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 |
|---|---|---|---|---|
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $77.00 | $140.00 | $11.08 – $28.53 | 7 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $33.00 | $60.00 | $35.06 – $35.06 | 1 |
| Mayo alpha 1 antitrypsin CPT 82103 | $119.90 | $218.00 | $10.08 – $25.94 | 7 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $138.05 | $251.00 | $11.31 – $29.10 | 7 |
| Mayo amphu amphetamines definitive assay 3 or 4 urine CPT 80325 | $82.50 | $150.00 | not published | 0 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | $188.65 | $343.00 | $35.06 – $35.06 | 1 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $333.85 | $607.00 | $91.22 – $234.75 | 7 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $508.20 | $924.00 | $68.74 – $176.90 | 7 |
| Mayo analysis gene smn1 dosage/deletion CPT 81329 | not published | not published | $102.75 – $264.41 | 7 |
| Mayo analysis microarray cytogenomic copy number/snp variants CPT 81229 | $3,087.70 | $5,614.00 | $870.00 – $2,238.80 | 7 |
| Mayo androstenedione CPT 82157 | $262.35 | $477.00 | $21.96 – $56.51 | 7 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $130.90 | $238.00 | $10.95 – $28.18 | 7 |
| Mayo antithrombin iii antigen CPT 85301 | $97.35 | $177.00 | $8.11 – $20.86 | 7 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $47.85 | $87.00 | $11.29 – $29.05 | 7 |
| Mayo avwpr vw factor activity CPT 85397 | $108.35 | $197.00 | $23.14 – $59.56 | 7 |
| Mayo babpb infectious agent nucleic acid amplified probe babesia microti CPT 87469 | $64.90 | $118.00 | $26.32 – $67.72 | 7 |
| Mayo barbiturates definitive assay confirmation urine CPT 80345 | $206.25 | $375.00 | $35.06 – $35.06 | 1 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $19.25 | $35.00 | $7.64 – $19.65 | 7 |
| Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 | $4.40 | $8.00 | $108.63 – $279.54 | 7 |
| Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative CPT 81208 | $541.20 | $984.00 | $160.96 – $414.22 | 7 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $19.80 | $36.00 | $9.68 – $24.90 | 7 |
| Mayo bnzu sedative hypnotics definitive urine CPT 80368 | $188.65 | $343.00 | $35.06 – $35.06 | 1 |
| Mayo bordetella pertussis antibody igg CPT 86615 | not published | not published | $9.89 – $25.46 | 7 |
| Mayo brcmg brucella antibody igm CPT 86622 | $14.85 | $27.00 | $6.70 – $17.23 | 7 |
| Mayo c1 esterase inhibitor CPT 83883 | $116.60 | $212.00 | $10.20 – $26.25 | 7 |
| Mayo cannabinoids natural definitive assay thc confirmation urine CPT 80349 | $200.20 | $364.00 | $35.06 – $35.06 | 1 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $127.05 | $231.00 | $12.65 – $32.56 | 7 |
| Mayo cd20b mononuclear cell antigen nos quantitative each CPT 86356 | $44.00 | $80.00 | $20.08 – $51.69 | 7 |
| Mayo cdcom hla class ii typing low resolution one locus each CPT 81376 | $325.60 | $592.00 | $91.66 – $235.88 | 7 |
| Mayo ceruloplasmin CPT 82390 | $90.75 | $165.00 | $8.06 – $20.73 | 7 |
| Mayo chemiluminescent parathyroid related peptide CPT 82397 | $124.30 | $226.00 | $10.59 – $27.25 | 7 |
| Mayo chikv chikungunya antibodies igg CPT 86790 | $53.90 | $98.00 | $9.66 – $24.86 | 7 |
| Mayo chlap chlamydia pneumoniae antibody igg CPT 86631 | $59.40 | $108.00 | $8.86 – $22.81 | 7 |
