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 |
|---|---|---|---|---|
| Motion analysis video/3d CPT 96000 | not published | not published | $276.82 – $712.35 | 4 |
| Motion test w/ft press meas CPT 96001 | not published | not published | $637.04 – $1,639.32 | 4 |
| Motor &/ sens nrve cndj test CPT 95905 | not published | not published | $331.39 – $852.79 | 4 |
| Mouth vestibule bx/w complex rpr 40814 CPT 40814 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| M/phmtrc alys ishquant/semiq CPT 88373 | not published | not published | $47.28 – $76.22 | 2 |
| M/phmtrc alys ishquant/semiq CPT 88377 | $630.30 | $1,146.00 | $126.39 – $325.23 | 5 |
| M/phmtrc alysishquant/semiq CPT 88369 | not published | not published | $82.65 – $108.55 | 2 |
| M/phmtrc alys skeletal musc CPT 88355 | not published | not published | $105.02 – $325.23 | 5 |
| Mpl gene analysis common variants CPT 81338 | $399.85 | $727.00 | $112.75 – $290.14 | 7 |
| M.pneumon dna dir probe CPT 87580 | not published | not published | $15.04 – $38.70 | 7 |
| M.pneumon dna quant CPT 87582 | not published | not published | $84.49 – $584.06 | 7 |
| Mpsv4 vaccine subq CPT 90733 | not published | not published | $226.31 – $226.31 | 1 |
| MRA abdomen post contrast CPT 74185 | not published | not published | $1,039.88 – $1,039.88 | 1 |
| MRA aorta thoracic w/wo contrast CPT 71555 | not published | not published | $1,020.86 – $1,020.86 | 1 |
| MRA chest w IV cont HCPCS C8909 | $2,373.25 | $4,315.00 | $258.81 – $665.99 | 4 |
| MRA chest wo IV cont HCPCS C8910 | $2,260.50 | $4,110.00 | $177.00 – $455.49 | 4 |
| MRA chest wwo IV cont HCPCS C8911 | $2,492.05 | $4,531.00 | $258.81 – $665.99 | 4 |
| MRA ext low(run-off)pst cntrst CPT 73725 | not published | not published | $1,032.75 – $1,032.75 | 1 |
| MRA pelvis CPT 72198 | not published | not published | $1,031.56 – $1,031.56 | 1 |
| MRA pelvis w IV cont HCPCS C8918 | not published | not published | $258.81 – $665.99 | 4 |
| MRA pelvis wo IV cont HCPCS C8919 | $2,045.45 | $3,719.00 | $177.00 – $455.49 | 4 |
| MRA spinal canal CPT 72159 | not published | not published | $1,082.64 – $1,082.64 | 1 |
| MRA upper extremity post contrast-bil CPT 73225 | not published | not published | $1,060.06 – $1,060.06 | 1 |
| MRA w/cont, abd HCPCS C8900 | $2,425.50 | $4,410.00 | $258.81 – $665.99 | 4 |
| MRA w/cont, lwr ext HCPCS C8912 | $2,356.20 | $4,284.00 | $258.81 – $665.99 | 4 |
| Mra, w/dye, spinal canal HCPCS C8931 | $2,426.60 | $4,412.00 | $258.81 – $665.99 | 4 |
| Mra, w/dye, upper extremity HCPCS C8934 | $2,494.80 | $4,536.00 | $258.81 – $665.99 | 4 |
| MRA without cont, abd HCPCS C8901 | $2,310.00 | $4,200.00 | $177.00 – $455.49 | 4 |
| MRA without cont, lwr ext HCPCS C8913 | $2,244.00 | $4,080.00 | $177.00 – $455.49 | 4 |
| Mra, without dye, spinal canal HCPCS C8932 | not published | not published | $177.00 – $455.49 | 4 |
| Mra, without dye, upper extr HCPCS C8935 | $2,376.00 | $4,320.00 | $177.00 – $455.49 | 4 |
| MRA without fol w/cont, abd HCPCS C8902 | $2,547.05 | $4,631.00 | $258.81 – $665.99 | 4 |
| MRA without fol w/cont, lwr ext HCPCS C8914 | $2,474.45 | $4,499.00 | $258.81 – $665.99 | 4 |
| MRA without fol w/cont, pelvis HCPCS C8920 | $2,305.60 | $4,192.00 | $258.81 – $665.99 | 4 |
