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 |
|---|---|---|---|---|
| Meperidine/promethazine inj HCPCS J2180 | not published | not published | $20.26 – $20.26 | 1 |
| Mepolizumab 100 mg/ml subcutaneous auto-injector HCPCS J2182 | not published | not published | $24.21 – $83.56 | 8 |
| Meropenem 1 gram intravenous solution HCPCS J2185 | not published | not published | $0.42 – $1.06 | 5 |
| Mesh/prosth/ pelvic floor rpr/vag 57267 CPT 57267 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Mesna 100 mg/ml intravenous solution HCPCS J9209 | not published | not published | $1.50 – $4.31 | 5 |
| Metabolic Blood Panel (Basic) CPT 80048 | $100.10 | $182.00 | $6.34 – $16.33 | 7 |
| Metabolic Blood Panel (Comprehensive) CPT 80053 | $132.55 | $241.00 | $7.92 – $20.38 | 7 |
| Metabolic panel ionized ca CPT 80047 | not published | not published | $10.30 – $26.50 | 7 |
| Metal frame recipro hip & ca HCPCS L2628 | not published | not published | $1,443.92 – $3,715.69 | 4 |
| Methacholine chloride 0.0625 mg/ml nebulization soln HCPCS J7674 | not published | not published | $1.74 – $4.39 | 5 |
| Methadone injection HCPCS J1230 | not published | not published | $22.37 – $56.25 | 5 |
| Methocarbamol ivpb 250 mg in 50 ml ns - cnr (headpain) HCPCS J2800 | not published | not published | $7.00 – $17.89 | 5 |
| Methotrexate sodium 2.5 mg tablet HCPCS J8610 | not published | not published | $0.19 – $0.50 | 5 |
| Methotrexate sodium (pf) 1 gram solution for injection HCPCS J9260 | not published | not published | $2.84 – $9.17 | 5 |
| Methotrexate therapeutic drug level CPT 80204 | $63.80 | $116.00 | $28.93 – $74.44 | 7 |
| Methyldopate hcl injection HCPCS J0210 | not published | not published | $136.13 – $136.13 | 1 |
| Methylene blue (antidote) 5 mg/ml intravenous solution HCPCS Q9968 | not published | not published | $8.15 – $24.24 | 5 |
| Methylergonovine 0.2 mg/ml (1 ml) injection solution HCPCS J2210 | not published | not published | $23.42 – $59.40 | 5 |
| Methylnaltrexone 12 mg/0.6 ml subcutaneous injection (wrapper) HCPCS J2212 | not published | not published | $4.90 – $4.90 | 1 |
| Methylphenidate CPT 80360 | $188.65 | $343.00 | $35.06 – $35.06 | 1 |
| Methylprednisolone 4 mg tablet HCPCS J7509 | not published | not published | $0.26 – $0.68 | 5 |
| Methylprednisolone acetate 40 mg/ml suspension for injection HCPCS J1010 | not published | not published | $0.12 – $0.33 | 5 |
| Methylprednisolone sodium succinate 1,000 mg intravenous solution HCPCS J2919 | not published | not published | $0.28 – $0.74 | 5 |
| Metoclopramide in d5w IV syringe 0.2 mg/ml (neo/ped) - cnr HCPCS J2765 | not published | not published | $1.12 – $2.81 | 5 |
| Metoprolol tartrate 5 mg/5 ml intravenous (wrapper) HCPCS J0616 | not published | not published | $0.25 – $0.25 | 1 |
| Metronidazole 500 mg/100 ml in sodium chlor(iso) intravenous piggyback HCPCS J1836 | not published | not published | $0.03 – $0.08 | 5 |
| Metyrapone panel CPT 80436 | not published | not published | $68.37 – $175.94 | 7 |
| Mgmt promoter methylation analysis CPT 81287 | $332.20 | $604.00 | $93.48 – $240.56 | 7 |
| Micafungin 100 mg intravenous solution HCPCS J2248 | not published | not published | $0.30 – $0.76 | 5 |
| Microalbumin urine screen CPT 82044 | not published | not published | $4.67 – $12.02 | 7 |
| Microbe susceptible mlc CPT 87187 | not published | not published | $20.96 – $77.53 | 7 |
| Microdissection laser CPT 88380 | $526.90 | $958.00 | $80.12 – $122.58 | 2 |