| Mayo chlap chlamydia pneumoniae antibody igm CPT 86632 | $35.20 | $64.00 | $9.51 – $24.47 | 7 |
| Mayo chrcb tissue culture non-neoplastic disorders lymphocyte CPT 88230 | $457.05 | $831.00 | $87.37 – $224.83 | 7 |
| Mayo chromium CPT 82495 | not published | not published | $14.72 – $39.14 | 7 |
| Mayo cocaine definitive assay confirmation urine CPT 80353 | $194.15 | $353.00 | $35.06 – $35.06 | 1 |
| Mayo coccidioides antibody CPT 86635 | $20.90 | $38.00 | $8.60 – $22.14 | 7 |
| Mayo cocou cortisone urine CPT 82542 | $158.40 | $288.00 | $18.07 – $46.49 | 7 |
| Mayo cortisol free CPT 82530 | $148.50 | $270.00 | $12.53 – $32.25 | 7 |
| Mayo covid-19 antibody nucleocapsid total CPT 86769 | $30.25 | $55.00 | $31.60 – $81.31 | 7 |
| Mayo coxiella brunetii (q fever) igg antibody CPT 86638 | $30.25 | $55.00 | $9.09 – $23.39 | 7 |
| Mayo csmpu benzodiazepines definitive assay >=13 urine CPT 80347 | $188.65 | $343.00 | not published | 0 |
| Mayo csmpu opiod/analogs definitive assay >=5 urine CPT 80364 | $188.65 | $343.00 | not published | 0 |
| Mayo cyanide CPT 82600 | $34.65 | $63.00 | $14.55 – $37.44 | 7 |
| Mayo cytopathology in situ hybridization urinary tract 3-5 probes each specimen manual CPT 88120 | $377.85 | $687.00 | $126.39 – $325.23 | 5 |
| Mayo deoxyribonuclease antibody titer CPT 86215 | $115.50 | $210.00 | $9.94 – $25.57 | 7 |
| Mayo dhea (dehydroepiandrosterone) CPT 82626 | $45.65 | $83.00 | $18.95 – $48.77 | 7 |
| Mayo dihydrotestosterone CPT 82642 | $38.50 | $70.00 | $21.96 – $56.51 | 7 |
| Mayo dipstick analyte single step qualitative/semiqualitative synovial fluid CPT 83518 | $29.15 | $53.00 | $7.23 – $18.61 | 7 |
| Mayo efpo chloride stool CPT 82438 | not published | not published | $3.75 – $9.65 | 7 |
| Mayo estriol CPT 82677 | not published | not published | $18.14 – $46.67 | 7 |
| Mayo estrone CPT 82679 | $46.20 | $84.00 | $18.71 – $48.15 | 7 |
| Mayo ethosuximide therapeutic drug level CPT 80168 | $135.30 | $246.00 | $12.26 – $31.54 | 7 |
| Mayo everolimus therapeutic drug level CPT 80169 | not published | not published | $10.30 – $26.50 | 7 |
| Mayo factor ii CPT 85210 | $52.80 | $96.00 | $9.74 – $25.05 | 7 |
| Mayo factor v CPT 85220 | $151.80 | $276.00 | $13.24 – $34.06 | 7 |
| Mayo factor vii CPT 85230 | $156.75 | $285.00 | $13.42 – $34.55 | 7 |
| Mayo factor viii vw factor antigen CPT 85246 | $217.80 | $396.00 | $17.20 – $44.27 | 7 |
| Mayo factor viii vw factor multimetric analysis CPT 85247 | $200.20 | $364.00 | $17.20 – $44.27 | 7 |
| Mayo factor viii vw factor ristocetin cofactor CPT 85245 | $217.80 | $396.00 | $17.20 – $44.27 | 7 |
| Mayo factor x CPT 85260 | $32.45 | $59.00 | $13.42 – $34.55 | 7 |
| Mayo factor xi CPT 85270 | $156.75 | $285.00 | $13.42 – $34.55 | 7 |
| Mayo fat/lipids feces quantitative CPT 82710 | not published | not published | $12.60 – $32.42 | 7 |
| Mayo fbl culture fungi blood CPT 87103 | $93.50 | $170.00 | $15.34 – $39.49 | 7 |
| Mayo fdp/fsp paracoagulation CPT 85366 | not published | not published | $17.45 – $155.29 | 7 |
| Mayo ffspg allergen clam igg CPT 86001 | not published | not published | $5.86 – $15.09 | 7 |
| Mayo fibrinogen antigen CPT 85385 | $25.85 | $47.00 | $10.84 – $27.91 | 7 |
| Mayo gabapentin bld/srm/plasma therapeutic drug level CPT 80171 | $146.85 | $267.00 | $16.25 – $41.82 | 7 |
