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 |
|---|---|---|---|---|
| Inj octafluoropropane mic,ml HCPCS Q9956 | not published | not published | $46.07 – $113.29 | 4 |
| Inj ogivri 10 mg HCPCS Q5114 | not published | not published | $23.96 – $141.14 | 7 |
| Inj, olaratumab, 10 mg HCPCS J9285 | not published | not published | $160.46 – $160.46 | 1 |
| Inj, oliceridine 0.1 mg HCPCS C9101 | not published | not published | $3.60 – $3.60 | 1 |
| Inj olipudase alfa-rpcp 1mg HCPCS J0218 | not published | not published | $303.71 – $1,038.86 | 8 |
| Inj, omacetaxine mep, 0.01mg HCPCS J9262 | not published | not published | $10.76 – $10.76 | 1 |
| Inj., omadacycline, 1 mg HCPCS J0121 | not published | not published | $3.14 – $10.68 | 8 |
| Inj onase abepar-xioi treat HCPCS J3399 | not published | not published | $2,010,028.04 – $6,543,416.45 | 5 |
| Inj ontruzant 10 mg HCPCS Q5112 | not published | not published | $15.74 – $71.79 | 7 |
| Inj, palonosetron (posfrea) HCPCS J2468 | not published | not published | $41.42 – $162.64 | 6 |
| Inj pantoprazole(hikma) 40mg HCPCS J2471 | not published | not published | $21.24 – $21.24 | 1 |
| Inj, panzyga, 500 mg HCPCS J1576 | not published | not published | $53.51 – $188.13 | 8 |
| Inj, pasireotide long acting HCPCS J2502 | not published | not published | $462.53 – $1,452.46 | 6 |
| Inj., patisiran, 0.1 mg HCPCS J0222 | not published | not published | $75.77 – $269.07 | 8 |
| Inj, pedmark, 100 mg HCPCS J0208 | not published | not published | $72.58 – $261.36 | 5 |
| Inj, pegcetacoplan, 1mg HCPCS J2781 | not published | not published | $111.71 – $398.49 | 8 |
| Inj pegfilgrastim-bmez 0.5mg HCPCS Q5120 | not published | not published | $27.18 – $254.95 | 7 |
| Inj, pegulicianine, 1 mg HCPCS A9615 | not published | not published | $28.13 – $102.12 | 5 |
| Inj. pemetrexed, 10 mg HCPCS J9304 | not published | not published | $6.00 – $143.48 | 8 |
| Inj pemetrexed (accord) 10mg HCPCS J9296 | not published | not published | $7.30 – $26.52 | 6 |
| Inj, pemetrexed (avyxa) 10mg HCPCS J9292 | not published | not published | $55.25 – $258.09 | 6 |
| Inj pemetrexed ditromethamin HCPCS J9323 | not published | not published | $11.37 – $28.73 | 3 |
| Inj pemetrexed, hospira 10mg HCPCS J9294 | not published | not published | $2.21 – $9.36 | 8 |
| Inj pemetrexed (sandoz) 10mg HCPCS J9297 | not published | not published | $1.66 – $4.16 | 5 |
| Inj pemetrexed (teva) 10mg HCPCS J9314 | not published | not published | $7.20 – $21.20 | 8 |
| Inj, pemivibart, 4500 mg HCPCS Q0224 | not published | not published | $7,241.85 – $17,923.59 | 4 |
| Inj, pemrydi rtu, 10 mg HCPCS J9324 | not published | not published | $50.95 – $223.62 | 8 |
| Inj peritoneal venous shunt CPT 49427 | $61.60 | $112.00 | $1,887.00 – $5,512.00 | 3 |
| Inj., perseris, 0.5 mg HCPCS J2798 | not published | not published | $9.15 – $33.18 | 8 |
| Inj plasminogen tvmh 1mg HCPCS J2998 | not published | not published | $28.82 – $88.54 | 5 |
| Inj., plazomicin, 5 mg HCPCS J0291 | not published | not published | $2.64 – $9.72 | 8 |
| Inj pozelimab-bbfg, 1 mg HCPCS J9376 | not published | not published | $68.80 – $282.73 | 5 |
| Inj proc ankle arthr CPT 27648 | $326.70 | $594.00 | $1,887.00 – $5,512.00 | 3 |
