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 |
|---|---|---|---|---|
| Infectious agent nucleic acid amplified probe trichomonas vaginalis CPT 87661 | $80.85 | $147.00 | $26.32 – $67.72 | 7 |
| Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae CPT 87494 | not published | not published | $52.64 – $135.45 | 4 |
| Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance CPT 87564 | not published | not published | $57.58 – $148.17 | 7 |
| Infectious agent nucleic acid joint space pathogens multiplex amplified probe >= 26 targets CPT 87627 | not published | not published | $509.83 – $1,311.96 | 4 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets CPT 87507 | not published | not published | $312.58 – $804.39 | 7 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets CPT 87505 | not published | not published | $96.22 – $247.60 | 7 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets CPT 87506 | $1,144.55 | $2,081.00 | $197.24 – $507.57 | 7 |
| Infectious agent nucleic acid quantification bk virus CPT 87799 | $279.40 | $508.00 | $32.13 – $82.68 | 7 |
| Infectious agent nucleic acid quantification hepatitis b CPT 87517 | $467.50 | $850.00 | $32.13 – $82.68 | 7 |
| Infectious agent nucleic acid quantification hepatitis c CPT 87522 | $473.00 | $860.00 | $32.13 – $82.68 | 7 |
| Infectious agent nucleic acid quantification hiv-1 CPT 87536 | $189.75 | $345.00 | $63.82 – $164.24 | 7 |
| Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets CPT 87631 | $584.65 | $1,063.00 | $106.97 – $275.28 | 7 |
| Infliximab 100 mg intravenous solution HCPCS J1745 | not published | not published | $23.61 – $83.11 | 8 |
| Infliximab-axxq 100 mg intravenous solution HCPCS Q5121 | not published | not published | $21.73 – $59.50 | 7 |
| Infliximab-dyyb 100 mg intravenous solution HCPCS Q5103 | not published | not published | $17.50 – $53.48 | 7 |
| Influenza dna amp prob addl CPT 87503 | not published | not published | $21.92 – $56.39 | 7 |
| Influenza virus vaccine, inact hemagglutinin tiv pf inj CPT 90673 | not published | not published | $91.84 – $227.30 | 4 |
| Influenza virus vaccine, live trivalent intranasal CPT 90660 | not published | not published | $31.76 – $78.61 | 4 |
| Infratemporal approach/skull CPT 61591 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Infratemporal approach/skull CPT 61590 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Inf thrc fascial pln blk bi w/wo image CPT 64469 | not published | not published | $5,512.00 – $5,512.00 | 1 |
| Inf thrc fascial pln blk uni w/wo image CPT 64467 | not published | not published | $5,512.00 – $5,512.00 | 1 |
| Infuse radioactive materials CPT 77750 | not published | not published | $286.12 – $736.29 | 4 |
| Ingest challenge ini 120 min CPT 95076 | not published | not published | $276.82 – $712.35 | 4 |
| Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis CPT 94642 | $237.60 | $432.00 | $162.44 – $418.02 | 4 |
| Init ak ischal plstr direct HCPCS L5505 | not published | not published | $1,915.78 – $4,929.95 | 4 |
| Init bk ptb plaster direct HCPCS L5500 | not published | not published | $1,361.87 – $3,504.55 | 4 |
| Initial care training 30 m HCPCS G0539 | not published | not published | $29.44 – $75.77 | 4 |
| Initial custom socket insert HCPCS L5683 | not published | not published | $1,214.80 – $3,126.10 | 4 |
| Initial foot exam pt lops HCPCS G0245 | not published | not published | $98.76 – $254.15 | 4 |