| Mra, w/o&w/dye, spinal canal HCPCS C8933 | not published | not published | $258.81 – $665.99 | 4 |
| Mra, w/o&w/dye, upper extr HCPCS C8936 | not published | not published | $258.81 – $665.99 | 4 |
| Mr elastography CPT 76391 | not published | not published | $177.00 – $455.49 | 4 |
| Mrgfus strtctc ablt trgt icr CPT 61715 | not published | not published | $7,609.00 – $21,271.19 | 4 |
| MRI brain w/dye CPT 70558 | not published | not published | $130.12 – $334.84 | 4 |
| MRI brain without dye CPT 70557 | not published | not published | $405.35 – $1,043.10 | 4 |
| MRI brain without & w/dye CPT 70559 | not published | not published | $130.12 – $334.84 | 4 |
| MRI breast c- unilateral CPT 77046 | $2,244.00 | $4,080.00 | $177.00 – $455.49 | 4 |
| MRI breast c-+ w/cad uni CPT 77048 | not published | not published | $980.96 – $980.96 | 1 |
| MRI breast without cont bi CPT 77047 | $4,191.00 | $7,620.00 | $177.00 – $455.49 | 4 |
| MRI breast w IV cont bi CPT 77049 | not published | not published | $976.14 – $976.14 | 1 |
| MRI cardiac morph & func wo IV cont CPT 75557 | $2,105.40 | $3,828.00 | $177.00 – $455.49 | 4 |
| MRI cardiac morph & func wwo IV cont CPT 75561 | $2,305.60 | $4,192.00 | $258.81 – $665.99 | 4 |
| MRI cardiac morph & func wwo IV cont w/stress img CPT 75563 | not published | not published | $581.54 – $1,496.49 | 4 |
| MRI chest without contrast CPT 71550 | $1,980.00 | $3,600.00 | $177.00 – $455.49 | 4 |
| MRI chest without & w/contrast CPT 71552 | $2,183.50 | $3,970.00 | $258.81 – $665.99 | 4 |
| MRI chest w IV cont CPT 71551 | $2,079.00 | $3,780.00 | $581.54 – $1,496.49 | 4 |
| MRI compatible system HCPCS L0859 | not published | not published | $1,049.92 – $2,701.79 | 4 |
| MRI fetal ea addl gestation CPT 74713 | not published | not published | $470.04 – $470.04 | 1 |
| MRI fetal sngl/1st gestation CPT 74712 | not published | not published | $177.00 – $455.49 | 4 |
| MRI guid ndl plc s&i CPT 77021 | $1,080.75 | $1,965.00 | $1,091.46 – $1,091.46 | 1 |
| MRI guid parenchymal tiss ablation CPT 77022 | not published | not published | $1,564.47 – $1,564.47 | 1 |
| MRI loex nonjt w IV cont CPT 73719 | not published | not published | $258.81 – $665.99 | 4 |
| MRI lower extremity other than joint without contrast (both sides) CPT 73718 | $2,227.50 | $4,050.00 | $177.00 – $455.49 | 4 |
| MRI lower extremity other than joint without & w/contrast (both sides) CPT 73720 | $2,450.80 | $4,456.00 | $258.81 – $665.99 | 4 |
| MRI orbit/face/neck without contrast CPT 70540 | $1,658.80 | $3,016.00 | $177.00 – $455.49 | 4 |
| MRI orbit/face/neck without & w/contrast CPT 70543 | $1,829.30 | $3,326.00 | $258.81 – $665.99 | 4 |
| MRI orbit fac&nck w IV cont CPT 70542 | $1,741.85 | $3,167.00 | $258.81 – $665.99 | 4 |
| MRI tmj CPT 70336 | $2,137.30 | $3,886.00 | $177.00 – $455.49 | 4 |
| MRI upper extremity other than joint without contrast (both sides) CPT 73218 | $2,194.50 | $3,990.00 | $177.00 – $455.49 | 4 |
| MRI upper extremity other than joint without & w/contrast (both sides) CPT 73220 | $2,419.45 | $4,399.00 | $258.81 – $665.99 | 4 |
| MRI upper extremity w/dye CPT 73219 | $2,303.95 | $4,189.00 | $258.81 – $665.99 | 4 |
