin peak therapeutic drug level CPT 80202 | $123.20 | $224.00 | $10.16 – $26.13 | 7 |
| Vanomycin dna amp probe CPT 87500 | not published | not published | $26.32 – $67.72 | 7 |
| Vantas implant HCPCS J9225 | not published | not published | $12,416.94 – $12,416.94 | 1 |
| Varicella zoster antibody igg CPT 86787 | $185.35 | $337.00 | $9.66 – $24.86 | 7 |
| Varicella-zoster immue globin im CPT 90396 | not published | not published | $1,873.30 – $6,131.83 | 5 |
| Varus/valgus strap padded/li HCPCS L2270 | not published | not published | $56.82 – $146.22 | 4 |
| Vasc emb/occ w/prs cath HCPCS C9797 | not published | not published | $5,512.00 – $34,994.75 | 4 |
| Vasc graft into carpal bone CPT 25430 | not published | not published | $2,427.27 – $16,106.00 | 6 |
| Vasectomy CPT 55250 | not published | not published | $1,550.71 – $7,791.00 | 6 |
| Vasopressin 20 unit/ml intravenous solution HCPCS J2598 | not published | not published | $1.56 – $4.44 | 5 |
| Vbac delivery 59610 CPT 59610 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Vbac/include postpartum care 59614 CPT 59614 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Vedolizumab 300 mg intravenous solution HCPCS J3380 | not published | not published | $16.22 – $59.00 | 8 |
| Veeg cont 2-12 hrs CPT 95713 | not published | not published | $276.82 – $712.35 | 4 |
| Veeg ea 12-26hr cont mntr CPT 95716 | not published | not published | $637.04 – $1,639.32 | 4 |
| Veeg intrmnt 2-12 hrs CPT 95712 | not published | not published | $276.82 – $712.35 | 4 |
| Veeg unmon 12-26 hrs CPT 95714 | not published | not published | $276.82 – $712.35 | 4 |
| Veeg unmon 2-12 hrs CPT 95711 | not published | not published | $160.18 – $412.19 | 4 |
| Vein bypass grft fem-popliteal 35583 CPT 35583 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Vein byp fem-tibial peroneal 35585 CPT 35585 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Vein byp pop-tibl peroneal CPT 35587 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Vein gft fem a/p tib/pero/dis art 35566 CPT 35566 | $12,057.10 | $21,922.00 | $4,428.00 – $4,428.00 | 1 |
| Vein x-ray adrenal gland CPT 75840 | not published | not published | $303.67 – $6,027.57 | 4 |
| Vein x-ray adrenal glands CPT 75842 | not published | not published | $351.92 – $351.92 | 1 |
| Vein x-ray eye socket CPT 75880 | not published | not published | $355.98 – $1,197.51 | 4 |
| Vein x-ray kidney CPT 75831 | $1,946.45 | $3,539.00 | $283.50 – $6,027.57 | 4 |
| Vein x-ray liver CPT 75891 | $3,305.50 | $6,010.00 | $297.74 – $6,027.57 | 4 |
| Vein x-ray liver w/hemodynam CPT 75885 | $7,461.85 | $13,567.00 | $295.36 – $6,027.57 | 4 |
| Vein x-ray liver w/hemodynam CPT 75889 | $3,719.10 | $6,762.00 | $295.36 – $6,027.57 | 4 |
| Vein x-ray liver without hemodyn CPT 75887 | $3,963.30 | $7,206.00 | $296.56 – $6,027.57 | 4 |
| Vein x-ray skull CPT 75870 | not published | not published | $301.32 – $6,027.57 | 4 |
| Vein x-ray skull epidural CPT 75872 | not published | not published | $289.41 – $1,197.51 | 4 |
| Vein x-ray spleen/liver CPT 75810 | not published | not published | $1,343.62 – $6,027.57 | 4 |
| Velaglucerase alfa 400 unit intravenous solution HCPCS J3385 | not published | not published | $294.63 – $1,018.26 | 8 |
| Vemp test i&r cervical CPT 92517 | not published | not published | $95.45 – $245.63 | 4 |
| Vemp test i&r ocular CPT 92518 | not published | not published | $95.45 – $245.63 | 4 |
| Vemp tst i&r cervical&ocular CPT 92519 | not published | not published | $160.18 – $412.19 | 4 |
| Ven blood coll snf/hha HCPCS G0471 | not published | not published | $7.43 – $21.89 | 6 |
| Vendaje, per square centimet HCPCS Q4252 | not published | not published | $92.32 – $237.56 | 7 |
| Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture) CPT 36410 | $188.65 | $343.00 | not published | 0 |
| Venipuncture <3 yrs other vein CPT 36406 | $94.05 | $171.00 | not published | 0 |
| Venogram ext bil s&i CPT 75822 | $1,870.00 | $3,400.00 | $283.50 – $3,005.03 | 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.