| Initiation & management bipap/cpap initial day CPT 94660 | $231.55 | $421.00 | $162.44 – $418.02 | 4 |
| Init/sub psych care m 1st 30 HCPCS G2214 | not published | not published | $75.36 – $193.93 | 4 |
| Inj, abilify asimtufii, 1 mg HCPCS J0402 | not published | not published | $4.64 – $16.12 | 8 |
| Inj, abilify maintena, 1 mg HCPCS J0401 | not published | not published | $5.60 – $19.26 | 8 |
| Inj acetaminoph 10mg/ibu 3mg HCPCS J0138 | not published | not published | $0.07 – $0.76 | 6 |
| Inj, acetaminophen (b braun) HCPCS J0136 | not published | not published | $0.06 – $0.13 | 5 |
| Inj acetaminophen -fresenius HCPCS J0134 | not published | not published | $0.05 – $0.12 | 5 |
| Inj, acetaminophen (hikma) HCPCS J0137 | not published | not published | $0.03 – $0.13 | 5 |
| Inj. acthar gel to 40 units HCPCS J0801 | not published | not published | $3,100.09 – $10,421.27 | 8 |
| Inj, adalimumab, 1 mg HCPCS J0139 | not published | not published | $249.73 – $249.73 | 1 |
| Inj adalimumab-ryvk, 1 mg HCPCS Q5142 | not published | not published | $28.69 – $28.69 | 1 |
| Inj, adstiladrin, per tx dos HCPCS J9029 | not published | not published | $48,248.71 – $172,612.06 | 8 |
| Inj, aducanumab-avwa, 2 mg HCPCS J0172 | not published | not published | $6.47 – $16.29 | 5 |
| Inj, adzynma, 10 iu HCPCS J7171 | not published | not published | $27.16 – $94.12 | 8 |
| Inj, aflibercept-ayyh, 1 mg HCPCS Q5147 | not published | not published | $602.44 – $1,651.26 | 5 |
| Inj, aflibercept hd, 1 mg HCPCS J0177 | not published | not published | $224.01 – $895.87 | 8 |
| Inj, afstyla, 1 i.u HCPCS J7210 | not published | not published | $1.21 – $4.14 | 8 |
| Inj, alfentanil hcl, 500mcg HCPCS J0216 | not published | not published | $12.31 – $12.31 | 1 |
| Inj allopurinol sodium 1 mg HCPCS J0206 | not published | not published | $3.06 – $11.98 | 8 |
| Inj, alyglo, 500 mg HCPCS J1552 | not published | not published | $91.16 – $399.91 | 8 |
| Inj alymsys 10 mg HCPCS Q5126 | not published | not published | $50.66 – $158.53 | 7 |
| Inj, amisulpride, 1 mg HCPCS J0184 | not published | not published | $7.18 – $24.72 | 5 |
| Inj andexxa, 10 mg HCPCS J7169 | not published | not published | $98.37 – $358.83 | 5 |
| Inj anifrolumab-fnia 1mg HCPCS J0491 | not published | not published | $13.88 – $48.35 | 8 |
| Inj. (ani), up to 40 units HCPCS J0802 | not published | not published | $2,756.01 – $9,443.94 | 8 |
| Inj, aponvie, 1 mg HCPCS C9145 | not published | not published | $5.07 – $5.07 | 1 |
| Inj., aristada initio, 1 mg HCPCS J1943 | not published | not published | $2.60 – $8.51 | 8 |
| Inj, artesunate, 1mg HCPCS J0391 | not published | not published | $38.87 – $141.11 | 5 |
| Inj. asceniv HCPCS J1554 | not published | not published | $381.85 – $1,347.56 | 8 |
| Inj, aspara, rylaze, 0.1 mg HCPCS J9021 | not published | not published | $44.02 – $147.39 | 8 |
| Inj atezolizumb 5mg hya-tqjs HCPCS J9024 | not published | not published | $24.42 – $62.83 | 5 |
| Inj avacincaptad pegol 0.1mg HCPCS J2782 | not published | not published | $77.40 – $295.94 | 8 |
| Inj aval alfa-nqpt 4mg HCPCS J0219 | not published | not published | $62.96 – $211.98 | 8 |
| Inj belantamab mafodot blmf HCPCS J9037 | not published | not published | $113.60 – $113.60 | 1 |
| Inj., benralizumab, 1 mg HCPCS J0517 | not published | not published | $124.17 – $451.64 | 8 |