| Microdissection manual CPT 88381 | $119.35 | $217.00 | $130.22 – $156.99 | 2 |
| Microfluid analy tears CPT 83861 | not published | not published | $16.86 – $43.39 | 7 |
| Microprcsr cu combo vad, rep HCPCS Q0482 | not published | not published | $4,203.26 – $10,816.38 | 4 |
| Microsatellite instability CPT 81301 | $435.60 | $792.00 | $261.42 – $672.72 | 7 |
| Microsurg tehniq require use oper micro (add-on)69990 CPT 69990 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Microvolt t-wave assess CPT 93025 | not published | not published | $95.45 – $245.63 | 4 |
| Microwave bronch, 3d, ebus HCPCS C9751 | not published | not published | $7,609.00 – $16,106.00 | 3 |
| Midazolam 1 mg/ml injection solution HCPCS J2250 | not published | not published | $0.14 – $0.35 | 5 |
| Midazolam 1 mg/ml in sodium chloride IV infusion (wrapper) HCPCS J2251 | not published | not published | $0.18 – $0.46 | 5 |
| Middle cerebral artery echo CPT 76821 | $485.10 | $882.00 | $77.56 – $199.58 | 4 |
| Milrinone 20 mg/100 ml(200 mcg/ml) in 5 % dextrose intravenous piggybk HCPCS J2260 | not published | not published | $1.42 – $3.56 | 5 |
| Milwaukee type superstructur HCPCS L1230 | not published | not published | $614.90 – $1,582.33 | 4 |
| Minocycline hydrochloride HCPCS J2265 | not published | not published | $2.05 – $7.05 | 5 |
| Miroderm HCPCS Q4175 | not published | not published | $75.42 – $237.56 | 7 |
| Mirvetuximab soravtansine-gynx 5 mg/ml intravenous solution HCPCS J9063 | not published | not published | $53.99 – $185.43 | 8 |
| Mitochondrial gene CPT 81440 | not published | not published | $2,493.00 – $6,415.32 | 7 |
| Mitomycin 40 mg intravenous solution HCPCS J9280 | not published | not published | $25.58 – $126.19 | 8 |
| Mitomycin instillation HCPCS J9281 | not published | not published | $247.45 – $847.67 | 8 |
| Mitoxantrone 2 mg/ml concentrate,intravenous HCPCS J9293 | not published | not published | $22.28 – $165.58 | 8 |
| Mitral valve replacement w/bypass 33430 CPT 33430 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Mlh1 gene CPT 81288 | $526.90 | $958.00 | $144.24 – $371.18 | 7 |
| Mlh1 gene dup/delete variant CPT 81294 | not published | not published | $151.80 – $390.63 | 7 |
| Mlh1 gene full seq CPT 81292 | not published | not published | $506.55 – $1,303.52 | 7 |
| Mlh1 gene known variants CPT 81293 | not published | not published | $248.25 – $638.83 | 7 |
| Mlt fam grp bhv train 1st 60 CPT 96202 | not published | not published | $12.77 – $32.87 | 4 |
| Mlt fam grp bhv train ea add CPT 96203 | not published | not published | $3.56 – $9.17 | 4 |
| Mlt osteot rlgnm imed rd hum CPT 24410 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Mnl appl strs jt radiography CPT 77071 | not published | not published | $64.56 – $166.13 | 4 |
| Mnl prep&insj dp rx dlvr dev CPT 20700 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Mnl prep&insj i-artic rx dev CPT 20704 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Mnl prep&insj imed rx dev CPT 20702 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Mnpj anes sho jt fixj aprats CPT 23700 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Mnpj elbow under anes CPT 24300 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Mnpj of tmj w/anesth CPT 21073 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Mnt subs tx for change dx HCPCS G0270 | not published | not published | $16.15 – $41.55 | 4 |