| Inj proc elbow arthro CPT 24220 | $139.15 | $253.00 | $1,887.00 – $5,512.00 | 3 |
| Inj proc for lymphang CPT 38790 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Inj proc lumbr disk ea lvl CPT 62290 | $1,736.90 | $3,158.00 | $1,887.00 – $5,512.00 | 3 |
| Inj proc myelogram lumbar CPT 62284 | $2,264.35 | $4,117.00 | $1,887.00 – $5,512.00 | 3 |
| Inj proc sialogram CPT 42550 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Inj progesterone per 50 mg HCPCS J2675 | not published | not published | $0.73 – $2.43 | 5 |
| Inj prohance multipack HCPCS A9576 | not published | not published | $1.57 – $3.98 | 4 |
| Inj recombin esperoct per iu HCPCS J7204 | not published | not published | $1.72 – $5.96 | 8 |
| Inj, releuko 1 mcg HCPCS Q5125 | not published | not published | $0.23 – $1.22 | 7 |
| Inj retacrit esrd on dialysi HCPCS Q5105 | not published | not published | $0.78 – $2.05 | 4 |
| Inj retro urethrocysto CPT 51610 | $335.50 | $610.00 | $1,887.00 – $5,512.00 | 3 |
| Inj, rimabotulinumtoxinb HCPCS J0587 | not published | not published | $9.97 – $35.36 | 8 |
| Inj roctavian ml 2x10^13vc g HCPCS J1412 | not published | not published | $9,415.28 – $31,766.05 | 5 |
| Inj romidepsin non-lyo 0.1mg HCPCS J9318 | not published | not published | $25.19 – $77.65 | 6 |
| Inj, rykindo, 0.5 mg HCPCS J2801 | not published | not published | $9.77 – $35.48 | 5 |
| Inj scleros sol mult veins CPT 36471 | $399.96 | $727.20 | $301.57 – $2,334.00 | 6 |
| Inj scleros sol sgl vein CPT 36470 | not published | not published | $301.57 – $2,334.00 | 6 |
| Inj, sculptra, 0.5mg HCPCS Q2028 | not published | not published | $1.62 – $4.17 | 5 |
| Inj sebelipase alfa 1 mg HCPCS J2840 | not published | not published | $404.70 – $1,468.85 | 5 |
| Inj secretin synthetic human HCPCS J2850 | not published | not published | $32.25 – $115.90 | 5 |
| Inj secukinumab intrav 1mg HCPCS J3247 | not published | not published | $13.67 – $48.25 | 8 |
| Inj, sezaby, 1 mg HCPCS J2561 | not published | not published | $0.84 – $2.16 | 5 |
| Inj, spesolimab-sbzo, 1 mg HCPCS J1747 | not published | not published | $49.30 – $167.24 | 8 |
| Inj(s) sclerosant spider veins limb/trunk CPT 36468 | not published | not published | $301.57 – $2,334.00 | 6 |
| Inj sulf hexa lipid microsph HCPCS Q9950 | not published | not published | $20.59 – $50.85 | 4 |
| Inj, susvimo 0.1 mg HCPCS J2779 | not published | not published | $56.10 – $219.05 | 8 |
| Inj, sutimlimab-jome, 10 mg HCPCS J1302 | not published | not published | $14.73 – $49.35 | 8 |
| Inj. tagraxofusp-erzs 10 mcg HCPCS J9269 | not published | not published | $268.14 – $922.63 | 8 |
| Inj, taliglucerace alfa 10 u HCPCS J3060 | not published | not published | $32.01 – $113.31 | 8 |
| Inj teclistamab cqyv 0.5 mg HCPCS J9380 | not published | not published | $26.49 – $88.62 | 8 |
| Inj tedizolid phosphate HCPCS J3090 | not published | not published | $1.56 – $4.93 | 8 |
| Inj teplizumab mzwv 5 mcg HCPCS J9381 | not published | not published | $29.41 – $101.39 | 8 |
| Inj. teprotumumab-trbw 10 mg HCPCS J3241 | not published | not published | $284.92 – $944.99 | 8 |
| Inj testostero enanthate 1mg HCPCS J3121 | not published | not published | $0.06 – $0.13 | 5 |