| Inj beta interferon sq 1 mcg HCPCS Q3028 | not published | not published | $127.58 – $127.58 | 1 |
| Inj, betibeglogene autotemce HCPCS J3393 | not published | not published | $2,197,695.26 – $8,080,380.00 | 5 |
| Inj, bezlotoxumab, 10 mg HCPCS J0565 | not published | not published | $29.87 – $108.55 | 8 |
| Inj bimatoprost itc imp1mcg HCPCS J7351 | not published | not published | $160.32 – $571.43 | 8 |
| Inj, biorphen, 20 micrograms HCPCS J2372 | not published | not published | $0.18 – $0.46 | 5 |
| Inj, bortezomib, dr. reddy's HCPCS J9046 | not published | not published | $2.60 – $13.37 | 5 |
| Inj, bortezomib freseniuskab HCPCS J9048 | not published | not published | $5.23 – $44.93 | 5 |
| Inj, bortezomib, hospira HCPCS J9049 | not published | not published | $1.56 – $3.93 | 5 |
| Inj., brexanolone, 1 mg HCPCS J1632 | not published | not published | $243.39 – $243.39 | 1 |
| Inj, brixadi, 7 days or less HCPCS J0577 | not published | not published | $322.93 – $1,167.03 | 8 |
| Inj brixadi, more than 7 day HCPCS J0578 | not published | not published | $1,291.73 – $4,668.08 | 8 |
| Inj, brolucizumab-dbll, 1 mg HCPCS J0179 | not published | not published | $269.78 – $922.63 | 8 |
| Inj bulking agent anal canal HCPCS L8605 | not published | not published | $2,804.55 – $2,804.55 | 1 |
| Inj, bupivacaine liposome HCPCS J0666 | not published | not published | $1.09 – $3.94 | 8 |
| Inj, bupivacaine (posimir) HCPCS C9144 | not published | not published | $1.37 – $1.37 | 1 |
| Inj. byooviz, 0.1 mg HCPCS Q5124 | not published | not published | $94.13 – $465.08 | 7 |
| Inj calcitriol per 0.1 mcg HCPCS J0636 | not published | not published | $2.92 – $2.92 | 1 |
| Inj, carmustine (accord) HCPCS J9052 | not published | not published | $0.13 – $0.13 | 1 |
| Inj cefazolin sodium, baxter HCPCS J0689 | not published | not published | $1.34 – $3.35 | 5 |
| Inj cefazolin sodium, hikma HCPCS J0688 | not published | not published | $1.08 – $2.72 | 5 |
| Inj cefazolin (wg crit care) HCPCS J0687 | not published | not published | $1.07 – $3.02 | 5 |
| Inj. cefepime hcl (baxter) HCPCS J0701 | not published | not published | $6.21 – $15.63 | 5 |
| Inj, cefepime hcl (b braun) HCPCS J0703 | not published | not published | $5.33 – $13.40 | 5 |
| Inj, cefiderocol, 10 mg HCPCS J0699 | not published | not published | $1.91 – $6.20 | 8 |
| Inj ceftolozane tazobactam HCPCS J0695 | not published | not published | $7.53 – $22.19 | 8 |
| Inj., cerliponase alfa 1 mg HCPCS J0567 | not published | not published | $92.53 – $358.56 | 5 |
| Inj. cetirizine hcl 0.5mg HCPCS J1201 | not published | not published | $12.87 – $42.82 | 8 |
| Inj, cimerli, 0.1 mg HCPCS Q5128 | not published | not published | $61.90 – $459.39 | 7 |
| Inj, cipaglucosidase, 5 mg HCPCS J1203 | not published | not published | $72.23 – $243.34 | 8 |
| Inj, clevidipine butyrate HCPCS C9248 | not published | not published | $7.62 – $7.62 | 1 |
| Inj, clindamycin (baxter) HCPCS J0737 | not published | not published | $2.78 – $7.11 | 5 |
| Inj cntr knee arthro incl ct/mri CPT 27369 | $466.40 | $848.00 | $1,887.00 – $5,512.00 | 3 |
| Inj., copanlisib, 1 mg HCPCS J9057 | not published | not published | $242.73 – $242.73 | 1 |
| Inj crotalidae im f(ab')2 eq HCPCS J0841 | not published | not published | $1,112.14 – $2,796.47 | 5 |
| Inj, crovalimab-akkz, 10 mg HCPCS J1307 | not published | not published | $413.63 – $1,459.00 | 5 |
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.