| Mobility cart pneum vad, rep HCPCS Q0502 | not published | not published | $600.49 – $1,545.25 | 4 |
| Mobilization of colon 44139 CPT 44139 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Modification of contact lens CPT 92325 | not published | not published | $98.70 – $253.99 | 4 |
| Modified maze/limited 33254 CPT 33254 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Modified maze/limited /w other op 33257 CPT 33257 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Mog-igg1 antb flo cytmtry ea CPT 86363 | not published | not published | $12.05 – $72.82 | 7 |
| Molded inner boot HCPCS L2280 | not published | not published | $520.34 – $1,339.00 | 4 |
| Molded socket shin sach foot HCPCS L5100 | not published | not published | $2,519.67 – $6,483.95 | 4 |
| Mold sckt ext knee shin sach HCPCS L5150 | not published | not published | $3,953.20 – $10,172.91 | 4 |
| Mold socket ank hgt with toe f HCPCS L5010 | not published | not published | $1,478.86 – $3,805.61 | 4 |
| Mold socket bent knee shin s HCPCS L5160 | not published | not published | $4,340.44 – $11,169.39 | 4 |
| Molecular pathology interpr HCPCS G0452 | not published | not published | $2.92 – $2.92 | 1 |
| Mometasone sinus sinuva HCPCS J7402 | not published | not published | $8.51 – $30.90 | 8 |
| Mon cable elec/pneum vad rep HCPCS Q0486 | not published | not published | $270.21 – $695.34 | 4 |
| Monitor cable elec vad, rep HCPCS Q0485 | not published | not published | $324.68 – $835.50 | 4 |
| Monitor elec vad, rep HCPCS Q0483 | not published | not published | $17,315.49 – $44,558.53 | 4 |
| Monitor reveal linq ii cardiac HCPCS C1764 | $5,940.77 | $10,801.40 | not published | 0 |
| Monovisc inj per dose HCPCS J7327 | not published | not published | $423.96 – $1,537.26 | 8 |
| Monthly tx for dmht 20mins HCPCS G0553 | not published | not published | $98.76 – $254.15 | 4 |
| Mopath procedure level 1 CPT 81400 | $170.50 | $310.00 | $47.97 – $123.44 | 7 |
| Mopath procedure level 3 CPT 81402 | $412.50 | $750.00 | $112.75 – $290.14 | 7 |
| Mopath procedure level 5 CPT 81404 | $958.10 | $1,742.00 | $206.12 – $530.42 | 7 |
| Mopath procedure level 6 CPT 81405 | $801.35 | $1,457.00 | $226.01 – $581.61 | 7 |
| Mopath procedure level 7 CPT 81406 | not published | not published | $212.16 – $545.96 | 7 |
| Mopath procedure level 8 CPT 81407 | not published | not published | $634.70 – $1,633.30 | 7 |
| Mopath procedure level 9 CPT 81408 | not published | not published | $1,500.00 – $3,860.00 | 7 |
| Morphine 4 mg/ml injection (wrapper) HCPCS J2270 | not published | not published | $4.95 – $12.47 | 5 |
| Morphine 4 mg/ml injection (wrapper)|discarded drug not administered HCPCS J2272 | not published | not published | $4.40 – $15.45 | 5 |
| Morphine (pf) 0.25 mg/0.5 ml injection (neo/ped) - cnr HCPCS J2274 | not published | not published | $10.80 – $31.45 | 5 |
| Morphometric analysis in situ hybridization computer-assisted per specimen each multiplex stain CPT 88374 | not published | not published | $126.39 – $325.23 | 5 |
| Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain computer-assisted CPT 88361 | not published | not published | $125.33 – $684.27 | 5 |
| Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain manual CPT 88360 | $377.85 | $687.00 | $92.30 – $325.23 | 5 |
| Mosunetuzumab-axgb 1 mg/ml intravenous solution HCPCS J9350 | not published | not published | $505.87 – $1,745.32 | 8 |
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.