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 |
|---|---|---|---|---|
| Venogram extremity supervision & interpretation unilateral CPT 75820 | $1,870.00 | $3,400.00 | $269.24 – $3,005.03 | 4 |
| Venous mech thrombectomy CPT 37187 | $3,479.30 | $6,326.00 | $6,019.00 – $22,037.64 | 6 |
| Venous m-thrombectomy add-on CPT 37188 | $2,620.20 | $4,764.00 | $2,342.32 – $8,770.00 | 6 |
| Venous sampling s&i CPT 75893 | not published | not published | $303.67 – $10,622.50 | 4 |
| Venous thrombosis imaging CPT 78457 | not published | not published | $402.79 – $1,036.52 | 4 |
| Ven thrombosis images bilat CPT 78458 | not published | not published | $296.56 – $763.16 | 4 |
| Ventilator each subsequent day CPT 94003 | $849.75 | $1,545.00 | not published | 0 |
| Ventilator initial day CPT 94002 | $849.75 | $1,545.00 | not published | 0 |
| Ventricular puncture prev burr hole without inj 61020 CPT 61020 | not published | not published | $656.13 – $3,030.00 | 6 |
| Ventriculomyotomy/ihss 33416 CPT 33416 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Version cephalic external CPT 59412 | $442.75 | $805.00 | $2,401.40 – $7,791.00 | 6 |
| Vertebral corpectomy partial/complete 63082 CPT 63082 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Verteporfin injection HCPCS J3396 | not published | not published | $8.53 – $31.32 | 8 |
| Very long chain fatty acids CPT 82726 | not published | not published | $14.81 – $38.12 | 7 |
| Vesiculotomy complicated CPT 55605 | not published | not published | $2,959.00 – $3,388.00 | 3 |
| Vest large holster HCPCS Q0498 | not published | not published | $474.36 – $1,220.69 | 4 |
| V-exc/lip/w/pri linear closure 40520 CPT 40520 | not published | not published | $2,459.51 – $6,329.15 | 6 |
| Vinblastine 1 mg/ml intravenous solution HCPCS J9360 | not published | not published | $5.23 – $13.15 | 5 |
| Vincristine 1 mg/ml intravenous solution HCPCS J9370 | not published | not published | $9.02 – $22.67 | 5 |
| Vinorelbine 10 mg/ml intravenous solution (wrapper) HCPCS J9390 | not published | not published | $3.72 – $17.70 | 5 |
| Viper venom prothrombin time CPT 85612 | not published | not published | $13.12 – $33.76 | 7 |
| Virus isolation addl studies ea CPT 87253 | $95.70 | $174.00 | $15.15 – $38.99 | 7 |
| Visc & infraren abd 1 prosth CPT 34845 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Visc & infraren abd 2 prosth CPT 34846 | $8,957.30 | $16,286.00 | $6,019.00 – $6,019.00 | 1 |
| Visc & infraren abd 3 prosth CPT 34847 | $14,182.30 | $25,786.00 | $6,019.00 – $6,019.00 | 1 |
| Visc & infraren abd 4+ prost CPT 34848 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Visit established high 40-54 minutes/level 5 HCPCS G0463 | $173.25 | $315.00 | $98.76 – $254.15 | 4 |
| Visual audiometry (vra) CPT 92579 | not published | not published | $160.18 – $412.19 | 4 |
| Vital capacity test CPT 94150 | $93.50 | $170.00 | $95.45 – $245.63 | 4 |
| Vitamin b-12 CPT 82607 | $91.30 | $166.00 | $11.31 – $29.10 | 7 |
| Vitamin D Test CPT 82306 | $252.45 | $459.00 | $22.20 – $57.13 | 7 |
| Vit for macular hole CPT 67042 | not published | not published | $3,066.31 – $16,106.00 | 6 |
| Vit for macular pucker CPT 67041 | not published | not published | $3,066.31 – $16,106.00 | 6 |