| MRI w/cont, breast, bi HCPCS C8906 | $4,401.10 | $8,002.00 | $258.81 – $665.99 | 4 |
| MRI w/cont, breast, uni HCPCS C8903 | $2,356.20 | $4,284.00 | $130.12 – $334.84 | 4 |
| MRI without fol w/cont, breast HCPCS C8908 | $4,620.55 | $8,401.00 | $258.81 – $665.99 | 4 |
| MRI without fol w/cont, brst, un HCPCS C8905 | $2,474.45 | $4,499.00 | $258.81 – $665.99 | 4 |
| Mr safety determination physician/other qhp CPT 76016 | not published | not published | $64.56 – $166.13 | 4 |
| Mr safety implant elec prepj CPT 76018 | not published | not published | $70.53 – $181.49 | 4 |
| Mr safety implant&/fb assmt clin staff ea add 30 CPT 76015 | not published | not published | $146.84 – $146.84 | 1 |
| Mr safety implt pos&/immoblj CPT 76019 | not published | not published | $43.76 – $112.62 | 4 |
| Mr sfty implt&/fb asmt stf 1 CPT 76014 | not published | not published | $21.46 – $55.21 | 4 |
| Mr sfty med physics xm cstmz CPT 76017 | not published | not published | $177.00 – $455.49 | 4 |
| Mr spectroscopy CPT 76390 | $2,237.95 | $4,069.00 | $64.56 – $166.13 | 4 |
| Msh2 gene dup/delete variant CPT 81297 | not published | not published | $159.98 – $411.67 | 7 |
| Msh2 gene full seq CPT 81295 | not published | not published | $225.02 – $736.68 | 7 |
| Msh2 gene known variants CPT 81296 | not published | not published | $192.13 – $651.82 | 7 |
| Msh6 gene dup/delete variant CPT 81300 | not published | not published | $178.50 – $459.34 | 7 |
| Msh6 gene full seq CPT 81298 | not published | not published | $426.92 – $1,238.77 | 7 |
| Msh6 gene known variants CPT 81299 | not published | not published | $231.00 – $594.44 | 7 |
| Mt bone graft microvasc CPT 20957 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Mthfr gene analy common variants CPT 81291 | $509.30 | $926.00 | $49.00 – $126.11 | 7 |
| M.tuberculo dna dir probe CPT 87555 | not published | not published | $20.16 – $51.88 | 7 |
| M.tuberculo dna quant CPT 87557 | not published | not published | $32.13 – $82.68 | 7 |
| Mucin synovial fluid CPT 83872 | not published | not published | $4.40 – $11.31 | 7 |
| Mucopolysaccharides CPT 83864 | not published | not published | $21.38 – $55.00 | 7 |
| Mucormycosis antibody CPT 86732 | not published | not published | $11.25 – $28.95 | 7 |
| Mult fam adapt bhv tx gdn CPT 97157 | not published | not published | $27.80 – $71.53 | 4 |
| Multi-axial knee/shin system HCPCS L5840 | not published | not published | $3,601.47 – $9,267.78 | 4 |
| Multi-axial rotation unit HCPCS L5986 | not published | not published | $716.31 – $1,843.30 | 4 |
| Multi-durometer below knee HCPCS L5665 | not published | not published | $534.73 – $1,376.03 | 4 |
| Multi-durometer symes HCPCS L5661 | not published | not published | $601.47 – $1,547.78 | 4 |
| Multi family grp psychotherapy CPT 90849 | $102.30 | $186.00 | $131.67 – $338.84 | 4 |
| Multifocal erg w/i&r CPT 92274 | not published | not published | $95.45 – $245.63 | 4 |
| Multiple sleep latency test CPT 95805 | $2,283.05 | $4,151.00 | $637.04 – $1,639.32 | 4 |
| Multipo locking shoulder jnt HCPCS L6646 | not published | not published | $2,912.78 – $7,495.54 | 4 |
| Mumps antibody igg CPT 86735 | $114.95 | $209.00 | $9.79 – $25.19 | 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.