| Inj, testosterone, azmiro HCPCS J1072 | not published | not published | $0.97 – $2.52 | 5 |
| Inj testosterone cypionate HCPCS J1071 | not published | not published | $0.03 – $0.08 | 5 |
| Inj theophylline per 40 mg HCPCS J2810 | not published | not published | $2.85 – $2.85 | 1 |
| Inj thiotepa nos 1 mg HCPCS J9342 | not published | not published | $3.70 – $23.25 | 5 |
| Inj thrc fascial pln blk bi w/wo image CPT 64468 | $7,733.00 | $14,060.00 | $5,512.00 – $5,512.00 | 1 |
| Inj thrc fascial pln blk uni w/wo image CPT 64466 | $3,866.50 | $7,030.00 | $5,512.00 – $5,512.00 | 1 |
| Inj. tigecycline (accord) HCPCS J3244 | not published | not published | $9.21 – $9.21 | 1 |
| Inj., tildrakizumab, 1 mg HCPCS J3245 | not published | not published | $93.20 – $362.59 | 8 |
| Inj, tislelizumab-jsgr HCPCS J9329 | not published | not published | $43.63 – $1,501.78 | 6 |
| Inj tofersen intrathec 1 mg HCPCS J1304 | not published | not published | $123.61 – $422.91 | 8 |
| Inj, tofidence, 1 mg HCPCS Q5133 | not published | not published | $3.76 – $16.34 | 7 |
| Inj travoprost intra impl HCPCS J7355 | not published | not published | $147.56 – $536.76 | 6 |
| Inj triamcinolone ace X-ray 1mg HCPCS J3304 | not published | not published | $14.46 – $49.01 | 8 |
| Inj., triluron, 1 mg HCPCS J7332 | not published | not published | $7.82 – $27.47 | 8 |
| Inj., triptorelin X-ray 3.75 mg HCPCS J3316 | not published | not published | $2,864.95 – $9,561.67 | 6 |
| Inj, trivisc 1 mg HCPCS J7329 | not published | not published | $2.28 – $16.62 | 8 |
| Inj, tyenne, 1 mg HCPCS Q5135 | not published | not published | $3.04 – $11.19 | 7 |
| Inj, uzedy, 1 mg HCPCS J2799 | not published | not published | $19.64 – $67.30 | 8 |
| Inj, vancomycin hcl (mylan) HCPCS J3371 | not published | not published | $6.94 – $17.51 | 4 |
| Inj, vancomycin hcl (xellia) HCPCS J3372 | not published | not published | $6.91 – $17.37 | 4 |
| Inj vancomycin (xellia) 10mg HCPCS J3375 | not published | not published | $0.25 – $0.25 | 1 |
| Inj vasopressin (am reg) 1 u HCPCS J2599 | not published | not published | $0.90 – $3.27 | 5 |
| Inj, vasopressin (baxter) HCPCS J2601 | not published | not published | $1.31 – $9.88 | 8 |
| Inj, vegzelma, 10 mg HCPCS Q5129 | not published | not published | $17.74 – $141.57 | 7 |
| Inj velmanase alfa-tycv 1 mg HCPCS J0217 | not published | not published | $359.39 – $1,200.11 | 8 |
| Inj., vestronidase alfa-vjbk HCPCS J3397 | not published | not published | $218.65 – $861.51 | 5 |
| Inj. viltolarsen HCPCS J1427 | not published | not published | $184.26 – $184.26 | 1 |
| Inj vocal cord bulking agent HCPCS L8607 | not published | not published | $167.95 – $167.95 | 1 |
| Inj w/fluor eval cv device CPT 36598 | $382.80 | $696.00 | $157.79 – $2,334.00 | 6 |
| Inj. xembify, 100 mg HCPCS J1558 | not published | not published | $11.43 – $38.82 | 8 |
| Inj xipere 1 mg HCPCS J3299 | not published | not published | $35.83 – $131.82 | 8 |
| Inj., yutiq, 0.01 mg HCPCS J7314 | not published | not published | $397.42 – $1,431.74 | 8 |
| Inj zanidatamab-hrii, 2 mg HCPCS J9276 | not published | not published | $19.25 – $49.53 | 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.