| Vit for membrane dissect CPT 67043 | not published | not published | $3,066.31 – $16,106.00 | 6 |
| Vkorc1 gene CPT 81355 | not published | not published | $66.15 – $170.23 | 7 |
| Vlvctmy rad comp bi lymphad CPT 56637 | not published | not published | $4,428.00 – $27,583.00 | 3 |
| Vlvctmy rad comp uni lymphad CPT 56634 | not published | not published | $4,428.00 – $27,583.00 | 3 |
| Vlvctmy rad prtl uni lymphad CPT 56631 | not published | not published | $4,428.00 – $27,583.00 | 3 |
| Voice amplifier HCPCS L8510 | not published | not published | $233.38 – $600.56 | 4 |
| Voiding pressure study/intra-abd 51797 CPT 51797 | $401.94 | $730.80 | $1,887.00 – $5,512.00 | 3 |
| Vol reduction of blood/prod CPT 86960 | not published | not published | $44.72 – $325.23 | 5 |
| Volume deplete of harvest CPT 38214 | not published | not published | $327.28 – $2,334.00 | 6 |
| Volume measurement urine timed CPT 81050 | $25.85 | $47.00 | $2.73 – $7.03 | 7 |
| Vonvendi inj 1 iu vwf:rco HCPCS J7179 | not published | not published | $1.36 – $5.03 | 8 |
| Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr HCPCS J3465 | not published | not published | $1.05 – $2.64 | 5 |
| Vulvectomy radical 56640 CPT 56640 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Vulvectomy radical complete CPT 56633 | not published | not published | $4,428.00 – $27,583.00 | 3 |
| Vulvectomy radical partial CPT 56630 | not published | not published | $3,710.98 – $9,549.58 | 6 |
| Vulvectomy simple partial CPT 56620 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Vutrisiran 25 mg/0.5 ml subcutaneous syringe HCPCS J0225 | not published | not published | $3,759.45 – $13,388.58 | 8 |
| Vyjuvek 5x10^9pfu/ml, 0.1 ml HCPCS J3401 | not published | not published | $774.33 – $2,768.19 | 8 |
| Waist belt HCPCS L2190 | not published | not published | $78.62 – $202.32 | 4 |
| Warde 1003990 aldosterone CPT 82088 | $367.40 | $668.00 | $30.56 – $78.65 | 7 |
| Warde 1005020 citrate 24 hour urine CPT 82507 | $50.05 | $91.00 | $20.85 – $53.65 | 7 |
| Warde 1005055 5-hiaa 24 hour urine CPT 83497 | $112.75 | $205.00 | $9.68 – $24.90 | 7 |
| Warde 1006955 catecholamines fractionated 24 hour urine CPT 82384 | $188.65 | $343.00 | $18.94 – $48.73 | 7 |
| Warde 1007138 vanillymandelic acid 24 hour urine CPT 84585 | not published | not published | $11.62 – $29.92 | 7 |
| Warde 1015200 kappa light chain free CPT 83521 | $31.35 | $57.00 | $12.95 – $33.33 | 7 |
| Warde 3004000 immunoglobulin subclass 1 CPT 82787 | $81.40 | $148.00 | $6.02 – $15.48 | 7 |
| Warde 3008005 oligoclonal bands CPT 83916 | $124.85 | $227.00 | $20.54 – $52.86 | 7 |
| Warde 3016000 west nile virus antibody CPT 86788 | $47.85 | $87.00 | $11.77 – $32.52 | 7 |
| Warde 3016000 west nile virus antibody igg CPT 86789 | $74.80 | $136.00 | $10.79 – $27.77 | 7 |
| Warde 3016300 saccharomyces cerevisiae iga antibody CPT 86671 | $41.80 | $76.00 | $9.19 – $23.64 | 7 |
| Warde 3400652 ova & parasites direct smear concentration and id CPT 87177 | $90.75 | $165.00 | $6.68 – $17.18 | 7 |
| Warde 3400652 smear complex special stain ova/parasites CPT 87209 | $160.60 | $292.00 | $13.48 – $34.70 | 7 |