| Mayo gamma-globin full gene sequencing CPT 81479 | $4,878.50 | $8,870.00 | not published | 0 |
| Mayo hemosiderin qualitative urine CPT 83070 | $8.25 | $15.00 | $3.56 – $9.17 | 7 |
| Mayo hip12 infectious agent nucleic acid amplified probe hiv-1 rna qualitative CPT 87535 | $169.40 | $308.00 | $26.32 – $67.72 | 7 |
| Mayo hip12 infectious agent nucleic acid amplified probe hiv-2 CPT 87538 | not published | not published | $26.32 – $67.72 | 7 |
| Mayo hiser histoplasma antibodies immunodiffusion CPT 86698 | $42.90 | $78.00 | $10.34 – $26.61 | 7 |
| Mayo hla typing a/b/c single antigen CPT 86812 | $42.35 | $77.00 | $19.36 – $49.81 | 7 |
| Mayo hvdip HIV 1 antibody CPT 86701 | $15.40 | $28.00 | $6.67 – $17.16 | 7 |
| Mayo hvdip HIV 2 antibody CPT 86702 | $23.10 | $42.00 | $10.14 – $26.09 | 7 |
| Mayo hydroxyprogesterone 17-d CPT 83498 | $243.65 | $443.00 | $20.38 – $52.44 | 7 |
| Mayo immunoassay c1 esterase inhibitor antibody quantitative CPT 83520 | $112.20 | $204.00 | $12.95 – $33.33 | 7 |
| Mayo immunoassay infectious agent antibody quantitative diptheria igg CPT 86317 | $119.90 | $218.00 | $11.24 – $28.93 | 7 |
| Mayo immunoassay tumor antigen quantitative ca 27.29 CPT 86300 | $163.90 | $298.00 | $15.61 – $40.16 | 7 |
| Mayo immunoassay tumor antigen quantitative chromogranin a CPT 86316 | $174.90 | $318.00 | $15.61 – $40.16 | 7 |
| Mayo inf agt nucleic acid amp prb helicobacter pylori clarithromycin resistance CPT 87513 | not published | not published | $26.32 – $67.72 | 7 |
| Mayo infectious agent antigen immunoassay direct optical observation cryptococcus CPT 87899 | $135.30 | $246.00 | $12.05 – $31.02 | 7 |
| Mayo infectious agent antigen immunoassay ql/sq multi step aspergillus bal CPT 87305 | $80.85 | $147.00 | $8.98 – $23.12 | 7 |
| Mayo infectious agent nucleic acid amplified probe enterovirus CPT 87498 | $80.85 | $147.00 | $26.32 – $67.72 | 7 |
| Mayo infectious agent nucleic acid amplified probe mycoplasma genitalium urine CPT 87563 | $93.50 | $170.00 | $26.32 – $67.72 | 7 |
| Mayo infectious agent nucleic acid amplified probe mycoplasma pneumoniae CPT 87581 | $187.00 | $340.00 | $26.32 – $67.72 | 7 |
| Mayo infectious agent nucleic acid amplified probe pneumocystis jirovecii CPT 87594 | $242.00 | $440.00 | $26.32 – $67.72 | 7 |
| Mayo infectious agent nucleic acid quantification cytomegalovirus CPT 87497 | $99.00 | $180.00 | $32.13 – $82.68 | 7 |
| Mayo infectious disease hepatitis c chronic six biochemical assays CPT 81596 | $140.80 | $256.00 | $54.14 – $139.33 | 7 |
| Mayo infliximab therapeutic drug level CPT 80230 | $65.45 | $119.00 | $28.93 – $74.44 | 7 |
| Mayo inhab inhibin a CPT 86336 | $90.75 | $165.00 | $11.69 – $30.09 | 7 |
| Mayo insft insulin free CPT 83527 | not published | not published | $9.71 – $24.99 | 7 |
| Mayo insulin antibodies CPT 86337 | $36.30 | $66.00 | $16.06 – $41.32 | 7 |
| Mayo iodine CPT 83789 | not published | not published | $18.08 – $46.53 | 7 |
| Mayo itraconazole therapeutic drug level CPT 80189 | $45.65 | $83.00 | $20.33 – $52.32 | 7 |
| Mayo lacosamide therapeutic drug level CPT 80235 | $44.55 | $81.00 | $20.33 – $52.32 | 7 |
| Mayo lamotrigine therapeutic drug level CPT 80175 | $151.80 | $276.00 | $9.94 – $25.57 | 7 |
| Mayo ld_i lactate dehydrogenase isoenzymes CPT 83625 | $51.15 | $93.00 | $9.59 – $24.68 | 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.