| Warde 3400683 amplification rna markers infectious disease bacterial vaginosis CPT 81513 | not published | not published | $106.97 – $275.28 | 7 |
| Warde 3400852 arsenic CPT 82175 | $169.95 | $309.00 | $14.23 – $36.61 | 7 |
| Warde 3708165 mercury urine CPT 83825 | $146.30 | $266.00 | $12.20 – $31.38 | 7 |
| Warde acetylcholine receptor blocking antibody CPT 86042 | $49.50 | $90.00 | $13.80 – $35.51 | 7 |
| Warde actin (smooth muscle) antibody each CPT 86015 | $19.25 | $35.00 | $9.04 – $23.26 | 7 |
| Warde adenosine deaminase pleural fluid CPT 84311 | $63.80 | $116.00 | $6.08 – $15.63 | 7 |
| Warde adrenocorticotropic hormone (acth) CPT 82024 | $325.60 | $592.00 | $28.96 – $74.54 | 7 |
| Warde aldolase CPT 82085 | $84.70 | $154.00 | $7.28 – $18.74 | 7 |
| Warde amino acids 6 or more quantitative each specimen CPT 82139 | $127.05 | $231.00 | $12.65 – $32.56 | 7 |
| Warde amiodarone therapeutic drug level CPT 80151 | $30.80 | $56.00 | $13.98 – $35.98 | 7 |
| Warde analysis gene hfe common variants CPT 81256 | $530.20 | $964.00 | $49.02 – $126.14 | 7 |
| Warde analysis translocation bcr/abl1 major breakpoint qualitative/quantitative CPT 81206 | $541.20 | $984.00 | $122.97 – $316.44 | 7 |
| Warde antiepileptics nos definitive assay 1-3 clobazam w metabolites CPT 80339 | $156.20 | $284.00 | $35.06 – $35.06 | 1 |
| Warde anti-mullerian hormone CPT 82166 | not published | not published | $28.96 – $74.54 | 7 |
| Warde apolipoprotein b CPT 82172 | $64.35 | $117.00 | $15.82 – $40.70 | 7 |
| Warde bile acids CPT 82239 | $73.15 | $133.00 | $12.84 – $33.04 | 7 |
| Warde cadmium blood CPT 82300 | $207.35 | $377.00 | $17.73 – $45.63 | 7 |
| Warde calcitonin CPT 82308 | $230.45 | $419.00 | $20.09 – $51.70 | 7 |
| Warde calculus (stone) infrared CPT 82365 | $24.20 | $44.00 | $9.68 – $24.90 | 7 |
| Warde clozapine therapeutic drug level CPT 80159 | $81.40 | $148.00 | $15.11 – $38.89 | 7 |
| Warde cobalt heavy metal quantitative each nes CPT 83018 | not published | not published | $16.47 – $42.38 | 7 |
| Warde collagen cross links c-telopeptide CPT 82523 | $90.75 | $165.00 | $14.01 – $36.05 | 7 |
| Warde complement total hemolytic CPT 86162 | $142.45 | $259.00 | $15.24 – $39.22 | 7 |
| Warde copper CPT 82525 | $89.65 | $163.00 | $9.31 – $23.95 | 7 |
| Warde cryoglobulin CPT 82595 | $50.05 | $91.00 | $4.85 – $12.49 | 7 |
| Warde erythropoietin CPT 82668 | $158.40 | $288.00 | $14.09 – $36.26 | 7 |
| Warde estrogen fractionated CPT 82671 | $58.30 | $106.00 | $24.22 – $62.34 | 7 |
| Warde fluorescent antibody screen endomysial iga CPT 86231 | $19.80 | $36.00 | $9.07 – $23.33 | 7 |
| Warde folic acid rbc CPT 82747 | $97.35 | $177.00 | $13.24 – $34.06 | 7 |
| Warde g6pd (glucose 6 phosphate dehydrogenase) quantitative CPT 82955 | $84.15 | $153.00 | $7.28 – $18.72 | 7 |
| Warde gastrin CPT 82941 | $151.80 | $276.00 | $13.22 – $34.03 | 7 |
| Warde growth hormone (hgh) CPT 83003 | $123.75 | $225.00 | $12.50 – $32.17 | 7 |
| Warde haloperidol therapeutic drug level CPT 80173 | $77.55 | $141.00 | $11.84 – $30.46 | 7 |
| Warde helminth antibody strongyloides igg CPT 86682 | $64.35 | $117.00 | $9.76 – $25.11 | 7 |
| Warde hemoglobin fractionation/quantitation electrophoresis CPT 83020 | $27.50 | $50.00 | $9.23 – $24.84 | 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.